Margret Meagher (Arts and Health Australia)

UK Arts and Humanities Research Council Communities, Culture, Health and WellbeingWorkshop, Cardiff Wales, 17 – 19 September 2011

Healthy Communities and CultureThink Local ... Think Global

Margret MeagherExecutive Director, Arts and Health Australia &The Australian Centre for Creative [email protected]

The Roseto Mystery Malcolm Gladwell

‘Outliers The Story of Success’ 2008

The word ‘Outlier’ is defined as “a statistical observation that is markedly different in value from the others of the sample”

The Roseto Mystery Revealed

“Virtually no one under 55 had died of heart attack. For men under 65, the death rate from heart disease was half (the national average). The death rate from all causes in Roseto was up to 35% lower than expected.

There was no suicide, no alcoholism, no drug addiction, and very little crime. They didn’t have any one on welfare. Then we looked at peptic ulcers. They didn’t have any of those either. These people were dying of old age. That’s it.”

John Bruhn, sociologist and co-investigator with Dr Stephen Wolf, researching the Roseto population aged 21+Malcolm Gladwell , Outliers The Story of Success 2008

Roseto Recipe for Health –A Creative and Connected Community

John Bruhn and Dr Stephen Wolf noticed how socially engaged the people of Roseto were and the extended family relationships that lay at the heart of the town’s social structure. Many homes had three generations living under the one roof and grandparents were respected. Attendance at church had a calming and unifying effect. There were 22 civic organisations in a town of under 2000 people. The community was markedly egalitarian.

“The Rosetans were healthy because of where they were from, because of the world they had created for themselves.”

The Roseto Mystery, Malcolm Gladwell Outliers The Story of Success

Roseto Mystery Bewilders Science

When John Bruhn and Dr Stephen Wolf presented their findings at medical conferences in the 1950s, they were met with scepticism by their peers.

Genetics, diet, exercise, regional location and medical care were considered the key determinants of health.

People did not think about health in terms of ‘community’.

The Roseto Mystery, Malcolm Gladwell Outliers The Story of Success

Roseto Case Study: A New Way of Thinking

Bruhn and Wolf sought to convince the medical establishment to think about health beyond an individual’s personal choices or actions in isolation.

Malcolm Gladwell concludes that in understanding the health of a person, it is important to understand the culture that he or she is part of, including that of their friends and families and to know where they and their families come from.

Finally, he says it is critical to understand that the values of the world we inhabit and the people we surround ourselves with have a profound effect on who we are and, by implication, on our health, wellbeing and connection to community.

Malcolm Gladwell, Outliers The Story of Success 2008

THIS IS AN IDEA OF WHO I AM AND WHERE I COME FROM...

THIS IS A GLIMPSE OF MY LOCAL COMMUNITY

My WorkplacePort Macquarieand the world

My Backyard

My Community Choirs

My Family and Friends

Arts and Health is taking great strides as an international movement

Black Grace Dance Company New Zealand

In 21st Century

What is Arts and Health?Arts and Health is an international field of practice and research that encompasses primary and acute care, aged care, palliative care, community health, health promotion, medical education, architecture and design.

An Arts and Health program provides participants with access to professionally delivered creative activities specifically designed to achieve positive health outcomes – such as singing to improve cardiovascular and lung function or restore voice facility for stroke victims; dance to improve mobility and combat obesity; clay modelling for arthritis; visual art and music to support people with dementia or Parkinson’s disease.

Art forms range from the visual arts, music, theatre, dance, circus arts, creative and narrative writing, storytelling, film, digital media.

In 21st Century

Growing Recognition of the Value of Arts and Health

“Arts and health initiatives are integral to health, healthcare provision and healthcare environments, including supporting staff, and are delivering real and measurable benefits across a wide range of priority areas for health, supported by a substantial evidence base” UK Dept of Health Review 200

The arts bring people together and forge essential links with the broader community, facilitate intergenerational exchange and foster social inclusion.

In 21st Century

Why is Arts and Health gathering momentum?

Major demographic changes as baby boomer generation ages People live longer and likely to experience chronic health conditions

eg dementia, depression, cancer, diabetes, cardiovascular disease 21st century expectations of the right to enjoy a high quality of life

and high level of accessible information Increased social isolation in the community with family fragmentation Healthcare now focussed on keeping well, prevention and potential

rather than illness and burden Increasing scientific research to

corroborate benefits of arts for health International exchange of people,

programs and ideasAlison Clough Pioneer Projects, Bentham, Yorkshire UK, WA HealthwayResidency 2008 working with Aboriginal Communities around diabetes

Arts and Health is developing as a global fraternityKey to the strengthening of the global arts and health movement is the unifying communications and networking role played by peak arts and health organisations, together with improved access to information and resources via the internet:Society for the Arts in Healthcare, USA (www.thesah.org)London Arts and Health Forum, UK (www.lahf.org.uk)Centre for Medical Humanities, UK (http://www.dur.ac.uk/cmh/)Arts and Health Australia (www.artsandhealth.org)Arts Health Network Canada (www.artshealthnetworkcanada.com)Arts and health blogs - Arts in Health Manchester MetropolitanUniversity (http://artsforhealthmmu.blogspot.com) Centre Medical Humanities (http://medicalhumanities.wordpress.com/Arts & Health International Journal of Research, Policy and Practice;Applied Arts and Health Journal; UNESCO Observatory Multi-DisciplinaryResearch in the Arts E Journal, University of Melbourne (2012 editions)

Arts and Health Australia (AHA) - www.artsandhealth.org

National advocacy, networking and consulting agency Expertise in designing and implementing creative communities

programs for hospitals, retirement villages, aged care facilities,community services

Strong regional, national and international networks provide access to best practice models and current research

Partner in training and research projects such as the Art and Dementia program at the National Gallery of Australia in Canberra (pictured).

Convenor of an annual international arts and health conference “The Art of Good Health and Wellbeing” Canberra ACT 14 – 17 November 2011Fremantle WA 13 – 16 November 2012

Defining Health and Wellbeing

National Aboriginal Health Strategy (NAHS) defines health as: ‘Not just the physical wellbeing of the individual but the social, emotional and cultural wellbeing of the whole community. This is a whole-of-life view.’

Sir Michael Marmot, Chair of WHO Commission on Social Determinants of Health, 2006 identifies the key determinants of health as -• Social justice and participation• Empowerment as a means – material, psychosocial, political• Creating the conditions for people to take control of their liveswww.who.int/social_determinantsStrategic Review of Health Inequalities in England post 2010www.ucl.ac.uk/gheg/marmotreview

Examples of Health Inequalities

Life expectancy at birth for selected London electoral wards, a few miles apart, 2002-06 (data from London Health Observatory)

Kensington & Chelsea Queens Gate ward:Life Expectancy for men: 88 years

Tottenham Green, HaringeyLife Expectancy for men: 71 years

Indigenous Australians have a life expectancy of 17 years less than non indigenous Australians

In 21st Century

Questions to Ask

What does existing research tell us about the efficacy of arts and health programs

in maintaining and improving health and wellbeing and nurturing flourishing communities ?

Where are the gaps?

What questions do we need answered to advance community cultural development, health and wellbeing?

“what is the problem to which we think we are the solution?” François Matarasso

Therapeutic Outcomes from Arts and Health Programs in Hospitals and Aged Care Facilities

reduced stress and anxiety; elevated mood and self esteem pain management improved communication – patients/family/hospital staff excite the imagination, entertain, educate and inform safe, non threatening environment improved design features - patient rooms,

signage, instrumentation, public spaces reduced length of time in hospital reduced reliance on medication, hospital staff enhanced wellbeing of hospital staff, carers,

families Royal Melbourne Hospital

Study of the Effect of Visual and Performing Arts in Health Care -Chelsea and Westminster Hospital, London. (www.hospitalarts.co.uk)

Landmark research (1999 – 2002) provided evidence that the integration of visual and performing arts into the health environment induce psychological, physiological and biological outcomes with clinical significance.

Units of research established in the following clinics: Medical Day Unit, Antenatal Clinic, High-Risk Clinic, Maternity, Post-natal Ward, Day Surgery Unit, Trauma and Orthopaedics Ward, HIV/AIDS Services

Rosalia Lelchuk Staricoff PhD, Director Research Project

Antenatal High Risk Clinic: Live music in waiting area effective in lowering blood pressure of patients

Maternity Unit – music and visual art: Duration of labour 2.1 hours shorter and requests by women in labour for epidural analgesia diminished

Trauma and Orthopaedic Ward – music and visual art: Patients during the post-operative period required less analgesia per day and stayed 1 day less in hospital than control group

Staff Evaluation: Two thirds of respondents (clinicians, nursing staff, managers) indicated the hospital environment – architecture, light, colour, visual art, live music – influenced decision to apply for job in the hospital or remain in current position

The arts can be the best medicine of all .. and it’s fun

Health Professionals and the Arts

Healthcare professionals recognize the arts can reduce the stressof a pressured healthcare environment, assist them to maintainmental alertness and provide respite and lifestyle balance.

Medical humanities education is valuable in honing communications and observational skills and improved diagnosis procedures. (www.nga.org.au/artmed)

Corpus Medicum, Melbourne, arts+medicine magazine

Arts and Community Health and Wellbeing

“Arts in community health is a distinct area of activity outside acute healthcare settings, characterised by the use of participatory arts to promote health.

The development of such work within the interweaving strands of health, education and social policy has evolved through recognition of the connection between engagement in cultural activity and wellbeing and that the arts can have a lasting and transforming effect on many aspects of people’s lives.” Mike White 2007

Mike White, Senior Research and Development Fellow in Arts and Health, Centre for Medical Humanities, University of Durham, UK (www.dur.ac.uk); author of Arts Development in Community Health: A Social Tonic (Radcliffe, Oxford 2009)

In the USA

Music in the Community for Health and Wellbeing

“There are now more community choirs in the UK than fish and chip shops.” The Independent, January 2010

Singing is widely reported to be enjoyable, energising, relaxing, stress relieving, mood enhancing and cognitive stimulating. Singing enhances self-confidence, self esteem, gives a sense of purpose and of achievement. Socially, it provides social support, friendship and a sense of community and belonging.

Reference: Group Singing, Wellbeing and Health A systematic mapping of research evidence Professor Stephen Clift, Research Director, Sidney de Haan Research Centre for Arts and Health,Canterbury Christ Church University, UK

In the USA

Quality of Life Research Informs Value of Arts Health

Dr Cheryl Dileo, PhD, MT-BC. Professor of Music Therapy and Coordinator of the MMT Program and Director: Arts and Quality of Life Research CenterTemple University, Philadelphia; faculty member University of Melbourne.

www.temple.edu/boyer/researchcenter - undertaking 7 Cochrane Reviews into arts and health, exploring: Are the arts effective modalities in healthcare? Do the arts make a difference? How do the arts make a difference? Why do the arts make a difference? What is the best evidence? What kind(s) of evidence is(are) needed?

A Logical Connection

New Laguna Honda Hospital for Long Term CareSan Francisco

Designed to create a sense of community among residents 780 bed facility, each patient has a window and fresh air Each floor is a distinctive neighbourhood 60 residents live in 4 x 15 people

households, each with living room Households are organised around

a central Great Room (Town Square) Every two households share dining room

A Logical Connection

New Laguna Honda Hospital for Long Term CareThe Esplanade is the main street, lined with places for residents, carers, volunteers and visitors to meet, including a community theatre, cafe, library, art studios, hairdresser.

A Logical Connection

The Esplanade – Laguna Honda’s Main Street

Cliff Garten Bronze Handrail

A Logical Connection

New Laguna Honda Hospital for Long Term Care

Buildings open onto a central park, home to the animal therapy center and horticultural program; 11 healing gardens include secure areas for dementia patients

Artwork is appropriate for a population diverse in its ethnicity, cultural backgrounds, andlevels of physical ability and mental cognition

A Logical Connection

New Laguna Honda Hospital for Long Term CareKey Elements of Design Criteria Meet Functional Needs

Way Finding and Location Identity Sensory Stimulation Activity Stimulation of Memory Orientation to Time

A Logical Connection

New Laguna Honda Hospital for Long Term Care

Design Principals

Sense of Place: Geography, History, Language

De‐Institutionalization through art

Personal Autonomy through activity,interaction and choice

Arts – Led Community Regeneration in the UK

In the UK

Arts – Led Community Regeneration

Arts-led regeneration can have a dynamic effect on the overall health, confidence and prosperity of a community, supporting social integration and lifelong learning.

High-quality arts facilities, supported by their local community, can attract significant investment into their region.

Cultural provision is an important economic indicator.

The Angel of the North, Newcastle Gateshead is a concrete example of the accumulator effect on the local economy of a high quality arts project.

In the UK

Arts – Led Community Regeneration

In the 1990's Gateshead was a blue collar town in North East England in long-term recession. The Council won Government funding to host a National Garden Festival in 1990. The land reclamation required for this led to a program of commissioning works of public art to establish a new image and identity for the town, under the project management of Mike White.

The most ambitious art work was the 20 metre high Angel of the North by Antony Gormley, installed 1998, which is now the most viewed and most publicly recognised contemporary sculpture in Britain.

The Times newspaper chose the Angel as its cover image for 1st January 2000 issue to herald thenew century.

Cost AUS $2million - Generated an estimated AUS $140 million in free tourism promotion and continuing.

The Angel became a national icon and helped Gateshead Council make a case for funding from the National Lottery and the private sector to support ...

In the UK

Arts Led Regeneration – Community Benefits Development of major art gallery The BALTIC on Gateshead Quays (AUS $80 million) and international concert hall The Sage designed by British architect Norman Foster (AUS $160 million)

These developments attracted further private sector investment of AUS $250 million for a science park, a tertiary college, new housing and leisure development

New Millennium Bridge over the Tyne (AUS $50 million) built to connect Gateshead's flagship arts facilities with sister city Newcastle.

A by-product of this success is that the population health profile of the town significantly improved.

Healthy Ageing: Creativity Matters

Creative Ageing: Health and wellbeing benefits for older people who engage in creative activities

A specialised area, at a critical time in healthcare globally, challenged by a rapidly increasing ageing population.

Office for an Ageing Australia appointed actress Noelene Brown as Ambassador for Ageing in 2008 to promote healthy, positive and active ageing messages in the Australian community – to minimise or delay disability and lead promotional activities to ensure communities value and respect older people.

Ageing in 21st Century : Some Facts

By 2041, 1 in 5 Australians will be over 65; 7% will be over 80 (ABS)

Older people want to age in place and live independently in a safe, familiar and welcoming environment. Connection to community is important.

We are moving to a time when the ageing population of the western world will be the best educated and skilled in history, with much to offer

Some of the Challenges for SocietyCombating ageist attitudes and discrimination towards older peopleHarnessing and nurturing the true potential of the ageing populationEnsuring that people with dementia and their carers enjoy quality of life

A Potent Mix

Strategies to Facilitate Positive Change around Ageing

Improved marketing communications / health promotion to promote healthy ageing through the arts, emphasising the physical and mental benefits of engaging in creative activities.

Promote positive attitudes to ageing by profiling older role models and champions, encouraging increased intergenerational exchange and highlighting the value of wisdom, experience and mentorship in the community.

Support the development of creative ageing strategies for older people living in the community independently or for people in aged care facilities, dementia care, hospitals and hospices, along with their carers and families.

A Potent Mix

Strategies to Facilitate Positive Change around Ageing

Increased research into the efficacy of arts and health programs in improving and maintaining health, wellbeing and social inclusion for older people

Extrapolating from research data the business case for creative ageing strategies.

Increased research into the use of the arts to support older people with depression, anxiety, dementia and other chronic illness, and their carers.

A path to Healthy Ageing

Creative Ageing Research in the USA“Art is like chocolate for the brain”

Dr Gene Cohen MD PhD

Gene Cohen was the Director, Center on Aging, Health & Humanities, Professor of Health Care Sciences & Professor of Psychiatry & Behavioral Sciences, George Washington University(www.gwumc.edu/cahh)

Acclaimed author, includingThe Creative Age: AwakeningHuman Potential in the Second Halfof Life (2000)

The Mature Mind : The PositivePoswer of the Aging Brain (2006)

Compelling Results

Creativity and Aging Study: The Impact of Professionally Conducted Cultural Programs on Older Adults

Dr Cohen completed this landmark study on the impact of professionally conducted, participatory cultural programs on older adults, 2001 – 2005, across 3 sites in Washington DC, New York City and San Francisco, with 300 people participants. Average age of participants was 80, with age range of 65 – 103 years

The intervention group maintained greater independence, higher morale, experienced less loneliness, used less medication than control group, expanded their interests and activities, achieveda greater sense of control and enjoyed higher social engagement

Ref: National Centre for Creative Aging, Washington DC www.creativeaging. org

A Universal Language

Creative Ageing – Art and DementiaThe Meet Me at MoMA Alzheimer’s Programand the National Gallery of Australia’s Art and Dementia program are outstanding models of arts and health programs in the galleries/museum sector - bringing people with Alzheimer’s and other forms of dementia, along with their carers, to each museum for interactive tours of masterpieces from their collections. (www.moma.org/meetme/index)

MoMA offers an invaluable online resource (www.moma.org/meetme/index)

bottom right: Carrie McGee Educator, MoMA

A Universal Language

Creative Ageing – Art and Dementia

The National Gallery of Australia’s Art and Alzheimer’s Outreach Project has been established to assist regional communities develop a sustainable model of tours for people living with dementia. Alzheimer’s Australia is a partner in the project.

This has been an important programin facilitating social inclusion and providing support for carers.

[email protected]

A Universal Language

3rd Annual International Arts and Health ConferenceNational Gallery of Australia National Portrait GalleryCanberra ACT14 – 17 November 2011

Mental health, creative ageing, social inclusion, intergenerational programs and medical education are areas of key focus.

Training workshops include the MoMA and NGA Art and Dementia programs

A Potent Mix

The Last Word on Arts and Health

“It might be the purgative power of watching a great tragedy, the soothing effect of a fine painting or even the robust exercise of singing in a choir, but the arts are good for your health”

Richard Smith, EditorBritish Medical JournalNew Scientist June 2002

Margret MeagherArts and Health Australia &The Australian Centre for Creative [email protected]