If the arts are to play an important role in improving the well-being of those in hospital and in reinforcing government messages about healthy lifestyles, Mike White argues that substantial evidence and effective evaluation methods are now needed to convince everyone concerned.
Last winter Alan Milburn, Secretary of State for Health, came to open an event in Newcastle attended by representatives of the 20-odd Health Action Zones across England. This event was ?A Six Hour Coffee Break?, a day of facilitated discussion and useful informality, enabling all of us in the burgeoning field of community-based arts in health to share ideas and experience of using creative approaches to addressing health inequalities.
The Secretary of State interestingly placed arts in health within regeneration and social inclusion initiatives, linked with an underlying concern to rebuild trust between healthcare services and the public. Participation in health-focused arts activities may not in itself be a cure for individual or social ills, but it can assist the development of a shared responsibility in identifying and addressing health needs. No surprise that the new school curriculum subject of personal/social and health education also embraces citizenship. Recently the US social psychology guru Robert Puttnam was invited to address Downing Street?s Social Exclusion Unit. Puttnam?s latest book, Bowling Alone, takes its title from a growing trend in the US for people to go tenpin bowling on their own. This lessening involvement in social recreation is having a noticeable effect on health. Recent studies in Sweden and the US suggest that the more culturally active and socially connected people are, the better their long-term health profiles. It might seem unwise to claim that an audience development initiative is in fact a health improvement programme, but we should surely be looking more closely at the experiential benefits of public engagement with the arts. And in focusing down on specific arts in health initiatives, participants? testimony can provide useful qualitative evidence as to whether art is in itself a therapeutic activity or an effective medium for health education. We need to carefully build an evidence base that can convince the health sector but does not compromise the arts. And for effective partnership one sector?s agenda should not dominate the other - it is important to be bowling together.
Best practice
There is a new research base helping the development of best practice in both the delivery and evaluation of arts in health. The Centre for Arts and Humanities in Health and Medicine (CAHHM) at the University of Durham was set up last year by Vice-Chancellor Sir Kenneth Calman who was formerly the government?s Chief Medical Officer. CAHHM?s ultimate aims are to encourage change in the way we learn, work and communicate in healthcare, and to build trusting creative partnerships between health professionals and the public. It works closely with the National Network for Arts in Health (profiled on page 7) and co-ordinates the medical humanities network on behalf of the Nuffield Trust. Our research interests include evaluation of the effectiveness of arts in patient-centred approaches to healthcare, the development of community-based arts in health and emotional literacy, and introducing arts and humanities into the education of medical students.
CAHHM is managing an initiative called ?Common Knowledge?, a three-year arts in health development programme for the Tyne and Wear Health Action Zone. This pioneers a new approach to placing arts activities at the heart of community health and clinical practice. Across the region it has created a large and vibrant network of artists, health professionals, teachers, local authority officers, voluntary sector entrepreneurs and community participants. Induction workshops provide an intensive exploration of how arts can both identify and address local health needs. These have led to the delivery of over 20 cross-sectoral pilot projects so far, as well as action seminars on topics of mutual interest such as arts on prescription schemes and the Six Hour Coffee Break event. The pilot projects have ranged from discreet live music in intensive care, to arts-led information design for primary care practice, to a health-themed friendship garden in a school playground. The whole programme has been intensively documented and evaluated and an interim report will be available in September.
Other CAHHM projects include a mapping of arts in health activities throughout the Northern and Yorkshire region, and a comparative evaluation study of several community-based arts in health projects in England. These projects include the Bromley-by-Bow Centre, Gateshead?s ?Healthy Hearts? Lantern Festival - now in its ninth year - and ?The Looking Well?, an arts-led healthy living centre in North Yorkshire.
The Looking Well was set up three years ago by artists from Pioneer Projects as an informal community space where arts, health promotion and lifelong learning programmes could come together. Purposefully shoestring and low-tech (there is no phone, but there is a wood stove!), The Looking Well has turned a small town store into a haven of creativity for the community and a growing number of care agencies. Domestic in feel and content, it offers a congenial space with the atmosphere of a well-functioning extended family developing supportive arts activities out of its own health needs assessments. It is cheap, simple , largely voluntary, and it works. The other projects selected for this evaluation study have similar fascinating stories to tell, and the report will be available in the autumn.
Effective evaluation
Some fundamental principles for effective evaluation in this field are starting to emerge. More arts in health work needs to be research driven, with a greater clarity of aims and language, encouraging and documenting reflective practice by the key players throughout. With financial and time constraints, it is safer ground to look for intermediate qualitative indicators of health gain, for example environmental improvement or better communication in healthcare contexts, than to press an arts project into delivering hard clinical outcomes. At the same time, just saying the arts increase well-being is not enough. Be specific, and tell your story on your own terms.
This winter we will put forward a range of evaluation methodologies for debate in a series of regional seminars organised with the National Network for Arts in Health. The seminars will lead in turn to the publication next spring of an evaluation guide for community-based arts in health.
Mike White is Director of Projects at CAHHM. t: 0191 374 7169, e: mike.white@durham.ac.uk