Authors: Ros McLellan and Maurice Galton with Megan Walberg
Institution: Creativity, Culture and Education, University of Cambridge
Full reference: McLellan R, Galton M and Walberg M (2015) The Impact of Arts Interventions on Health Outcomes – A survey of young adolescents accompanied by a review of the literature.
Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (World Health Organization, 1948).
When thinking about issues related to their health, most people probably think of physical symptoms of illness and perhaps a visit to their General Practitioner for treatment; but as is clear in the World Health Organization definition above, health encompasses much more than simply not being physically ill. In fact health is expressed in terms of wellbeing in the physical, mental and social domains. If health and wellbeing are seen as synonymous in this way, it stands to reason that research on wellbeing has important implications for health.
The authors of the report have a long-standing interest in young people’s engagement, motivation and more recently wellbeing in educational settings and have been working with Creativity, Culture and Education (CCE) for a number of years.
Their initial work, The Impact of Creative Partnerships on the Wellbeing of Children and Young People, (full report here) explored whether the Creative Partnerships programme had a positive impact on young people’s wellbeing. This provided us an opportunity to explore in detail what is meant by wellbeing and to distinguish two facets; namely eudaimonic or functional wellbeing (ie self-actualisation and fulfilling potential) and hedonic or feeling wellbeing (ie feeling good and enjoying life.) Their review of the literature, The Impact of Creative Initiatives on Wellbeing: A Literature Review, (review here) suggested, that both could be fostered through engagement in creative initiatives. Their empirical research revealed that schools participating in the Creative Partnerships (CP) programme were more likely to facilitate young people’s eudaimonic wellbeing as an outcome of the various creative initiatives undertaken, whilst schools that were not involved in the programme tended to try and promote hedonic wellbeing as a means to engage young people more fully in their schooling.
This work had therefore demonstrated a strong, although complex, link between engagement in creative initiatives and young people’s wellbeing in school. With the support of Guy’s and St Thomas’ Charity, CCE asked the authors to review the evidence of whether arts-based interventions could help promote health, given the overlap between wellbeing and health noted above. The authors did three things:
Their review of the literature indicated that a very wide range of arts-based interventions are being used to promote various facets of health. In clinical settings, music, visual arts and dance/expressive movement were most often deployed to support emotional or psychosocial rather than physical aspects of health. In schools story telling combined with visual art tended to be used with children who had suffered trauma, whilst music was more likely to be the art of choice for students suffering from mental health issues such as depression or mental disability (for instance autism). Dance/expressive movement tended to be used to improve physical health but also to promote self-esteem. Most studies published reported some positive evidence that the intervention was impacting positively on the specific health indicators in question. However properly evaluated intervention studies (for instance using randomised control trials or at least a control group, with a reasonable sample size, utilising outcome measures that didn’t just rely on one form of self-report and running over a decent time period of at least 9-12 months) are thin on the ground. Thus overall the evidence is suggestive but not persuasive and more research is needed.
The health survey revealed students reported the same frequency overall of symptoms relating to poor physical health at the beginning and end of Year 7 and this did not differ by type of school. In other words, the self-reported physical health of students in schools promoting the arts did not differ from those attending the other schools in the study. The second aspect of health captured on the questionnaire related to reports of engaging in a healthy lifestyle (diet and exercise). Students in arts-specialist schools reported engaging in activities indicative of a healthy lifestyle less frequently at the end of the year compared to the start, whilst students in the other schools remained level in this respect. However, this scale turned out to be borderline in terms of acceptable reliability, so we need to be cautious in drawing conclusions. Other data gathered during the study indicate that many of the arts activities promoted in the arts-specialist schools were not targeted at Year 7 and the overall experience of students in terms of arts interventions was quite similar in all four schools. Thus it is difficult to make any claims about the impact of arts interventions on health outcomes based on this research.
Finally, the reanalysis of data from the previous CCE study indicated that there is a significant and stronger relationship between eudaimonic wellbeing and feeling healthy and energetic, compared to hedonic wellbeing and the same health indicators, a relationship which was more robust for students in secondary compared to primary schools and more evident in the Creative Partnerships schools. Feeling stressed was more negatively associated with hedonic than eudaimonic wellbeing, and again the relationship was more marked for older students, and this trend was more evident in non CP schools. Overall this provides some evidence that wellbeing (eudaimonic wellbeing in particular) and health seem to be more closely connected in schools undertaking arts interventions, especially at secondary school level. Although this does not prove any sort of causality, it does imply it is worth looking more closely at the role of arts interventions in promoting health outcomes in the school context.