• What's the story? 
• What's the learning?
• Additional information 
• Resources cited in case study

“It is a common experience for Aesop: health professionals think of music, dance, painting and the other arts as ‘fluff’ – a nice-to-have extra, peripheral to the serious business of medicine and health improvement. Aesop exists to challenge this. ” Dance to Health Evaluation report, April 2020

What’s the story?

Significant claims have been made for the arts’ ability to improve our health and wellbeing. The 2017 Creative Health report concluded ‘arts engagement has a beneficial effect upon health and wellbeing’ (page 11). The World Health Organisation followed this in 2019 with a scoping review which concluded ‘the arts can potentially impact both mental and physical health’ (vii). But is this true for all arts engagement, and all arts interventions in health and social contexts? Or do different activities have different value and benefits?

Our Dance to Health programme, piloted in 2016 and 2017, is a nationwide dance programme for people aged over 55 years. It has been delivered with community groups across the UK (and online) and was created to be an arts solution to reduce older people’s falls. It is an exemplar ‘Active Ingredients’ project, an initiative by Aesop in collaboration with BOP Consulting, that aims to deepen our understanding of the ways in which arts interventions in health and social contexts actually work, to improve the ways they are designed and their impacts are measured.

The starting point for developing this project was consultations with existing bodies of research, health professionals, researchers and falls experts. We were introduced to Dafna Merom, Professor in Physical Activity and Health at Western Sydney University who, in 2012-2014, had conducted a randomised controlled trial – the gold standard of health evidence – on whether dance actually reduced older people’s falls. It demonstrated that dance in general, and social dance in particular (such as folk and ballroom dance workshops) do NOT prevent falls or their associated risk factors and, more broadly, challenges the validity of generalised claims about arts activities achieving health improvements. We realised therefore that Dance to Health needed to do things differently to achieve the outcomes we desired.

We know that reducing falls is not a universal benefit of dance interventions more generally. Yet the evaluation of the Phase 1 Roll-out (2017-19) of the Dance to Health found that falls amongst participants were reduced by 58%. Conducted by Sheffield Hallam University Sport Industry Research Centre, the mixed-methods evaluation concluded that the programme ‘offers the health system an effective and cost-effective means to address the issue of older people’s falls’ (page 18). Here was a counter-example to previous research. What is it about the Dance to Health programme that makes it effective at reducing falls, when folk and ballroom styles do not?

The evaluation report concluded that it was the particular artistic aspects of the dance programme, rather than the generic health benefits, that seemed to be the key: ‘[t]he use of music and storytelling empowered participants artistically to engage in movement; they were encouraged to move limbs through a range of movements and gain confidence to ‘go further’, reaching higher or bending lower, as they were embraced by the music and lost in the storytelling or memories’ (page 35). The programme was not just designed to provide generic exercise and movement benefits, but to empower participants artistically, be culturally sensitive and enable participants to progress creatively and technically, aiming to develop their interest and enjoyment of dance.

These context-specific benefits of the programme are what we refer to as the ‘active ingredients’, inseparable from the artistic experience of dance. The medical/pharmaceutical metaphor here is used to emphasise that there is something particular - some property, some dynamic - in the arts experience itself which enables certain artistic outcomes to occur, such as expression (finding a voice, making performances that are special, and telling stories) and achievement (state of flow/absorption, accomplishment, celebration and sense of artistic achievement).

What’s the learning?

A more nuanced approach is needed to evaluate arts-in-health collaborations in their specific, situated contexts, drawing on the impacts of specific arts experiences, rather than generic health and wellbeing benefits.

• To address any major health challenge, an in-depth understanding of the area is essential. This will involve, as the Dance to Health programme did, consultations and collaborations with health experts, artists, and community arts practitioners, as well as being sceptical of broad claims of generic health and wellbeing benefits of arts engagement.
• Researchers have a major role to play in understanding how specific and practical artsand-health programmes actually work (or don’t), and a responsibility to carry out rigorous, evidence-based research to capture a range of context-specific outcomes and benefits.
• For arts interventions to work most effectively, particularly over the longer term, they need to be informed by a deep understanding of: - the particular social, health or educational issues that they are seeking to address; as well as - the institutional context and processes in which arts work is trying to intervene. (For instance, in arts and health work, often the nonclinical, non-medicalised setting is key to the nature of the arts intervention, ensuring that participants perceive them to be ‘safe spaces’ suitable for expression.)
• This requires close collaboration and co-design of socially-purposeful arts interventions with and by social, health and education partners.

Both the health and arts sectors have their jargon which offer different ‘lenses’ or perspectives of activity.

• While the NHS’s focus is to provide universal services, the arts sector delivers projects that are often time and resource-limited. These perspectives are not mutually exclusive, but acknowledging and recognising these different contexts is crucial.
•  Neither are these different professional languages irreconcilable; using everyday language and avoiding arts-speak can act as a springboard for describing your own artistic programmes to health professionals, patients and the general public. For example, the ‘active ingredients’ concept helps health professionals understand what art interventions can offer.

Our Active Ingredients logic model (see 5-6 in PDF download) is designed to provide a grounding for evaluations in specific and situated contexts of arts-in-health programmes to explore both artistic and cultural outcomes, as well as assessing those social and health outcomes required by partners. The model is covered in more detail in our Active Ingredients report (pages 16-17), but here are a few key points:

• The Active Ingredients logic model differs from typical logic models in that it does not simply seek to identify which activities are the ones that produce a set of intended outcomes. Rather, we are interested in also identifying how these activities contribute to the generation of particular outcomes.
• Specifically, the Aesop development work to date has enabled us to identify and distil a set of ‘Active Ingredients’ in participatory arts work, describing the moments (in anticipation of as well as during the experience) when context-specific arts successfully engages with a particular target group.
• We summarise these in the model under the headings ‘Engaging’ (to include social interaction, arousal of curiosity, sense of expectation, feeling of safe space for expression) and ‘Imagining’ (to include encountering the other, developing a sense of possibilities, scope for experimenting, trying new modes of expression, building on old forms).

Within health, criminal justice, social inclusion, citizenship and community cohesion work, socially engaged arts practice has developed distinct methods and pedagogies for working creatively and sensitively with a wide range of groups. However, this is often not commonly understood and differs from many people’s conception and experience of what ‘the arts’ is.

•  You do not have to compromise the quality of artistic practice to satisfy a health agenda. In our experience; this is a common, one-dimensional misconception. As I argued in a recent blogpost, improving artistic practice and meeting health outcomes is possible and indeed mutually beneficial, without subsuming one into the other.
• Our workshop leaders were not an alternative to exercise professionals, but dancers and artists in their own right. It is important to understand their motivation and practice as practitioners and create opportunities for them to develop their artistic voice and creative practice, as well as provide the requisite specialist health training.
• The evaluation found that translating the evidence-based falls-prevention programmes by incorporating moves which reduce falls into dance activities was an enjoyable challenge for Dance Artists; instead of finding this experience constraining, they often found the process artistically and creatively stimulating (page 28).

Additional information

For more information on Aesop’s work, including details of their professional development programme for health and arts professionals with an interest in devising and running successful arts in health programmes, and their Active Ingredients programme and toolkit, as well as associated evaluation reports and resources, visit their website: ae-sop.org/active-ingredients. For more details on the Dance to Health programme, resources and information visit: https://www.dancetohealth.org/

Resources cited in case study

• Dance to Health ‘Phase 1 Roll-out ‘test and learn’ Evaluation Report, Aesop, April 2020
• Active Ingredients: The Aesop planning and evaluation model for Arts with a Social Purpose, Aesop & BOP Consulting, September 2018 https://ae-sop.org/wp-content/uploads/ sites/63/2018/09/Active-Ingredients-Report-Sept-2018-Final-low-res.pdf

Case study written and provided by: Tim Joss, Chief Executive & Founder, Aesop

(Edited by: Emma McDowell, University of Leeds on behalf of the Centre for Cultural Value)