In the light of the recent publication of ‘Healthy Ireland', Senior Health Promotion Officer Caroline Peppard calls for a recognition of the role of the arts in developing a culture of healthcare that goes beyond the scientific and considers all the determinants of health.
Grey Matters: The role of the Arts and Health in the delivery of ‘Healthy Ireland’
Our health is our wealth! It may be a cliché but one which rings true particularly in the light of the massive social and economic changes that we have seen in Ireland in recent times. It is timely then that our government has recognised the resource that is health through the publication of ‘Healthy Ireland 2013 – 2025 – a Framework for Improved Health and Wellbeing’. This is the first Irish intergovernmental framework of its kind and as such is much welcomed. The strategy, which was developed in partnership with statutory and voluntary sectors is about creating ‘a healthy Ireland, where everyone can enjoy physical and mental health and wellbeing to their full potential, where wellbeing is valued and supported at every level of society and is everyone’s responsibility’.1 In other words, we are all in this together!
Health services in Ireland have traditionally followed a medical model which is underpinned by the philosophical principles of science. Advances in modern medicine arise from scientific experimentation based on a hypothesis and the principle of isolating factors in order to follow a particular line of enquiry. Usually this involves testing the effect of external stimulus on isolated risk factors or particles of a disease to formulate a theory and/or a treatment. The development of vaccinations is a good example. Much of public health policy and practice is based on this particular paradigm which although valuable has its limitations.
One of the limitations of this model is that it underestimates other variables such as context and meaning. I like to think of these as ‘grey matters’.
From a health promotion perspective, we know that health is created and maintained by factors external to the individual and outside of the scope of a health system. Social factors such as income, education status and housing all influence physical and mental health. Furthermore, there is evidence to say that a person’s health is influenced by his / her perception of it. The factors that shape a person’s self-image can be difficult to articulate and measure within traditional healthcare systems and can be seen as too soft or ‘grey’ to consider when formulating policy and practice.
One of the ways of working in health promotion is to develop people’s personal skills to make informed choices about their health. This depends on a shared understanding of health and the factors that influence it. Often, assumptions are made about how individuals interpret and understand information and health messages in this regard. The type of language that is used can be an important factor in imparting information about health and it depends on the level of comprehension and literacy of the person receiving the information. There are alternative means of imparting information and the use of non-threatening and inclusive methods and approaches, such as the arts, is well documented. Reducing health inequalities is a fundamental goal of public health. In order to achieve this, it is essential that people and communities are empowered and supported to take responsibility for their own health and wellbeing.
François Matarasso 2 reported that art projects with vulnerable groups showed improvement in self-perception of physical and mental health and improved health outcomes which were attributed to improved self-confidence, activity and social contact. People voluntarily become involved in arts initiatives as a means of personal expression and social interaction. Engaging in arts experiences is a good forum for exploring health-related ideas in accessible, safe and non-prescriptive ways. Social engagement is in itself an important health predictor – socially engaged individuals are better disposed to understanding and to taking on board health information.
Healthy Ireland aims to ‘…..remove barriers to participation and to provide more opportunities for the involvement of older people in all aspects of cultural, economic and social life in their communities’.3 There are many initiatives for older people to engage in arts experiences, for example, through the national Bealtaine Festival run by Age and Opportunity. Healthy Ireland recognises that health is socially produced and that all sectors of society have a role to play in promoting health and wellbeing. Working together in partnership is the most effective way to harness resources and support for work in the area of arts and health. Local structures and partnership are in place which seek to do this such as the Arts for Health initiative in West Cork. These partnerships could be used as models of good practice ‘to promote and foster advocates for health and wellbeing in all sectors of society’.4
In order to be sustainable and for the value of art and its impact on health and wellbeing to be fully recognised and integrated into health care, policy is needed in this area. The Arts Council of Ireland developed its Arts and Health Policy and Strategy in 2010 which was endorsed by the HSE, but was never formally incorporated into health policy or practice. One of the key themes in Healthy Ireland is the reform of the health system and this sets the stage for the integration of arts and health as a standard in health care. There is a commitment to the implementation of health and wellbeing quality and performance standards for health care staff. There is also a commitment to training and continual professional development of staff and this could include, for example the roll out of a high quality sustainable national care staff training programme in the arts which could be based on best practice in this area in Ireland and the UK.
As a public health policy document, Healthy Ireland is exciting in that, for the first time there is official acknowledgement that health and wellbeing is a human right and there is a government commitment to creating the best possible conditions for health to flourish. Of course the implementation of policy must be based on both need and best evidence. Healthy Ireland recommends that a research plan be developed which will inform future policy, practice and service development. One hopes that the research plan can include other paradigms beyond the scientific. I believe that there is an opportunity to include a more humanistic viewpoint which encompasses all of the determinants of health and wellbeing including the social, spiritual and psychological and this is where art has a role to play. Other countries have managed to do this, Australia for example, and so there are models to follow.
Caroline Peppard works as a Senior Health Promotion Officer in the HSE. She is interested in ways to engage difficult to reach groups in conversations about health and wellbeing and she sees the potential for using art to achieve this. She is also interested in social and health policy and how this can influence arts and health.
1 Department of Health (2013). Healthy Ireland: A Framework for Improved Health and Wellbeing 2013-2025. Department of Health.
2 Matarasso, F. (1997). Use or Ornament, The Social Impact of Participation in the Arts. UK: Comedia.
3 Department of Health (2013). Healthy Ireland: A Framework for Improved Health and Wellbeing 2013-2025. Department of Health.
In order to be sustainable and for the value of art and its impact on health and wellbeing to be fully recognised and integrated into health care, policy is needed in this area.