By Tim Joss, Chief Executive and Founder, Aesop Arts & Society
With social prescribing in the ascendant, the arts and culture sector should no longer feel that they have to knock in vain at the door of health. But Chief Medical Officer Chris Whitty recently made it plain exactly what is expected of the sector. Strong evidence and closing the gap between academia and practice.
One clear direction of travel is that the definition of an NHS health professional is expanding. Of course, there was always more than the doctor, nurse or porter of popular imagination. Allied Health Professionals alone include art therapists, drama therapists and music therapists. The net is now cast wider still. The Royal Society for Public Health suggests a ‘wider public health workforce’ should include people such as firefighters (who perform home checks in older people’s home to prevent falls).
Since its launch in 2019 the National Academy for Social Prescribing works ‘to create partnerships, across the arts, health, sports, leisure, and the natural environment, alongside other aspects of our lives, to promote health and wellbeing at a national and local level.’
And now, launched this month, there is the UCL Health of the Public. It’s ‘a new virtual School bringing multiple disciplines together to improve health for all.’ It acknowledges that ‘physical and mental health is shaped by a multitude of factors, from the food we eat, to the air we breathe, the work we do, the places we live, the taxes we pay, the health care we receive, and the people around us.’
The arts and culture sector should feel a strong sense of arrival. But what do they need to do? Chris Whitty made it plain at the Health of the Public launch.
First evidence. ‘When we’re getting people to change behaviours or inviting them to do so, when we’re getting governments to invest in different ways, when we’re asking for government to think about different approaches to regulation for example, when we’re asking local authorities to move budgets from one area to another, it must be based on a strong evidence-base and the more difficult the change we’re asking people to think about, more difficult the budgetary implications, the stronger the evidence is going to have to be.
Most arts organisations are small and cannot be expected to marshal this kind of evidence, but neither can they afford to resist developing it.
Channelling the spirit of UCL Health of the Public, many existing academic disciplines need to be brought together with the arts: health economics for cost-effectiveness, implementation science for scaling, cultural workforce research for recruiting diverse artists, and so on.
But this is categorically not enough. Academics have published extensively on the arts achieving health improvement (helpfully reviewed in 2004 and most recently in a 2019 WHO report) without a single arts intervention going to scale.
For an arts programme to be taken up by the health system, it needs to work in the real world, not just in a research-led project. It needs to be cost-effective. It needs to slot into the health system – a complex system with patient pathways, procurement rules and data requirements. It needs to be scalable and of consistent quality and work as well in Hartlepool or Haverfordwest as in artist-rich London.
The second point made by Whitty plots a path to this future and indicates where arts and culture can support this future. There is a gap between academic work and practice. He stressed the need for ‘academic back up and research to test which of those innovations are having the biggest impact so that they can be replicated …. the need of public health academia to re-engage with local authorities and with people working on the frontline of health. … this is an area where the UK has historically been very strong, I think we should be self-aware and say at the moment we [academic researchers] could do better still in many of the ways in which academia and research can support practical public health.’ Arts-and-health programmes know all about the sharp end, working directly local authorities and the public.
It is time for the gap between practice and academia to close, for academia to engage with arts organisations working on the frontline of health who understand how things work in real life. New partnerships are needed with arts organisations and academia co-designing and conducting the research together.
If both Whitty’s points are met, demand for arts-led interventions could be strong, especially if the right business models for rapid adoption and diffusion are developed.
This new approach calls for leadership from the four nations’ arts councils. All are already engaged in the arts-and-health agenda and the prize of high-quality, national arts programmes delivering well-evidenced health improvement is an attractive one. Yes, this is a long way from where we are now: mostly small project-funded initiatives lacking their own evidence base. But it can be done.
Over the last five years, Aesop has conducted a £3 million action research project to demonstrate that an arts solution to a major health challenge can be made available to all who need it. The challenge is prevention of falls amongst older people and the arts solution is Dance to Health, the national falls prevention dance programme.
Thanks to our academic partner, Sheffield Hallam University, we know that Dance to Health reduces falls by 58%, potentially saving £98 million a year. It is popular, scoring 98% in the NHS Friends and Family Test. Dance to Health is pivoting now from a grant-funded innovation to a commercial social enterprise. We are winning NHS contracts. A partnership with Middlesex University Business School will enable us to study social franchising as a possible model for speeding up adoption. It has worked for parkrun and could well work for Dance to Health.
The opportunity for the arts sector is immense, the potential value to the public enormous. We must not miss the boat again.