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, in partnership with Dr. Daisy Fancourt at University College London, builds on research conducted in the UK to explore the impacts of arts and cultural engagement on population health outcomes, as well as the mechanisms involved, in the US. This work is being undertaken through epidemiological analyses of US cohort studies and, in its current third phase of work, is exploring Social Prescribing in the US through implementation science studies. The Lab is also working to create 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. 

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.

Research

Completed Research

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

Phase One:

• completed a comprehensive scoping of the data sets,
• convened key national arts and public health stakeholders to identify the priority research questions and outcomes for analysis in the US context,
• established partnerships with key federal agencies and organizations to position the work in the most impactful way for policy action

Phase two:

• 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.

In response to the priorities that were identified through the convenings in phase one, we sequenced our analyses and publications according to which questions were of greatest immediate relevance to policy and practice. Our work produced eight publications in high-impact public health journals with four publications currently under review. See our full publications list here.

Key findings include:

• Teenagers who take part in arts and cultural activities are less likely to engage in antisocial and criminalized behavior.
• Engaging in extracurricular arts activities at ages 10-11 is associated with fewer behavioral problems in teen years
• In young adults, an increase in arts engagement is associated with increased flourishing and social wellbeing. 
• Young people who engage in extracurricular arts activities and creative hobbies have lower rates of substance use
• Older adults who do creative hobbies, at least monthly, are 20% less likely to be depressed.
• In older adults, arts engagement is associated with decreased depression and increased wellbeing
• People over the age of 50 who engage in receptive arts activities just once per month or more are 84% more likely to have healthy aging two years later

Current Research 

We are currently in phase three of the initiative. This phase builds on the previous work and encompass three primary components, as outlined below.

1. Development of a Core Outcomes Set (COS) for Arts in Public Health: We are utilizing a national team of investigators and robust stakeholder-driven consensus methods, including dialogue with a range of stakeholders using focus groups and the Delphi Method, data integration, robust external review, and translation to broad audiences through publication of open-source resources as well as peer-reviewed publication. We have established partnerships for this project with the Yerba Buena Center for the Arts, Stanford University, the Federal Reserve Bank of New York, Americans for the Arts, Michigan State University, Brown University, and the International Arts & Mind Lab at Johns Hopkins. We anticipate that a core outcomes set will: 

• Create consistency and clarity in how arts programs are documented and interpreted by policy makers and practitioners
• Enable evidence synthesis across programming, populations and issues
• Increase searching efficiency in health literature databases – allowing for metanalysis
• Lead to development of tools to advance evidence-based programming and empower cross-sector collaboration among artists, arts organizations, community builders, and public health professionals

2. Social Prescribing (SP) Implementation Science Studies: We have designed and are conducting a multi-site community-based prospective trial to assess various pilot applications of social prescribing in the US, in alignment with both EpiArts prior statistical findings and with prior work undertaken to study SP in the United Kingdom (Pescheny, et al., 2018; Gottlieb, et al., 2018). Within these studies, we will:

• Undertake quantitative outcomes analyses of American SP programs using original scales that we will develop for the US, based on UK instruments
• Undertake qualitative outcomes analyses using the NHS England Social Prescribing Outcomes Framework to map impacts to individuals, community groups and health systems
• Apply implementation science research frameworks to assess and report on the feasibility, acceptability, and suitability of the programs – based on the data noted above
• Produce sound recommendations that can guide social prescribing across a broader range of health system structures than currently exists

Key Common Outcomes Development for Social Prescribing in the US: We are developing a set of key common outcomes for social prescribing in the US. Our methods include identification of common outcomes being studied in social prescribing studies around the world and focus groups in communities across the nation. Our findings will be translated in an outcomes framework that will guide the development of social prescribing, guide research on social prescribing, and position the US to advance a robust social prescribing research agenda – based on key common outcomes – as programming and policy develop. We anticipate that this work will:

• Establish an outcomes framework for guiding social prescribing development in the US
• Inform future development of a formal core outcomes set (COS) for social prescribing in the US

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).