The document summarizes a workshop held in Cardiff, Wales from September 17-19, 2011 on communities, culture, health and wellbeing. It discusses the Roseto Mystery case study from the 1950s which found that residents of Roseto, Pennsylvania had remarkably low rates of heart disease and other health issues, which was attributed to strong social connections within the close-knit immigrant community. The document also discusses how arts and health programs are gaining recognition for improving health outcomes and how arts can help address health inequalities.

1. UK Arts and Humanities Research Council
Communities, Culture, Health and Wellbeing
Workshop, Cardiff Wales, 17 – 19 September 2011
Healthy Communities and Culture
Think Local ... Think Global
Margret Meagher
Executive Director, Arts and Health Australia &
The Australian Centre for Creative Ageing
www.artsandhealth.org
margret@artsandhealth.org

2. The Roseto Mystery
Malcolm Gladwell
‘Outliers The Story of Success’ 2008
The word ‘Outlier’ is defined as “a statistical observation that is
markedly different in value from the others of the sample”

3. The Roseto Mystery Revealed
“Virtually no one under 55 had died of heart attack. For men under
65, the death rate from heart disease was half (the national
average). The death rate from all causes in Roseto was up to 35%
lower than expected.
There was no suicide, no alcoholism, no drug addiction, and very
little crime. They didn’t have any one on welfare. Then we looked
at peptic ulcers. They didn’t have any of those either. These
people were dying of old age. That’s it.”
John Bruhn, sociologist and co-investigator with
Dr Stephen Wolf, researching the Roseto population aged 21+
Malcolm Gladwell , Outliers The Story of Success 2008

4. Roseto Recipe for Health –
A Creative and Connected Community
John Bruhn and Dr Stephen Wolf noticed how socially engaged
the people of Roseto were and the extended family relationships
that lay at the heart of the town’s social structure. Many homes
had three generations living under the one roof and grandparents
were respected. Attendance at church had a calming and unifying
effect. There were 22 civic organisations in a town of under 2000
people. The community was markedly egalitarian.
“The Rosetans were healthy because of where they were from,
because of the world they had created for themselves.”
The Roseto Mystery, Malcolm Gladwell Outliers The Story of Success

5. Roseto Mystery Bewilders Science
When John Bruhn and Dr Stephen Wolf presented their
findings at medical conferences in the 1950s, they were
met with scepticism by their peers.
Genetics, diet, exercise, regional location and medical care
were considered the key determinants of health.
People did not think about health in terms of ‘community’.
The Roseto Mystery, Malcolm Gladwell Outliers The Story of Success

6. Roseto Case Study: A New Way of Thinking
Bruhn and Wolf sought to convince the medical establishment to
think about health beyond an individual’s personal choices or
actions in isolation.
Malcolm Gladwell concludes that in understanding the health of a
person, it is important to understand the culture that he or she is
part of, including that of their friends and families and to know
where they and their families come from.
Finally, he says it is critical to understand that the values of the
world we inhabit and the people we surround ourselves with have
a profound effect on who we are and, by implication, on our
health, wellbeing and connection to community.
Malcolm Gladwell, Outliers The Story of Success 2008

7. THIS IS AN IDEA OF WHO I AM
AND WHERE I COME FROM...

8. THIS IS A GLIMPSE OF
MY LOCAL COMMUNITY

9. My Workplace My Family and Friends My Backyard
Port Macquarie
and the world
My Community Choirs

10. Arts and Health is taking great strides
as an international movement
Black Grace Dance Company New Zealand

11. In 21st Century
What is Arts and Health?
Arts and Health is an international field of practice and research that
encompasses primary and acute care, aged care, palliative care,
community health, health promotion, medical education, architecture and
design.
An Arts and Health program provides participants with access to
professionally delivered creative activities specifically designed to achieve
positive health outcomes – such as singing to improve cardiovascular and
lung function or restore voice facility for stroke victims; dance to improve
mobility and combat obesity; clay modelling for arthritis; visual art and
music to support people with dementia or Parkinson’s disease.
Art forms range from the visual arts, music, theatre, dance, circus arts,
creative and narrative writing, storytelling, film, digital media.

12. In 21st Century
Growing Recognition of the
Value of Arts and Health
“Arts and health initiatives are integral to health, healthcare
provision and healthcare environments, including supporting staff,
and are delivering real and measurable benefits across a wide range
of priority areas for health, supported by a substantial evidence
base” UK Dept of Health Review 200
The arts bring people together and forge essential links
with the broader community, facilitate intergenerational
exchange and foster social inclusion.

13. In 21st Century
Why is Arts and Health gathering momentum?
 Major demographic changes as baby boomer generation ages
 People live longer and likely to experience chronic health conditions
eg dementia, depression, cancer, diabetes, cardiovascular disease
 21st century expectations of the right to enjoy a high quality of life
and high level of accessible information
 Increased social isolation in the community with family fragmentation
 Healthcare now focussed on keeping well, prevention and potential
rather than illness and burden
 Increasing scientific research to
corroborate benefits of arts for health
 International exchange of people,
programs and ideas
Alison Clough Pioneer Projects, Bentham, Yorkshire UK, WA Healthway
Residency 2008 working with Aboriginal Communities around diabetes

14. Arts and Health is developing as a global fraternity
Key to the strengthening of the global arts and health movement is the
unifying communications and networking role played by peak arts and
health organisations, together with improved access to information and
resources via the internet:
Society for the Arts in Healthcare, USA (www.thesah.org)
London Arts and Health Forum, UK (www.lahf.org.uk)
Centre for Medical Humanities, UK (http://www.dur.ac.uk/cmh/)
Arts and Health Australia (www.artsandhealth.org)
Arts Health Network Canada (www.artshealthnetworkcanada.com)
Arts and health blogs - Arts in Health Manchester Metropolitan
University (http://artsforhealthmmu.blogspot.com)
Centre Medical Humanities (http://medicalhumanities.wordpress.com/
Arts & Health International Journal of Research, Policy and Practice;
Applied Arts and Health Journal; UNESCO Observatory Multi-Disciplinary
Research in the Arts E Journal, University of Melbourne (2012 editions)

15. Arts and Health Australia (AHA) - www.artsandhealth.org
 National advocacy, networking and consulting agency
 Expertise in designing and implementing creative communities
programs for hospitals, retirement villages, aged care facilities,
community services
 Strong regional, national and international networks provide access to
best practice models and current research
 Partner in training and research projects such as the Art and Dementia
program at the National Gallery of Australia in Canberra (pictured).
 Convenor of an annual international
arts and health conference
“The Art of Good Health and Wellbeing”
Canberra ACT 14 – 17 November 2011
Fremantle WA 13 – 16 November 2012

16. Defining Health and Wellbeing
National Aboriginal Health Strategy (NAHS) defines health as:
‘Not just the physical wellbeing of the individual but the social,
emotional and cultural wellbeing of the whole community. This is a
whole-of-life view.’
Sir Michael Marmot, Chair of WHO Commission on Social
Determinants of Health, 2006 identifies the key determinants of
health as -
• Social justice and participation
• Empowerment as a means – material, psychosocial, political
• Creating the conditions for people to take control of their lives
www.who.int/social_determinants
Strategic Review of Health Inequalities in England post 2010
www.ucl.ac.uk/gheg/marmotreview

17. Examples of Health Inequalities
Life expectancy at birth for selected London electoral wards,
a few miles apart, 2002-06 (data from London Health Observatory)
Kensington & Chelsea Queens Gate ward:
Life Expectancy for men: 88 years
Tottenham Green, Haringey
Life Expectancy for men: 71 years
Indigenous Australians have a life expectancy of 17 years less than
non indigenous Australians

18. In 21st Century
Questions to Ask
What does existing research tell us about
the efficacy of arts and health programs
in maintaining and improving health and wellbeing
and nurturing flourishing communities ?
Where are the gaps?
What questions do we need answered to advance
community cultural development, health and wellbeing?
“what is the problem to which we think we are the solution?”
François Matarasso

19. Therapeutic Outcomes from Arts and Health
Programs in Hospitals and Aged Care Facilities
 reduced stress and anxiety; elevated mood and self esteem
 pain management
 improved communication – patients/family/hospital staff
 excite the imagination, entertain, educate and inform
 safe, non threatening environment
 improved design features - patient rooms,
signage, instrumentation, public spaces
 reduced length of time in hospital
 reduced reliance on medication, hospital staff
 enhanced wellbeing of hospital staff, carers,
families
Royal Melbourne Hospital

20. Study of the Effect of Visual and Performing Arts in Health Care -
Chelsea and Westminster Hospital, London.
(www.hospitalarts.co.uk)
Landmark research (1999 – 2002) provided evidence that
the integration of visual and performing arts into the
health environment induce psychological, physiological
and biological outcomes with clinical significance.
Units of research established in the following clinics:
Medical Day Unit, Antenatal Clinic, High-Risk Clinic,
Maternity, Post-natal Ward, Day Surgery Unit,
Trauma and Orthopaedics Ward, HIV/AIDS Services
Rosalia Lelchuk Staricoff PhD, Director Research Project

21. Antenatal High Risk Clinic: Live music in waiting area effective in lowering
blood pressure of patients
Maternity Unit – music and visual art: Duration of labour 2.1 hours shorter
and requests by women in labour for epidural analgesia diminished
Trauma and Orthopaedic Ward – music and visual art: Patients during the
post-operative period required less analgesia per day and stayed 1 day
less in hospital than control group
Staff Evaluation: Two thirds of respondents
(clinicians, nursing staff, managers) indicated the
hospital environment – architecture, light, colour,
visual art, live music – influenced decision to apply
for job in the hospital or remain in current position

22. The arts can be the
best medicine of all ..
and it’s fun
Health Professionals and the Arts
Healthcare professionals recognize the arts can reduce the stress
of a pressured healthcare environment, assist them to maintain
mental alertness and provide
respite and lifestyle balance.
Medical humanities education is
valuable in honing communications
and observational skills and improved
diagnosis procedures.
(www.nga.org.au/artmed)
Corpus Medicum, Melbourne, arts+medicine magazine

23. Arts and Community Health and Wellbeing
“Arts in community health is a distinct area of activity outside acute
healthcare settings, characterised by the use of participatory arts to
promote health.
The development of such work within the
interweaving strands of health, education and
social policy has evolved through recognition of
the connection between engagement in cultural
activity and wellbeing and that the arts can have
a lasting and transforming effect on many
aspects of people’s lives.” Mike White 2007
Mike White, Senior Research and Development Fellow in Arts and Health,
Centre for Medical Humanities, University of Durham, UK (www.dur.ac.uk);
author of Arts Development in Community Health: A Social Tonic (Radcliffe, Oxford 2009)

24. In the USA
Music in the Community for Health and Wellbeing
“There are now more community choirs in the UK than fish and chip
shops.” The Independent, January 2010
Singing is widely reported to be enjoyable, energising, relaxing, stress
relieving, mood enhancing and cognitive stimulating. Singing enhances
self-confidence, self esteem, gives a sense of purpose and of
achievement. Socially, it provides social support, friendship and a
sense of community and belonging.
Reference: Group Singing, Wellbeing and Health
A systematic mapping of research evidence
Professor Stephen Clift, Research Director,
Sidney de Haan Research Centre for Arts and Health,
Canterbury Christ Church University, UK

25. In the USA
Quality of Life Research Informs Value of Arts Health
Dr Cheryl Dileo, PhD, MT-BC. Professor of Music Therapy and Coordinator of
the MMT Program and Director: Arts and Quality of Life Research Center
Temple University, Philadelphia; faculty member University of Melbourne.
www.temple.edu/boyer/researchcenter - undertaking
7 Cochrane Reviews into arts and health, exploring:
 Are the arts effective modalities in healthcare?
 Do the arts make a difference?
 How do the arts make a difference?
 Why do the arts make a difference?
 What is the best evidence?
 What kind(s) of evidence is(are) needed?

26. A Logical
Connection
New Laguna Honda Hospital for Long Term Care
San Francisco
 Designed to create a sense of community among residents
 780 bed facility, each patient has a window and fresh air
 Each floor is a distinctive neighbourhood
 60 residents live in 4 x 15 people
households, each with living room
 Households are organised around
a central Great Room (Town Square)
 Every two households share dining room

27. A Logical
Connection
New Laguna Honda Hospital for Long Term Care
The Esplanade is the main street, lined with places for residents, carers,
volunteers and visitors to meet, including a community theatre, cafe,
library, art studios, hairdresser.

28. A Logical
Connection
The Esplanade – Laguna Honda’s Main Street
Cliff Garten Bronze Handrail

29. A Logical
Connection
New Laguna Honda Hospital for Long Term Care
Buildings open onto a central park, home
to the animal therapy center and horticultural
program; 11 healing gardens include secure
areas for dementia patients
Artwork is appropriate for a population diverse
in its ethnicity, cultural backgrounds, and
levels of physical ability and
mental cognition

30. A Logical
Connection
New Laguna Honda Hospital for Long Term Care
Key Elements of Design Criteria Meet Functional Needs
 Way Finding and Location
 Identity
 Sensory Stimulation
 Activity
 Stimulation of Memory
 Orientation to Time

31. A Logical
Connection
New Laguna Honda Hospital for Long Term Care
Design Principals
 Sense of Place: Geography, History,
Language
 De‐Institutionalization through art
 Personal Autonomy through activity,
interaction and choice

32. Arts – Led Community Regeneration in the UK

33. In the UK
Arts – Led Community Regeneration
Arts-led regeneration can have a dynamic effect on the overall health,
confidence and prosperity of a community, supporting social integration and
lifelong learning.
High-quality arts facilities, supported by their local
community, can attract significant investment into
their region.
Cultural provision is an important economic indicator.
The Angel of the North, Newcastle Gateshead
is a concrete example of the accumulator effect on the
local economy of a high quality arts project.

34. In the UK
Arts – Led Community Regeneration
In the 1990's Gateshead was a blue collar town in North East England in
long-term recession. The Council won Government funding to host a
National Garden Festival in 1990. The land reclamation required for this led
to a program of commissioning works of public art to establish a new image
and identity for the town, under the project management of Mike White.
The most ambitious art work was the 20 metre high Angel of the North by
Antony Gormley, installed 1998, which is now the most viewed and most
publicly recognised contemporary sculpture in Britain.
The Times newspaper chose the Angel as its cover
image for 1st January 2000 issue to herald the
new century.

35. Cost AUS $2million - Generated an estimated AUS $140 million in free
tourism promotion and continuing.
The Angel became a national icon and helped Gateshead Council make
a case for funding from the National Lottery and the private sector to
support ...

36. In the UK
Arts Led Regeneration – Community Benefits
Development of major art gallery The BALTIC on Gateshead Quays
(AUS $80 million) and international concert hall The Sage designed by
British architect Norman Foster (AUS $160 million)
These developments attracted further private sector investment of AUS
$250 million for a science park, a tertiary college, new housing and leisure
development
New Millennium Bridge over the Tyne (AUS $50 million)
built to connect Gateshead's flagship arts facilities with
sister city Newcastle.
A by-product of this success is that the population
health profile of the town significantly improved.

37. Healthy Ageing: Creativity Matters
Creative Ageing: Health and wellbeing benefits for older people who engage
in creative activities
A specialised area, at a critical time in healthcare globally, challenged by a
rapidly increasing ageing population.
Office for an Ageing Australia appointed
actress Noelene Brown as Ambassador for
Ageing in 2008 to promote healthy, positive
and active ageing messages in the Australian
community – to minimise or delay disability
and lead promotional activities to ensure
communities value and respect older people.

38. Ageing in 21st Century : Some Facts
By 2041, 1 in 5 Australians will be over 65; 7% will be over 80 (ABS)
Older people want to age in place and live independently in a safe, familiar
and welcoming environment. Connection to community is important.
We are moving to a time when the ageing population of the western world
will be the best educated and skilled in history, with much to offer
Some of the Challenges for Society
Combating ageist attitudes and discrimination towards older people
Harnessing and nurturing the true potential of the ageing population
Ensuring that people with dementia and their carers enjoy quality of life

39. A Potent Mix
Strategies to Facilitate Positive Change around Ageing
 Improved marketing communications / health promotion to promote
healthy ageing through the arts, emphasising the physical and mental
benefits of engaging in creative activities.
 Promote positive attitudes to ageing by profiling older role models and
champions, encouraging increased intergenerational exchange and
highlighting the value of wisdom, experience and mentorship in the
community.
 Support the development of creative ageing strategies for older people
living in the community independently or for people in aged care
facilities, dementia care, hospitals and hospices, along with their carers
and families.

40. A Potent Mix
Strategies to Facilitate Positive Change around Ageing
 Increased research into the efficacy of arts and health programs in
improving and maintaining health, wellbeing and social inclusion for
older people
 Extrapolating from research data the business case for creative ageing
strategies.
 Increased research into the use of the arts to support older people with
depression, anxiety, dementia and other chronic illness, and their carers.

41. A path to Healthy
Ageing
Creative Ageing Research in the USA
“Art is like chocolate for the brain”
Dr Gene Cohen MD PhD
Gene Cohen was the Director, Center on Aging, Health &
Humanities, Professor of Health Care Sciences & Professor of
Psychiatry & Behavioral Sciences, George Washington University
(www.gwumc.edu/cahh)
Acclaimed author, including
The Creative Age: Awakening
Human Potential in the Second Half
of Life (2000)
The Mature Mind : The Positive
Poswer of the Aging Brain (2006)

42. Compelling Results
Creativity and Aging Study: The Impact of Professionally
Conducted Cultural Programs on Older Adults
Dr Cohen completed this landmark study on the impact of professionally
conducted, participatory cultural programs on older adults, 2001 – 2005,
across 3 sites in Washington DC, New York City and San Francisco, with
300 people participants. Average age of participants was 80, with age
range of 65 – 103 years
The intervention group maintained greater
independence, higher morale, experienced less
loneliness, used less medication than control group,
expanded their interests and activities, achieved
a greater sense of control and enjoyed higher
social engagement
Ref: National Centre for Creative Aging, Washington DC www.creativeaging. org

43. A Universal
Language
Creative Ageing – Art and Dementia
The Meet Me at MoMA Alzheimer’s Program
and the National Gallery of Australia’s
Art and Dementia program are outstanding
models of arts and health programs in the
galleries/museum sector - bringing people
with Alzheimer’s and other forms of dementia,
along with their carers, to each museum for
interactive tours of masterpieces from their
collections. (www.moma.org/meetme/index)
MoMA offers an invaluable online resource
(www.moma.org/meetme/index)
bottom right: Carrie McGee Educator, MoMA

44. A Universal
Language
Creative Ageing – Art and Dementia
The National Gallery of Australia’s Art and Alzheimer’s Outreach Project
has been established to assist regional communities develop a
sustainable model of tours for people living with dementia. Alzheimer’s
Australia is a partner in the project.
This has been an important program
in facilitating social inclusion and
providing support for carers.
www.nga.gov.au
education@nga.gov.au

45. A Universal
Language
3rd Annual International
Arts and Health Conference
National Gallery of Australia
National Portrait Gallery
Canberra ACT
14 – 17 November 2011
Mental health, creative ageing,
social inclusion, intergenerational
programs and medical education are
areas of key focus.
Training workshops include the MoMA
and NGA Art and Dementia programs

46. A Potent Mix
The Last Word on Arts and Health
“It might be the purgative power of watching a great tragedy, the
soothing effect of a fine painting or even the robust exercise of singing
in a choir, but the arts are good for your health”
Richard Smith, Editor
British Medical Journal
New Scientist June 2002
Margret Meagher
Arts and Health Australia &
The Australian Centre for
Creative Ageing
www.artsandhealth.org
margret@artsandhealth.org