A social model for health

'In a social model perspective on health, the health services are but one element, albeit an important element, in terms of impacting on both individual and community health and wellbeing.'

The recent initiative from the Arts Council to develop an arts and health policy and strategy is to be welcomed.  One of the interesting proposals arising from this policy and strategy is the development of a strategic partnership with the HSE at national level in order to:

1. Facilitate practical collaboration across respective arts and health policies to facilitate cross sector learning and develop shared understanding and language relating to arts and health practice.
2. Build a strategic framework for the sustainable development and support of arts and health practice at national and regional levels into the future.

In this article I wish to comment on the ‘Health’ aspect of arts and health practice and specifically explore the social model of health which focuses on the social determinants of health (age, sex, hereditary factors, individual lifestyle factors, social and community networks and general socio-economic, cultural and environmental conditions). I feel this dimension of the work has received insufficient focus to date within critical discussion on arts and health practice in Ireland.  It is also timely in the context of ongoing and proposed future change in the organisation of health services in Ireland.

In a social model perspective on health, the health services are but one element, albeit an important element, in terms of impacting on both individual and community health and wellbeing. The health sector encompasses an extremely broad range of settings and engages with people at all stages of the life cycle with a view to enhancing both their own and their community’s health and well being.  The HSE is partnered in this work with a highly diverse range of NGO  groups (from large voluntary organisations delivering specific services to small community-based groups offering modest but very important services such as social contact opportunities etc).  Furthermore and in the context of a social model of health, the role of other sectors such as education, housing, local government etc, all impact on the individual and community health and well being agenda.  This broader view of health and well being (individual and community) has implications for the arts and health debate in that it brings into play wider health sector agenda issues that need to be seen as equally valid and given appropriate acknowledgement in the process. Arts and health work can be part of a health agenda that seeks to intervene positively across the domains of , for example, health inequalities, person centred care, the development of social support networks, social inclusion, advocacy, recovery models of work in mental health, early intervention work with young children, community development / health, childcare/ family support etc.

Arts and health work is a partnership of two sectors which are extremely diverse.  There is a need for conversations not just between the sectors but also within the sectors.  On the health side we need to move away from limiting terminology such as ‘healthcare’ settings and focus on promoting the arts and health agenda in the context of a social model of health. This approach recognises the validity of work not just in traditional healthcare settings such as hospitals, day care centres etc. but also across a wide spectrum of groups / settings including for example children under three in early years settings, users of services for people affected by domestic / gender violence, visiting services to vulnerable older people, children in residential care etc.

Extending the range of settings / groups involved in the arts and health sector will not diminish the acknowledged importance from the arts sector side of the need for clear artistic vision, goals and outcomes in the process.  The social model of health approach and its focus on both individual and community health and well being will enhance the range and type of arts intervention possible – participatory arts practice, performance work, environmental enhancement access programmes – and provide opportunities for a wide range of art forms to be deployed. It will also broaden opportunities for greater access to cultural experiences amongst groups of people who are often excluded from such access.

I acknowledge that a definition of the arts and health sector based on the social model of health perspective could become a sector without boundaries and that that could cause its own problems.  However I would argue that especially in the current social and economic climate that discussion about boundaries between arts and health, arts and disability, art therapy, arts and education etc is of less importance than focussing on the promotion of good practice across this broad and diverse field. On a practical level arts and health work will be stymied in its development if it allows itself to be pigeon-holed in terms of budgets etc.  Despite all the funding difficulties across all the sectors I would argue that there are resources (funding, personnel, expertise etc.) within the health and related NGO sector to effectively promote this agenda.  It will need to involve collaborative working at local, regional and national level and can provide opportunities for creative and exciting new partnerships involving local community groups/expertise, health services providers (from acute services settings to the emerging field of primary care), links with third level education providers, the arts world (artists, theatre companies, arts centres etc) and relevant statutory agencies etc. It is important for any arts and health initiative that both sides would work to recognise and understand the particular history, institutional contexts and issues that both bring to the process and that the resultant learning feeds into an ongoing process of reflection and development.

Aidan Warner is the Principal Community Worker for the South Lee Community Work Department, HSE South (Cork).