July 10, 2023
“Whether you are the maker or the beholder, engaging in the arts can benefit you, especially if we can address issues of isolation. [Arts and culture] is just a way to say a big, ‘Yes!’ to life and provide those avenues for older adults to thrive in.”
– Käthe Swaback, Program Officer, Mass Cultural Council (Creative Youth Development and CultureRx: Social Prescription Pilot Program)
This post includes the full version of the seventh issue of The Creative Aging Resource Journal. To receive issues directly in your email inbox, please subscribe to the journal for free! Read previous issues
In this issue, we explore the emerging research and practices of social prescribing for the arts (SPA) and discuss the future of SPA efforts as a vital component of arts and health services in the U.S., especially for older adults. This issue starts framing answers to key questions related to the challenges and opportunities this practice surfaces in healthcare and creative aging. Featured in this issue is a recorded conversation between three leading experts on SPA in the U.S.: Tasha Golden, S. Sudha, and Käthe Swaback.
Table of Contents
Click on the links below to quickly jump to the sections in this post.
What is Social Prescribing for the Arts (SPA)?
Social Prescribing for the Arts (SPA) is a framework enabling doctors or other health service professionals to connect patients with non-clinical health problems to local cultural resources for improved health and wellbeing. These non-clinical referrals may include museum visits, theater or dance performances, or participatory arts programs. SPA is a variation on social prescribing — a more general model for community referrals — that enables health providers to link patients with non-clinical health problems to a range of local services, including housing assistance and food support, nature experiences, physical activity, social centers, and/or the creative arts.
The Intersection of Arts and Health
SPA builds on the robust evidence now available concerning the positive role of the arts in ameliorating non-clinical health issues. For example, a 2019 World Health Organization Report analyzed over 3,000 studies on the intersection of health and arts, indicating that the arts plays a major role, “… in the prevention of ill health, promotion of health, and management and treatment of illness across the lifespan.”
SPA also addresses two growing concerns among health and arts professionals: (1) The need to reduce the negative impacts of social determinants of health, such as loneliness, prejudice, anxiety, or discrimination that undermine wellbeing; and (2) the need to reduce inequities of cultural access that prevent individuals and communities from experiencing the health benefits of cultural experiences.
While all SPA programs inherently involve collaboration between health and arts professionals, each local initiative is different. Programs take varied forms, have varied partners and funding mechanisms, and engage people at varied points across the lifespan, including youth or older adults. Some follow the British model using “link workers,” which are non-health professionals who receive patient referrals from healthcare providers and recommend relevant arts programs or cultural experiences to that individual to improve their physical and mental wellbeing. Alternatively, some programs engage social workers or others with experience and training in health services and/or community referrals.
Some SPA program goals aim to reduce the costs and burdens of unnecessary visits to emergency rooms or doctors, while others aim to strengthen participants’ sense of wellbeing. Roslyn Poulos, a director of Arts on Prescription in Sydney, Australia, states in an article published by the Australian Center for Arts and Health: “When we talk about wellbeing, we are talking about feeling happy, but also about more long-lasting attributes such as a sense of purpose, achievement, and being important to other people.” With a mix of institutional and organizational partners, participants, and socio-economic contexts, it is not surprising that SPA activities and structures are different from place to place; there is no one exact “model.” According to Kerryn Husk of the University of Plymouth (UK), and author of “Global Developments in Social Prescribing” (BMJ Global Health): “Social prescribing isn’t one coherent, individual thing. It’s an idea…the way that idea has been interpreted is quite different in different places.”
Unveiling SPA in the U.S. with Arts and Health Professionals — Roundtable + Transcript (35:42 mins)
“If we had more connected communities, there’s something to be said, not just for the systems and the structures that could be more helpful to the communities, but for interconnected communities that are doing mutual aid and mutual care. We can help shore up some of that to help these programs advance as well.”
– Tasha Golden, Director of Research at the International Arts + Mind Lab at Johns Hopkins Medicine
The adoption of SPA as a health improvement and cultural equity strategy is leading to revised health care policies, practices, and funding in some localities internationally, and even prompting new public and private investment at regional and national levels. In the U.K., where SPA is more highly developed than anywhere else, the 2019 NHS Long Term National Health Plan states: “Within five years, over 2.5 million people will benefit from Social Prescribing.”
Given this international context, it is not surprising that there is discussion, experimentation, and initial investment in SPA programming in the U.S. While U.S. activities are still relatively limited, many professionals in medicine, arts education, community health, social services, and related research are intrigued by SPA and are raising questions about its potential as a framework for addressing the social determinants of health. Lifetime Arts convened the roundtable discussion above with Tasha Golden, PhD, Director of Research at the International Arts + Mind Lab at Johns Hopkins Medicine; S. Sudha, PhD, Professor in the Department of Human Development and Family Studies at University of North Carolina Greensboro; and Käthe Swaback, Program Officer, Mass Cultural Council (Creative Youth Development and CultureRx: Social Prescription Pilot Program) on the key issues involved in the assessment of SPA as a new or enriching strategy for arts and health collaborations in the U.S. Download an enhanced transcript (with links).
For more resources on this topic, please reference this document which includes research and studies, reports, programs, and initiatives developed, researched, and/or supported by Tasha Golden, S. Sudha, and Käthe Swaback.
What Can We Conclude About the Future of Arts and Health for Older Adults?
“People are recognizing that it takes leaders and influencers from the community to create change. Change is truly possible for people when funding is backed with deep listening in communities that are given the tools and resources to be able to heal themselves. This change is deep, powerful, and replicable to every city.”
– Vanessa Ford, Care Coordinator for CultureRx: Social Prescription and Project Manager for the Trust Transfer Project at the Community Music School of Springfield
- Increasing awareness and accessibility of SPA opportunities is the first step.
As S. Sudha mentioned in our roundtable discussion, participation is linked to awareness and access. In the U.S., individuals who are excluded from the healthcare system or not connected to a primary care physician may never discover the opportunities that social prescribing offers for them. In CultureRx’s focus groups, many individuals didn’t realize that these places or programs were applicable to them, let alone offered to them for free. Most importantly, the idea is to increase access to arts and cultural opportunities in the U.S. and not restrict this access to a doctor’s approval. The more transparent and accessible arts and health professionals are about this practice, the more responsive communities will be in participating.- The role of the link worker is vital for making connections and building trust.
In the U.S. and beyond, link workers pave the road between arts and health. Their knowledge of community resources and non-clinical arts and cultural experiences helps to customize a patient’s journey to wellness. S. Sudha emphasized that link workers are the most important, but often overworked and underpaid in most countries. In the U.K., the National Health Service (NHS) funds link workers in a range of healthcare settings, but individual physicians or healthcare directors must seek out and apply for the opportunity to have a link worker. Arts providers are not funded by the NHS, which leads to an uneven distribution of funding and financial support in the U.K. In order for social prescribing methods to be successful, there needs to be proper funding and training resources for link workers. Without their expertise, the relationship and trust-building part of this process between the arts and healthcare system and their patients will not be achieved.- Building camaraderie between arts/culture professionals and healthcare providers can lead to structural change.
Tasha Golden emphasized an important point related to a collaborative and structural process to funding support in the arts, culture, and healthcare sectors: “We are not alone in this work. If you imagine anything that’s a non-clinical referral that a health care provider might refer somebody to, whether it’s housing assistance, food assistance, support groups, etc., all of these programs are having to figure out how to finance their work.” This collective thinking among the different sectors could potentially strengthen camaraderie and generate a shared strategy on how to increase and sustain funding support within the social prescribing spectrum.- Engendering trust within communities can benefit an organization’s program design.
These efforts are rooted in not only identifying and understanding health mistreatment and discrimination throughout history in marginalized communities and groups of people, but also offering arts and cultural programs that are co-designed with those who, “…have lived experiences to inform the issues, wisdom, challenges, and solutions,” as stated by Käthe Swaback. A great example of this trust-building component is the Trust Transfer Project, a collaborative project between the Community Music School of Springfield and the Springfield Cultural Partnership, which was designed to build trust through the eyes of those most impacted by COVID-19. The more transparent and accessible arts and health professionals are about this practice, the more responsive and trustworthy individuals will be — especially older adults — to social prescribing recommendations.- SPA efforts need to be, “…an advocacy for us all.”
In our roundtable discussion, Swaback presented two thought-provoking questions: 1) What is going to be the prescribing model?; and 2) How can arts/culture and health sectors build an alliance with social determinants of health at the roots of social prescribing? The answers are still being researched and explored through the diverse and robust pilot programs happening globally, but as Swaback and Golden stated, the social change around this practice, “…needs to be an advocacy for us all.” This movement is not only about making non-clinical prescriptions more accessible and diverse, but also about shifting mistrust, stereotypes, and negative attitudes about healthcare among the youth and older population. Most importantly, it’s unveiling new ways for older adults to rediscover and redefine their worth and journey to wellness through sustainable and research-backed arts/cultural programs.
SPA Initiatives in the U.S.
A word cloud of responses and testimonials from participants in the CultureRx Social Prescription Pilot Program launched at the Massachusetts Cultural Council. Credit: Massachusetts Cultural Council
The following initiatives stand out as models in the U.S. landscape, with a selection being led by SPA specialists featured in our roundtable discussion. Although each initiative is distinctive, together they offer the beginnings of a framework for a national SPA agenda.
- CultureRx, Massachusetts
CultureRx, a three-year pilot program launched in 2020 at the Massachusetts Cultural Council, is the first fully developed Social Prescribing for the Arts (SPA) program in the U.S. This statewide pilot aims to, “advance the wellbeing of Massachusetts residents and to provide a U.S. model for improving community health via increased access to arts and culture.” The program is soon to move into a fourth phase. With 12 diverse health services and cultural agency partners, participants of all ages, and dedicated staff, CultureRx offers an instructive example of how social prescribing for the arts could help address social determinants of health while expanding access to culture in the U.S. In addition to completing the complex program, a parallel evaluation was carried out by an independent research team. The researchers developed a tailored approach to assessing the effectiveness of the program for participants, partner organizations, and health care providers. The final evaluation offers a model for other complex, multi-partner, geographically distributed projects. The conclusion to the evaluation states that, “…integrating arts/culture assets into health and social care approaches can enrich and improve traditional U.S. models of community referral.” - The Cleveland Clinic, Ohio
The Cleveland Clinic is one of the few hospitals in the nation that is incorporating SPA into its clinical practices. Under the leadership of Dr. Ardeshir Hashi, Chief of Geriatric Medicine, a team has organized a program that emphasizes community activities, including participatory arts, over medications or procedures. Clinicians interview patients about their interests and health goals and work with a referral specialist to connect participants with local cultural opportunities. Dr. Hashmi states that this approach means “really digging in to understand each patient’s personal priorities – the things they live for.” This program offers not only an example of a hospital based SPA program; it also provides a beacon for other physicians and hospital administrators who need to see peer-led programs before launching their own SPA initiatives. - University of North Carolina Greensboro, North Carolina
Dr. S. Sudha, PhD, Human Development and Family Studies Professor at the University of North Carolina at Greensboro, is lead investigator on an international research project designed to determine whether and how SPA could be effective as part of the U.S. healthcare system, particularly for older adults. “Encouraging arts participation can work as a lower cost health intervention,” says Shreeniwas. “It can improve a range of physical and mental health conditions.” To date, she has carried out a portion of the international interviews and will soon be examining projects in the U.S. - National Organization for Arts and Health & Social Prescribing USA
These two national organizations provide organizing bases for SPA activities and advocate for increased integration of arts and health services. These groups may be instrumental in building a constituency for SPA. - New Jersey Performing Arts Center, New Jersey
The New Jersey Performing Arts Center is the site of an arts and health program to, “leverage the power of the arts to encourage mental health and well-being.” The Center aims to, “find new ways to tie public performances, arts education, and community engagement to health and wellness.” Although this program is not strictly social prescribing for the arts, it does reinforce SPA goals, especially in terms of closing the gap between low income communities and the performing arts. - Dr. Alan Siegel, Contra Costa Regional Medical Center, California
Individual physicians are embracing SPA and carrying out practices that advance new thinking about ways people can heal through arts participation. Dr. Alan Siegel, for example, a family physician based in California, and a co-founder of Social Prescribing USA, has been instrumental in building a network of health professionals committed to social prescribing. - University of Florida Center for Arts in Medicine, Florida
Academic institutions offer another path towards greater awareness and understanding of SPA in the U.S. For example, the University of Florida Center for Arts in Medicine, organized and hosted, “Creating Healthy Communities Convening” in October 2022. SPA was a topic of discussion, along with health equity and the role of the arts in health. These kinds of convenings are essential for stimulating new ideas and gaining momentum for changes in practice.
International Pilot Projects
Participants during the pilot program, “Theater Therapy” implemented in Bucharest, Romania as part of the Culture on Prescription project. Credit: Culture on Prescription; Read more
There are numerous examples of new collaboration between the arts and health sectors for the benefit of individuals, communities, and health care systems. Some of these examples include international pilot projects such as:
- Culture on Prescription Project; Germany, Ireland, Belgium, Portugal, Romania, and The Netherlands
This project recently started under the umbrella of the European Union’s Erasmus + initiative, which aims to, “prevent and combat social isolation and loneliness through arts and culture.” Arts, health, and academic institutions in eight countries are involved, with coordination based in Frankfurt, Germany, funding from the EU, and plans for initial “study pilots” in several of the participating countries, including Portugal and Romania. - Social Prescribing and Creative Arts Pilot Program; Waterford, Ireland
This pilot project aimed to establish linkages between Waterford Social Prescribing Service, the Cultural Services of Waterford City and County Council, and external practitioners in creative disciplines. Over two four-week periods, the partners created, implemented, and evaluated two sets of participatory events which were based on cultural activities in the area of creativity. For more details about this pilot project, please connect with Waterford Social Prescribing Service via their GP or by contacting services in Waterford City socialprescribing@sacredheartfrc.ie or socialprescribing-county@sacredheartfrc.ie. - Royal Ontario Museum (ROM); Toronto, Canada
The museum’s health and wellness initiative launched in 2018 as a pilot program, enabling thousands of people from across the province to visit the museum at no cost with a referral from associated ROMCAN healthcare, community, or social service professionals. The pilot program was a collaborative effort with the partners of the ROM’s Community Access Network (ROMCAN), and provided an opportunity for people accessing health or social services to benefit from the uplifting experience of engaging with art and culture. - Kultur am Recept (Culture on Prescription); Denmark
From 2016-2019, four municipalities — Aalborg, Nyborg, Silkeborg and Vordingborg — offered citizens with mild to moderate stress, anxiety or depression to participate in Culture on Prescription, a 10-week fixed group course with cultural activities implemented two to three times a week. The entire course was coordinated by a cultural specialist and encouraged participants to sing, read, draw, and more in the municipality’s cultural institutions with guidance by a cultural guide. Results showed that eight out of 10 participants experienced that their health had improved after a 10-week course, and 3 out of 4 assessed that prescription culture had greatly or somewhat improved their wellbeing. - Arts on Prescription; Gloucestershire, England
In 2015, Create Gloucestershire launched an innovative grant program that gave “test and learn” capacity to 12 arts and health projects in Gloucestershire, designed to generate positive health outcomes for people with long-term health conditions. In 2020, during the height of the pandemic, Create Gloucestershire and five Arts on Prescription (AoP) providers in Gloucestershire, who currently make up Gloucestershire Creative Health Consortium (GCHC), shifted to meet new ways of working. Gloucestershire Creative Health Consortium shared the key aspects of how work was tailored, allowing for ongoing and greater access to the services provided, and explored outcomes over the lockdown periods from 2020-2021 in this paper: GCHC Providing Creative Health in Gloucestershire During Lockdown. In 2022, they launched the “Off We Go” project, a series of peaceful and engaging free activities for people in Berkeley, Cam, Dursley, Sharpness, Wotton-under-Edge and surrounding villages who were feeling more anxious, especially when faced with going out since the pandemic.
Share Your Resources on Social Prescribing for the Arts!
We invite you to share additional research and efforts that are happening in the U.S. and beyond on The Creative Aging Resource Website. Please submit your resources via the form linked below.
Lifetime Arts Says Thank You to Diantha Dow Schull
Following the publication of this issue, our dear friend and creative aging mentor, Diantha Dow Schull, will be stepping away from her current role at Lifetime Arts as the writer, researcher, and curator for The Creative Aging Resource Website and Journal. We are incredibly grateful for her contributions to Lifetime Arts’ growth and impact over the last 15 years. As a cultural organization program specialist, she has helped develop major national creative aging programs for public libraries in collaboration with Lifetime Arts. Diantha’s work underpins our success in making the case for creative aging throughout hundreds of cultural systems across the country. In her latest role, she has helped us curate over 600 resources on The Creative Aging Resource and developed seven robust and thought-provoking scholarly journals on diverse creative aging topics. While we say farewell to Diantha in this role, she will always remain a valued partner to Lifetime Arts.
Diantha is Principal and Founder of DDSchull Associates LLC, providing advisory and training services for museums, libraries, foundations and nonprofits. She has written articles and books for museum and library professionals, including, Boomers and Beyond: Reconsidering the Roles of Libraries, with Pauline Rothstein, PhD.