How the arts, creativity and cultural participation can support health

Highlighting the growing research demonstrating the effects of arts and cultural engagement on health across the lifespan, Dr Daisy Fancourt, a Wellcome research fellow at University College London, gave a stirring keynote address to open the second day’s proceedings of the 4th European Healthcare Design Congress earlier this week.

Her presentation took delegates on a whirlwind tour through arts and health research, exploring recent studies in psychotherapy, psychobiology and behavioural health, and explained how this is now moving into areas of policy and practice.

Magic and science
In exploring the incredibly rich history between the arts and health, which can be traced back around 40,000 years. She a key milestone as the 18th century, when Richard Brocklesby, an English physician, wrote one of the first medical treaties on the power of music. But although this triggered a revolution in the arts and how they might be used to support our health, the arts’ association with magic and mysticism was a barrier to acceptance. Indeed, the glass harmonica of the time was believed not only to cure diseases but also wake the dead, and perhaps even cause mental illness.

“So, we’ve had this dual relationship across history between the hopes and aspirations of how magical the arts could be versus the reality of the scientific evidence that has been growing since,” Dr Fancourt remarked.

In the late 20th century and early 21st century, there has been a shift in how we now conceptualise the arts, she explained, and arts and health is now broadly considered an umbrella term that incorporates lots of different activities. Pointing to arts in psychotherapy, arts in communication, how technology can be used to bring arts into more sensitive areas, such as infection control units, and how arts can be used in the community and our everyday lives, she stressed that the one common thread of all these activities is the conceptualisation of the arts to see if there is a multi-modal intervention.

Dr Fancourt said: “This can include: the arts for reducing isolation by connecting us to other people; providing social support; opportunities for emotional expression and cognitive stimulation; giving us a chance to develop our own sense of agency and self-esteem or allow us to learn; reducing our stress; providing general hedonic and pleasurable experiences; being mindful; modelling social and healthy behaviours in our lives; and reducing sedentary behaviours, such as getting us out of the house.

“There is a strong evidence base between all these different components and our health. But what the arts do is provide a vehicle with an intrinsic motivation to get involved, in order to experience these health risk-reducing factors.”

To highlight the breadth and depth of research taking place in this space, she then proceeded to offer delegates a smorgasbord of arts research studies, programmes and interventions that have been found to have a tangible impact on the health of participants.

Psychological research
Continuing the theme of music, she detailed two programmes around mental health. The first, a community drumming programme for people with moderate mental health depression involved two groups – one group undertaking 10 weeks of drumming sessions for an hour a week, while the second group did nothing over the same period. The drumming group enjoyed significant improvement in factors such as anxiety and social resilience over the period, with an improvement in depression of about 38 per cent.

In a follow-up three months later, researchers found the results had maintained statistically, which suggests that relatively short-term interventions for health can have long-lasting benefits.

Another programme looked at post-natal depression, where mothers were split into three groups: one group undertook 10 weeks of usual care; another undertook 10 weeks of social classes every week; and the third undertook 10 weeks of social singing classes every week. The singing group improved significantly faster compared with the other two groups, recovering about a month earlier.

Another fascinating piece of research involved a whole systematic review of the role of music in helping premature babies.

“ICU environments are very different to what they experience in the womb,” said Dr Fancourt. “They can be very loud, with high-pitched noises, irregular rhythms and patterns, so studies have looked at whether playing relaxing music that is much lower in its pitch, and much more regular in its beats, can actually support premature babies. It’s been found not only to reduce their stress hormones and heartbeats but also help them feed better, gain weight more quickly, and therefore leave hospital sooner.”

The arts in prevention
Arts have also been shown to help memory and cognitive functions – and music is, once again, a powerful intervention in this respect. Shown to affect many different parts of the brain, music can be one of the last things people are able to retain, even after they lose the ability to perform certain tasks, explained Dr Fancourt.

But the arts are now also being used to look at prevention, and whether cultural engagement might be used to help prevent people from developing dementia.

“This builds on the theory of cognitive reserve, the concept that you can essentially enhance the resilience of the brain,” said Dr Fancourt.

Taking into account other factors such as participants’ socio-economic status, education, health conditions, and other social activities, researchers are now finding that the more you engage with culture through places like museums, galleries and theatre, the better your memory is ten years later. Moreover, the rate of dementia has been found to be lower the more frequently people engage in these cultural activities.

Research is now exploring how our biological markers correlate to engagement with the arts, so, for example, drumming not only leads to reduction in stress hormones but also impacts other biological markers such as cytokines, which are essentially small proteins that are important in sending chemical messages, and play a key role in activating the immune system. Studies have been shown to support the notion that the more we engage in activities, the stronger we respond physiologically.

Another interesting area is how we can synchronise with regular beats – something Dr Fancourt referred to as “entrainment”. While it’s often used in exercise as an instinctive motivational push to perform, it’s now starting to be applied in rehabilitation, she added.

For example, dance music has been shown to encourage exercise among people with Parkinson’s disease and help people adhere for longer, even if it starts to get painful. As a result, there are some programmes that have been set up to try to encourage this within healthcare spaces.

Highlighting it as one of her favourite interventions, Dr Fancourt described the merits of the Breathe Magic programme for children who have paralysis on one side (hemiparesis). For these children, the most effective treatment is intensive hand therapy, for around 60 hours every 10 days. To help them, a programme was set up with the Magic Circle, which turned every hand exercise into a magic trick.

“As well as doing functional rehabilitation, they learn to be young magicians, which improves confidence, body language and eye contact,” explained Dr Fancourt. “This programme has been shown not only to be just as functionally effective as the regular hand therapy programme but it’s also been shown to improve their confidence, self-esteem and mental health.”

Behavioural research
Looking briefly at the impact of behavioural research, Dr Fancourt highlighted the Choir with no name, which works with homeless people and gets them involved with singing in choirs around the UK. Tapping into behavioural models around motivation, agency and self-advocacy, the choir programme has led to 60 per cent of participants going on to take up employment, volunteering or secure housing.

Technology programmes are also being developed, such as gamification designed for teenagers, where apps can show them what their cancer medication is doing inside them to increase their adherence to this medication.

Summing up, Dr Fancourt underlined that the arts’ role in health cannot be likened to the cherry on the top of the cake. Nor is it something that is expendable or something you can just add on to have a well-functioning healthcare system.

“I believe that arts can be completely transformative to the way that we design both primary and preventive health, but also in supporting people within hospitals and social care,” she concluded. And suggesting a need for better health and arts messaging – perhaps similar to the ‘five a day’ bulletin on eating enough fruit and vegetables – she concluded: “I genuinely believe that when we put the arts into these more unusual settings, they can be the most inspirational.”