Master of Public Health
Arts and Public Health
IN TR ODUCTION
Welcome
Course Unit Overview
Assessment and Feedback
Unit timetable
Contacts
Essential Reading
TOPIC 1: IN TR ODUCTION TO AR TS AN D H EALTH
Topic 1 Learning outcomes
Introductions
Definitions of Health and Wellbeing
Definitions of Art
Individual claims of benefit
History of arts and health
Reflective learning
Reflective learning frameworks
Reflective Journal task: Introduction to the reflective journal
Topic 1 summary
TOPIC 2: LOOKIN G AT TH E EVIDEN CE
Topic 2 Learning Outcomes
Hierarchy of Evidence
Systematic Reviews: Arts and Dementia
Qualitative Evidence: Dementia
Arts Based Research
Reflective Journal Task
Topic 2 Summary
TOPIC 3: SOCIALLY EN GAGED AR T
Topic 3 Learning Outcomes
Wider Determinants of Health
What is Socially Engaged Art?
Participation
Case Study 1 and 2 - Population-based
Case Study 3 and 4 - Project-based
Case Study 5 - Place-based
Reflective Journal Task 3: Reflection exercise
Topic 3 Summary
TOPIC 4: EVALUATION AN D AR TS IN TH E H EALTH SETTIN G
Topic 4 Learning Outcomes
Manifesto task
Arts and Health evaluation
Frameworks for evaluation
Art in the Health Care Setting
Reflective Journal Task
Topic 4 Summary
TOPIC 5: AR TS AN D H EALTH IN DIFFER EN T SETTIN GS
Topic 5 Learning Outcomes
Museums and Galleries
Criminal Justice System
End of Life Care
Assessed Reflective Journal Task
Topic 5 Summary
FACE TO FACE TEACH IN G
Welcome
TOPIC 6: AR TS AN D TH E LIFE COUR SE
Topic 6 Learning Outcomes
The Life Course Approach
Art and Children and Families
Art and Adolescents
Topic 6 Summary
TOPIC 7: AR TS AN D TH E LIFE COUR SE
Topic 7 Learning Outcomes
Arts and Adults
Arts and the Elderly
Finding useful information
Topic 7 Summary
Page 1 of 56
Welcome
Master of Public Health
Welcome to the Arts and Public Health Module.
We hope you will enjoy this course unit and find the learning useful in your public health
practice.
The image we are using to illustrate the course is 'The Map of Health' by Odra Noel. You can see
the full image on the Blackboard Home page. We have chosen it as an example of one way in
which art can be used to communicate health messages.
This image shows a map of the world with each area made up of human tissue relating to the
main health problems within those areas.
North America struggles with rising obesity, and therefore this area is made up of adipose
tissue (fat).
Central and South America are represented by pulmonary tissue (lungs); smoking and
respiratory infections are a leading cause of death here.
Europe, with its ageing population, suffers greatly from neurodegenerative diseases,
including dementia (neurones, brain tissue).
Large areas of the Middle East and Central Asia are shown here as cardiac muscle (heart),
as these regions are afflicted with rising levels of hypertension and other causes of heart
and cardiovascular failure.
The Far East and the Pacific are made up of pancreatic acinar tissue; its failure causes
diabetes, a major problem in this area, frequently described as a diabetes epidemic.
Africa is made of blood here. The only continent where the leading causes of death are
transmittable diseases (infections), notably malaria and HIV.
This image and other images by Odra Noel, as well as many other artists, can be seen on the
Wellcome Collection website, which is a free museum and library that aims to challenge how we
all think and feel about health.
https://wellcomecollection.org/works
If you are an MRes or MPH student, before starting the course, please ensure you have
completed the Introductory Unit which can be found on Blackboard.
Page 2 of 56
Course Unit Overview
Master of Public Health
Aims
The course unit aims to help Public Health, Primary Care and other interested professionals, UK
based or international, make use of the arts in their interventions and communications.
Learning Objectives
On completion of this unit, successful students will be able to:
Systematically understand and critically analyse the role of the arts in the public
health setting
Form a comprehensive understanding of and critically evaluate the history of the
use of arts in health
Form a comprehensive understanding of and assess the use of the arts in Public,
Patient, Professional Involvement and Engagement (PPIE) with application to real
life situations
Critically analyse and evaluate the impact of art on health and wellbeing
Appraise and evaluate research using examples from arts programmes used in
health, both locally and globally
Students are expected to play an active role collaborating with experienced trainers
and other students to examine the use of the arts in their work and cultural setting
and exit the course with a greater understanding of the issues involved as well as
possible solutions
Develop critical appraisal and competency skills in arts applications.
Apply the potential for arts inclusion in their practice
Work collaboratively on a range of activities – teamwork.
Apply principles of evidence based practice.
Transfer knowledge gained to influence local practices and become ambassadors
for arts in public health as a component within their own workplace.
Page 3 of 56
Assessment and Feedback
Master of Public Health
There are three assessed elements on this course. The tasks and their weightings can be seen
in the table below. Details of when the assessments will be released can be found in the course
timetable.
If you have any difficulty accessing the information in this table, please contact the course unit
lead.
Task
Length
Weighting within unit
Reflective journal
500 words
20%
Group presentation
Final written
assignment
20 minute presentation
and 10 minute Q&A
3000 words
30%
50%
Page 4 of 56
Unit timetable
Master of Public Health
The course unit timetable below shows all the key dates for topics, residential and assignments.
If you have any difficulty accessing the information in this table, please contact the course unit
lead.
Week
beginning
Teaching week
Key activities
23rd
September
1
Topic 1 - Introduction and definitions
30th
September
2
Topic 2 - Looking at the evidence
7th October
3
Topic 3 - Socially Engaged Art
14th October
4
Topic 4 - Evaluation and Health Care
settings
21st October
5
Topic 5 - Arts and Public Health in different
settings
Reflective Journal assignment posted in the
Assignments link on Blackboard, Monday
21st October.
28th October
Assignment
Working Time
- Midterm
4th November
Assignment
Working Time
- Midterm
Reflective journal submission 8th
November at 12 noon
Face to face teaching starts 6pm on Monday
11th November
6
11th November and ends 6pm on Thursday
14th November. Details to follow
Group presentation assignment will be
made available and completed during the
face to face teaching.
18th
7
Personal study week
25th
November
8
Personal study week
2nd December
9
Topic 6 - Arts and health in the life course children and adolescents
November
9th December
16th
December
10
Working Time
- Final
Assignment
Topic 7 - Arts and health in the life course adults and the elderly
Final Assignment posted 12th December at
12 noon
23rd
Christmas
December
Break
30th
December
University closed (23 December – 1 January)
Working Time
- Final
University closed (23 December – 1 January)
Assignment
Working Time
6th January
- Final
Assignment
13th January
Semester 1 Final Assignment submission
(13 January @ 12:00 noon)
Page 5 of 56
Contacts
Master of Public Health
Course Unit Lead - Annie
Harrison
annie.harrison@manches
Course Unit Teaching
Assistant - Bex Rippon
rebecca.rippon@manche
ter.ac.uk
ster.ac.uk
Contacts
Course Unit Lead: Annie Harrison annie.harrison@manchester.ac.uk
Course Unit Tutor: Rebecca.rippon@manchester.ac.uk
Administration enquiries: mph.admin@manchester.ac.uk
Page 6 of 56
Essential Reading
Master of Public Health
Accessing Materials
There is a reading list which you will find on the left hand menu on Blackboard. Here you will
find some of the texts which we will return to throughout the course.
There is also course textbook for this course unit, 'The Oxford Textbook of Creative Arts, Health
and Wellbeing'. It can be accessed through the reading list, or through the eTextbook link on
the left hand menu in Blackboard or through the Course Content link on the left hand menu in
Blackboard.
It is important that you initially access the book via Blackboard to set up your Kortext account –
Kortext only makes the ebook accessible to students doing the Arts and Public Health module,
and needs to recognise that you are eligible to access it. As soon as you have registered you can
access it via the app, and download it so you can access it offline. It will be available to you for 12
months.
Links to other papers or resources will be provided in the course materials and will mostly be
accessed via a link to the University of Manchester library.
Page 7 of 56
Topic 1 Learning outcomes
Master of Public Health
Intended Learning Outcomes (ILOs)
This topic covers introductions to the course and to each other and will look at the history of art
and health.
By the end of this topic you should be able to:
Systematically understand and critically analyse the role of the arts in the public
health setting
Form a comprehensive understanding of and critically evaluate the history of the
use of arts in health
Critically analyse and evaluate the impact of art on health and wellbeing
Page 8 of 56
Introductions
Master of Public Health
Introductions: Meet the tutors and your fellow students
Please watch this short video which introduces you to your tutors
Discussion board activity (1.1)
Now we would like to hear more about you. Return to Blackboard and use the discussion board
to introduce yourselves:
Tell us a bit about yourself. What is your background? What is your interest/experience
related to Arts and Public Health?
Enter a question title here...
Type your answer here
SUBMIT
Why study Arts and Public Health?
The UK All-Party Parliamentary Group on Arts, Health and Wellbeing in their 2017 report said;
“While
not wishing to overclaim, we firmly believe
that the arts can be enlisted to assist in addressing a
number of difficult and pressing policy challenges:
strengthening preventative strategies to maintain
health for all; helping frail and older people stay
healthy and independent; enabling patients to take
a more active role in their own health and care;
improving recovery from illness; enhancing mental
healthcare; improving social care; mitigating social
isolation and loneliness, strengthening local
services and promoting more cohesive
communities; enabling more cost-effective use of
resources within the NHS; relieving pressure on GP
services; increasing wellbeing among staff in
health and social care; encouraging voluntary work;
creating a more humane and positive existence for
prisoners; enhancing the quality of the built
environment; and ensuring more equitable
distribution of arts resources and better access to
the arts for people who are socially or economically
disadvantaged.”
- Access the full report here
Page 9 of 56
Definitions of Health and Wellbeing
Master of Public Health
Definitions of Health and Well-being
WHO (1948) definition of health from its constitution:
‘Health is a state of complete physical, mental and social well-being and not merely the absence of
disease or infirmity.’
The WHO Constitution was adopted by the International Health Conference held in New York
from 19 June to 22 July 1946, signed on 22 July 1946 by the representatives of 61 States and
entered into force on 7 April 1948.
In Health 2020: A European policy framework and strategy for the 21st Century (2013) the WHO
expands on this and sees health and well-being not just as an individual state but a resource for
communities and something which is affected by factors beyond the individual’s physical and
psychological status (i.e. by the wider determinants of health);
‘Health and well-being are public goods and assets for human development and of vital concern to
the lives of every person, their family and community. Good health for the individual is a dynamic
state of physical, mental and social well-being. It is much more than just the absence of illness or
infirmity. Good health for communities is a resource and capacity that can contribute to achieving
strong, dynamic and creative societies. Health and well-being include physical, cognitive,
emotional and social dimensions. They are influenced by a range of biomedical, psychological,
social, economic and environmental factors that interconnect across people in differing ways and
at different times across the life-course.’
Some authors have focused on well-being as a dynamic state, which depends on maintaining a
balance between resources and challenges. Consequently, people with poor psychological,
social or physical resources can experience a reduction in their well-being if they experience
difficult life events such as stress, bereavement or ill-health, whereas those with more
resources can ride out similar challenges without such a negative impact on their well-being.
Additional Reading:
Dodge, R., Daly, A., Huyton, J., & Sanders, L. (2012). 'The challenge of defining wellbeing.
International Journal of Wellbeing', 2(3), 222-235
The relationship between the arts and health and well-being and the contribution of the arts to
health and well-being will be the subject of this course.
Page 10 of 56
Definitions of Art
Master of Public Health
What does the course cover?
Below are some of the aspects of the arts that we will be discussing in this course:
Active participation
This includes any arts activity in which an artist works with the public or patients, which could
be anywhere on the spectrum of participants taking part in an artist-designed and artist-run
workshop, to participants working with an artist to co-develop or co-design a collaborative
project.
Additional Reading:
https://helixarts.blogspot.com/2011/06/what-does-participatory-arts-mean.html
We will hear more about participatory art in Topic 3
Art forms might include:
visual arts
crafts
performance arts
dance
film-making
photography
literature (prose and poetry)
music (instrumental and singing)
digital arts
gardening
Some studies have shown that there are health and well-being benefits to being an audience
member or viewer for the arts, for example the two papers below:
Additional reading:
Froggett and Roy (2014) Cultural Attendance and Public Mental Health – an evaluation of a
programme to encourage health trainers to promote cultural attendance to people with mental
ill health
Wikström, B. M, Theorell, T., Sandström, S. (1993) 'Medical Health and Emotional Effects of Art
Stimulation in Old Age' Psychotherapy and Psychosomatics 60:195-206 - A controlled
intervention study examining the use of pictures with older people (Abstract Only)
Art performance might include:
music
theatre
film
spoken word
performance art
Arts settings might include:
galleries
libraries
museums
heritage sites
gardens
What this course is not about
We will not cover design on the course, so will not be looking at subjects such as architecture
and planning or the design of public health information such as posters, leaflets etc . However,
there is plenty of research on all these subjects if you want to pursue them further.
We will not be considering art therapy, ‘a form of psychotherapy that uses art media as its
primary mode of expression and communication’ http://www.baat.org/About-Art-Therapy
which is primarily individual treatment.
What this course is about
We will be looking at the evidence for Arts and Public Health. We will first look at what people
have experienced and observed about the benefits of the arts for health and well-being.
Page 11 of 56
Individual claims of benefit
Master of Public Health
Individual claims of benefit
During the UK All-Party Parliamentary Group on Arts Health and Wellbeing (APPGAHW) inquiry
into the arts in health and social care, submissions were heard and in their 2017 report they list
the benefits reported by individuals from engagement in the arts.
‘During the course of the Inquiry, a great range of first-hand benefits was attributed to the arts.
This included recognition that creativity can: stimulate imagination and reflection; encourage
dialogue with the deeper self and enable expression; change perspectives; contribute to the
construction of identity; provoke cathartic release; provide a place of safety and freedom from
judgement; yield opportunities for guided conversations; increase control over life circumstances;
inspire change and growth; engender a sense of belonging; prompt collective working; and promote
healing. Creativity was also seen as a means of empowerment that can help us to face our problems
or be distracted from them. Consistent with all this, it was acknowledged that the arts are not
anodyne; they allow us to access a range of emotions, including anguish, crisis and pain, which can
serve as a preferable alternative to being sedated.’
What do we mean by arts and public health?
The UK’s Royal Society for Public Health (RSPH) in their report ‘Arts, Health and Wellbeing
Beyond the Millennium: How far have we come and where do we want to go?’ discusses the
shift towards a more holistic model of health following the increase of non-communicable
disease. Public health began to focus on interventions where people are in control of their own
health, and the arts began to be seen as a tool for ‘improving public health, reducing social
inequalities and promoting social inclusion (RSPH, 2013 p7)'.
Required Reading:
Go the eTextbook link in Blackboard and read the following chapter
eTextbook Chapter 3: Hanlon, P. and Carlisle, S. (2016). ‘Creating a fifth wave of public
health and the contributions of culture to the arts' in Clift, S, and Camic, P. M. (eds) Oxford
Textbook of Creative Arts, Health and Wellbeing p19-25
Additional reading:
RSPH Report sections 2.1-2.3
RSPH (2013) 'Arts, Health and Wellbeing Beyond the Millennium: How far have we come and
where do we want to go?
Page 12 of 56
History of arts and health
Master of Public Health
What does it mean to be human?
For many years, humans were thought to be the only beings that created art and the production
of art was one of the ways of defining human beings. Watch the first 4 minutes of the video
YOUTUBE
Ice Age art
Ice Age art
A new exhibition at the British Museum features sculptures made up to 40,000
years ago. Dr. Alice Roberts meets curator Jill Cook to discuss three artefacts in
the collection; the Lion Man, a group of female figurines from Siberia, and the
oldest known flute.
VIEW ON YOUTUBE 
In contrast to what Alice and Jill said, it has recently been discovered that Neanderthals also
created art and this has started a rethink of what Neanderthals were like - not necessarily
brutish early ancestors but 'they were not cognitively distinct or less...smart, but just a variant of
human kind that exists no more...'
Watch the video below:
YOUTUBE
Neanderthal Origin of Iberian Cave Art (Science)
Neanderthal Origin of Iberian Cave Art (Science)
For the scientific article "U-Th dating of carbonate crusts reveals Neanderthal
origin of Iberian cave art" visit Science (www.sciencemag.org) Featuring (in
order of appearance): Dr Dirk Hoffmann Department of Human Evolution, Max
Planck Institute for Evolutionary Anthropology Dr Chris Standish Department
of Archaeology, University of Southampton Professor Alistair Pike Department
of Archaeology, University of Southampton Professor Paul Pettitt Department
of Archaeology, Durham University Professor João Zilhão Department of
Prehistory, Universitat de Barcelona Research: D.
VIEW ON YOUTUBE 
Additional Reading:
Marris, E (2018) 'Neanderthals artists made oldest-known cave paintings', available at
https://www.nature.com/articles/d41586-018-02357-8
The discovery of the production of art by Neanderthals has revolutionised our thinking about
the entire species, from a primitive species to a variant of humans, ‘not cognitively distinct…
that as such exists no more’ – such is the power and uniqueness of art.
Personal Reflection
What were your thoughts after watching the videos? How has our thinking about the
Neanderthals changed after the discovery of their production of art? This is an opportunity for
you to consolidate your thoughts from the learning so far.
As well as your assessed reflective journal, you may also wish to record personal reflections
which are not assessed and for which you will not receive feedback. You will be prompted to do
this with the heading 'Personal Reflection'. If you wish to discuss anything from your personal
reflection publicly, please post it on the appropriate discussion board which will be clearly
marked for personal reflection contributions. Feel free to start a new thread on the subject of
your personal reflection.
Discussion Board Activity (1.2):
Return to blackboard and discuss the following questions with your peers:
Is art what makes us human? How important is art to humans? How important is art to
you?
Additional reading:
Camic,P.M. (2008). 'Playing in the mud: Health psychology, the arts and creative
approaches to health care' Journal of Health Psychology 13(2) pp.287-98
From Motivation and Personality, Abraham Maslow (1954) adapted by Saul McLeod:
https://www.simplypsychology.org/maslow.html
Maslow suggests that the basic human needs start with physiological needs (food, water,
warmth, rest), followed by safety, then love and belonging, then esteem - the feeling of
accomplishment and achievement and recognition - and at the top, when all the other needs
have been fulfilled, self-actualisation including creative activities. However, in the clip below
Prof James Thompson describes his experience of the importance and value of the arts in war
zones where basic needs were sometimes missing or in short supply.
Watch the video below from 1:01:50 to 1:04:50. See https://www.inplaceofwar.net/ for more
information.
YOUTUBE
In Place of War - Professor James Thompson (Cockcroft R…
R…
In Place of War - Professor James Thompson
(Cockcroft Rutherford Lecture 2013)
HCRI Executive Director, and Professor of Applied and Social Theatre in the
Department of Drama, Professor James Rutherford gives the prestigious
Cockcroft Rutherford Lecture on his 'In Place of War' project, which explores
how artists that experience armed conflict interact with events that occur
around them.
VIEW ON YOUTUBE 
History of the development of Arts and Health in the UK
Arts and health in the UK could be said to have started in Manchester. We will hear more about
this in future weeks.
See UK All-Party Parliamentary Group on Arts, Health and Wellbeing p21-22
In the recent history of the arts interacting with health and wellbeing, Greater Manchester is
arguably the wellspring. In 1973, Neil Kessell, Professor of Psychiatry at the University of
Manchester, invited artist Peter Senior to exhibit his work in the outpatients’ department of
Withington Psychiatric Hospital. This led to Senior’s appointment, funded by the Calouste
Gulbenkian Foundation, as artist-in-residence at St Mary’s Hospital, Manchester. In 1977,
Senior established a team of artists under the Manpower Services Commission’s job creation
programme. This experiment was consolidated as Manchester Hospitals Arts Project, which
undertook to produce site-specific works within hospital buildings and beyond.
In the 1990s, under the directorship of Brian Chapman and in recognition of the fact that
success had rendered ‘hospital arts’ a generic term, the project was renamed Lime. This early
experiment gave rise to a wealth of projects and activities across Greater Manchester,
spanning the categories outlined above.
On 14 June 2016, the archives of several prominent arts and health organisations from Greater
Manchester and beyond were accepted into the Wellcome library. In 1987, Peter Senior
established Arts for Health at Manchester Metropolitan University (MMU), which has
continued to influence research and development in a rapidly evolving global field. In 2011 and
2012, Arts for Health published a defiant two-part manifesto which declared: ‘I am part of this
movement. I might be in the North of England. I might be anywhere in the world. We are the
same. We are unique. We believe the arts shape and challenge thinking. We believe the arts are
a vehicle for health, wellbeing and social change’.
Page 13 of 56
Reflective learning
Master of Public Health
Assessed reflective journal
The Assessed Reflective Journal in Topic 5 is your opportunity to reflect on the learning from
the course and how it relates to your own work, setting or practice. In preparation for this
assessed piece of work, there are exercises in Topics 1-4. For these exercises you will use the My
Reflective Journal area of Blackboard. Entries that you write can only be viewed by you and the
course tutors. Other students can't see your entries in My Reflective Journal. You are
encouraged to do all the exercises. Exercises in Topics 1-4 will receive formative feedback
which does not count towards your assessment. The Reflective Journal assignment will be
released in Teaching Week 5 and the submission date is in Teaching Week 6 which is also the
week of the Face to Face teaching. Go to the Assignment link on Blackboard and look for the
Mid Term Assignment - Reflective Journal.
Rogers (Rogers, C. (2002). 'Defining Reflection: Another look at John Dewey and reflective
thinking' Teachers College Record 104(4) 842-866) says that reflection is ‘a meaning-making
process that moves a learner from one experience to the next with deeper understanding of its
relationships with and connections to other experiences and ideas’. This Assessed Reflective
Journal is an opportunity for students to deepen their understanding of the course material and
make connections with their own personal and work experience and with learning from other
parts of the course.
During Topics 1, 2 and 4 you will be expected to write a 250 word Reflective Journal entry on the
template provided in the My Reflective Journal area of Blackboard on a specific aspect of the
learning material from that week. You should include any relevant attachments or links which
should be referred to in your text so that the tutor understands what you think the relevance of
each attachment is. You will receive formative feedback on this reflection but it will not be
assessed.
In Topic 3, using the assessment criteria below you will be asked to assess a fictitious reflective
journal submission and write feedback for the fictitious journal writer (250 words) including
suggestions for how to improve their reflection. This should be written on the template
provided in the My Reflective Journal area of Blackboard. This is an opportunity to reflect on
what makes for a good reflective journal before you write your mid-term assignment. You will
receive formative feedback as in topics 1,2 and 4.
Mid-term assignment: Your mid-term assignment will be released in Teaching Week 5 and can
be found in the Assignments link on Blackboard. It will be a 500 word Assessed Reflective
Journal entry on an aspect of the course of your choosing, reflecting on what you have learned
from the process and how you plan to use it in your practice. This will be submitted through
Turnitin.
Topics 6-7 - There will be no further reflective journal tasks and you will not receive any further
prompts, but you are encouraged to continue to do personal reflection to help you to integrate
your learning and practice.
Reflective journal assessment
Your journal will be assessed according to the Faculty assessment criteria. In addition, the
following guidance outlines the expectation for the reflective journal.
If you have any difficulty accessing the information in this table, please contact the course unit
lead.
Diploma pass
Pass
Good pass
Excellent pass
40-49%
Habitual action
– Nonreflective,
reporting or
describing
events, no
attempt to
provide reasons,
surface level
learning
50-59%
60-69%
70-79%
Reflection Demonstration
Critical
Understanding –
Deeper approach
of the
relationship of
reflection –
Showing that
to learning,
searching for
meaning but
concepts to
personal
experience,
their perspective
of the experience
has changed as a
little or no
attempt to relate
this to individual
reflection
relating to
theory and
result of the
experience. Able
to reflect on own
experience
student’s
knowledge or
subconscious
beliefs.
insights
We went to the
We went to the
The zoo was very
Since visiting the
zoo as a course
visit. The
elephants were
zoo as a course
visit. It was very
different from
different from
when I visited it
as a child. The
zoo, I’ve been
wondering
whether my love
my favourite.
There were
many more
when I visited
the zoo as a
child. The
elephants were
my favourite and
seemed to be the
of elephants is
culturally
determined or
animals than
when I visited as
elephants were
my favourite. I
most popular
animal. I
has to do with
positive
a child and the
buildings were
much more
wondered why it
is that people in
the UK seem to
wondered
whether this is
culturally
childhood
experiences.
Would the
modern. They
have obviously
done lots of
love elephants so
much and
whether it is
determined or
has to do with
individual (e.g.
effectiveness of
the animal
therapy sessions
updating and
maintenance
culturally
determined.
childhood)
experience. It
we discussed last
week be
which it
probably needed
as it looked
made me think
about the animal
therapy sessions
influenced by
individual or
cultural factors
pretty shabby
when I went ten
years ago.
we discussed last
week. Would
their success be
relating to
animals? I have
seen in my work
affected by
with prisoners,
the
individual or
cultural factors?
psychological
effect of
incarceration
(refs) and I
wonder about
the impact of
incarceration on
animals and
whether that
would change
the effectiveness
of animal
therapy.
References
Kember, D., McKay, J., Sinclair, K. and Wong, F (2008) 'A four-category scheme for coding and
assessing the level of reflection in written work' Assessment and Evaluation in Higher
Education 33(4) 369-379
McKay, F. H. and Dunn, M. (2015). 'Student reflections in a first year public health and health
promotion unit' Reflective Practice 16(2) 242-253
Page 14 of 56
Reflective learning frameworks
Master of Public Health
Reflective Learning Frameworks
A framework gives us a set of rules or ideas which can be used to explore an issue, deal with a
problem or make a decision.
Caroline Ramsey in her booklet 'Introducing Reflective Learning' (Introducing Reflective
Learning. Caroline Ramsey. BU130 - Working and learning. Open University 2006) offers three
frameworks for reflective learning:
Kolb's Experiential Learning Cycle
Bringing our feelings into our reflection
Including others in our reflection
Follow the link below to access the booklet and read the section from pp12-28. You may find it
useful to work through the examples. They focus on a business rather than a health setting but
they illustrate the principles. In your first reflective journal task, you should choose one of the
frameworks, and use the reflective journal to reflect on why you have chosen it.
http://www.open.edu/openlearncreate/pluginfile.php/159274/mod_resource/content/3/Intro
ducing%20Reflective%20learning%20Ramsey%2C%202006.pdf
Page 15 of 56
Reflective Journal task: Introduction to the reflective
journal
Master of Public Health
Reflective Journal 1
There are journal tasks throughout the first four topics of the course which ask you to reflect on
aspects of your learning in Arts and Public Health. Your journal entries will help you prepare for
the Assessed Reflective Journal. Your journal entries can be seen by the course tutors who will
give you formative feedback. Other students can't see your journal entries.
For your first journal entry, go to My Reflective Journal in the left hand panel of Blackboard and
chose Reflective Journal 1
Chose a framework for your reflective journal
State which framework you are going to use
Describe the framework in no more than 50 words including references if necessary
Reflect on why you have chosen this framework. Explain why you chose this framework.
Consider your choice in relation to other frameworks. Why does this framework suit you?
(In no more than 200 words in total) If you wish you can upload supporting evidence using
the box below, but this is not a requirement.
Page 16 of 56
Topic 1 summary
Master of Public Health
Summary
As we come to the end of Topic 1 you should now be able to:
Systematically understand and critically analyse the role of the arts in the public
health setting
Form a comprehensive understanding of and critically evaluate the history of the
use of arts in health
Critically analyse and evaluate the impact of art on health and wellbeing
In Topic 2 we will look at the evidence of the effectiveness of arts and public health
interventions.
Page 17 of 56
Topic 2 Learning Outcomes
Master of Public Health
Intended Learning Outcomes (ILOs)
This topic looks at the evidence for arts and health. On completion of this topic, successful
students will be able to:
Systematically understand and critically analyse the role of the arts in the public
health setting
Develop critical appraisal and competency skills in arts applications.
Apply principles of evidence based practice.
Page 18 of 56
Hierarchy of Evidence
Master of Public Health
What is Evidence?
The concepts of evidence based practice and the hierarchy of evidence will be familiar to those
of you who have completed the Evidence Based Practice module on the MPH. In public health
and clinical practice we use evidence to inform our decisions and it is recognised that some
types of evidence may be more reliable than others, depending on the question we want to
answer. The hierarchy of evidence reflects the relative value placed on different research
methods and study designs. In general, for most clinical decisions more weight is placed on
experimental study designs such as Randomised Control Trials, with systematic reviews and
meta-analysis (MA) of these trials considered the ‘gold-standard’ of evidence, than
observational study designs such as case-control or cohort studies. Case studies and anecdotal
evidence are placed at the bottom of the hierarchy.
There is a good summary of the hierarchy of evidence in the following e-book available through
the University of Manchester library:
Somerville, M., Kumaran, K., & Anderson, R. (2012). Public Health and Epidemiology at a Glance
Chapter 5
You may also wish to read further chapters in this e-book to recap your learning on different
types of study design.
Evidence for Arts and Public Health
In this topic, we will look at whether the hierarchy of evidence is relevant to arts and health.
How does the reliance on the hierarchy of evidence impact on arts and health?
Required Reading:
Go the eTextbook link in Blackboard and read the following chapter
e-textbook (Chapter 8): Theorell, T. and Ullen, F. (2016) Epidemiological studies of the
relationship between cultural experiences and public health in Clift, S. and Camic, P.M. (eds)
Oxford Textbook of Creative Arts, Health and Wellbeing p55–63
Personal reflection:
What are your initial thoughts? How does the hierarchy of evidence apply to arts-based
approaches
As well as your assessed reflective journal, you may also wish to record personal reflections
which are not assessed and for which you will not receive feedback. You will be prompted to do
this with the heading 'Personal Reflection'. If you wish to discuss anything from your personal
reflection publicly, please post it on the appropriate discussion board which will be clearly
marked for personal reflection contributions. Feel free to start a new thread on the subject of
your personal reflection.
Page 19 of 56
Systematic Reviews: Arts and Dementia
Master of Public Health
Arts-based interventions for specific conditions - Dementia
There is a plethora of research on arts-based treatment for different health conditions. In this
topic we have chosen to focus on dementia but you can also look for research on any other
condition that you are interested in.
There have been three recent Cochrane reviews on dementia. A Cochrane review is a type of
systematic review, published by the Cochrane Collaboration, recognised for rigorous standards
and high quality evidence synthesis.
Have a look at the abstracts to the following reviews to see what kind of evidence is available.
Think about the implications for practice and implications for research:
Reminiscence Therapy (2018)
Woods B, O'Philbin L, Farrell EM, Spector AE, Orrell M. Reminiscence therapy for dementia.
Cochrane Database of Systematic Reviews 2018, Issue 3. Art. No.: CD001120. DOI:
10.1002/14651858.CD001120.pub3.
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001120.pub3/full?
highlightAbstract=dementia&highlightAbstract=dementi
Dance Therapy (2017)
Karkou V, Meekums B. Dance movement therapy for dementia. Cochrane Database of
Systematic Reviews 2017, Issue 2. Art. No.: CD011022. DOI: 10.1002/14651858.CD011022.pub2.
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011022.pub2/full?
highlightAbstract=dementia&highlightAbstract=dementi
Music-based therapy (2018)
van der Steen JT, Smaling HJA, van der Wouden JC, Bruinsma MS, Scholten RJPM, Vink AC.
Music‐based therapeutic interventions for people with dementia. Cochrane Database of
Systematic Reviews 2018, Issue 7. Art. No.: CD003477. DOI: 10.1002/14651858.CD003477.pub4.
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003477.pub4/full?
highlightAbstract=dementia&highlightAbstract=dementi
Discussion board activity (2.1)
Return to the discussion board and think about the following questions:
Are these interventions appropriate for a systematic review?
What other aspects of the interventions might be missed in this kind of systematic review?
Is there something else that might give better evidence of the impact of interventions like
these?
Page 20 of 56
Qualitative Evidence: Dementia
Master of Public Health
Alternative methods of evidence synthesis
In the previous section, we explored some examples of systematic reviews of RCTs relating to
arts-based interventions for dementia. Now take a look at the following paper, which reviews
qualitative evidence for an arts-based intervention for dementia:
Robyn Dowlen, John Keady, Christine Milligan, Caroline Swarbrick, Nick Ponsillo, Lucy Geddes
& Bob Riley (2018) The personal benefits of musicking for people living with dementia: a
thematic synthesis of the qualitative literature, Arts & Health, 10:3, 197-212
https://doi.org/10.1080/17533015.2017.1370718
https://www.librarysearch.manchester.ac.uk/discovery/fulldisplay?
docid=tayfranc10.1080/17533015.2017.1370718&context=PC&vid=44MAN_INST:MU_NUI&searc
h_scope=MyInst_and_CI&tab=Everything&lang=en
Discussion board activity (2.2)
Return to the discussion board and think about the following questions:
Compare this paper with the Cochrane review on music-based therapy.
What are the differences in the findings?
What are the differences in approach?
What is the difference between the ‘evidence’ in the two papers?
Additional reading
This systematic review looks at the impact of music and dance therapy on the health and
wellbeing on people with dementia. It was a response to the criticism that previous reviews of
the literature had focused on RTCs. They therefore included quantitative, qualitative and artsbased studies in their search, and review five mainly qualitative studies.
Lyons, S., Karkou, V., Roe, b., Meekums, B., Richards, M. (2018) 'What research evidence is there
that dance movement therapy improves the health and wellbeing of older adults with dementia?
A systematic review and descriptive narrative summary' The Arts in Psychotherapy 60 p32-40
https://www.librarysearch.manchester.ac.uk/discovery/fulldisplay?
docid=sciversesciencedirect_elsevierS0197-4556(17)301466&context=PC&vid=44MAN_INST:MU_NUI&search_scope=MyInst_and_CI&tab=Everything
&lang=en
Page 21 of 56
Arts Based Research
Master of Public Health
Arts as a research methodology
The arts are not just an intervention method but can also be a research method in their own
right. During the face-to-face sessions, we will discuss the use of photo-elicitation for
collecting data and below you will find other examples of arts-based research methods.
Examples of arts-based research
In this paper, 'Narratives of health and illness: Arts-based research capturing the lived
experience of dementia' three artists worked with patients, carers and staff to explore and find
a way to communicate the experience of dementia and the research was shared through
performances and art works.
Moss, H. and O'Neill, D. (2017) 'Narratives of health and illness: Arts-based research capturing
the lived experience of dementia' Dementia (online)
https://www.librarysearch.manchester.ac.uk/discovery/fulldisplay?
docid=alma992975989813701631&context=L&vid=44MAN_INST:MU_NUI&search_scope=My
Inst_and_CI&isFrbr=true&tab=Everything&lang=en
In this paper, 'The second sight: Learning about and with dementia by means of poetry', poetry
is used as a means for a carer to share her experience of dementia. In addition, through a
collaborative poetry project with people with dementia, the reader gets a window into the
interior life of people with dementia.
Aadlandsvic, R (2008) 'The Second Sight - learning about and with dementia by means of
poetry' Dementia 7(3) 321-339
https://journals-sagepub-com.manchester.idm.oclc.org/doi/pdf/10.1177/1471301208093287
Practice-based research
Practice-based research involves the generation of research data partly through the process of
creating - and is not restricted to arts-based research but is also used in many other disciplines.
The generation of a hypothesis comes not through abstract thought or literature review, but
through examining the outcomes of the creative process. A good outline of practice-based
research can be found in the additional reading below.
Additional Reading
The following chapter, available as an e-book through the library, discusses arts-based
methods as a new research paradigm, distinct from quantitative and qualitative techniques, and
the theoretical and philosophical structures that underpin it. You may wish to take a look if this
is an area of interest for you:
Leavy, P. (2015) Method Meets Art: Arts-Based Research Practice 2nd Edition New York: The
Guilford Press. See Chapter 1: Social Research and the Creative Arts: An Introduction p1-38
https://www.librarysearch.manchester.ac.uk/discovery/search?
query=any,contains,Narratives%20of%20health%20and%20illness:%20Arts-
based%20research%20capturing%20the%20lived%20experience%20of%20dementia&tab=Eve
rything&search_scope=MyInst_and_CI&vid=44MAN_INST:MU_NUI&offset=0&pcAvailability
=false
Personal reflection
Think of a specific area of public health you have been involved with or are interested in. What
kinds of evidence have you/might you use to consider the impact of an arts-based approach?
Having covered the reading in this chapter, what sort of evidence do you think would be most
appropriate for your specific area/intervention?
As well as your assessed reflective journal, you may also wish to record personal reflections
which are not assessed and for which you will not receive feedback. You will be prompted to do
this with the heading 'Personal Reflection'. If you wish to discuss anything from your personal
reflection publicly, please post it on the appropriate discussion board which will be clearly
marked for personal reflection contributions. Feel free to start a new thread on the subject of
your personal reflection.
Page 22 of 56
Reflective Journal Task
Master of Public Health
How do we use evidence?
Chose one of the questions below and answer it in your journal entry.
Think of a time when evidence has been contradictory to your existing beliefs and how did you
reconcile this?
Or
Think of an example of when you were aware that decisions were being made that were not
supported by existing evidence. How did you respond to this situation?
Page 23 of 56
Topic 2 Summary
Master of Public Health
Intended learning outcomes
You have completed Topic 2. You should now be able to:
Systematically understand and critically analyse the role of the arts in the public health
setting
Develop critical appraisal and competency skills in arts applications.
Apply principles of evidence based practice.
In Topic 3 we will look at socially engaged art.
Page 24 of 56
Topic 3 Learning Outcomes
Master of Public Health
Intended Learning Outcomes (ILOs)
Welcome to Topic 3, which looks at socially engaged art. By the end of this topic successful
students will be able to:
Systematically understand and critically analyse the role of the arts in the public
health setting
Critically analyse and evaluate the impact of art on health and wellbeing
Critically appraise and have developed competency skills in arts applications
Page 25 of 56
Wider Determinants of Health
Master of Public Health
Wider determinants of health
We have started to look at the way that public health uses the arts to achieve a public health
outcome. The focus for this week is the way that artists impact on the wider determinants of
health as either an aim or a by-product of their work.
We will look at what socially engaged art is, and what it involves.
We will look at a range of case studies, including project-based, place-based and populationbased, although these are often artificial distinctions.
Most of the projects described here are from the UK, but examples can be found from around
the world.
The arts can't affect the age, sex or hereditary factors of individuals, but what about other
levels? Do the arts have anything to contribute to improving the health and well-being at the top
level (general socioeconomic, cultural and environmental conditions), at the middle level
(social and community networks) or at the lower level (individual lifestyle factors)?
The Determinants of Health (1992) Dahlgren and Whitehead, taken from:
https://esrc.ukri.org/about-us/50-years-of-esrc/50-achievements/the-dahlgrenwhitehead-rainbow/
Discussion Board Activity (3.1)
Return to Blackboard and use the discussion board to discuss the following question with your
colleagues:
What contribution could the arts make at each level in Dahlgren and Whitehead's rainbow
of the determinants of health?
Page 26 of 56
What is Socially Engaged Art?
Master of Public Health
Required Reading
Read the following extract from Grant Kester's book 'Conversation pieces : community and
communication in modern art' (2004) which gives examples of artist interventions which have
public health outcomes. Read from P1 - the end of the first paragraph on p10
https://contentstore.cla.co.uk/secure/link?id=7807903c-52af-e811-80cd-005056af4099
Discussion Board Activity (3.2)
Return to Blackboard and use the discussion board to discuss your thoughts on the article.
Is there a difference between these projects and 'public health' practice? If so, what is the
difference?
Definitions of Socially Engaged Art
The broad term for activity by artists in what we might regard as the public health arena is
'socially engaged art'.
'A working definition of 'socially engaged art' is artistic or creative practice that aims to
improve conditions in a particular community or in the world at large. A range of different
approaches fall under this umbrella, including what is sometimes called art and social justice,
artistic activism, community-based art, cultural organising, participatory art, relational
aesthetics, civic practice, and social practice art.'
Fransz, A. and Sidford, H. (2017). 'Mapping the landscape of socially engaged artistic practice'
Helicon Collaborative
Additional Reading:
The above report is a good survey of socially engaged art if you are interested in finding out
more.
Page 27 of 56
Participation
Master of Public Health
Participation
One element running through most, though not all, socially engaged art is public participation,
which can be anywhere on a spectrum from the artist using participants or their experience as
material for a piece of art work, to involving participants in a planned activity or event, to
participants being central to the project initiation, design and roll out.
Picturing the Past (2017) Annie Harrison
This project involved participation in different forms throughout the project.
This project was initiated by Saddleworth Museum as part of a community engagement project.
They were looking for a way to bring the history of the area to life, particularly for young people.
I was asked to develop a multi-generational project which captured stories about the history of
farming on the Saddleworth Moors. I interviewed three older people about their memories of
farming practices and farming life and asked them to draw diagrams and maps of the things
they were describing, using a tablet. These digital drawings were put together in a short film.
This film was shown to a group of young people, with the older people present to answer
questions about their stories and drawings. The young people then went to some of the places
that had been described in the stories and made their own collaborative drawings. These
drawings and photographs of the activity were incorporated into the final film which is on
display in the museum. Watch the short video below:
(The full film (28min 42sec) can be seen here: https://vimeo.com/289069956)
VIMEO
'Picturing the Past' (5 minute exerpt)
annie harrison
03:57
'Picturing the Past' (5 minute exerpt)
Film commissioned by Saddleworth Museum to capture stories about farming
traditions in Saddleworth.
VIEW ON VIMEO 
The Silhouette movement
The following example shows a completely different level of participation, spontaneous
participation in a protest art event which captured the imagination of the public.
As with academic research, most participatory art is initiated by professionals, however, there
are examples of projects which capture the public imagination to such an extent that they are
taken over and become owned by the participants. In 1983, the 'Mothers of the Disappeared' in
Argentina were campaigning for information about their children who had been 'disappeared’
by the Argentine military dictatorship. They met in the central square in Buenos Aires each
week and walked in a procession around the square, carrying pictures of their family members.
They were approached by three artists who suggested making a representation of each of the
disappeared by creating silhouettes of the individuals - the presence of an absence. The
Mothers identified a problem with this plan, as it was not possible to identify all those who had
disappeared. It was decided therefore to create uniform silhouettes. The artists initiated an
open-air workshop to create these silhouettes, but the project was picked up by the general
public in a way that made the artists redundant and indeed it was forgotten for many years that
the initiative had come from artists. Thousands of silhouettes were pasted on buildings across
the city.
Pirámide de Mayo, and Mother's of the Plaza de Mayo; signs held of family members
murdered in the Dirty Wars.
Originally designed by Pedro Vicente Cañete and Juan Gaspar Hernández, current
version by Prilidiano Pueyrredon crowned with allegory of Liberty by Joseph
Dubourdieu. (1811, Image: October 2012). Retrieved from
http://library.artstor.org/asset/ARTONFILE_DB_10313747468
Additional reading
For further information about the silhouette movement and images of the silhouettes, read Ana
Longoni’s article;
Longoni, A. (2010). 'Photographs and silhouettes: Visual politics in the human rights
movement of Argentina' Afterall: A Journal of Art, Context and Enquiry 25 p9-14
Personal reflection
In what ways did the Silhouette project contribute to public health in Argentina? What level or
levels of the wider determinants of health would this project fit into?
As well as your assessed reflective journal, you may also wish to record personal reflections
which are not assessed and for which you will not receive feedback. You will be prompted to do
this with the heading 'Personal Reflection'. If you wish to discuss anything from your personal
reflection publicly, please post it on the appropriate discussion board which will be clearly
marked for personal reflection contributions. Feel free to start a new thread on the subject of
your personal reflection.
Discussion Board Activity (3.3)
Return to Blackboard and discuss the following questions:
Why is participation an important aspect of socially engaged art?
What were the benefits to participants in these projects?
Where would you put these activities on the participation spectrum?
Could they have been redesigned to increase participation?
Additional Reading:
Additional Reading:
This report commissioned by Arts Council Wales addresses some of the issues around quality in
participatory settings:
https://artworks.cymru/uploads/documents/Quality-Framework-Paper-Rhian-HutchingsNovember-2014.pdf
Page 28 of 56
Case Study 1 and 2 - Population-based
Master of Public Health
Working with the homeless - The Booth Centre and
Streetwise Opera
The Booth Centre has been working with homeless people in Manchester for over 20 years.
They have always had an arts programme in parallel with their other support programmes. In
2014 they began to work with Streetwise Opera in a project which culminated in a production of
The Passion, an amalgamation of Bach's St Matthew Passion and special material written by
homeless people themselves. The opera was performed in 2016.
The full opera can be seen here
YOUTUBE
Streetwise Opera and The Passion on BBC Breakfast
Streetwise Opera and The Passion on BBC Breakfast
Footage from BBC Breakfast - 26 March 2016 The Passion performers Matt Reid
and Danny Collins, The Sixteen soprano Kirsty Hopkins and Streetwise Opera
CEO Matt Peacock speak about our production of The Passion in a report by Jayne
McCubbin. Booth Centre CEO Amanda Croome and The Passion volunteer Dave
Kelly then join the BBC Breakfast presenters on the sofa.
VIEW ON YOUTUBE 
Refugees and asylum-seekers: Public artwork commissioned
by Documenta, Kassel, Germany
This is an example of a piece of socially engaged public art that is on the extreme end of the
participation scale – using participants and their experiences as material.
The monument is an obelisk inscribed with the same text in four languages (German, English,
Arabic, and Turkish) – the text is ‘I was a stranger and you took me in’ a biblical quote from
Matthew 25:35. It was sited in the Koenigsplatz, in Kassel – often used as an assembly point for
festivals as well as protests, and a place where people including the homeless and refugee
communities gather to sit and talk or while away the hours. The artist is from Nigeria and as a
child was caught up in the Biafran War.
This art work was shown at a time of heated discussions about immigration in Germany and
brought with it unwanted attention from the right wing Alternative for Germany (AFD) party
who opposed the purchase of the obelisk by the city.
‘Das Fremdlinge und Fluechtlinge Monument’ (2017) [The Strangers and Refugees
Monument] Olu Oguibe. Image source: Rabax63
Page 29 of 56
Case Study 3 and 4 - Project-based
Master of Public Health
Project-based: Dragon Cafe
Dragon Cafe is run by an organisation called 'Mental Fight Club' and is predominantly for people
affected by mental illness. It offers food, and an inspirational creative programme. It is mostly
run by volunteers with some paid artists providing the creative input.
Go to their website to find out more about their work
https://dragoncafe.co.uk/
and watch the video below which was made by Dragon Cafe members working with Chris
Haydon from Community TV Trust who train local people in media skills.
YOUTUBE
Dragon Cafe documentary March 2013
Dragon Cafe documentary March 2013
This is a film made by participants in filmmaking workshops at Dragon Cafe
about the Cafe. Mondays in Borough, in the crypt of St George The Martyr to be
precise, are different now, and have been since October 2012.
VIEW ON YOUTUBE 
Project based: Examining economic models
Socially engaged artists are often engaged in interrogating society. Here are two projects which
take a different approach to questioning economic systems.
Ek-uh-nom-iks
Ian Nesbitt is a socially engaged artist whose project 'Ek-uh-nom-iks' looked at the ancient
idea of 'The Commons' and what this means in contemporary society. Read about the project
here
Knitcoin
Artist Richard DeDominici looked at the very modern phenomenon of crypto-currency in his
project Knitcoin where he created a bespoke crypto-currency for the town of Brightlingsea.
Watch the video below to find out more.
YOUTUBE
Knitcoin
Knitcoin
With many thanks to Zoe from Woolybuly, and the people of Brightlingsea. A
PILOT Festival commission. http://pilotfestival.co.uk http://dedomenici.com
VIEW ON YOUTUBE 
Page 30 of 56
Case Study 5 - Place-based
Master of Public Health
In Situ
In Situ is an on-going socially engaged art project founded by Paul Hartley, Kerry Morrison and
William Titley. As artists, they were frustrated by the time-limited nature of much community
art commissioning. They wanted to become embedded in a place and develop a long-term
relationship with a community. Brierfield is a former mill town in Pendle, Lancashire which
since the closure of Brierfield Mill has experienced the same economic and social problems as
many similar northern towns.
In Situ were originally based in the mill, in the period between the acquisition of the building by
developers and the start of their redevelopment of the mill for residential and business use.
They reanimated the space with arts events, film nights, community events, artist residencies
and created opportunities for the community who had been estranged from the mill since its
closure, to reclaim the building.
Now that the redevelopment has started, they have a permanent space in the old mill garage as
well as a base in the library. They have run community projects on environmental issues, multigenerational communication, transport, as well as art, music and film projects.
Go to their website to explore their work and watch the video below about Talkeoke, a project
which brings people together to talk about important issues.
http://www.in-situ.org.uk/
YOUTUBE
Talkaoke
Talkaoke
A snapshot of a year developing a Talkaoke hub in Pendle.
VIEW ON YOUTUBE 
Page 31 of 56
Reflective Journal Task 3: Reflection exercise
Master of Public Health
Reflection exercise
This week your reflective journal exercise is to give feedback on an example journal entry.
The entry below follows the format of your previous reflective journal entries and the fictitious
student is writing about about The Dragon Cafe, which was a Case Study in this week's module.
Using the Faculty assessment criteria and the guidance in the section on 'Reflective Learning'
in Topic 1 to assess the fictitious journal submission. Write feedback for the fictitious journal
writer (250 words) including suggestions for how to improve their reflection.
This is an opportunity for you to think about what makes a good reflective journal entry and
have a chance to practice again next week before you write your mid-term assignment in Topic
5.
Go to My Reflective Journal on the left panel of Blackboard to see the material
Page 32 of 56
Topic 3 Summary
Master of Public Health
Intended Learning Outcomes (ILOs)
You have now completed Topic 3. You should now be able to:
Systematically understand and critically analyse the role of the arts in the public
health setting
Critically analyse and evaluate the impact of art on health and wellbeing
Critically appraise and have developed competency skills in arts applications
Topic 4 looks at evaluation and the use of arts in health care settings.
Page 33 of 56
Topic 4 Learning Outcomes
Master of Public Health
Intended Learning Outcomes (ILOs)
This topic looks at how we can evaluate the use of arts in health. On completion of this topic,
successful students will be able to:
Systematically understand and critically analyse the role of the arts in the public
health setting
Form a comprehensive understanding of and critically evaluate the history of the
use of arts in health
Critically analyse and evaluate the impact of art on health and wellbeing
Examine the use of the arts in their work and cultural setting, and by collaborating
with experienced trainers and other students exit the course with an greater
understanding of the issues involved as well as possible solutions
Apply principles of evidence based practice
Transfer knowledge gained to influence local practices and become ambassadors
for arts in public health as a component within their own workplace.
Page 34 of 56
Manifesto task
Master of Public Health
Write your own Arts and Health manifesto
The link below takes you to the Arts and Health manifesto parts one and two produced by Arts
for Health at Manchester Metropolitan University. What do you think it is trying to do? What do
you think it is saying? Who is it directed at?
http://www.artsforhealth.org/manifesto/
Discussion Board Activity 4.1
What would you put in your arts and health manifesto?
Spend 15 minutes composing your own manifesto for arts and health (no more than 150
words). Think about your own impressions, experience, values etc. You can use this as a
baseline to develop your ideas from.
Then return to Blackboard and copy and paste it on the discussion board. Discuss your
manifestos with your fellow students.
Page 35 of 56
Arts and Health evaluation
Master of Public Health
Individual claims of the benefits of arts for health and
wellbeing
In Topic 1 we looked at individuals' claims of the benefits of arts for health and wellbeing.
What is the evidence for these claims?
Required Reading:
Go to the eTextbook link in Blackboard and read the following chapter:
eTextbook Chapter 2: Belifore, E. (2016) 'The arts and healing: the power of an idea' in
Clift, S. and Camic, P.M. (eds) Oxford Textbook of Creative Arts, Health and Wellbeing p1117
Discussion Board Activity (4.2)
Return to Blackboard and use the discussion board to discuss your thoughts on the article. What
do you think of the argument in Clift's final quote (p16) that '...it is important to recognise that
the growth, scope, and variety of practical initiatives in this field should, in itself, be regarded as
important evidence of the feasibility, acceptability, flexibility and vitality of working through the
creative arts in supporting health care and promoting health.' Do you regard the prevalence of
initiatives as evidence? Are you convinced by his argument?
Required reading
All Party Parliamentary Group on Arts, Health and Wellbeing, Chapter 3, Considering the
Evidence (p32-42)
Personal Reflection
The APPGAHW report (Chapter 3) discusses various methods to assess the evidence for artsbased approaches to health. Think of an initiative you have been involved with or read about.
What was the evidence base for this activity?
How did the project itself add to the evidence base?
How was the evidence demonstrated?
Do you recognise any of the approaches given in the chapter?
As well as your assessed reflective journal, you may also wish to record personal reflections
which are not assessed and for which you will not receive feedback. You will be prompted to do
this with the heading 'Personal Reflection'. If you wish to discuss anything from your personal
reflection publicly, please post it on the appropriate discussion board which will be clearly
marked for personal reflection contributions. Feel free to start a new thread on the subject of
your personal reflection.
Page 36 of 56
Frameworks for evaluation
Master of Public Health
Frameworks for Evaluation
Evaluation needs to be designed to assess the specific outcomes of a project.
An evaluation framework needs to be appropriate for the project
Below are a number of frameworks used by different organisations. Spend some time looking at
them and reviewing the documents.
1) Public Health England: Arts for Health and Wellbeing - An
Evaluation Framework
PHE has produced a good overview of evaluation in arts and health, as well as tools for use in
evaluation.
Sections 2 and 3 (p9-21) are particularly relevant
Access the framework from the link below.
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/496230/PHE
_Arts_and_Health_Evaluation_FINAL.pdf
2) Arts Council England Framework
Arts Council England has a framework for assessing the quality of participatory arts
interventions involving a set of metrics. Each metric has a statement associated with it. The
figures below show the set of metrics or measures used in the quality framework and the way
that these statements are grouped into clusters.
Access the framework from the link below.
https://www.artscouncil.org.uk/sites/default/files/downloadfile/Participatory_Report_Knell_Whitaker_2016.pdf
Arts Council England Participatory Metrics Set from: Knell, J, Whitaker A (2016) A
Participatory Metrics Report: Quality Metrics National Test, Arts Council England
Example of the ACE Framework
The Arts Council England model above was used by a team of researchers from University of
Manchester in an evaluation of a project by Manchester Camerata with older people in
Tameside. In this case, they took the statements and participants were asked to mark the degree
to which they agreed with them (Strongly disagree, disagree, agree, strongly agree or n/a). The
statements were dichotomised with n/a being counted as a missing value. The data was then
analysed in the project evaluation.
3) Realist Evaluation
Realist Evaluation was developed by Ray Pawson and Nick Tilly.
They proposed a theory based evaluation, which acknowledges that programmes are based on
people's vision for what the programme will achieve. They argue that there are many factors
which influence the success or failure of a programme, not just the programme itself. This
means that a successful programme in one setting will not necessarily be successful if it is
replicated in another setting.
Realist Evaluation asks not just 'What works?', but 'What works for whom in what
circumstances and in what respects, and how?'. It uses the terms 'Context' to describe the
specific setting where the programme takes place, not locality, but the quality of the setting,
which could include economic and social conditions, interpersonal relationships etc.
The term 'Mechanism' refers to what it is about the programme that brings about change
which could be to do with the attitudes of the participants, the way the programme redirects
people away from less constructive activity, the concrete offer of the programme etc.
The term 'Outcome' refers to the intended or unintended consequences of the programme
which may be positive or negative.
A realist evaluation will probably identify a number of contexts, mechanisms and outcomes at
play in any one programme. A goal of realist evaluation is to develop models which identify the
elements needed to ensure that a 'successful' programme will work in a different setting.
Example of Realist Evaluation
Between 2007-2011, the Arts Council was part of a project called Well London, in which they
rolled out about 100 creative programmes in 20 of London's poorest communities. The Be
Creative Be Well programme was evaluated by independent researchers using realist methods.
Find the evaluation here: Ings, R., Crane, N. and Cameron, M. (2012) 'Be Creative Be Well - Arts,
wellbeing and local communities: an evaluation' London: Arts Council England (p15-17)
There is also a paper about this project focusing on what 'the artist and the creative process
bring to a community context and how that can best be supported by policy makers and
funders.'
https://www.librarysearch.manchester.ac.uk/discovery/fulldisplay?
docid=sage_s10_1177_1757913912466951&context=PC&vid=44MAN_INST:MU_NUI&search
_scope=MyInst_and_CI&tab=Everything&lang=en
Discussion Board Activity (4.3)
Return to Blackboard and use the discussion board to consider the differences between these
approaches. Can you think of different types of arts and health programmes which would be
appropriate for the different frameworks? Do you see limitations to any of the frameworks?
Page 37 of 56
Art in the Health Care Setting
Master of Public Health
Arts in Healthcare Settings
The status of arts and health is different in different countries, often due to a variety of factors,
including:
the funding of health care,
the level of economic development of the country,
the culture and traditions of the country.
The following examples show how arts have been used in very different healthcare settings.
Case Study 1. LIME, Manchester, UK
LIME is an arts and health organisation based in Central Manchester Foundation Trust. Listen
to the Interview below with Director of LIME Dawn Prescott.
23:11
Interview with Director of LIME, Dawn Prescott
You can read more about the work of LIME and see some examples of their work by clicking on
the file below.
A_Guide_to_Lime_Art_2017.pdf
5.3 MB
Case Study 2: Arts and Healthcare in Uganda
In Uganda there is a long history of the use of the arts in traditional healing and formal arts and
health programmes have been in place since the 1960s.
Required reading
Go to the eTextbook link in Blackboard and read the following chapter:
Read Chapter 15 in the course eTextbook: Kasuke, K.M., Kakinda, K.F. and Sonke, J. (2016). 'Arts
and healthcare in Uganda: An historical, political and practical case study' in Clift, S. and Camic,
P.M. (eds) Oxford Textbook of Creative Arts, Health and Wellbeing pp123-127
Case Study 3: Arts and Healthcare in USA
In the US, arts and health interventions exist in a competitive health market and are sometimes
promoted as an attractive addition to other health services. There is a focus on accreditation of
practitioners. Interventions are institution-based rather than focusing on reducing inequalities
or health promotion or prevention. However the US Department of Health and Human
Services: Office of Disease Prevention and Health Promotion programme 'Healthy People 2020',
which provides evidence-based objectives for improving health, promotes community-based
arts and health initiatives.
Required Reading:
Go to the eTextbook link in Blackboard and read the following chapter:
eTextbook Chapter 14: Sonke, J., Rollins, J., Graham-Pole., J (2016). 'Arts in healthcare
settings in the United States' in Clift, S. and Camic, P.M. (eds) Oxford Textbook of Creative
Arts, Health and Wellbeing p113-120
Case Study 4: Arts and Healthcare in India
In India, there is a pluralistic health service with traditional and indigenous health practices
existing alongside modern ‘Western’ medicine. Arts practices are a strong and surviving part of
many cultural traditions and sometime there are links between the arts and the traditional view
of health as a balance between physical and spiritual elements, for example the tradition of
healing through music. Music, dance and drama are all used in arts and health programmes,
and Yoga is widely practiced for health benefits. However, there is no institutionalisation of arts
and health and no formalisation of training.
Required Reading
Go to the eTextbook link in Blackboard and read the following chapter:
eTextbook Chapter 19: Venkit, V.R., Godse, A.S., Godse, A.A. (2016). 'Ares and health
initiatives in India' in Clift, S. and Camic, P.M. (eds) Oxford Textbook of Creative Arts,
Health and Wellbeing p151-159
Discussion Board Activity (4.4)
Return to Blackboard and use the discussion board to discuss the following questions with your
colleagues.
Chose one of the case studies which describes a healthcare setting that is very different
from the one in your country. Compare the status of arts and health in your country or
setting to the one described in the case study.
Return to Blackboard and post your findings on the discussion-board
Additional Reading
If you are interested in how the arts are being used in health settings in countries with different
economies, go to the eTextbook link in Blackboard and read the following chapter:
eTextbook Chapter 20: Sun, J, Buys N 'A role for the creative arts in addressing health care
challenges in China, and ' in Clift, S. and Camic, P.M. (eds) Oxford Textbook of Creative Arts,
Health and Wellbeing pp163-172
and
eTextbook Kasuke, K.M., Kakinda, K.F. and Sonke, J. (2016). 'Arts and healthcare in Uganda: An
historical, political and practical case study' in Clift, S. and Camic, P.M. (eds) Oxford Textbook of
Creative Arts, Health and Wellbeing pp123-127
Page 38 of 56
Reflective Journal Task
Master of Public Health
Choose a personal example where you have experienced the
use of arts in a healthcare setting:
Describe this example (50 words)
Reflect on what you learnt from this use of the arts and how
you might apply this learning in any area of your work or
personal life (200 words)
Page 39 of 56
Topic 4 Summary
Master of Public Health
Intended Learning Outcomes (ILOs)
You have now completed Topic 4. You should now be able to:
Systematically understand and critically analyse the role of the arts in the public
health setting
Form a comprehensive understanding of and critically evaluate the history of the
use of arts in health
Critically analyse and evaluate the impact of art on health and wellbeing
Examine the use of the arts in their work and cultural setting, and by collaborating
with experienced trainers and other students exit the course with an greater
understanding of the issues involved as well as possible solutions
Apply principles of evidence based practice
Transfer knowledge gained to influence local practices and become ambassadors
for arts in public health as a component within their own workplace.
Topic 5 looks at the Arts in different settings
Page 40 of 56
Topic 5 Learning Outcomes
Master of Public Health
Intended Learning Outcomes (ILOs)
Topic 5 looks at the use of arts in different settings.
By the end of this topic successful students should be able to:
Systematically understand and critically analyse the role of the arts in the public
health setting
Demonstrate development of critical appraisal and competency skills in arts
applications.
Apply principles of evidence based practice.
Page 41 of 56
Museums and Galleries
Master of Public Health
Arts and Pubic Health in Different Settings
In this topic we will consider the use of arts in three different settings - museums and galleries,
the criminal justice system and end of life care.
Arts and Public Health in Museums and Galleries
During the face to face teaching, you will hear more about how galleries and museums can
contribute to public health through health and wellbeing activities. The Whitworth Gallery in
Manchester has worked hard to increase access to the gallery through its arts and health
programme. The 'Not So Grim Up North' research project, looks into the impact of museum
activities on health and well-being for people living with dementia, stroke survivors and mental
health service users. You can access a copy of the report on here:
Not So Grim Up North Research Team (2018) Not So Grim Up North
http://www.healthandculture.org.uk/wp-content/uploads/2018/11/W615-Not-so-grim-upNorth-Spreads_single-spreads-web.pdf
At Manchester Art Gallery in the city centre, there is a focus on health and wellbeing through
the establishment of a Wellbeing Gallery with art works chosen by a panel of interested people
because of they create a sense of immersion in the artwork. This Wellbeing Gallery also has
comfortable chairs where visitors can sit and relax while looking at the art.
You can have a look at a 360 degree video of the Wellbeing Gallery and an interview with Louise
Thompson, Health and Wellbeing Manager by following this link and logging into the
University Video Portal. Download the video and select 360 view to get the full effect.
Manchester Art Gallery have also taken another approach by providing space for existing health
services within the gallery. They host the weekly city centre baby clinic and commission an
artist to create a child-friendly space each week.
You can hear interviews about the baby clinic with Katy McCall, the Learning Manager at
Manchester Art Gallery, and Artist Naomi Kendrick in the audio file below:
14:09
Interview with Katy McCall, Learning Manager at Manchester City Art Gallery
12:42
Interview with Artist Naomi Kendrick,
Arts and health as an audience member
As suggested in the chapter above, in addition to the benefits of participation in groups and
activities in museums and galleries, there has been some research into the benefits of simply
visiting galleries without active participation. An Arts Council England (2014) report addressing
the value of art and culture found that from a survey of 10,000 people, those who had attended a
cultural place or event in the previous 12 months were almost 60 percent more likely to report
good health compared to those who had not, and theatre-goers were almost 25 per cent more
likely to report good health.
Arts Council England (2014) The Value of Arts and Culture to People and Society - An Evidence
Review available at https://www.artscouncil.org.uk/sites/default/files/downloadfile/The_value_of_arts_and_culture_to_people_and_society_an_evidence_review.pdf
Manchester City Council commissioned a pilot project in which health trainers were empowered
to encourage their clients to attend cultural establishments such as museums and galleries. At
the beginning of the pilot, it was found that the health trainers themselves did not regularly
attend cultural establishments. Following the pilot, health trainers still had some reservations
about referring people to cultural establishments, but those that had reported that the clients
benefited from and enjoyed
Required Reading:
Froggett L and Roy A (2014) Cultural Attendance and Public Mental Health: Evaluation of Pilot
Programme 2012. http://clok.uclan.ac.uk/10962/1/CAPMH%20final%20report%20v91.pdf
Discussion Board Activity (5.1)
Return to the discussion board to think about the following questions:
Are there ways that partnerships with cultural organisations such as art galleries and museums
can contribute to the public health outcomes of your organisation?
What can you learn from the findings of the pilot project which might feed into and inform
plans to work with cultural organisations in your area?
Page 42 of 56
Criminal Justice System
Master of Public Health
Arts in the Criminal Justice System
Required Reading:
Go to the eTextbook link in Blackboard and read the following chapter:
e-textbook: Chapter 35 - Robertson, T. (2016) Case Study: Creativity in criminal justice settings
- the work of the Koestler Trust in Clift, S. and Camic, P.M. (eds) Oxford Textbook of Creative
Arts, Health and Wellbeing p292–297
The chapter above identifies theoretical models through which the arts could lead to improved
health outcomes in criminal justice contexts and points us in the direction of evidence for artsbased interventions in this setting. Theoretical models include:
Individual change - Arts-based activities are used to achieve desistance (the move away
from crime) and thereby reduce reoffending. Activities could be related to specific skills
(such as the use of drama or roleplay to improve understanding of the impact of criminal
activity) or more generally to improve intellectual or interpersonal skills. Robertson (2016)
suggests that use of the arts in this setting can help improve health through physical,
intellectual, emotional and spiritual realms.
Social Change - Organisations such as the Koestler Trust aim to 'promote public
awareness and understanding of arts by offenders (Robertson, 2016 p294)' and in doing
so attempt to change social attitudes to offenders and encourage acceptance of
rehabilitation by emphasising the humanity of offenders.
Human Rights - This model considers art and the ability to express oneself to be a human
right, as expressed in Article 27 of the Universal Declaration on Human Rights. Selfexpression through art should therefore be open to all, including those in a prison setting.
This flyer, produced by the National Criminal Justice Arts Alliance, summarises the way arts can
be utilised in the criminal justice system:
https://www.artsincriminaljustice.org.uk/wp-content/uploads/2018/11/NCJAAFlyer_FINAL.pdf
Evidence for arts-based interventions in the criminal justice
system
In November 2018 Arts Council England published an evidence review on the topics of Arts and
Culture in health and wellbeing and in the criminal justice system. Follow this link to see the full
report).
The report cumulates evidence from over 200 recent academic papers which will be used to
inform the organisation's strategy in this area for the next ten years (2020-2030).
With regard to the use of arts to improve health in the criminal justice system, the report
identifies some major emerging themes:
development of positive identity and agency
tackling depression and anxiety
contributing to desistance from criminal activity
If you do not have time to read the full report, take a look at this blog entry from Senior Manager
in Policy and Research at Arts Council England, John McMahon, which summarises the
research:
Arts, Health and Criminal Justice - The evidence stacks up
https://www.artscouncil.org.uk/blog/art-health-and-criminal-justice-evidence-stacks
Some of the evidence for this report comes from the Evidence Library, run by the National
Criminal Justice Arts Alliance. Here you can find research and evaluation documents relating to
numerous arts-based interventions in the criminal justice system.
https://www.artsincriminaljustice.org.uk/arts-council-england-publish-evidencereview/
Case Study: Odd Arts - Creative Leadership and Forum
Theatre
Odd Arts is a North-West England based organisation delivering creative programmes to
vulnerable and excluded groups .
One example of their arts-based interventions is a theatre workshop carried out in a range of
criminal justice settings including prisons and young offenders institutes, with the main aim of
improving leadership skills. The evaluation found that the intervention also resulted in a wide
range of health-related benefits:
raised self-esteem, enabling re-evaluation of past ‘failures’ and future opportunities
developed awareness of imaginative approaches to life and problem-solving
demonstrated to participants that creative activities offer opportunities for self-expression
and peer recognition
enabled participants’ voices to be heard through theatre increasing their ability to
communicate
enabled participants to share and reflect upon apparently intractable issues that might
otherwise have remained unexpressed
developed a feeling of empowerment and personal authority, highlighting aspects of
leadership other than rule-bound discipline
increased appreciation of the nature and benefits of teamwork
provided an opportunity for pleasure, freedom of thought and a sense of release that was
obtained through being able to participate in the creative process
A summary of the evaluation is available through the Evidence Library and the full evaluation
report can be found here. This is for reference, so do not feel you need to read the whole report
unless this is an area of particular interest for you.
Froggett, L., Manley, J., Kelly, L. (2018) Creative Leadership and Forum Theatre: An Evaluation
Report for Odd Arts available at http://www.artsevidence.org.uk/media/uploads/180213oddarts-creativeleadershipproject.pdf
Read more about the work of Odd Arts here: http://www.oddarts.co.uk/criminal-justice/
YOUTUBE
Odd Arts Showreel
Odd Arts Showreel
Uploaded by Odd Arts on 2018-10-31.
VIEW ON YOUTUBE 
Further sources of information
The issue of arts in the criminal justice is one that has received considerable attention recently.
For example, the Prison Service Journal dedicated it's September 2018 issue to reports of arts-
based activities with case studies covering storytelling, music, theatre and visual arts. If you are
particularly interested in this area, you might want to have a look at some of the evidence
presented here:
https://www.crimeandjustice.org.uk/sites/crimeandjustice.org.uk/files/PSJ%20239%20Septe
mber%202018.pdf
Page 43 of 56
End of Life Care
Master of Public Health
The arts in an end of life setting
The arts can be used in several ways to improve the end of life experience for the dying and their
loved ones and carers. One example is 'This Grief Thing', a creative initiative which gives the
bereaved a channel to discuss their emotions.
People at facing death can also be drawn to creative activities as a way of telling, and finding
meaning in their own life stories, and the arts can act as a facilitator for reflections on life and
death. The arts can also be used to improve the environment for those in palliative care.
Additional Reading:
The All Party Parliamentary Group on Arts Health and Wellbeing report contains a good
overview of the use of arts in end of life care:
All Party Parliamentary Group on Arts Health and Wellbeing (2017) Creative Health: The Arts for
Health and Wellbeing p142-152
Arts in a hospice setting
" I did a self portrait of what I thought about life when I was ill. It was a tunnel with a wee light at
the end of the tunnel and that was how my life looked when I was ill. There was a brick on the
outside of the tunnel and everyone who helped me in the hospice, I put their initial on each brick, the
doctors, the nurses, the volunteers, everyone who had helped me through my illness. That's the way I
seen my life, they were the foundation, as it were, for this tunnel with a wee light. A year later I did a
painting, only this time I had come through the tunnel. It was a bright, bright tunnel with a wee,
wee dark dot at the end of the tunnel. The same sort of painting but it was 'then' and 'now', as it
were, and that's the best way I can describe what art has done for my life."
John Leiser, Day service patient at Prince and Princess of Wales Hospice, Glasgow, quoted in
Macleman (2007)
The chapter below discusses the implementation of an arts-based intervention in the Prince
and Princess of Wales Hospice in Glasgow, highlighting the positive and negative aspects from
the point of view of the practitioner and the participant, with both concluding that art had the
potential to provide those at the end of life with a voice, and to provide a platform for that voice
to be heard.
In addition to highlighting the positive role arts can play in improving wellbeing in this setting,
the chapter also touches on issues such as funding sources, the importance of co-production
with service-users and physical resources such as space.
Required Reading:
Macleman, M (2007) ‘Arts in Palliative Care: the Prince and Princess of Wales Hospice’ in
Jarrett, L (ed) Creative Engagement in Palliative Care; New Perspectives on user involvement
p33-40
More details on the programme, including examples of some of the artwork produced, an
evaluation methodology and outcomes can be found at the following links:
The Prince and Princess of Wales Hospice - The Art Room
Case Study: The Prince and Princess of Wales Hospice
BBC article featuring an interview with one of the participants in the project.
Personal Reflection
Have you had any experience of the arts being used in end of life care or by people who are
entering the end of their life? If so, what have been the benefits?
As well as your assessed reflective journal, you may also wish to record personal reflections
which are not assessed and for which you will not receive feedback. You will be prompted to do
this with the heading 'Personal Reflection'. If you wish to discuss anything from your personal
reflection publicly, please post it on the appropriate discussion board which will be clearly
marked for personal reflection contributions. Feel free to start a new thread on the subject of
your personal reflection.
Page 44 of 56
Assessed Reflective Journal Task
Master of Public Health
Reflective Journal assignment
Please go to the Assignments tab in Blackboard to access your Reflective Journal assignment.
The assignment will be released on Monday 21st October and needs to be submitted by 12 noon
on Friday 8th November via Turnitin.
Page 45 of 56
Topic 5 Summary
Master of Public Health
Intended Learning Outcomes (ILOs)
You have now completed Topic 5. You should be able to:
Systematically understand and critically analyse the role of the arts in the public
health setting
Demonstrate development of critical appraisal and competency skills in arts
applications.
Apply principles of evidence based practice.
In Topic 6 we will look at Arts and the Life Course
Page 46 of 56
Welcome
Master of Public Health
Welcome and general information
We are looking forward to meeting you for the face to face part of the Arts and Public Health
module. We hope you will take the opportunity to get to know each other, work together on
tasks and learn from the arts projects you will be visiting over these 3 days.
Full details about the face to face teaching can be found in the Face to Face Teaching link on the
left hand side of Blackboard.
Page 47 of 56
Topic 6 Learning Outcomes
Master of Public Health
Intended learning outcomes
Topics 6 and 7 look at the use of arts across the life course. At the end of this topic successful
students should be able to:
Critically analyse and evaluate the impact of art on health and wellbeing
Appraise and evaluate research using examples from arts programmes used in health, both
locally and globally
Demonstrate development of critical appraisal and competency skills in arts applications
Page 48 of 56
The Life Course Approach
Master of Public Health
Introduction to the Life Course Approach
The life course approach to public health recognises that our experiences throughout our
lifespan contribute to health outcomes later in life. Biological, behavioural and psychosocial processes interact across our lifespan to impact on our health. Using this approach we
can identify critical points for intervention and develop life-stage appropriate strategies to
improve both current and future health outcomes. However, it is also recognised that factors
that influence poor or good health can accumulate over the life course and even across
generations.
This video from the World Health Organisation provides a simple introduction to the life course
approach:
YOUTUBE
What is the life course approach to public health?
What is the life course approach to public health?
The life course approach suggests that your current state of health is usually a
result of your previous life experiences.
VIEW ON YOUTUBE 
Our health is also shaped by wider social, economic and cultural experiences. Work on these
wider social determinants of health shows that advantage and disadvantage accumulate
through the life course, so that those born into less deprived environments will have more
opportunities and choices available to them, and subsequently better long-term health
outcomes, and vice-versa. Interventions at all stages of the life course are necessary if we are to
reduce these inequalities.
Stages of the life course and accumulation of effects from The Marmot Review Team
(2010) ‘Fair Society, Healthy Lives', available here p42.
For more detail on health inequalities and the social determinants of health in the UK context
take a look at The Marmot Review Team (2010) Fair Society, Healthy Lives: Strategic Review of
Health Inequalities in England post-2010
Key stages of the life course are gestation, childhood, adolescence, adult life and older age. This
week we will look at some examples of arts-based interventions with children and young
people. In Topic 4 we will look more closely at how arts can influence the health and well-being
of adults and the elderly.
Required Reading:
Go to the eTextbook link in Blackboard and read the following chapter:
eTextbook Chapter 4: Allen, J. and Allen, M. (2016). 'The Social Determinants of Health,
Empowerment and Participation' in Clift, S. and Camic, P.M. (eds) Oxford Textbook of
Creative Arts, Health and Wellbeing p27-34
Additional Reading:
Parkinson, C. and White, M. (2013) 'Inequalities, the arts and public health: Towards an
international conversation' Arts Health 5(3) pp177-189.
Discussion Board Activity (6.1)
Return to Blackboard and discuss the following question with your colleagues:
Do the arts have the potential to challenge health inequalities? In what ways?
Post your initial thoughts and then revisit the board after working through the case studies
presented this week and next, and answer the following questions.
Has your opinion changed? At what stage in life might arts-based interventions be most
beneficial?
Page 49 of 56
Art and Children and Families
Master of Public Health
Case Study 1: Children and Families
The early years are vital to our development. The Marmot Review Team (2010) recommends
policies that give every child ‘the best start in life’, working across the social gradient to ensure
children from deprived backgrounds are given the opportunity to gain the same developmental
skills, resilience and self-confidence as their wealthier counterparts.
The All Party Parliamentary Report on Arts, Health and Wellbeing provides several examples of
the way in which the arts can help to achieve this (Chapter 6 p84-99). One of these is Sistema
Scotland.
Read the following report on the Sistema Big Noise Project which aims to bring about social
change in deprived areas by providing children with the opportunity to play in an orchestra:
https://makeabignoise.org.uk/sistema-scotland/
In the following video the leaders and participants in the project talk about the benefits they
have seen:
YOUTUBE
Big Noise Torry - An Introduction
Big Noise Torry - An Introduction
An introduction to Big Noise Torry made by our friends at Station House Media
Unit.
VIEW ON YOUTUBE 
Personal reflection
Reflection: In what ways do you think the Big Noise Project contributes to health?
As well as your assessed reflective journal, you may also wish to record personal reflections
which are not assessed and for which you will not receive feedback. You will be prompted to do
this with the heading 'Personal Reflection'. If you wish to discuss anything from your personal
reflection publicly, please post it on the appropriate discussion board which will be clearly
marked for personal reflection contributions. Feel free to start a new thread on the subject of
your personal reflection.
An Evaluation of the Sistema Project carried out by Glasgow Centre for Population Health (2015)
identifies 7 pathways for potential improvements in health and wellbeing:
Engagement with learning
Life skills
Emotional wellbeing
Social skills and networks
Respite and protection
Musicianship
Healthy behaviours
Additional Reading:
Read the evaluation report here:
Glasgow Centre for Public Health (2015) 'Evaluating Sistema Scotland: Initial Findings Report
available at http://www.gcph.co.uk/assets/0000/5059/Sistema_summary_updated.pdf
El Sistema Venezuela
Big Noise project originated in Venezuela as a project called El Sistema. You can read more about
it below.
Additional Reading:
Go to the eTextbook link in Blackboard and read the following chapter:
eTextbook Chapter 24: Creech, A., Gonzalez-Moreno, P.A., Lorenzino, L., Waitman, G.
(2016). 'Case study: lost-or found? in translation. The globalisation of Venezuela's El
Sistema' in Clift, S. and Camic, P.M. (eds) Oxford Textbook of Creative Arts, Health and
Wellbeing p193-197
YOUTUBE
El Sistema - The Miracle
El Sistema - The Miracle
ENGLISH] In 1975, José Antonio Abreu, conductor, composer and economist,
developed the idea of improving social conditions in his country through
classical music, by giving children an alternative to life on the streets.
VIEW ON YOUTUBE 
Discussion Board Activity (6.2)
Return to Blackboard and discuss the following questions:
What role do you think the different global settings have played in the design of these two
projects?
What factors would have to be taken into account in order to transfer these examples into a
different global setting?
Page 50 of 56
Art and Adolescents
Master of Public Health
Case Study 2: Adolescents and Young People - Dance United
Required Reading:
Go to the eTextbook link in Blackboard and read the following chapter:
eTextbook Chapter 28: Gladstone-Barrett, P. and Hunter, V. (2016). 'The power of dance to
transform the lives of disadvantaged youth' in Clift., S and Camic, P.M. (eds) Oxford
Textbook of Creative Arts, Health and Wellbeing p227-232
Dance United show how interventions modelled on professional dance training can transform
the lives of people living in challenging circumstances. The company ran award winning
programmes for young people experiencing multiple challenges and deficits in their lives such
as exclusion from education, homelessness, criminality, addiction and sexual exploitation.
Read the above chapter for a discussion of the ways in which dance can improve health
outcomes and a case study on Dance United's intervention for mental health.
A related project is now running in Yorkshire:
https://twitter.com/DUYorkshire
http://www.duy.org.uk/
Additional Reading:
If you are interested in this type of project, the evaluation report can be found here:
Dance United (2014) Seabreeze: South London Mental Health Pilot Project Evaluation Report
May 2014
YOUTUBE
First Encounter - Gradient
First Encounter - Gradient
Dance United Yorkshire's Gradient company performing "First Encounter" at
the Alhambra Studios in Bradford. Filmed and Edited by Sam Drake on the 14th
of December 2017
VIEW ON YOUTUBE 
Case Study 3: Music projects with Aboriginal and Torres
Strait Islanders (Australia)
The link below shows examples of the use of hip-hop with Aboriginal and Torres Strait
Islanders young people, which addresses their low self esteem and in addition, often
communicates public health messages on subjects such as mental health, substance misuse,
and cultural identity.
http://www.abc.net.au/news/2017-02-01/hip-hop-engages-indigenous-teenagers-in-socialchange/8229232
Personal Reflection
In what ways do you think these projects contribute to health? How do they respond to the
needs of the communities? How effective are they?
As well as your assessed reflective journal, you may also wish to record personal reflections
which are not assessed and for which you will not receive feedback. You will be prompted to do
this with the heading 'Personal Reflection'. If you wish to discuss anything from your personal
reflection publicly, please post it on the appropriate discussion board which will be clearly
marked for personal reflection contributions. Feel free to start a new thread on the subject of
your personal reflection.
Additional Reading:
If you have not already read it, there are more examples of how arts can be used to impact the
health of young people and adolescents in the All Party Parliamentary Group on Arts, Health and
Wellbeing Report - Chapter 6 p84-99.
Page 51 of 56
Topic 6 Summary
Master of Public Health
Intended learning outcomes
You have now finished Topic 6. You should be able to:
Critically analyse and evaluate the impact of art on health and wellbeing
Appraise and evaluate research using examples from arts programmes used in health, both
locally and globally
Demonstrate development of critical appraisal and competency skills in arts applications
In Topic 7 we will look at further examples of the arts in the Life Course.
Page 52 of 56
Topic 7 Learning Outcomes
Master of Public Health
Intended learning outcomes
Topic 7 continues to look at the use of arts across the life course. At the end of this topic
successful students should be able to:
Critically analyse and evaluate the impact of art on health and wellbeing
Appraise and evaluate research using examples from arts programmes used in health, both
locally and globally
Demonstrate development of critical appraisal and competency skills in arts applications
Page 53 of 56
Arts and Adults
Master of Public Health
Case Study 4: Adults - Social Prescribing
There are many settings in which adults can engage with the arts to improve health and wellbeing.
The following examples in the required reading show how arts have been used to address
specific health issues such as anxiety and depression.
Required Reading:
UK All-Party Parliamentary Group on Arts, Health and Wellbeing Report p102-118.
Social Prescribing
Social prescribing allows GPs and other healthcare professionals to refer patients to nonclinical, community-based activities such as volunteering, exercise or creative pursuits. The
practice developed in response to the large number of patients visiting their doctor with
concerns that were psychosocial rather than medical.
Additional Reading:
Read more about social prescribing here – The King’s Fund (2017) What is Social Prescribing?
Arts on Prescription
Arts on Prescription is one form of social prescribing.
Required Reading:
UK All-Party Parliamentary Group on Arts, Health and Wellbeing Section 5.5 Arts on
Prescription p72-75
Case study: Start in Salford
Professionals such as GPs, mental health services and employment officers can refer people
with mental health conditions, anxiety or depression to Start in Salford where they can receive a
six month intervention, which can be extended to two years if necessary. Participants receive
arts skills training, with the opportunity to complete accredited courses. Through these
activities gain not only practical skills and qualifications, but rebuild self-confidence and
resilience.
Visit the Start in Salford website to see their latest activities and watch the video below to hear
how engaging with the arts has improved the health and well-being of these participants.
YOUTUBE
Start in Salford Promo by Hive
Start in Salford Promo by Hive
Hive Manchester (http://hivemanchester.co.uk/) made this incredible short
film about what Start in Salford is and how we can help people.
VIEW ON YOUTUBE 
Personal Reflection
In what ways do you think Start in Salford contributes to health?
As well as your assessed reflective journal, you may also wish to record personal reflections
which are not assessed and for which you will not receive feedback. You will be prompted to do
this with the heading 'Personal Reflection'. If you wish to discuss anything from your personal
reflection publicly, please post it on the appropriate discussion board which will be clearly
marked for personal reflection contributions. Feel free to start a new thread on the subject of
your personal reflection.
Additional Reading:
In this module we have also looked at how to generate evidence for the value of arts-based
initiatives, and how we can evaluate our projects. If you are interested in Arts on Prescription
you can take a look at another project from the North West of England, Creative Alternatives.
Read a case study of the project here and follow the links to the project reports to look at how
the project was evaluated.
A full evaluation of the project can be read here:
Whelan, G., Holden, H., Bockler, J. (2016) A social return on investment: Evaluation of the St
Helens Creative alternatives Arts on Prescription Programme Liverpool: John Moores
University
Page 54 of 56
Arts and the Elderly
Master of Public Health
Case study 5: Later Life
As we have seen earlier in the module, the arts have been shown to have significant benefits for
people with specific conditions related to later life, such as dementia. In this section we look at a
more general approach, open to all older people - group singing.
Watch the following video from Silver Songs Club - You can read more about their initiative here
.
YOUTUBE
Len Goodman hits the high notes with Silver Song Clubs
Len Goodman hits the high notes with Silver Song
Clubs
Len Goodman makes a visit to National Lottery Awards Finalist, Silver Song
Clubs. The project provides sing-a-long sessions which aim to improve the
health and well-being of older people living with long-term health conditions.
VIEW ON YOUTUBE 
Required Reading
Go to the eTextbook link in Blackboard and read the following chapter:
eTextbook Chapter 31: Clift, S., Hancox, G., Morrison, I. et al. (2016) 'Group singing as a
public health resource' in Clift, S. and Camic, P.M. (eds) Oxford Textbook of Creative Arts,
Health and Wellbeing p252-257
Randomised Controlled Trials (RCTs) have been used to assess the effectiveness of group
singing for the mental health of older people. Group singing has been shown to improve quality
of life and lower anxiety and depression. Several mechanisms have been identified through
which group singing can improve health:
Controlled breathing - counteracts anxiety and stress
Social support - to overcome isolation and loneliness
Promotes learning - counteracts cognitive decline
Regular commitment - discourages inactivity
Makes people happy!
Japan: Gold Theatre Saitama
Additional Reading:
Cutler, D. (2015) Living National Treasure: Arts and Older People in Japan, The Baring
Foundation https://baringfoundation.org.uk/wp-content/uploads/2015/07/Livingnational-treasure-final.pdf
This report from Japan provides an example of how arts-based activities can be used to tackle
specific social issues related to health, in this case a rapidly ageing society. A combination of low
birth rates and high life expectancy means Japan has one of the world's oldest populations, with
over a quarter of the population over 65. This leads to pressures on health and social care
provision, and a workforce and pensions shortage, and also requires innovative approaches to
tackle age-related issues for individuals such as dementia and social isolation.
A pioneering approach highlighted in the report above is the Gold Theatre Saitama, established
by the renowned theatre director Yukio Ninagawa in 2006, which recruited participants over 55
with no previous acting experience to join a touring theatre troupe. In 2015 the average age of
members was 76.
"The performers themselves are also afflicted by the numerous problems that face our ageing society,
from physical decline to mental issues, so putting on a show involves hard work, but at the same
time, the performers have their own remarkable acting style that differs from that of professional
actors and produces many poignant moments"
Yukio Ninagawa (Saitama Arts Foundation website)
The video below (from 00min55sec - 07min48 sec) shows scenes from a performance of
'Raven, we shall load bullets' by the Saitama Gold Theatre . (Warning: there are mild sexual
references at 06min42sec)
YOUTUBE
The Works：Japanese theatre "Raven, We Shall Load
Bullets", Li Hongbo "Shadow of Knives", Microwave
A ground-breaking stage production created by renowned Japanese theatre
director, Yukio Ninagawa and playwright Kunio Shimizu: "Raven, We Shall
Load Bullets". It's the story of two young protesters on trial for throwing
explosives, and what happens when the court proceedings are disrupted by a
gang of elderly armed rebels.
VIEW ON YOUTUBE 
Personal Reflection
What were the identified needs in the communities in these two settings? What were the
programme aims? How effective were they? What sustainability issues might there be?
As well as your assessed reflective journal, you may also wish to record personal reflections
which are not assessed and for which you will not receive feedback. You will be prompted to do
this with the heading 'Personal Reflection'. If you wish to discuss anything from your personal
reflection publicly, please post it on the appropriate discussion board which will be clearly
marked for personal reflection contributions. Feel free to start a new thread on the subject of
your personal reflection.
Discussion Board Activity (7.1)
Do the arts have the potential to challenge health inequalities?
Look at your initial ideas. Has your opinion changed after working through the case studies?
At what stage in life might arts-based interventions be most beneficial?
Page 55 of 56
Finding useful information
Master of Public Health
Information sources
During the course we have looked at a wide range of art forms, settings and age groups. We
have discussed the importance of evaluation and the collecting of evidence of effectiveness. As
we discussed earlier, the hierarchy of evidence is not always appropriate in assessing the value
of arts and public health interventions because of their complexity. Systematic reviews are
often unable to give recommendations as they are unable to find high quality evidence for the
effectiveness of such interventions. However, it is sometimes useful to look at systematic
reviews which bring together studies into particular areas of research, identify the potential
therapeutic benefits of interventions, as well as highlighting gaps in the evidence which can be
addressed by good quality research and evaluation.
If you are interested in a particular setting or art form, search for systematic reviews which may
give you some insight into the potential benefits, how to plan or develop interventions, or ideas
for evaluation.
For example:
Music interventions
There are a number of Cochrane Reviews on the use of music with different conditions
(insomnia, dementia, cancer, brain injury) as well as overall systematic reviews by ‘What Works
Wellbeing’ of the benefits of music and singing for people with health conditions
https://whatworkswellbeing.org/product/music-singing-and-adults-with-diagnosedconditions/
and for people without health conditions
https://whatworkswellbeing.org/product/music-singing-and-healthy-adults/
Dance interventions
There are Cochrane Reviews on Dance Movement Therapy (DMT) which look at schizophrenia,
dementia (where no studies were found), and depression.
There are a number of systematic reviews on dance for people with Parkinson's Disease,
looking at both motor symptoms and non-motor symptoms with some finding improvement
in different aspects, but again with the caveat that further high quality research is needed.
Two systematic reviews find some evidence for the benefits of dance in falls prevention, but
again, point out that the evidence is not high quality.
Page 56 of 56
Topic 7 Summary
Master of Public Health
Intended learning outcomes
You have now finished Topic 7. You should be able to:
Critically analyse and evaluate the impact of art on health and wellbeing
Appraise and evaluate research using examples from arts programmes used in health, both
locally and globally
Demonstrate development of critical appraisal and competency skills in arts applications
You have now completed the Arts and Public Health module!
Your final assignment will be released on Thursday 12th December at 12 noon. You will find the
assignment in the 'assignments' section on Blackboard. The assignment will be submitted
through Turnitin by January 13th at 12 noon.
Thank you for your participation, we hope you have enjoyed the course and will find it useful in
your work.