A DCMS report asserting that ‘the arts can,’ ‘music can,’ and ‘dance can’ improve arts and health includes highly flawed studies that should not be relied upon to guide policy, says Stephen Clift.
News of a DCMS-commissioned study proclaiming the existence of strong evidence on arts and health that "can be trusted to guide policy" may be reassuring to some, but glance beneath its cover and you will find all is not as it appears. While this report includes an assessment of the ‘quality’ of the evidence on arts and health interventions, it signally fails to provide a critical review of available research.
Academic studies are organised according a standard hierarchy of evidence, with meta-analyses and systematic reviews said to provide the highest standards of evidence, followed by randomised controlled trials (RCTs) and then observational and qualitative studies. But categorising them in this way does not guarantee that the claims made provide strong evidence of validity, generalisability and impact, which can guide policy.
Earlier this year – a good three months before the appearance of this new DCMS report – I published a critical review of the recent WHO Scoping Review that underpins it, and followed that with a series of blogs elaborating on my concerns. Yet there is no evidence that any account has been taken of the substantial issues the review and blogs raised.
Here are some telling examples of studies quoted favourably in the report, which are highly questionable:
- A systematic review of RCTs on dance for older people is cited, which includes at least one study which is highly flawed in failing to report results on falls. On this basis the review should have been excluded.
- An RCT controlled trial on music and prejudice is cited which is not concerned with health outcomes, and has no place in an arts and health review. Even in its own terms, it does not show impacts on prejudice in any meaningful sense.
- An observational study of creativity and older people is cited as showing that singing can improve health and reduce falls, even though careful analysis shows that the study is flawed. The claim regarding falls is implausible and has never been replicated.
The report consistently reifies the arts, repeatedly stating that ‘the arts can,’ ‘music can,’ ‘dance can’ without acknowledging any of the specifics of country, context, timing, quality of the arts experience, and people involved. It is claimed, for example, that ‘The evidence base on arts and physical decline’ provides ‘an overall grade of recommendation of A: the evidence on the use of the arts to reduce physical decline in older age is strong and can be trusted to guide policy development.’ But the studies on which this conclusion is based were undertaken in Brazil, China, Germany, Thailand, Turkey and the United States, to name but a few of the countries involved – all with different cultural and artistic traditions and health and social care systems. One wonders how policy in the UK can possibly be formulated on a body of evidence drawn together from all corners of the globe no matter how good the quality?
I call on all researchers, health practitioners, policy analysts and artists actively involved in the field of arts and health to critically assess the value and limitations of this report. I may be wrong in my assessment, but to me it signals a worrying failure of critical scholarship.
Stephen Clift is Professor Emeritus at Canterbury Christ Church University and Visiting Professor at York St John University