SUMMARY
GENNING UP
A Research Paper for Blue Drum
on Community-based Arts in Health
by
Mike White
Centre for Arts and Humanities in Health and Medicine
University of Durham
May 2006
CAHHM, Dawson Building, Science Site, University of Durham, Durham DH1 3LE
Tel: (0)191 334 2917
e-mail: cahhm.info@durham.ac.uk
Web: www.dur.ac.uk/cahhm
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BACKGROUND
Blue Drum
In spring 2005, Blue Drum commissioned the Centre for Arts and Humanities in
Health and Medicine (CAHHM) at Durham University:
 To research effective and innovative models of practice in Ireland and
elsewhere of arts based community development approaches to addressing
health issues and
 To identify key learning, conclusions/observations, about the value of
community based arts and health work
Blue Drum is a Specialist Support Agency established to support the community
development sector. The Agency assists groups in tackling issues of access to quality
arts experience, and in developing creative methodologies in their work towards
social inclusion. Blue Drum works from the principle that participation in the arts and
creative activity is fundamental to the health, well being and development of
individuals, groups, communities and society.
Blue Drum received funding from the Combat Poverty Agency Building Healthy
Communities Fund to research and develop creative methodologies which will enable
groups to explore poverty and health issues in their community. These methodologies
are to be developed and tested in partnership with local community organisations and
practitioners from both the arts and the health sectors. Combat Poverty’s work on
building healthy communities has the following aims:
 To explore mechanisms for effective, meaningful and sustainable community
participation in decision making relating to health issues
 To build the capacity of community and health interests to draw out practice
and policy lessons from their work
CAHHM
The Centre for Arts and Humanities in Health and Medicine (CAHHM) was set up in
2000 by Sir Kenneth Calman, the Vice Chancellor of Durham University and former
Chief Medical Officer for England, to follow on from the Nuffield Trust’s influential
pre-millennium conferences on arts and humanities in medicine. CAHHM aims to
meet the groundswell of interest from many areas of social policy and academic
disciplines in the importance of the arts as a force for improving the health and wellbeing of communities and individuals.
CAHHM currently runs research and project work in three priority areas:
1. Arts and health in community settings
2. Architecture and design of health service buildings
3. Medical humanities.
CAHHM’s interest in providing Blue Drum with this paper on community-based arts
in health is informed by its recent audits of arts in health in UK regions and by
research that its author Mike White is doing through a NESTA fellowship.
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1. INTRODUCTION
“Factors which make for health are concerned with a sense of personal and social
identity, human worth, communication, participation in the making of political
decisions, celebration and responsibility. The language of science alone is
insufficient to describe health; the languages of story, myth and poetry also disclose
its truth.”
Health Is For People (1975) Michael Wilson
This is a summary of a report produced for Blue Drum in spring 2005. The report
examines the emerging practice of community-based arts in health and the challenges
it poses for evaluation, summarising what has been learnt from recent research and in
a number of case examples from the UK and Ireland. The full report can be
downloaded from CAHHM’s website at www.dur.ac.uk/cahhm
Throughout this report I refer to the work as ‘arts in health’ simply because that is the
term I am most accustomed to using; although behind phrases such as ‘arts for
health’, ‘arts and health’, ‘arts into health’, and ‘arts in health’ there can lie different
approaches and differing assumptions about the roots of ill health and the ways arts
can improve it. The field may, however, be broadly defined as creative activities that
aim to improve individual/community health and healthcare delivery using arts
based approaches, and that seek to enhance the healthcare environment through
provision of artworks or performances. Community-based arts in health is a distinct
area of activity operating outside of acute healthcare settings and is characterised by
the use of participatory arts to promote health and to help build ‘social capital’ which
is commonly defined as a network of trust and reciprocity within a community
(Putnam 2000) .
Community-based arts in health began in the UK in the mid-1980’s through sporadic
pilot projects that placed arts development in public health and primary care contexts.
It has since grown and expanded to embrace community health practice on a broad
front. The rapid emergence of this field of work internationally from the mid-1990’s
has begun to impact on policy in arts funding systems, on cross-sector partnerships in
health service delivery, and in local authority cultural strategies. In communities and
schools in disadvantaged areas it has combined creative activities with health
promotion and amassed testimony from participants as to its value.
It would be incorrect to assume this burgeoning field has come about solely as a
result of the arts sector making an advocacy pitch to the health sector. It originates
just as much in health thinking of the last thirty years on the social determinants of
health and well-being , especially in the rise of the ‘new public health’ movement
which has opened up opportunities for arts practice to engage with this wider health
environment at a profound level. Community-based arts in health is attempting to
make manifest a cultural base to health promotion. It may also address an underlying
concern to maintain trust between healthcare professionals and the public.
An emphasis on creative messaging is often at the core of community-based arts in
health. Art can be a potent medium for expressing health – and indeed ill health and
distress. Through sustained programmes of participatory arts, a shared creativity can
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make committed expressions of public health, simultaneously identifying and
addressing the local and specific health needs in a community. This is what
distinguishes arts in health work from art therapy and connects it into social inclusion
work.
There is presently a window of opportunity for community arts development to help
realise a social model of health. The move to multi-agency working is still new to the
health services and the arts can have both an integral and a catalytic role in this. What
used to be understood as the preventative approach to healthcare is increasingly about
building capacity for change, internally through improved training and holistic
approaches and externally in developing social capital. It is important not just to look
at the arts activity in isolation as delivering the benefit; rather in many instances it can
also be in the quality of relationships forged between arts, health services, and other
partners such as education, local government regeneration schemes, and the voluntary
sector.
Funding sources for community-based arts in health are many. Different funding
regimes for projects must also be significant in explaining the range and diversity of
community-based arts in health work. They are also a factor in why arts in health
projects, and the organisations delivering them, have substantially grown in recent
years. Such diversity and resourcefulness may, however, work against communitybased arts in health in the end as no single funding sector may find the need or
willingness to take responsibility for arts in health as a component of mainstream
services.
As community-based arts in health is essentially a grassroots movement, its potential
might be best realised by understanding the distinctive character and balance of
practice between regions and nations so that learning can be shared both locally and
internationally. A strategic vision with the right incentives to forge network
connections needs to emerge.
Some key things I have learned in years of doing community-based arts in health
projects are these:
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The role of arts in health in the community is broader than the role of arts
in health in hospitals.
Primary care facilities and the localities they serve should be places where
we learn creatively how to be healthy.
The arts (and friendly artists) can shape contexts in the community to
produce mediating images for health education so that people are
‘touched’ rather than indoctrinated.
The integration of art into health checks the de-humanisation of medical
science and is essential for both mental and physical health promotion.
There is a relationship between creativity and well being, and to encourage
people’s latent creativity community-based arts in health can be domestic,
communal and celebratory.
This is a new and distinctive area of arts practice, shaping an aesthetic of
care from the quality of relationships forged between artists, health
workers and community.
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CAHHM’s research in UK regions has identified these issues for practice and
evaluation:
1. There is rapid growth of arts in health at local level but little advance in a strategic
framework
2. There is a need to consider what makes for quality in both health-focused arts and
in the health care environment
3. Multi-sector relationships must be developed for meaningful creative engagement
with the public through arts in health
4. Arts in health has so far tended to be driven by enthusiasts rather than by
corporate policy
5. Arts in health can be as much about the relationships developed through the
activity by partners and participants as the activity itself
6. Arts in health needs to connect more with the public health agenda and with
primary care
7. Community-based arts in health lacks bases to develop or showcase work and
build long-term programmes
8. Healthy schools are key to creative and healthier communities, so arts in health
and arts in education programmes should work in alliance
9. Arts in health needs to be understood as a way of working within community and
healthcare environments, not just as products and activities
10. The complexity of arts in health work requires continuous learning development
and a support structure for frontline practice
11. Appreciating cultural diversity in arts in health needs to go deeper than ‘social
inclusion’ as people’s differences determine health choices
12. Small networks of like-minded projects may be better able to formulate,
implement and share research-guided practice
13. The practice and evaluation of arts in health is too often driven to delivery
outcomes rather than process outcomes
14. Short-term modestly funded arts in health projects cannot easily measure health
gain, but may offer intermediate indicators of improvement
15. Collecting meaningful evidence will require cross-disciplinary dialogue and joint
practice
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2. THE CONTEXT FOR COMMUNITY-BASED ARTS IN
HEALTH IN IRELAND
Community-based arts in health is less developed in Ireland than in the UK, perhaps
because it does not yet have a breadth of agency partnerships behind the work. Arts
Council strategy has tended to focus understandably on supporting partnerships
between its clients and Health Service Executives for arts development within
healthcare buildings. The broader context required for community-based arts in
health has started to emerge, however.
Health Profile and Strategy
The health profile of the nation set out in the Quality and Fairness health strategy
report (2002) makes for sober reading. Irish life expectancy at age 65 years was still
the lowest of all 15 EC states in 1997, with cancer and cardiovascular disease
accounting for nearly two-thirds of deaths. Twenty five per cent of families are likely
to have at least one member with a mental health problem. Adults in the lowest
socio-economic group are twice as likely to report a long-standing illness as those in
the highest socio-economic group. In traveller communities life expectancy is
approximately 10 years less than in settled communities. Areas of low health status
directly correspond to areas of high social deprivation.
The Quality and Fairness foreword written by (then) Health Minister Micheal Martin,
stressed the importance of addressing health inequalities caused by poverty and
disadvantage and noted that “the strategy at all points envisages cross-disciplinary
collaboration to achieve new standards, protocols and methods.” The report
elaborated on this later in declaring that “many other factors, and therefore many
other individuals, groups, institutions and public and private sector bodies have a part
to play in the effort to improve health status and achieve the health potential of the
nation.” The Strategy acknowledged that cultural conditions can impact on the social
determinants of health and recognised the “formal and informal roles of family and
community in improving and sustaining well-being in society”. It concluded that “the
quality of life aspect of health needs to be highlighted. This will involve creating a
supportive environment to maximise social well-being for vulnerable groups”. The
approach set out in Quality and Fairness runs in parallel with current health service
development in the UK, and the World Health Organisation’s 2004 report Holistic
Health which states that: “ prevention and promotion in public health should be
integrated within a public policy approach that encompasses horizontal action through
different public sectors”. The 2004 review of the National Health Promotion Strategy
also emphasises cross-sector collaboration and the potential of health promotion to be
a lead on policy development. Providing practical assistance to health promotion is
central to community-based arts in health; it is usually the identifying factor that
distinguishes it from arts in institutional healthcare contexts which focus more on
therapeutic processes.
International Arts in Health Conference, Dublin, June 2004
This conference offered opportunity to reflect on arts in health practice in Ireland
within an international context though it said little about the social context for arts in
health in the wider agenda of social capital and community regeneration. It focused
mainly on the healing experience of arts in healthcare settings rather than the health
promotion dimension of arts in health in community contexts. Yet the thematic
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strands that emerged from speaker presentations and workshops at the conference
were ones that community-based arts in health could readily engage with, even if they
were not articulated in this context. Identified themes of arts in health practice, as set
out in CREATE’s report on the conference, were:
The notion of home.
Understandings of illness and health
The inter-relationship between different forms of intelligence
The benefits to the artist and the art form
The biological necessity of art-making
The effectiveness of the arts in addressing distress and dislocation
The need for greater integration of arts and health sectors
What constitutes elements of good practice
A Pilot Partnership - Eastern Regional Health Authority/Arts Council
This partnership was begun in 1998 to explore how a common policy framework for
arts and health sectors might be developed, and provide peer example to other
regions. It has supported a number of evaluated pilot projects, summarised in The
Practice of Arts in Healthcare (ERHA 2003), leading to a framework for the practice
of arts in healthcare settings, summarised in A Picture of Health (ERHA 2004). As
the pilot projects were located in residential or rehabilitative healthcare settings rather
than in acute care, both their impact and the organisational issues they brought to light
have relevance for community-based arts in health projects. The evaluation report
shows the intermediate indicators of benefits from the arts interventions are weighted
more to social gain than health gain, though they also had impact on service delivery
in that participating staff saw their patients/clients in a new light as a result of the
activities. The most commonly cited benefit was improved self esteem. Specific
organisational issues, in addition to a general need for better resources and advocacy,
include the induction and support for artists moving into arts in health practice, and
‘unrealistic work planning’ which highlights a common problem of insufficient
preparation time
Culture + Health - Cork European Capital of Culture 2005
Despite the exponential growth internationally in arts in health practice in recent
years, Cork has done something that nowhere else has so far attempted – to articulate
the relationship between arts and health services throughout a city and its environs,
and to build the potential and vitality of such a relationship on the involvement of
those who might otherwise be marginalised due to their health status. Cork’s
programme drew on the experience of earlier pilot projects in arts in health in other
districts – such as Co. Mayo and Co. Sligo Arts Offices and a Music Network
partnership with Midlands Health Board. Some of the Culture + Health projects in
2005 focused on the intrinsic therapeutic benefits of the arts, some on environmental
improvements to support health staff in delivering their care services, and others
looked at producing more creative approaches to achieving patient-centred care. In
addition, there was much community-based arts in health work tackling issues of
social exclusion and focusing on a concept of social capital where 'unity is health’.
These are arts projects that start from using creativity to enhance social relationships,
reflecting growing evidence that good relationships are a major determinant of health.
The programme is summarised and assessed in Culture + Health Strand, Cork
Festival Office, 2006 (available from annp.oconnor@mailp.hse.ie).
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3. ISSUES IN VALUING THE WORK AND COLLECTING
EVIDENCE
i.) Evidence-based practice or practice-based evidence?
This has become a conundrum in research into community-based arts in health. In
health services a clinical based research model, often using randomised control
methods, is the required ‘gold standard’ driving even those interventions that are
based on a social model of health. But this supposes that art is applied as a form of
treatment (and also explains why it is frequently confused with art therapies) rather
than as a channel of expression for self-reported health awareness and the articulation
of health needs. We first need to bring an interdisciplinary approach to bear if we are
to understand better what the practice of community-based arts in health is about at
the process stage rather than the outcomes stage
It is important to give due weight and consideration to people’s testimony about the
practice and its effect on them. Though this does not in itself constitute hard evidence
of benefit, it at least reveals the value placed on the activity. A practice-based
approach to evidence gathering and participatory evaluation draws on a combination
of forward planning processes and reflective thinking, with the kind of contextual
‘deep immersion’ found in anthropology and some areas of social science. The value
that participants ascribe to this construct is crucial. CAHHM has found that a roughand-ready means of beginning this process is to keep an open book during the life of a
project in which to record formal and informal meetings, comments and reflections,
visitors, sketches and snapshots. Everyone is encouraged to contribute.
ii.) A question of value
A Demos report, Capturing Cultural Value by John Holden (2004), gives an
interesting analysis of how the social value agenda needs to revitalise the relationship
between funders, funded and public, exploring the current tension between
instrumental approaches and ‘arts for arts sake’ (or intrinsic) approaches to
identifying cultural value and social outcomes. The word ‘health’ as a core value
occurs throughout this report.
Similar arguments are found in a recent USA report titled Gifts of the Muse –
Reframing the Debate about the Benefits of the Arts (McCarthy et al 2004),
commissioned by the Wallace Foundation. It argues that intrinsic benefits of the arts
include the creation of social bonds and communal meanings. But the trouble with
promoting ‘intrinsic benefits’ is that we go back to arts for art’s sake arguments and
still focus on the individual experience more than the communal.
The Australia Council’s distinction between instrumental and transformational
benefits as set out in its report .Art and Well-Being (2004) seems much clearer. It
states: “In considering the role of community cultural development, it is useful to
distinguish between instrumental approaches which involve the arts ('let’s implement
policy using the arts'’) and transformational approaches ('let's allow creative activity
to determine policy, negotiate shared understandings and map out solutions’).” It
probably requires a mix of these approaches but in community-based arts in health the
weighting should be to the transformational
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iii.) A health assets model
The growing interest from public health in a ‘health assets model’ offers potential for
arts-led engagement with community health. A World Health Organisation paper
titled Assets for Health and Development – Developing a Conceptual Framework
(Harrison et al 2004) considers that historically health promotion has worked on a
deficit model that is focused on the problems and needs of communities to be
addressed through health resources. An asset model on the other hand looks at
communities’ capability and capacity to identify problems and activate their own
solutions, so building their self-esteem
iv.) Self-esteem and status
Arts in health project reports frequently refer to the improved feeling of self-worth of
participants. Increased self-esteem is cited as a key indicator in Matarasso’s Use or
Ornament? (1997), a study of the social impact of the arts. It is also a powerful factor
in the social gradient of health as evidenced in the work of Michael Marmot (2004) on
the impact of social status on health: “Autonomy and full social participation are so
important for health that their lack leads to deterioration in health.” This thinking,
which is informed by thirty years of solid international research, could be an
important basis on which to develop evaluation by arts in health projects in areas of
high social and economic deprivation.
v.) A need for consensus
The majority of practitioners in community-based art for health recognise that it is
important to evaluate their activity. Many are attempting to do so, but they are
struggling to find appropriate methods, and the evaluation they carry out is frequently
inadequate. A serious and widespread shortcoming is a failure to state and agree clear
aims for a project. There is uncertainty about what evaluation methods to use and
what methods will be acceptable to other stakeholders There seems to be a mismatch
between the aims of the practitioners and the expectations of those requesting the
evidence. The practitioners are addressing a wide range of particular circumstances in
many ways and with a wide range of assumptions. Those requesting evidence seem
to be expecting effects on individual health and behaviour, but they are not stating
that explicitly. In order to make progress in the search for evidence, it is essential that
all parties clarify their intentions, assumptions and requirements. The practitioners
need to state clearly what they are aiming to achieve. The funders and others
requesting evidence need to state clearly for what effects they require evidence, and
what would be acceptable as evidence. These conclusions are based on CAHHM’s
literature review for the UK Health Development Agency (Angus 2002).
vi.) Building research networks
Research might take the form of comparative case studies, pooling data to construct
larger and more robust samples for quantitative survey. If, as a collective body, the
arts in health field could agree on the common aims and issues, agree a way of
evaluating, and then share and collate the results, we would achieve a critical mass of
information. To achieve critical mass, there needs to be joint funding applications for
research-guided practice by like-minded organisations. This research, and the
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projects concerned, must be longer-term in order for them to be able to achieve effects
and to evaluate them effectively
vii.) D.I.Y.
What happens outside formal evaluation of practice is still vitally important and
projects should devise their own checklists for ongoing assessments. Useful guides
are:
Arts Council England’s publication Sharing Practice by Gerri Moriarty (2003)
www.newaudiences.org.uk
Arts Victoria Evaluating Community Arts and Community Well Being (2002)
www.arts.vic.gov.au
Creating Value by Francois Matarasso (2000) www.homepage.mac.com/matarasso
Angus J. (2002) An Enquiry into Possible Methods for Evaluating Arts in Health
Projects. CAHHM, Durham.
For a comprehensive literature review, see:
Centre for Cultural Policy Research, University of Glasgow Quality of Life and WellBeing: Measuring the Benefits of Culture and Sport.
www.scotland.gov.uk/Publications/2006/01/13110743/15
viii.) Log frame plans for participatory evaluation
CAHHM’s UK national study Arts, Health and Community by Angela Everitt (2003)
deployed log frame planning to gather evidence and evaluate the progress of five
projects over a two-year period. A log frame has four columns and four rows as
follows:
narrative
indicators of
effectiveness
methods of verification
assumptions/risks
Goal
Objectives
Activities
Inputs
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The first column, the narrative of the project, sets out the overall goal, the
objectives which should ensure that the project travels in the direction of this goal,
the activities that will help meet the objectives and the inputs or resources needed
to conduct these activities. It has an ‘if-then’ logic, eg if these inputs are secured,
then these activities will be undertaken, then these objectives will be met, then this
goal becomes realisable.
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
The second column, indicators of effectiveness, addresses the question ‘what
would show us that we have been, and the extent to which we have been,
successful in:
getting nearer to realising our goal?
going someway to achieving our objectives?
undertaking our activities?
securing the resources needed?’
The ‘if-then’ logic is continued both vertically and horizontally.

The third column, methods of verification, addresses the question ‘how will we
discover those things that would show us that we have been successful?’ Again,
the ‘if-then’ logic is pursued vertically and horizontally.

The fourth column, assumptions/risks, addresses those concerns that are summed
up by the phrase ‘but what if …?’ This column allows us to identify those factors
that may affect the project pursing the programme as identified in the other three
columns. This column helps to build realism into the project, to develop
understanding of risks, and to identify factors critical to success. Some of these
factors are outside of our control. Others alert us to the need to be vigilant or to
introduce additional activities to address factors potentially detrimental to the
project.
Log frames are useful for project planning and management generally as well as for
evaluation design. For evaluation the second and third columns particularly help
ensure that monitoring, review and evaluation are built into the project. Log frames
also help to accommodate the sometimes different evaluation requirements of
different stakeholders.
ix.) Performance Indicators for community-based arts in health
Edel Nolan of Waterford Institute of Technology has been using Performance
Inidicators (PIs) on participatory arts in health projects run by Waterford Healing Arts
Trust. The creation of a set of PIs for an arts in health project is an (ideally) simple
method of being able to assess the performance of a project at a given time. It does
require, however, an agreement between all parties on what the indicators should be
along with close monitoring and regular review. PIs are commonly used in both
health services and local authority arts departments and they can be flexible to
accommodate both quantitative and qualitative results. Importantly, they keep you
focused on aims and objectives. They might usefully be combined with a logistical
framework planning approach as outlined above. Both require stakeholder
involvement throughout and can accommodate a larger holistic evaluation strategy.
Some PIs may be project specific and others may be generic and applicable to other
situations. Edel has come to the view that: “PIs are just one aspect of a larger
evaluation strategy but they act as a good primer or catalyst because they are
something tangible and specific that help people focus on evaluation in general.”
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4. CASE EXAMPLES
Case examples from both the UK and Ireland are more comprehensively described
and assessed in the full text of this report. The UK examples are drawn from research
work undertaken by CAHHM in recent years. As this report was produced largely
through desk-based research it was more difficult to select case examples from
Ireland. I decided not to include as case examples the three projects in Blue Drum’s
pilot Arts, Health and Community project because these were being monitored and
assessed internally, and any from-a-distance description that I might put forward
seemed superfluous. The first three chosen, Sligo Arts Office, Mayo Arts Office, and
‘Wishes and Choices’, I had earlier had opportunity to visit and observe, and after this
report was originally written in May 2005 I made three visits to Cork to view projects
there and speak with their organisers. ‘Once Is Too Much’ was chosen because,
along with the ‘Wishes and Choices’ project, it shows how a Family Resource Centre
or Community Development Project can embed community-based arts in health
within a long-term wider agenda of tackling poverty and social exclusion. ‘The
Presence of Absence’ was selected because it is an artist-led project dealing with the
impact of bereavement on health, an issue too rarely addressed by arts in health work.
Finally, the arts in health programme within Cork Capital of Culture 2005 highlighted
arts in health through a national showcase, and showed how meaningful creative
engagement with health can be an integral part of a city’s cultural profile.
UK
Project
Common Knowledge, Tyne and Wear
Description
Building a cross-sector learning network,
and defining the arts in health field within
a region through a network of pilot
projects.
A rural-based, arts-led healthy living
centre addressing mental health and
social inclusion.
Developing a regional cluster of projects
promoting healthy schools, heart
awareness, and emotional literacy.
Using stand-up comedy to promote men’s
health and access to health services.
A city-wide mental health community
project with thoughtful and honest
evaluation
An enterprise model to create a healthy
inner-city community, embracing cultural
diversity in health.
A studio model for achieving social
integration in mental health
Pioneer Projects Ltd./Looking Well
‘Making Sense’ Lanterns
Leicester Comedy Festival
‘Pathways’, LIME, Manchester
Bromley-by-Bow Centre, London
South Tyneside Art Studio
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IRELAND
Project
Sligo County Council Arts Office
Description
Intergenerational work on health issues
with arts-led cross-sector training
Arts work with elderly with a mentoring
support scheme for artists
A women’s health project with traveller
community, producing touring art
exhibition for maternity units
A women’s project on domestic violence,
co-produced with IMMA, Dublin,
inspiring an ongoing campaign and an
extensive tour of artwork produced
An artist-initiated project on theme of
bereavement, developing links with
health services and hospice movement
A year-long programme of artist
residencies, commissions, exhibitions and
performances in a wide range of
healthcare and community settings
Mayo County Council Arts Office
CDP Priorswood, Dublin
‘Wishes and Choices’
St. Michael’s FRC, Inchicore
‘Once Is Too Much’
Art Installation by Adrienne Lord
‘The Presence Of Absence’
Cork Capital of Culture 2005
5. CONCLUSIONS
Key issues that need to be addressed in the context of community-based arts in health
development in Ireland are:
i.)
Networking and/or strategy
The ‘and/or’ here is deliberately uncertain, as it begs the question as to whether a
bottom-up or top-down approach, or a combination of the two, is best placed to
drive the development of community-based arts in health. Strategy cannot
substitute for the importance of developing relationships between people involved
in the everyday planning and delivery of this work. It looks like local and
regional networks are already emerging around project development and they
should increasingly become the rationale for resource investment from funders.
They can deliver practically on the ‘joined-up’ agenda. In a network the whole is
greater than the sum of its parts, knowledge of the work is shared, and there is the
prospect of changing the way that people think and work in healthcare. There is
always the difficulty of funding, but the problem to hand is really one of achieving
better dialogue between arts and health sectors.
ii.)
Unifying arts and health practice
Arts in health has become a diverse and international field of practice,
encompassing acute services, care and rehabilitation, community health and
public health, as well as extending across a whole gamut of social policy.
This report has focused on community-based arts in health as a distinct strand of
practice requiring its own developmental framework and intellectual base. Yet
there must still be much commonality with arts in healthcare settings. In both
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fields therapeutic effects are embedded in the process and outcomes are a
resonance of this. Hospital arts and community based arts in health could
develop interesting exchange of research and practice. It may be helpful to look
in particular at the handful of arts in health organisations whose work
encompasses the range of practice. Artscare in Belfast, for example, run both
hospital and community-based programmes. Also, some geographic exchange of
information and practice across the province and the republic could usefully
connect the UK and Ireland in this work.
iii.)
Longevity in programming
Long-term projects are essential if arts in health is to build public support and
reveal the evidence base of its effectiveness. This is not only a matter of sustained
resources; it also requires an ongoing commitment from artists and other key
partners to stick with certain communities and evolve models of practice from
them. Because of the inherent difficulties in applying randomised control
techniques to community-based arts in health, the ideal approach would be
through longitudinal research across a generation. To conduct a longitudinal
study in community-based arts in health would probably require a consortium of
significant health partners and universities capable of accessing international
research funds. In the meantime, keep on documenting the practice.
iv.)
Bases for community-based arts in health
This is connected to point iii.). A base is a showcase for work in progress, and it
can be a network as much as a building. It has a story to tell and can provide
ready access to testimony from participants. In the UK there a few arts-led
Healthy Living Centres and these are repositories of ideas in practice. In Ireland,
some FRCs and CDPs could provide a similar function provided arts in health is
not an add-on but central to the organisation’s thinking and ethos. Politically this
is an opportune time to be demonstrating human values in health and social care
as government moves on from looking at service infrastructure.
v.)
Training
Job placement and mentoring seem the most effective means of delivering training
that is integral with practice. It also opens up a continuum of learning from
volunteer to apprentice to arts in health practitioner and strengthens community
resources for the work at grassroots. Counselling support for artists is needed to
develop resilience and empathy as well as expertise. Accreditation of skills
acquired by community participants in arts in health projects is a direct means of
building the self-esteem that impacts significantly on health. ‘In-service’ training
needs to go hand-in-hand with practice as there is a shortage of experienced artists
in this field. Skills sharing with health workers is also crucial to sustainability.
The ‘arts in health practitioner’ need not be seen as only the artist.
vi.)
Impressions of what is distinctive about arts in health in
Ireland compared to the UK
-
There is a greater readiness to engage with intellectual issues
underpinning the work, as evidenced in the content of the 2004
Dublin International Conference
14
-
-
-
-
-
The Arts Council and Health Service Executive seem more
focused on arts in healthcare settings so an emerging strategy
may be limited to these. Community-based arts in health also
needs allies such as the Combat Poverty Agency and local
authority arts offices, as well as a partnership with public health
(an alliance which is now driving much of this work in the UK)
Poverty is seen as the core health problem, whereas in the UK
it is fudged into issues of ‘social exclusion’ and ‘health
inequalities’. A liberation theologian once defined poverty as
“the deprivation of every stimulus to change one’s condition.”
Arts are all about stimulus
Boundaries are less defined between arts in health and
disability arts, and there is a clearer continuum of arts in health
practice across health and care services
There is an emerging specialism in Ireland in arts for older
people and the health dimension of this is being articulated
through action research
There is interest in artist residencies as the principal model for
delivering arts in health
Local networks are emerging out of project development, even
though there is no national co-ordination
The work is more invisible than in the UK and lacks champions
15
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