The EpiArts Lab: Exploring the impact of arts and cultural engagement on population health outcomes in the US through epidemiological analyses of US cohort studies

The EpiArts Lab at the University of Florida Center for Arts in Medicine is a National Endowment for the Arts (NEA) Research Lab and a partnership between the UF Center for Arts in Medicine and University College London’s Social Biobehavioral Research Group. The Lab builds on research conducted in the UK to investigate the impact of arts and cultural engagement on population health outcomes in the U.S. through epidemiological analyses of US cohort studies.  

Background

Over the past few decades, there has been a heightened interest in the effects of arts and cultural participation on health. Research in the United Kingdom has shown that arts engagement is associated with: 

• better mental health, lower risk of depression, reduced loneliness, fewer childhood adjustment problems, and enhanced health behaviors.

Arts and cultural participation has also been associated with: 

• lower risk of physical illness, including onset and progression of chronic pain, frailty, age-related disability, dementia, and premature mortality. 

Notably, these results have been found while accounting for demographic, socio-economic, health, behavioral, and social confounders. Further, these analyses have considered the underlying mechanisms that might explain these associations, including psychological mechanisms such as self-esteem, neurocognitive mechanisms such as memory and executive function, and biological mechanisms such as inflammatory immune response. Despite the presence of these findings, little research has been undertaken in the United States to explore the benefits of arts on population-level health.

In the UK, this work has had significant impacts on national health and social care policy. The National Health Service’s (NHS) Department of Health and Social Care has made a major investment in social prescribing (SP), and in 2019 the World Health Organization (WHO) issued a report with policy recommendations for the WHO European Region on how to capitalize on the importance of the arts for public health. As a result of the work of Dr. Fancourt’s team, several UK government departments have implemented major policy and practice changes, such as the Department of Health and Social Care investing in Arts on Prescription, which provides funding and a structure through which care providers refer patients to local arts and social engagement activities by way of professional link workers who are employed to connect people to local cultural resources.

The program has resulted in positive impacts, including improved quality of life and emotional wellbeing for those participating. We anticipate that published and widely disseminated findings from this research will have similar and equally transformative policy implications in the United States, including:

• increased investments in community-based arts and cultural programming
• increased cross-sector collaboration between the public health and arts and culture sectors
• increased understanding of the health benefits of arts and cultural participation among the general public

As a result, we anticipate several broader impacts, including overall growth in the arts and culture sector, increased participation in the arts among the general public and, most importantly, enhanced health, wellbeing and social cohesion among Americans.

Completed Research: Phases 1 - 3

With support from the National Endowment for the Arts, Pabst-Steinmentz Foundation, and Bloomberg Philanthropies, we have completed phases one through three of the project. 

Phase One:

The project began with a comprehensive review of datasets to identify relevant variables for analysis, drawn from hundreds of questions on arts participation, health, and well-being. Findings informed three national roundtable discussions with arts and public health stakeholders to define priority research questions and outcomes. These convenings, held across the U.S., engaged diverse practitioners, researchers, policymakers, and agency leaders. This phase also established partnerships with key federal agencies and organizations to maximize policy impact and lay the groundwork for future multi-site experimental studies.

Phase Two: 

During this phase, we tested associations between arts engagement and specific health outcomes that were determined through the convenings in phase one. The investigation included different types of arts activities that combine various mechanistic components and explored the mediating role of potential causal mechanisms.

We sequenced our analyses and publications according to which questions were of greatest immediate relevance to policy and practice. Our work produced publications in high-impact public health journals. See our full publications list here.

Phase Three: 

In its third phase, the Lab continued statistical analyses exploring the effects of arts participation on physical health outcomes. The Lab also explored Social Prescribing in the US through implementation science studies, created Core Outcomes Sets for key public health issues (racism, collective trauma, social isolation, mental health, and chronic disease), and a set of key common outcomes for social prescribing research in the US. 

Current Research: Phase 4

Phase Four

Phase four of the research agenda examines longitudinal datasets from the U.S. alongside selected international data, including longitudinal studies from Australia, England, Germany, Ireland, Japan, Norway, and Malawi, to explore how arts engagement influences health outcomes such as mental health, life satisfaction, and overall well-being. These datasets enable a comparison of the impact of arts engagement across different cultural and social contexts.

Using advanced methods like causal analysis and multilevel modeling, this phase isolates the impact of arts participation from factors like socioeconomic status and personality and simulates interventions to assess how the arts compare to other health-promoting activities. By leveraging global datasets and incorporating new U.S. data, Phase Four deepens understanding of the complex relationships between arts engagement and health, providing evidence to guide public health strategies and policy development.

Key Research Aims:

1. Identify the "Ingredients" of Arts and Culture:
   • Analyze how and when individuals engage with arts and culture and whether this evolves over time in the US.
   • Evaluate which “active ingredients” of arts and cultural activities impact outcomes like mental health, subjective well-being, and psychological resilience.
2. Explore Mechanisms of Action:
   • Investigate the pathways linking arts engagement to positive health outcomes, including clinical and biological indicators of aging.
   • Use mediation and structural equation modeling to uncover explanatory mechanisms.
   • Explore whether pathways are consistent across diverse demographic groups.
3. Use Advanced Statistical Methods:
   • Compare the benefits of arts engagement to other health-promoting activities, such as physical exercise.
   • Apply multilevel modeling to explore individual- and area-level contexts.
   • Use parametric survival models to assess the time-to-onset of illness.
   • Improve causal inference techniques.
4. Health Outcome Focus Areas:
   • Prevalence of mental illness
   • Multidimensional aspects of wellbeing (life satisfaction, eudaimonia, etc)
   • Self-rated health
   • Healthcare utilization

This work is being undertaken in partnership with Dr. Daisy Fancourt at University College London, with support from the National Endowment for the Arts, the Pabst-Steinmentz Foundation, and Bloomberg Philanthropies, Dharma Endowment Foundation, the State of Florida Division of Arts and Culture, and through a collaborator agreement with the World Health Organization.

US principal investigator: Dr. Jill Sonke, University of Florida

UK principal investigator: Dr. Daisy Fancourt, University College London

Please note: The opinions expressed in materials on this website are those of the author(s) and do not represent the views of the National Endowment for the Arts Office of Research & Analysis or the National Endowment for the Arts. The Arts Endowment does not guarantee the accuracy or completeness of the information included in these materials and is not responsible for any consequences of its use. This NEA Research Lab is supported in part by an award from the National Endowment for the Arts (Award#: 1862896-38-C-20).