A GUEST BLOG BY DR STEPHEN CLIFT
This guest blog by Dr Stephen Clift calls for a thorough appraisal of research about how art might contribute to health and wellbeing and argues for greater critical debate about arts and health practice and research.
Stephen Clift (BA, PhD, PFRSPH) is Professor Emeritus, Canterbury Christ Church University, and former Director of the Sidney De Haan Research Centre for Arts and Health. He is a Professorial Fellow of the Royal Society for Public Health (RSPH) and is also Visiting Professor in the International Centre for Community Music, York St John University. Stephen has worked in the field of health promotion and public health for over thirty years, and has made contributions to research, practice and training on HIV/AIDS prevention, sex education, international travel and health and the health promoting school in Europe. His interests relate to arts and heath and particularly the potential value of group singing for health and wellbeing. Stephen is one of the founding editors of the journal Arts & Health: An international journal for research, policy and practice. He was the founding Chair of the RSPH Special Interest Group for Arts, Health and Wellbeing, and a founding trustee of Arts Enterprise with a Social Purpose (AESOP). He is also co-editor with Professor Paul Camic of the Oxford Public Health Textbook on Creative Arts, Health and Wellbeing published in November 2015. Currently, he is working on developing a series of provocations in arts and health research. a special collection of critical papers on arts and health with Frontiers in Psychology, and a special issue of the International Journal for Community Music on the impacts of the COVID-19 pandemic.
ARTS, HEALTH AND WELLBEING: THE NEED FOR ROBUST APPRAISAL OF RESEARCH IN THE FIELD, BY STEPHEN CLIFT
Here are some initial thoughts on the need for robust appraisal of research on the contribution of the arts to health and wellbeing. These are followed by a proposal to initiate critical debates on the current status of arts and health practice and research. Three specific provocations to practitioners and researchers will be forthcoming.
- There is a serious need for more robust and critical scholarship in the field of arts and health. This is revealed by reviews of the APPG (2017) Creative Health report and the Fancourt and Finn (2019) WHO Scoping Review (Phillips, 2019; Clift, 2020). There are also examples of recent publications in the field which are of questionable value, and which may even be described as banal, trivial, and spurious (e.g. Burns and Van Der Meer (2020) on the wellbeing benefits of crochet; Haiblum-Itskovitch, Czamanski-Cohen and Galili (2018) on the effects of materials used to draw on heart-rate variability, and Fancourt (2019) on emotion regulation through artistic creative activities). Such publications raise questions about the standards of journal reviewing of manuscripts submitted for publication, but more fundamentally, questions on the decisions made by researchers on what lines of enquiry are important to pursue; how research is reviewed by funding bodies and how research is reviewed and approved by ethics committees.
- There is continued fragmentation in practice and scholarship in arts and health, with little mutual exchange between communities of interest in the creative arts therapies, medical/health humanities, and arts and health. There is a need for renewed debate on whether such ‘boundary maintenance’ is acceptable and appropriate or whether further efforts are needed to foster cross-sector collaborations.
- There are continuing philosophical and ideological challenges regarding the underpinning values and assumptions regarding the role of the arts in relation to health. Atkinson (2017), for example, draws a contrast between ‘arts as a panacea’ and arts as ‘a provocateur’ and asks whether art therapists are ‘agents of social control or agents of social change?’. There is a need to revisit the roots of the field (for example, the position outlined in the seminal 1990 PAT-10 report) and understand its continued principal drivers in values.
- There is no clarity on the principal academic disciplines and theoretical frameworks which provide the foundation for ‘arts and heath’ research and practice. What does current research look like when viewed from different disciplinary perspectives? It would be useful, for example, to consider the analysis of the state and challenges facing Psychology as outlined in Seven Deadly Sins of Psychology (Chambers, 2019) in relation to research in ‘arts and health.’ Is arts and health research subject to these ‘sins?’ Are arts and health researchers aware of the issues Chambers raises? Is the field attempting to address them?
- There is a need for further debate on the ways in which arts and health research and practice can have integrity both with respect to artistic creativity and process, and from a scientific point of view. What is the role of the creative artist in arts and health practice and research? What conceptions of ‘artistic, creative activities’ are adopted in research studies and are they intelligible (see for example, Fancourt et al., 2019 for a controversial view)? Is it meaningful to regard the arts as ‘an intervention’ in health and social care? The work of Aesop (2019) in the development of its Dance to Health initiative is provocative in this regard and deserves to be widely debated and explored in further projects.
- There is a need, in addition to systematic reviews of research evidence, for the identification of key exemplars of robust research that can serve as models of the best work so far and what such work has succeeded in demonstrating. Cutler (2018) identifies Cohen et al. (2006, 2007) as ‘the landmark study’ in this field – when in fact, it was flawed (Clift et al., 2008), and key findings (e.g. a reduction in falls associated with singing) have not been replicated. Where are the robust, convincing demonstrations that creative arts engagement really does impact substantially on health and wellbeing?
- There is a need to work towards consensus on standards for practice and research in specific areas of the field, and clear priorities on the key theoretical, methodological and empirical questions to be addressed (models for this kind of work are the consensus statement provided by Lewis et al. (2016) on practice and research on singing and lung function). Discussions are especially needed on the relationships between artists, researchers and participants in practical/research projects, with a focus on the idea of ‘co-production.’ (see Rose, Carr and Beresford (2018), for example, for a critical discussion on the role of mental health service users in research)
- There is a need for careful monitoring of published research on arts and health to assess it robustly in the light of the concerns outline above. This could involve a critical assessment of arts and health research published in peer-reviews journals over a specified period to monitor trends on: topic, context, participants and their role, activity, role of creative artists, role of participants, theoretical frameworks, methodological perspectives, results, key conclusions, policy and practice implications.
- There is evidence of naivety in relation to the extent to which and the ways in which research evidence can inform policy and practice in the health field (Clift, 2020). The current model pursued by Aesop (2019) in the development of the Dance to Health initiative explicitly recognises the challenges of translating research into practice and scaling up provision. This model deserves to be more widely appreciated in the field and acted upon in other areas of arts and health.
In order to explore these issues further, the following steps are in process:
- A call for papers providing critical reappraisals of what has been achieved in the field of arts and health; critical reviews of psychological research in arts and health following the analysis provided by Chambers; explorations of radical perspectives in arts and health focused on social change; assessments of the relative values of quantitative and qualitative research on the contributions of the arts to health and wellbeing; a new focus on concepts of artistic integrity in arts and health programmes, and an exploration of co-production and user-led research in arts and health. Discussions are on-going with Frontiers in Psychology for a collection entitled: Towards a critical appraisal of practice and research in arts and health. A webinar on the need for a more critical perspective on arts and health research will take place from the International Centre for Community Music, York St John University in September 2020.
- A more specific call for papers for a special issue of the International Journal for Community Music to be published Autumn 2021. We would welcome contributions from individual community musicians and community music therapists offering considered reflections on their practice in response to the COVID-19 challenge; contributions from community music organisations on how the pandemic has affected them and their future plans, and researchers who have explored the wider implications of the COVID-19 crisis for the field. Reviews of research literature published elsewhere would also be welcome. A special editorial board will be established to support the development of this issue; encourage submissions and review manuscripts. A webinar associated with this call will be organised by the International Centre for Community Music in September 2020. An online conference for the Autumn of 2021 to coincide with the publication of the special issue.
AESOP (2019) Final report on Phase one of the Dance to Health project: Oxford: Arts Enterprise with a Social Purpose. https://www.artshealthresources.org.uk/docs/creative-health-the-arts-for-health-and-wellbeing/ https://ae-sop.org/resources/
APPG (2019) Creative Health: the arts for health and wellbeing. London: All Party Parliamentary Group. https://www.culturehealthandwellbeing.org.uk/appg-inquiry/
Burns, P. and Van Der Meer, R. (2020) Happy Hookers: findings from an international study exploring the effects of crochet on wellbeing https://journals.sagepub.com/doi/abs/10.1177/1757913920911961
Chambers, C. (2019) The 7 Deadly Sins of Psychology. Princeton: Princeton press (with new preface) https://press.princeton.edu/books/paperback/9780691192277/the-seven-deadly-sins-of-psychology
Clift, S. (2020) Review of Fancourt and Finn (2019) What is the Evidence on the Role of the Arts in Health and Wellbeing: A scoping review. Copenhagen: World Health Organization. https://www.idunn.no/nordic_journal_of_arts_culture_and_health
Clift, S. et al. (2008) Singing and health: A systematic mapping and review of non-clinical research: Canterbury: Canterbury Christ Church University. https://www.artshealthresources.org.uk/docs/singing-health-a-systematic-mapping-review-of-non-clinical-research/
Cohen, G. et al. (2006) The impact of professionally conducted cultural programs on the physical health, mental health, and social functioning of older adults, The Gerontologist, 46, 6, 2006, 726–734. https://academic.oup.com/gerontologist/article/46/6/726/584645
Cohen, G. et al. (2007) The impact of professionally conducted cultural programs on the physical health, mental health, and social functioning of older adults: Year 2 results. The Journal for Aging, Humanities and the Arts, 1, 1-2, 5-22. https://www.tandfonline.com/doi/abs/10.1080/19325610701410791
Cutler, D. (2019) Around the World in 80 Creative Ageing Projects. London: Baring Foundation. https://baringfoundation.org.uk/resource/around-the-world-in-80-creative-ageing-projects/
Fancourt, D. et al. (2019) How do artistic creative activities regulate our emotions? Validation of the Emotion Regulation Strategies for Artistic Creative Activities Scale (ERS-ACA) PLoS One, 14, 2, 1-22. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0211362
Fancourt, D. and Finn, S. (2019) What is the Evidence on the Role of the Arts in Health and Wellbeing: A scoping review. Copenhagen: World Health Organization. https://www.euro.who.int/en/publications/abstracts/what-is-the-evidence-on-the-role-of-the-arts-in-improving-health-and-well-being-a-scoping-review-2019
Haiblum-Itskovitch et al. (2018) Emotional response and changes in heart rate variability following art-making with three different art materials, Frontiers in Psychology, 18, 9, 1-9. https://pubmed.ncbi.nlm.nih.gov/29967587/
Lewis, A. et al. (2016) Singing for lung health – a systematic review of the literature and consensus statement, npj Primary Care Respiratory Medicine, 26. Published online. https://pubmed.ncbi.nlm.nih.gov/27906158/
Policy Action Team (1999) PAT-10: The Contribution Arts and Sport Can Make. London: HMSO. https://www.artshealthresources.org.uk/docs/pat10-policy-action-team-10-report/
Phillips. K. (2019) A constructive-critical response to Creative Health: The Arts for Health and Wellbeing (July 2017) by the All–Party Parliamentary Group on Arts, Health and Wellbeing, International Journal of Art Therapy, 24, 1, 21-29. With a response from the APPG. https://www.tandfonline.com/doi/abs/10.1080/17454832.2018.1491612
Rose, et al. (2018) ‘Widening cross-disciplinary research for mental health’: what is missing from the Research Councils UK mental health agenda? Disability & Society, 33:3, 476-481. https://www.tandfonline.com/doi/pdf/10.1080/09687599.2018.1423907?needAccess=true