Culture, Health and Wellbeing: Building a Manifesto

The constant interloper

To lay my cards on the table, I am an arts-in-health person from the UK, who moved north–south to Johannesburg, and into the medical humanities, and has now clambered back north again into what has expanded into culture, health and wellbeing, and with great luck and some trepidation taken on the directorship of a new national alliance.

When I first worked in arts-in-health – as a hospital arts manager in London – the medical humanities (MH) were a distant relation seen blurrily at the edge of my world; our paths rarely crossed, but I had a vague sense of poetry and classicism. When I moved much later into the MH in a Johannesburg research institute, I shifted focus, and the arts suddenly seemed to lose a little of their primacy – becoming one part of the bigger question of bringing different thinking to bear on the shape and grain of medicine and health.

We see each other’s worlds through different ends of a telescope perhaps.

New alliances

The Culture, Health and Wellbeing Alliance is a national organisation representing everyone who believes that cultural engagement and participation can transform our health and wellbeing. We are developing a new Manifesto for Culture, Health & Wellbeing, which will address this question: What do we want the intersection of Culture, Health and Wellbeing to achieve in society? This blog is a chance to say hello from the other side of the telescope, and to ask you for your contributions.

Bleakley and Jones suggest that ‘the medical humanities “begin” as the nascent art therapy movement’ of the 1940s. Where the arts therapies sit now in relation to medical humanities, I’m not sure – possibly a wandering parent still, but I wonder whether they are generally regarded as central to, or generative of the MH? I would be interested to hear any reader’s thoughts on this for a blog later in this series. And then there are the many other kinds of arts or culture working with health and medicine that come from different traditions. The histories of the applied arts and community arts, the commercial arts and the heritage sector all feed into culture, health and wellbeing. Not to mention Fiona Johnstone’s recent call for a Visual Medical Humanities on this blog. Indeed in relation to medical humanities, it’s all a messy, unstable Venn diagram that at various times I have tried to share with students, although they are doubtless a lot less interested in these niceties than I am. Perhaps they’re right, and in fact it doesn’t matter at all which bit intersects with what and how. We do get a bit obsessed with semantics in this world.

Words often do matter, though – and the recent shift from ‘arts in heath’ to ‘culture, heath and wellbeing’ that I mention above is significant. The ‘wellbeing’ bit is a conversation for another day (although see the What Works Centre for Wellbeing), but on ‘culture,’ Arts Council England is shifting too, as a new consultation document for their forthcoming 10-year strategy suggests:

Within this document, we refer repeatedly to ‘culture’, ‘creativity’, and ‘creative practitioners’, rather than ‘art’, ‘the arts’ or ‘artists’. This is partly to acknowledge that our role includes activities involving museums and libraries as well as the arts, but it also reflects findings from the research commissioned for the new strategy, which showed that the general public’s understanding of what is meant by ‘the arts’ and ‘artists’ is significantly narrower than our own.

The new Culture, Health and Wellbeing Alliance is a regionally constituted group that brings together two pre-existing national alliances, one for arts, health and wellbeing and one for museums, heath and wellbeing. We work too with national organisations like Paintings in Hospitals, Live Music Now, Voluntary Arts, GEM – not to mention NHS England, the Royal Society for Public Health, and many many others. As ACE explain, ‘culture’ is a way of bringing the worlds of heritage and the arts together. But it’s a bigger term than that, and particularly in medical humanities, where the cultures of health are considered, it implies something quite different. This has in the past meant that some confused submissions to the International Conference for Culture, Health and Wellbeing that have more to do with anthropology than creativity. But its ambiguity also makes it a useful term. The Alliance is currently developing a Manifesto for Culture, Health and Wellbeing and planning a conference for March 2019. Both will tackle the meanings of this word head-on as a way to open up our work, critique it and move the conversation forward.

Working with creative practice in relation to health is about culture. The culture of health, the culture of medicine, the culture of the arts, the culture of heritage. That is what happens when you bring cultures together – the ‘entanglement’ (Whitehead and Woods 2016) leads one – healthily – to question the integrity of each. Working in medical humanities has taught me this, or rather has given me the tools and points of reference to be able to articulate it. This is not to say that everyone has to be a medical humanities researcher to be able to think clearly. One of my least favourite aspects of academia is the persistent tendency implicitly to sideline knowledge developed outside the confines of the university. What is best about the best medical humanities is that it seeks to treat all knowledge as equal, whether it is written or embodied, manifested in a garden or an article.

So to the question: What do we want the intersection of Culture, Health and Wellbeing to achieve in society?

Since I left the UK in 2013 the growth of this field has been vast – in terms both of the sheer numbers of people doing this work, the increased political credibility conferred by the publication of the All Party Parliamentary Group’s Creative Health report, and the confidence with which people discuss the work. Alex Coulter recently pointed out the significance of the Sun’s coverage of social prescribing, which reported positively on sending people to art classes, in stark contrast to their legendary Taking the Picasso headline about a decade years ago (you can see it in Clive Parkinson’s blog, scroll down the sidebar). We’re close here to the ‘activist edge’ (Viney et al. 2015) of medical humanities and more and more this work is discussed in activist terms. For me this is only exposing what has always been there in the effort to collapse the boundaries between creativity and health. But the politics of today lends these arguments a certain urgency. Our new Manifesto has to take into account a political climate different to the atmosphere around the Charter for Arts, Health and Wellbeing in 2012. To that end we are asking a series of questions – ways to start the conversation.

1. What does culture mean to you, and how does it relate to creativity and the arts?
2. How does the intersection of culture, health and wellbeing relate to health and social inequalities?
3. What implications do both environmental change and the movement of people have for this work, and how can we work best in relation to this?
4. How might we work with rapidly developing digital and artificial intelligence thinking and practice?
5. How can we ensure diversity in our work, in every sense of this word?

Because leading questions are always a problem, we have also suggested some key words that may spark ideas:

• culture
• diversity
• partnership
• inequalities
• knowledge
• context
• environment
• digital and AI

And because key words are leading too, you are most welcome to ignore all of the above, and send any thoughts you have to us by emailing victoria@culturehealthandwellbeing.org.uk

Your thoughts will be collated with many others’ into a document – which we hope will also be a creative object that goes beyond text – that will be produced in early 2019 in time to stimulate the next round of discussion at our March 2019 conference. Watch this space.

References

Bleakley, Alan and Therese Jones. 2013. “Appendix: a timeline of the medical humanities.” In Medicine, Health and the Arts, edited by Victoria Bates, Alan Bleakley and Sam Goodman, 281–4. Oxford: Routledge.

Viney, William, Felicity Callard and Angela Woods. 2015. “Critical Medical Humanities: embracing entanglement, taking risks.” BMJ Medical Humanities 41: 2–7. Doi:10.1136/medhum-2015-010692

Whitehead, Anne and Angela Woods. 2016. “Introduction.” In The Edinburgh Companion to the Critical Medical Humanities, 1–31. Edinburgh: Edinburgh University Press.