Museums, Health and Well-Being

Helen Chatterjee, Guy Noble

• Publisher: Routledge
• Year: 2016
• ISBN:
  9781317092704
• Edition: 1
• Topic: Arte
• Subtopic: Studi museali

The role of museums in enhancing well-being and improving health through social intervention is one of the foremost topics of importance in the museums sector today. With an aging population and emerging policies on the social responsibilities of museums, the sector is facing an unprecedented challenge in how to develop services to meet the needs of its communities in a more holistic and inclusive way. This book sets the scene for the future of museums where the health and well-being of communities is top of the agenda. The authors draw together existing research and best practice in the area of museum interventions in health and social care and offer a detailed overview of the multifarious outcomes of such interactions, including benefits and challenges. This timely book will be essential reading for museum professionals, particularly those involved in access and education, students of museums and heritage studies, as well as practitioners of arts in health, art therapists, care and community workers.

CHAPTER 1
MUSEUMS, HEALTH AND WELL-BEING

INTRODUCTION

Many populations are facing an unprecedented socio-economic challenge. Individuals are living longer but with unhealthier lifestyles, with a significant rise in age- and lifestyle-related diseases, such as Alzheimer’s and diabetes. A key consequence of these trends is considerable pressure on health services (including the National Health Service (NHS) in the UK) and social services. In addition, evidence reveals that there is a ‘social gradient’ in relation to health, whereby individuals from poorer socio-economic backgrounds experience reduced health, well-being and social resilience (the Marmot Review: Marmot et al. 2010; GCPH 2010). The Marmot Review recognises that a range of social factors must be taken into account in order to alleviate health inequalities and that services such as the NHS alone cannot reduce health inequalities. It goes on to suggest that social networks and local communities strongly influence individual health and well-being, and, further, that the extent to which people are able to participate in society and control their own lives makes a ‘critical contribution to psychosocial well-being and health’ (Marmot et al. 2010).

Health reforms in the UK as part of the Health and Social Care Act 2012 are also placing greater emphasis on the role of communities through the notion of a Big Society, which seeks to create an environment that empowers local communities and people to take collective responsibility for their environment, communities and public health. A key focus of these health reforms sees a shift towards ‘prevention is better than cure’, within a model which will require a multi-agency approach with an increased reliance on third-sector organisations such as charities, voluntary and community organisations. Not without controversy and opposition, these radical health reforms will change the way in which health and social care services are delivered; this may create not only new challenges but also opportunities for organisations such as museums, which have traditionally not been part of the ‘public health offer’. The inclusion of museums under the Arts Council England umbrella is also likely to encourage a museum sector shift which recognises the value of creative experiences and access to knowledge and information in relation to health and well-being (ACE 2011).

This book seeks to define a new field of study and practice in museology, namely Museums in Health. The field is grounded in Arts in Health and draws heavily from research stemming from this field of study and associated good practice (Chapter 2). The book aims to encourage heritage professionals to promote museums as assets for enhancing health and well-being. It brings together a breadth of literature pertinent to the debate around the value of museums and cultural encounters in relation to tangible health and well-being outcomes, and explores the underlying psychological and physiological mechanisms which explain the value of Museums in Health (Chapter 3). Practice-based examples are explored in detail, including several case studies written by museum professionals, exemplifying the diversity of current Museums in Health practices (Chapter 4). The evaluation methods and approaches for measuring health and well-being in relation to cultural encounters are critically examined (Chapter 5) and recommendations for the future development of the field are offered (Chapter 6).

BACKGROUND

It is widely acknowledged that the environment has a significant effect on individual health and well-being. Roger Ulrich’s seminal study from 1984, for example, provided some of the first quantitative evidence to show that patients with views of nature recover more quickly after surgery compared to those with no view of nature (Ulrich 1984). The idea that objects may have therapeutic value is also not new. Florence Nightingale noted the effects that objects could have on patient recovery, suggesting that the ‘variety of form and brilliancy of colour in the objects presented to patients are actual means of recovery’ (Nightingale 1860: 58). It is well established that museums are custodians of objects of historical, scientific or other significance, and are concerned with collecting, cataloguing, displaying and providing interpretations of objects for the benefit of furthering knowledge and encouraging the public to engage with, and learn about, their own and others’ heritage. However, museums and galleries are now beginning to articulate a less paternalistic approach to engaging with their public by recognising the therapeutic and health benefits that their collections and resources can offer.

Not surprisingly for some, this raises the question of why should museums be involved in the business of delivering health benefits to their audiences in the first place? The same argument has been directed at the arts more generally. Belfiore, for example, has questioned the impact that museums and galleries have made to social outcomes. She explores the ‘instrumental’ aspects of government policy and public arts organisations in using the arts as a means to tackle social inclusion, drawing attention to a shift towards ‘an instrumental cultural policy, which justifies public expenditure in the arts on the grounds of the advantages that they bring to the nation’ (2002: 92). This stance focuses on the policy implications for the future funding of subsidised arts and arts organisations as agents of social change, arguing that if social benefits cannot be demonstrated, funding will be lost to those organisations that are better set up to deal with social issues. Whilst this may be a worthwhile debate, rather than justify the wider role and funding for museums and the cultural heritage sector, this book primarily seeks to explore the evidence base for museums’ role in healthcare and does not set out to make a case for instrumentalism in museums. However, it does recognise that individual and community health and well-being is complex and fluid, and as such the health services offered should reflect this. The increasing pressures on health services and governments on personal choice in healthcare do provide potential opportunities for museums to use their collections in a more altruistic way. Notwithstanding this, we are in agreement with Belfiore and others who recognise the importance of gathering a strong evidence base which is grounded in a critical evaluation of the social impact of the arts (Belfiore 2002; Staricoff 2006; Belfiore and Bennett 2007). It is vital that Museums in Health is supported by robust and reliable evidence, not only to justify public expenditure in this area, but crucially to ensure that museums and their partners deliver effective and efficient services which meet the needs of their audiences. Thus, the debate as to whether museums should consider health and well-being outcomes at all is largely beyond the remit of this book, as the same argument could be levelled at virtually any area of museum programming; for example, why should museums focus on the intrinsic educational value of their collections? Does this imply that the intrinsic value of objects is more important than the instrumental value of using them for societal benefit, whether that be for educational or well-being objectives? We argue that it is not a case of ‘either/or’ and that museums can be viewed in their widest sense as more than simply places where objects are kept for posterity:

Museums and galleries have always served a number of purposes other than the evident one of enabling visitors to appreciate their collections of art and artefacts. They are a site for social interaction and for acquiring and conveying an air of cultural authority. They may provide a cool place on a hot day or a quiet retreat. (Classen 2007: 897)

Many authors have described the social role of museums (e.g. Sandell 2002; Classen 2005; Silverman 2010) and the link between health and socio-economic status is well understood, as discussed above (e.g. Marmot et al. 2010; GCPH 2010). Most Western approaches to healthcare are firmly rooted within the medical profession, despite increasing awareness of the negative health outcomes associated with low income, poor housing and other socio-economic factors (Dodd et al. 2002). As Dodd describes, ‘medical expertise can diagnose disease, treat individuals’ symptoms but do little or nothing to prevent the cause of depression, stress and chronic disease resulting from unemployment, the disintegration of stable relationships, poor housing and poverty’ (Dodd et al. 2002: 183). The concept of preventative versus remedial medicine is also not new, but for many people preventative approaches to medicine are shrouded in doubt and disbelief. This is for good reason in many cases; as with remedial healthcare, preventative healthcare requires a robust evidence base gathered using standardised, reliable and repeatable techniques. Sadly the latter is lacking for many preventative approaches to healthcare, but with museums’ expertise in evaluation, albeit often geared towards educational outcomes, the transition to securing health and well-being outcomes should not, in theory, be too onerous. Furthermore, given the forthcoming health and social care reforms in the UK, it is extremely timely for the museum sector to reposition itself as a core asset in the new framework, the central tenet of which will see a focus on ‘prevention is better than cure’.

One of the biggest challenges for museums is understanding, demonstrating and articulating their value (both preventative and remedial) to individual and societal health (both physical and psychological) and well-being. These three challenges form the focus of this book, which seeks to define a new field of Museums in Health.

THE THERAPEUTIC POTENTIAL OF MUSEUMS

Lois Silverman has described the museum as a promising tool for therapy and, further, that ‘through their therapeutic potential, museums have a means to social inclusion of individuals who are often overlooked by cultural institutions’ (2002: 70). She advocates that one pathway to expanding the social role of museums is to recognise their therapeutic potential. By acknowledging that museums assume a healthy visitor population and that those facing health challenges, such as people with depression, adjusting to older age and associated loss of function, those with terminal illness or those dealing with substance abuse, are often excluded from museums, Silverman proposes that museums could play a valuable therapeutic role.

In her recent book The Social Work of Museums, Silverman suggests that museums contribute to the pursuit of health in five major ways: promoting relaxation; an immediate intervention of beneficial change in physiology, emotions or both; museums encourage introspection which can be beneficial for mental health; museums foster health education; and museums are public health advocates and enhance healthcare environments (Silverman 2010: 43). The role of museums as agencies which encourage social cohesion and interaction, affording enhanced psychosocial well-being, might also be added to this list. These are, by necessity, generalisations and not all museums are working to address these agendas, but they highlight the potential contribution that museums can make to individual psychological and physiological health, and public health.

Silverman (2002) describes a collaborative project from 1997 at Indiana University (MATA: Museums as Therapeutic Agents) which brought together museum staff, social/mental health programmes, researchers and students. The aim of this innovative project was to study a set of pilot museum programmes with explicitly therapeutic goals and to develop a better understanding of the therapeutic potential of museums. The study resulted in the identification of eight concepts pertaining to the theory and practice of museums as therapeutic agents; four of these concepts relate to mental healthcare and four to the unique environment of museums (Silverman 2002: 71). Regarding the latter, Silverman identified the following concepts as fundamental to the therapeutic role of museums: 1) people’s response to artefacts in museums, where she explores the power of objects to elicit responses from people; 2) interpretive media, where she advocates that a wide variety of media can be harnessed towards therapeutic outcomes; 3) the social roles possible in museums, where museums can help reinforce a sense of self and connection to others, which is particularly important for those experiencing decreased health or function; and 4) the need for ongoing evaluation.

Many of these themes plus new ideas pertinent to the emerging Museums in Health field will be developed throughout this book. The themes are helpful as a vehicle for exploring not only the therapeutic potential of museums but also the underlying theoretical and conceptual basis for understanding the value of museums for enhancing health and well-being. A wider exploration of these issues is crucial in order to clearly articulate the therapeutic value of museums across the cultural sector and beyond, particularly to the health sector.

Silverman advocates a focus on outcomes since this provides a framework to acknowledge and support the varied aspects of a museum encounter (2002). This is a valuable approach as it is also the framework for evaluating individual health and well-being. Outcome measures in healthcare are the key criteria for assessing the impact of a particular intervention (be it pharmacological or otherwise) and for assessing change in patients over time. For Silverman, lessons from the field of mental healthcare can enrich our understanding of what sorts of therapeutic outcomes that museums might facilitate, since ‘mental health can remind museums of the range of goals that are essential for a health society’ (2002: 75). Whilst this is undoubtedly valuable, we advocate incorporating a wider spectrum of healthcare outcomes, including physical and psychological, into the planning, design, evaluation and communication of the therapeutic value museums. Healthcare outcomes are the main currency and language used by healthcare professionals, and if museums are to clearly articulate their therapeutic potential, it is essential to communicate and define a system which is understood and valued by both sectors. Practitioners need to think strategically, focusing first on health priorities and how they in turn can support heritage priorities. Through establishing better links with health organisations, practitioners can begin to understand the business and management of health which is essential if this field of work is to be sustained.

SOME DEFINITIONS

Since the study of the role of Museums in Health is relatively new, it is appropriate to attempt to define some recurring terms. The focus of this book is museums (to include galleries) and the cultural heritage collections (see Article 1, UNESCO 1972) such institutions house or represent. The word ‘culture’ is used as a catch-all term in this and comparable contexts (e.g. Ruiz 2004) to include museums, galleries, libraries, literature, theatre, dance, festivals and celebration, music, crafts, film and art. ‘The arts’ is often referred to as a separate entity, but includes not only the people and places producing and experiencing art but also artworks and art collections. Davies et al. (2012) recently sought to define arts engagement via art forms, activities and level (magnitude) of engagement, and proposed that arts engagement can be defined by five art forms: performing arts; visual arts, design and craft; community/cultural festivals, fairs and events; literature; and online, digital and electronic arts. Interestingly, this study and other literature refer to visiting a museum or gallery as arts engagement. In other words, there is some overlap between the use of the terms ‘culture’ and ‘the arts’, but suffice to say that although the focus of this book is on the cultural heritage sector (museums, galleries and heritage sites), examples, evidence and ideas from the broader cultural sphere will, through necessity, be drawn upon. The term ‘cultural encounter’ is used here to define any interaction with a cultural heritage organisation and its collections, including: visiting museums, galleries and heritage sites; exhibition and gallery tours; talks and lectures; and participatory and creative sessions such as art workshops, object handling and reminiscence activities. The term ‘museum encounter’ is likewise used to refer to any interaction with a museum (or gallery), its collections, its staff or its spaces.

Health and well-being are two of the top agenda items for most developed and developing countries, and are often used in combination with each other. The World Health Organization (WHO) defined health as ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’ (WHO 1946: 100). There is relatively little dispute about the definition of health, but the same cannot be said for well-being. Well-being is an ambiguous term which has little agreement among disciplines on its definition or measurement and is often conflated with ‘health’, ‘quality of life’ and ‘happiness’ (Galloway and Bell 2006; Ander et al. 2011; Thomson et al. 2011). Ereaut and Whiting, writing for the Department for Children, Schools and Families, suggest that ‘well-being is no less than what a group or groups of people collectively agree makes “a good life”’ (2011: 1). A useful definition is that by the UK Think Tank the New Economics Foundation (NEF). NEF defines well-being as...