Centre for Medical Humanities University of Durham

• Workforce development• Interdisciplinary research

and evaluation• Delivery of multi-sector

‘arts in health’ projects• International profile and

network hub• A special commitment to

the North East region cmh.info@durham.ac.uk www.dur.ac.uk/cmh

Arts in Community Health - ‘the collective body’(Image: Antony Gormley Domain Field 2003)

Are arts in health a means of treating people …or a way of helping them view the world?

- Making ‘new traditions’-an alignment between the social determinants of health

and the cultural imperative to make art?

From past social evils to present injustices

Adapted from Daniel Dorling Injustice (2010)

Past social evils (1940s) Present injustices (2010)

Ignorance Elitism

Want Exclusion

Idleness Prejudice

Squalor Greed

Disease Despair

In 2007…urban dwellers became the majority of the world’s population

Autonomy and full social participation are so important for health that their lack leads to deterioration in health.

Michael Marmot Status Syndrome 2004

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.

Michael Wilson Health Is For People. 1975

The Health Map. Barton & Grant 2006Based on a public health concept by Whitehead & Dahlgren. The Lancet 1991

Waste management professionals, Farmers, Gardeners, Landscape Designers Architects, Traffic engineers, Spatial

planners, Electricians, Plumbers, Builders Restaurant owners,

Caterers, Transportation planners, Teachers, Business owners/Employers, Airline workers/ Pilots, Engineers, Scientists, Community Artists

Employers, Businessmen, Bankers

Religious leaders, Local Leaders, School teachers

Doctors, Nurses, Pharmacists, Carers, Social Workers

Political and Global Leaders, Scientists, Business Leaders, Civil Servants

A Sample of Workforces with the potential to influence Determinants of Health

Technical rationality Professional artistry

Practice is concerned with certainty

Uncertainty is endemic

Complexity must be reduced Complexity is inevitable

Factual knowledge is required Some things remain unknowable

Protocols should drive practice Judgment is central to practice

Quality is measurable Quality lies within each professional

Services are to be delivered Care can only be realised

Performance management is essential

Professional self regulation is needed

Regulatory mechanisms are required

Development achieves high quality

Staff training is needed Professional education is required

Coles C. Where is the wisdom? Professional education and the realisation of health care. Oxford University Press; 2005.

Common KnowledgeTyne and Wear Health Action Zone

2000-2004

• Multi-sector arts in health learning programme

• Network of 250 people• 50 pilot projects• Research and

evaluation• Has influenced growth

of networks in Yorkshire, East Midlands, North West, County Cork and Western Australia

Project Director

ProjectCoordinator

Project Manager

Art

Education

LocalGovt.

Health

Vol.Sector

Admin

Sunderland

South Tyneside

North Tyneside

Gateshead

The Governance Group

Core Staff

Phase I Pilot Project

Phase II Pilot Project

The COMMON KNOWLEDGE NETWORKThe Arts in Health initiative for the Tyne and Wear Health Action Zone

Phase I Regional Project

Action day/ event

The constituents of the Governance Group are also representative of the region and most have direct experience of CK Projects.

Evaluator

CAHHM

Core staff are all part time, with a total of 250 person days per annum, excluding administrative assistance.

DCMSEvaluation

As well as the CK evaluator and links with The Centre for Arts and Humanities in Health and Medicine at Durham University, CK is being evaluated by the Dept. of Culture, Media and Sport.

The Common Knowledge network has created projects using differing art forms including music, drama and the visual arts, for a variety of care groups representative of the five HAZ targets – older people, young people, coronary heart disease, cancer and mental health.

Phase III Development Project

Newcastle

250+ constituents, most also representing organisations. All have participated in CK events.

Key dimensions of arts/health

Supporting care – projects that support the process of care by working on the softer aspects of ill-health that health services, under the strain of heavy demand, cannot reach. Projects in the third group share some common ground, but aim to communicate with communities as a whole.

Unity is health – projects that start from the point of using creativity to enhance social relationships. These reflect a growing school of thought that good relationships are a major determinant on health.

Engaging groups – projects that engage groups to bring communities and health promotion closer together. They use creative methods to explore, disseminate, and communicate messages about health.

Creativity and well being –projects that emphasise creativity as a route to well being. These aim to work with individuals to better understand their health, using creative approaches as a means to expression. Art is seen as a potential therapy.

Art

Health Services

Social Individual

Key dimensions of arts/health

Supporting care – projects that support the process of care by working on the softer aspects of ill-health that health services, under the strain of heavy demand, cannot reach. Projects in the third group share some common ground, but aim to communicate with communities as a whole.

Unity is health – projects that start from the point of using creativity to enhance social relationships. These reflect a growing school of thought that good relationships are a major determinant on health.

Engaging groups – projects that engage groups to bring communities and health promotion closer together. They use creative methods to explore, disseminate, and communicate messages about health.

Creativity and well being –projects that emphasise creativity as a route to well being. These aim to work with individuals to better understand their health, using creative approaches as a means to expression. Art is seen as a potential therapy.

Art

Health Services

Social Individual

Key dimensions of arts/health

Supporting care – projects that support the process of care by working on the softer aspects of ill-health that health services, under the strain of heavy demand, cannot reach. Projects in the third group share some common ground, but aim to communicate with communities as a whole.

Unity is health – projects that start from the point of using creativity to enhance social relationships. These reflect a growing school of thought that good relationships are a major determinant on health.

Engaging groups – projects that engage groups to bring communities and health promotion closer together. They use creative methods to explore, disseminate, and communicate messages about health.

Creativity and well being –projects that emphasise creativity as a route to well being. These aim to work with individuals to better understand their health, using creative approaches as a means to expression. Art is seen as a potential therapy.

Art

Health Services

Social Individual

Key dimensions of arts/health

Supporting care – projects that support the process of care by working on the softer aspects of ill-health that health services, under the strain of heavy demand, cannot reach. Projects in the third group share some common ground, but aim to communicate with communities as a whole.

Unity is health – projects that start from the point of using creativity to enhance social relationships. These reflect a growing school of thought that good relationships are a major determinant on health.

Engaging groups – projects that engage groups to bring communities and health promotion closer together. They use creative methods to explore, disseminate, and communicate messages about health.

Creativity and well being –projects that emphasise creativity as a route to well being. These aim to work with individuals to better understand their health, using creative approaches as a means to expression. Art is seen as a potential therapy.

Art

Health Services

Social Individual

‘When a gift passes, it becomes the binder of many wills. What gathers in it is not only the sentiment of generosity but the affirmation of individual goodwill, making of those separate parts a spiritus mundi, a unanimous heart, a band whose wills

are focused through the lens of the gift. Thus the gift becomes an agent of social cohesion, and this again leads to the feeling that its passage increases its worth,

for in social life at least, the whole is greater than the sum of its parts’.

Lewis Hyde “The Gift” 1981

Closing The Gap in a Generation: health equity through action on the social determinants of health. WHO: Geneva 2008.

“Evidence is only one part of what swings policy decisions – political will and institutional capacity are important too. But more than simply academic exercises, research is needed to generate new understanding in practical, accessible ways…recognising and utilising a range of types of evidence, and recognising the added value of globally expanded Knowledge Networks and communities”.

Arts in community health – a small-scale global phenomenon

Siyazama [‘We Are Trying...’]

“We used to sit around all day doing nothing, but now we can do this and children come and ask what we are doing, so we tell them they can do it one day, so they grow up with the message in them. It is very empowering that I can teach others, and when I die, other people have something to remember me by. I am very happy about that and to think I can make a difference in the world.”

Tholiwe Sithole, aged 80

Msinga, Kwazulu-Natal, South Africa

International ‘critical mass’ meeting, Durham 2011- from UK, Australia, USA, South Africa, Mexico, Ireland

Looking for a meaningful exchange of research and practice between North of England and

Western Australia

From 2010, new Common Knowledge programmes in Gateshead, South Tyneside and Co. Durham

Induction event

Developing a multi-sector workforcefor community-based

arts in health promotion

Health TopicSeminars

Leading to…

Pilot Projects

Co-mentoring

Placements

Developing reflective practice

• The foundation of purposeful learning.

• Learning how to take a perspective on ones own actions and experience - examine experience rather than just live it.

“• I will tell others that if they take part in Common Knowledge they will be inspired and they will

make lots of contacts and see the bigger picture.“

• "You learn about the evidence base for arts in health and wellbeing, getting practical ideas about project process and evaluation.“

• "I have greater understanding of evaluation tools for capturing information to use for future development and partnership working to access funding. It's been a wonderful and enlightening experience.“

• "I am surprised I have been able to apply the knowledge I have gained into a real project - I was sceptical at the start but now feel I could explain to colleagues the benefits of using the arts to promote health.“

• "I can see the impact it has had on my personal life - trying to do more creative things myself - and I recognise creative elements in my work that are not necessarily about producing things but about the way I do things."

Common KnowledgeBringing together arts, health and education

To develop:• Relationship-based

working through creative activity

Common KnowledgeBringing together arts, health and education

To develop:• Relationship-based

working through creative activity

• Health literacy

Common KnowledgeBringing together arts, health and education

To develop:• Relationship-based

working through creative activity

• Health literacy• Emotional health

and well-being

Common KnowledgeBringing together arts, health and education

To develop:• Relationship-based

working through creative activity

• Health literacy• Emotional health and

well-being• Resilience

Resilience occurs when the personal meets the political, when the resources we need for health are available so we can realise our potential…We need a communitisation of health, understanding health as a communal experience.

Handbook for Working with Children and Youth: pathways to resilience. 2005.

Participatory Arts Practice in Healthcare Contexts Guidelines for Good Practice

The development of these Guidelines for Good Practice was commissioned from the Centre for Medical Humanities at Durham University, UK, by the Waterford Healing Arts Trust and the Health Service Executive South (Cork) Arts + Health Programme with financial support from Arts Council Ireland/An Chomhairle Ealaíon

Guidelines under 5 headings:

- Participants come first- A responsive approach- Upholding values- Feedback and evaluation - Good management and governance

Download from: www.waterfordhealingarts.com

Seven essential principles

1. Art as the gift

Seven essential principles

2. Congenial space

Seven essential principles

3. Responsiveness

Seven essential principles

4. Self-care

Seven essential principles

5. Identity and sense of place

Seven essential principles

6. Generate well-being

Seven essential principles

7. Responsibility