Health Inequalities Roundtable
‘The arts go deeper’: Creative Health and Health Inequalities
“For me it saved my life. Arts gave me that access to see the world differently and for the world to see me differently” – David Tovey, Artist and Co-Director of Arts and Homelessness International
“Creativity is so much more than just creating art. For some it helps rescue them from their darkest days. For me it helped me be part of a community, helped me be heard, and helped give me my voice back” – Kelly McLaughlin, Photographer and Community Organiser, East Marsh
Creative Health and Health Inequalities was the second in our series of themed roundtables, contributing to the Creative Health Review. Through the roundtable, we wanted to highlight the diverse ways in which creativity can help to tackle health inequalities, in particular looking at the influence of creativity in the places that people live, and on the wider determinants of health, which account for such a large proportion of health outcomes. With a greater focus on inequalities since the pandemic, and the cost of living crisis expected to have a significant impact on health and wellbeing for many, our speakers emphasised the power of communities to mitigate some of these impacts, but also the need for change in systems and funding models, to foster the conditions that allow communities to effectively improve their own environments in a sustainable way.
Our speakers shared their own experiences of using creative health to improve their own health and wellbeing, and the work they do with their communities to improve both access to creativity and health outcomes. We were joined in the session by David Tovey, Co-Director Arts and Homelessness International; Rose Sergent, Health and Science Producer, Contact, a theatre and arts venue in Manchester; Josie Moon and Kelly McLaughlin, East Marsh United, a community group based in Grimsby; Liz Morgan, Interim Executive Director for Public Health and Community Services, Northumberland County Council and Ruth Bromley, GP and Clinical Lead for Homeless Health, Greater Manchester Integrated Care, Lead for Ethics & Law, Manchester Medical School. Sandra Griffiths, Founder and Director, Red Earth Collective and Health and Wellbeing Consultant was unable to join on the day due to illness. Her evidence will be submitted to the review separately.
The role of creative health in tackling inequalities
From their various perspectives, our speakers articulated the value of the arts, culture and creativity in tackling health inequalities. For example, in homeless communities the arts have been found to have a positive impact on wellbeing, agency, resilience and knowledge and skills. Rose Sergent gave the perspective of Contact, a theatre working closely with the populations it serves. Using one example of a production developed in collaboration with a community partner to address disproportionately high rates of HIV in Black African communities, Rose described how performances can encourage visibility of experience, promote education and reduce stigma and isolation, busting myths and fostering a sense of understanding around the realities of life with HIV. Similarly, Liz Morgan outlined programmes in Northumberland which used theatre to facilitate conversations around mental health. Feedback from Northumberland’s Director of Public Health Report, which focused on creative health, found that the arts matter because they “give people confidence, improve their lives, enable people to express their innermost thoughts and opinions in a creative way, give them ways of looking at the world and make them feel really emotionally attached.”
“Engaging with the arts is not a luxury, it is something everybody should have the opportunity to engage in” – Liz Morgan
Acknowledging the benefits of creative health, many of our speakers were involved in initiatives to ensure equitable access to creative opportunities. For example, Arts and Homelessness International have worked with cultural organisations and the homeless community to identify where there are barriers to access and facilitate change, such as the removal of bag checks on entry to cultural institutions. Provision of online and digital activities can improve access for disabled and neurodivergent audiences, particularly during the pandemic when many people are shielding and at risk of isolation. Establishing a new narrative between cultural institutions and those with lived experience of exclusion can reduce fear and stigma, and lead to new, inclusive ways of working. In Northumberland, the council have used funds from the national Creative People and Places programme to encourage participation in arts and culture in the most marginalised communities, including refugees and asylum seekers and those from deprived areas, leading to positive changes in health and wellbeing. Contact organises outreach activities in communities least likely to access arts and culture, to help to ensure the offer is available to all. In response to the impact of the cost of living crisis, the theatre has considered where and how it carries out its work, providing free drop-in activities, low cost tickets to shows, travel and food costs or free lunches for participants. Our speakers felt this was particularly important given that the creative curriculum in schools has been diminished, with activities such as music lessons an drama clubs now considered a ‘luxury’ rather than core.
“In challenging inequalities it is important for the arts to be responsible and flexible” - Rose Sergent
There should also be equitable opportunities to practice as an artist. When David Tovey was setting out as a homeless artist there were no cultural spaces willing to promote the work; ‘…when I was trying to get back on my feet it was difficult to get my work seen because it was difficult to get myself taken seriously.’ Having set up his own festival in response, this has now developed into an international network showcasing the work of artists who have experienced homelessness.
Communities, co-production and person-centred approaches
“Communities know what works for them. If we start with where people are, we have a much better chance of creating real and lasting change” – Josie Moon
As important as the use of creative health is the way in which creative programmes and interventions are designed and implemented. Co-production with communities – doing ‘with’ rather than ‘to’, and trusting communities and devolving power to them was seen as vital to tackling inequalities. The ‘power of communities’, whether place-based or around a particular issue or population group, came through strongly in all contributions. Communities understand their own needs, and what needs to change. The examples provided in the session demonstrated that when communities are empowered and trusted to respond to their own challenges, positive and lasting results can be observed. For instance, East Marsh United have established a community wealth fund, and now act as a responsible landlord, providing high quality housing.
Public bodies and statutory services can support this. For example, in Northumberland creative approaches have been used to involve the most marginalised communities in consultation around a new cultural centre in Blyth, part of a programme of regeneration, to ensure that once completed people from these communities will feel full ownership of the centre. Arts and Homelessness International has co-produced a training programme for local councils, which has not only ensured that the arts are incorporated in homeless strategies, but that a spirit of co-production has been embedded in the council, with some members of the community now being mentored in council roles.
Achieving co-production, and truly reflecting the voices of lived experience, requires changes in the way services and organisations work, recognising that people’s needs are multi-faceted and cross-sectoral. Person centred approaches allow people to thrive rather than simply survive. Josie Moon believes that East Marsh United’s strengths lie in its core values of trust, openness and empathy. Contact has a dedicated health and wellbeing space to support its target young audience in all aspects of their lives – ‘a 360 degree approach’. This inclusive and supporting environment is underpinned by Contact’s anti-racism policy and training, a social model of disability, and a focus on trauma informed approaches. Arts and Homelessness International centres the wellbeing of its staff across its approach.
“I can’t grow as a person if my community doesn’t” – David Tovey
People are invested in making positive changes in their own communities, and can do amazing things when supported to do so, encouraging each other through the process. For example, having benefited from the creative activities offered from East March United, Kelly McLaughlin has gone on to become a community organiser and photographer, capturing the work that is taking place in East Marsh.
Creative health and the social determinants of health
"What do we do? Everything, all at once, all at the same time" - Josie Moon
Josie Moon painted a stark picture of the challenges that face East Marsh, one of the most deprived areas of Grimsby, as a result of shifting patterns of industry and years of austerity. To give an idea of the impact on health, East Marsh has a life expectancy for men that is 12 years lower than the neighbouring, more affluent ward. Whilst the challenges in East Marsh are multifaceted, the arts and creativity are ‘not an add on’ but central to the response by community group East Mash United. The group has run a grassroots community arts project since 2019 including a choir, writing group, community library, recording studio and community garden (set up on a piece of wasteland) as well as music, theatre and storytelling events. Josie believes these activities provide joy to the community who benefit little from national or local cultural spending and investment.
East Marsh community member Kelly McLaughlin provided passionate testimony to the impact of grassroots arts activity, across all aspects of her life, after a chance encounter with Josie in the local marketplace led to Kelly joining the creative writing group;
"The writing group helped me express what I needed to say, put words down with pen on paper …After battling with systems and getting let down for 9 years, this amazing creative writing group gave me my voice back”
For Kelly, the creative writing group offered support where statutory services had let her down for large portions of her life.
Many of the activities considered in the session use creativity as a means to engage and impact on a wider range of social issues. East Marsh United, for example, provide upstream solutions to issues rooted in poverty, tackling housing, crime and training and education. In Northumberland, investment in the arts and culture is considered a commitment to a health and prosperity. Creative approaches are utilised in children’s centres to support early years development, to improve health literacy, in employment services to reduce isolation and improve self-esteem and confidence, bringing people closer to employment, and in provision for older people, including those with dementia.
Contact‘s Manifesto of Care responds to wider themes affecting its young audience such as ‘How do we make a more caring world?’ and ‘How can we look after ourselves and the planet in the face of public service cuts and the climate crisis?’ Artists have been commissioned to address these themes creatively.
What do we need to change?
"Is there any wonder that people’s mental and physical health is so badly impacted when there is such little commitment and investment in human beings living their lives?" – Josie Moon
Despite the fantastic initiatives taking place at grassroots and community level, there was an acknowledgement that the way we work has to change if we are to tackle the entrenched issues of inequalities in a sustainable way. The experiences reflected in this roundtable suggest a need for investment in upstream, preventative and person-centred approaches to health, which can be achieved by transferring power to communities who are best placed to recognise and respond to their needs. As demonstrated by the presentations today, creative approaches can be used not only as part of interventions to improve health and wellbeing, but as a medium through which those most at risk of inequalities can express and communicate their feelings and needs.
Ruth Bromley, from her perspective as a GP, considered how statutory organisations can be part of the solution, whilst taking into account the enormous pressures faced by frontline workers. With creative health able to make a difference to patient outcomes, particularly as part of prevention and early intervention, she believes the offer should be part of day to day provision, embedded as part of a therapeutic offer, and not something considered 'additional'.
Funding structures are considered a barrier. In many cases grassroots organisations are getting on with the work, with little experience, capacity or resource to apply for funding. An embedded and long-term approach to investment would relieve the pressure and uncertainty around sustainability. The way that success is measured could also be adapted to support more equitable approaches. Provision for the inclusion of lived experience, focus on quality and reach of engagement and longer term impacts, as well as support for the development of partnerships, were all raised as desirable routes for improvement.
At a systems level, recently established integrated care boards (ICBs), which are responsible for the local provision of health services, should be a conduit for change. With frontline staff stretched, supporting and resourcing the VCSE to ‘do what it does best’ – providing bespoke and holistic solutions to local need - will help improve health outcomes and reduce inequalities. Creative health should be an integral part of this. In Northumberland, an arts for wellbeing coordinator post has been funded within the ICB with the aim of embedding arts and cultural provision into healthcare at a system level.
As Ruth summarised, when thinking about how everyone can access and benefit from creative health;
‘There is so much to celebrate, but so much still to do’ .
What happens next?
The themes covered in the roundtable and the contributions from the audience in the chat will be fed back to our commissioners who will consider how they can be translated into a final set of recommendations to Government.
We thank all our speakers for their brilliant contributions to the discussion. The roundtable is available to watch back here and we welcome your own perspectives and experiences through our open call for contributions – find details of how to submit here.
Roundtable Agenda & Biographies: https://ncch.org.uk/uploads/Creative-Health-Review-Health-Inequalities-Agenda-and-Speaker-Biographies.pdf
Our next roundtable is on Social Care find out more here >>