How can creative health support a prevention agenda
Reflections from the APPG on Creative Health Roundtable on Prevention and Creative Health
“It’s not only about how we engage for our own health and wellbeing, it’s about how we can use the creative arts to engage everybody in health and wellbeing, and in the future of our NHS and ensure we work together as a society to prevent long-term illness”. Ashley Dalton MP, Minister for Public Health
In its consultations for a new 10-year health plan for England, the Government has emphasised a shift from sickness to prevention, reducing pressures on the health system by supporting people to live healthier lives for longer. We know that creative health can be transformational in this space. Indeed, Lord Kamall (Shadow Minister for Health and Social Care and Vice Chair of the APPG on Creative Health) noted the potential for creative health to play a ‘massive role’ in the proposed changes to the health system in his opening remarks. This might be through creative activity for health and wellbeing, addressing the wider determinants of health and tackling inequalities in places and communities, or supporting the quality of life for people living with long-term conditions through creative engagement.
In the first in a series of thematic sessions, the APPG on Creative Health, chaired by Dr Simon Opher MP, convened a panel of experts to discuss how creative health can support a prevention-focused agenda, and the opportunities for embedding creative health at every level of the system.
Some key themes emerged from our discussion, which have helped us to develop some specific asks of the government, as it prepares its plan for health.
Addressing inequalities
“I think we need creativity in thinking about social change as well as creativity in the nature of people’s lives” – Professor Sir Michael Marmot
Professor Sir Michael Marmot (Director, The UCL Institute of Health Equity) used his keynote to emphasise that prevention is much broader than telling people to change their behaviour and must address the structural factors, such as poverty and deprivation, that lead to health inequalities. At the same time as tackling these macro-level issues, at a micro-level, people need to live ‘lives that they have reason to value’ and creativity is an important way to provide meaning and improve quality of life.
Both David Tovey (Co-Director, Arts and Homelessness International) and Professor Monique Lhussier (Director, Centre for Health and Social Equity, Northumbria University) spoke about the role of creativity in supporting people with experience of homelessness, as an example of how creative health can support the most marginalised of communities. Monique described her research on homelessness and trauma, and the role for creativity in helping to recover some of the executive brain function that can be lost as a result of trauma and adverse childhood experiences. In her work, which co-produces pathways to services for people with experience of homelessness, she notes the importance of creative engagement for confidence and social connection, self-expression, and helping people to grow around their trauma and begin to flourish and value themselves. David spoke of his personal experience of art in his recovery from health issues and a period of homelessness, helping him to regain a sense of self-worth, confidence, resilience and wellbeing, eventually leading him to exhibit his work internationally, and establishing a homeless arts festival.
For both David and Monique, creativity forms an important part of a pathway to recovery, building resilience and agency, and should be incorporated into holistic and wraparound support, improving wellbeing and ultimately leading people back into housing.
“I believe that art and creativity has to sit alongside housing, healthcare and employment – it’s pretty obvious why. It helps build resilience, wellbeing, confidence, a voice… but also, art and culture is a human right…those who are homeless have a right to access the arts and to make art” – David Tovey
Founder and CEO of BlackOut, Rob Berkeley, spoke of the way his organisation uses storytelling to listen to and understand the experiences of black queer men in the UK, making space to discuss the needs of this community, and to address the structural discrimination that leads to health inequalities.
Working with places and communities
“Prevention isn’t a service that can be specified and delivered for people, it needs to grow and flourish within communities and with people” – Pippa Jones
Pippa Jones (Director, Create Gloucestershire) set out some of the challenges of a prevention-focused approach at place, including siloed working and funding models. Using arts and culture as a catalyst, Create Gloucestershire has created spaces for citizens and the public sector to come together to co-create solutions that respond to community needs and assets, and a micro-grant system that supports communities to develop their ideas. Naomi Draper, of Community Interest Company GL4 described how in Matson, an area of Gloucester historically underserved by arts and culture, the Culture Matson group brings together cross-sectoral representatives including housing, youth services, debt advice, education, police and the NHS to develop creative solutions. Regular cultural events and groups for young people have increased opportunity and aspiration, challenging and changing perceptions of Matson both inside and outside the community.
Drawing on work as Director of Public Health for Birmingham City Council, which takes a Creative Public Health approach, Justin Varney-Bennett (now Regional Director of Public Health, South West) described the role of artistic organisations as anchor institutions at place, but also the value of artistic organisations that work with communities:
“We have artistic organisations that specifically and significantly attract communities of identity and communities of experience, and have particular expertise in creating communication, trust and ownership of those different communities, and that’s a huge opportunity for public health”. – Justin Varney-Bennett
Creative health in systems
“There’s something about the holistic offer of creativity and the arts that is getting women into these spaces where traditional healthcare is not working” – Yvonne Farquharson
Breathe Arts Health Research works to develop long-term, sustainable, creative programmes for healthcare, working in partnership with the NHS. Using the example of Melodies for Mums, a singing programme for mothers at risk of postnatal depression (PND), Founder and Managing Director, Yvonne Farquharson, described how the programme supports prevention, reaching out into communities to bring in mothers who are not accessing NHS services, providing an inclusive space for social connection, and providing mothers with tools to support their mental health post-intervention. The programme has been shown to reduce PND by up to 40%, with further impacts on family members and the infant, helping to provide the best start in life. Working with academic partners, Breathe has demonstrated the impact of the programme, through Randomised Controlled Trials, and as part of the SHAPER (Scaling-up Health Arts Programmes: Implementation and Effectiveness Research) programme, with King’s College London, has generated evidence of the value of embedding creative services into the NHS.
“We demonstrated that the intervention was cost-effective according to the standard NICE guidelines. So it is scientifically valid, clinically valid and economically valid.” – Carmine Pariante, Professor of Biological Psychiatry, King’s College London
Providing an NHS Confederation perspective, Rosalia Munro (Senior External Affairs Manager) noted the challenge of investment in prevention without a clear definition of what it means for a health system, and with the return on investment or deliverables often only seen over the long term. Nevertheless, prevention is recognised as a key policy priority, and Rosalia highlighted three enablers necessary to support prevention within systems: 1) Place-based approaches, devolving decision-making to regional level in line with the government’s plans for increased devolution 2) Leadership that recognises the value of joined-up working 3) Developing data sharing approaches, and a shared understanding of needs and what works well across sectors.
“Prevention interventions are best delivered by the people that know that area best” – Rosalia Munro
Challenges and Opportunities for Creative Health
Throughout the session, participants noted challenges to providing an equitable and sustainable creative health offer, most notably around investment in the approach and the availability of funding and support for providers.
Cedric Whilby (Chair of Southwark Culture, Health and Wellbeing Partnership) put this into context with an example of a community centre in Bermondsey, South London, commissioning creative activities for elderly residents. The activities supported expression, connection and resilience, reduced loneliness and improved health. Cedric set out a scenario in which project funding ended after 6 weeks and the participants, without continuing support, returned to their GPs and medication. In Bermondsey, this was avoided through a year-long investment by the council, but Cedric made the case that more policymakers need to think in this way and invest in their residents, through a sustainable investment in creative health.
Linked to this is our ability to demonstrate the impact of creative health, and to ensure that creative health is visible and connected to systems.
[In the current financial climate], how do we do more with less and make sure what we are doing is value for money, and where creative arts are the answer, that they are competitive and can demonstrate that?” – Justin Varney-Bennett
The challenge comes not only from limited funding for interventions, but also from wider cuts to the arts in society.
However, as more people suffer the effects of the cost-of-living crisis, creative health will be more important than ever. Our participants pointed out that in times of societal challenge, the arts can help us to understand people’s experiences and co-explore ways through.
Coordination across sectors and the removal of silos was considered an important way to mitigate some of these challenges. Leadership that supports a joined-up approach, including at national level, can help to create the conditions for creative health to flourish.
“Let’s look at the creative industries, the creative arts, whether that is literature, visual arts, music…at how we can use them all together as a community. So not just to say, these are for people to help them feel better, but it is about all of us being able to engage together, and prevent us from developing some of these illnesses, and preventing some of that social isolation and mental health issues all together." – Ashley Dalton MP, Minister for Public Health
Our Ask
Drawing on the discussions at the meeting, we propose the following asks to government in relation to creative health and the prevention agenda. In line with the recommendations from the Creative Health Review we recommend a co-ordinated, cross-departmental approach to creative health at national-level. Furthermore, we ask that:
- The benefits of Creative Health should be recognised in the 10-year health plan
- Interventions that have proven to be effective should be routinely incorporated into care pathways. For example, creative services to prevent postnatal depression as part of maternity care.
- Creativity and culture should be integral to a cross-departmental, Health In All Policies approach
- Creative Health should be embedded into Integrated Care Systems to enable equitable access. This will reduce pressure on systems and support them to improve population health, reduce inequalities and support broader economic and social development.
Further Information
A recording of the session is available here - https://www.youtube.com/watch?v=_JT8jsiFgoM
Find the agenda and speaker biographies here - https://ncch.org.uk/uploads/AGENDA-Prevention-and-Creative-Health-250325.pdf
A summary briefing ‘Creative Health and Prevention’ is available here - https://ncch.org.uk/uploads/APPG-Prevention-Summary-Briefing.pdf
The National Centre for Creative Health provides the secretariat for the All-Party Parliamentary Group on Creative Health. More information is available here: https://ncch.org.uk/appg-on-creative-health
The next APPG meeting will take place on 3rd June on the topic of creative health and mental health. Information on how to register will be released soon.
