This blog is a reblog of content originally posted at Voluntary Health Scotland

I joined Renfrewshire Council in late 2018 in the newly-created post of Paisley Partnership, Strategic Lead for Cultural Regeneration, having previously held culture-related roles with the Scottish Government, Creative Scotland and a variety of other organisations. On 29th November 2019 I was invited to speak at the Faculty of Public Health annual Scottish Conference. The theme for the two days was social justice in public health. I was asked to talk about the role of arts and culture in health, wellbeing and social justice. Other speakers gave extraordinary accounts and inspiring talks on what is holding us back and what opportunities we have in terms of achieving more equality and equity in relation to health and wellbeing. The following is drawn from my speaking notes and makes the case for us to connect more and to have the confidence to be bold.

Culture, health and social change

It was a real honour to be invited to be part of the FPH conference. I think the worlds of public health and culture should mix more. When I was Head of Culture Strategy at the Scottish Government, health and wellbeing were an obvious focus in the development of the culture strategy. There are areas of outstanding practice across Scotland that bring together culture, health and wellbeing. I will highlight some here, but we do lag behind other countries in terms of developing an overarching, integrated culture and health policy approach. Voluntary Health Scotland, along with many others, are really seizing upon this and offering leadership with a view to us being more strategic. The Culture Strategy should be published soon.

It’s perhaps worth saying that when I use the world culture, I am broadly meaning it to refer to the arts, heritage, libraries, screen, creative industries and everyday creativity. I imagine that in public health terms it can refer to different things. I am going to cover a few things. First, in broad terms, the role of arts and culture in pursuing social justice. Then more about my current role in Paisley. Where we are building from the success of Paisley’s UK City of Culture bid process and developing, what we hope is, a radical and pioneering approach to cultural regeneration that is physical, social, economic and long-term.

So what role does culture, the arts and creativity have in social justice and health inequalities?

This is a huge area and covers a vast range. It can probably be summed up in the following ways:

1. Art and culture are a force for good in society and should be free to create, to reflect, refract and challenge. They bring joy, meaning and disruption – helping us all to think differently about the world and our experience of it, learning from our past, understanding the present and imagining alternative futures.
2. Many cultural projects, practice and approaches focus on inequalities and acknowledge disparities in power, voice and agency.
3. Every day artists and performers are working directly in health and care settings as of course is art therapy.
4. There are certain types of cultural activity that are focused on patient groups, a piece of the overall jigsaw in providing effective treatment.

And finally, the way that artists, designers and architects contribute to well places through the design of physical environments – health settings, housing, schools and public spaces – and to the design of services that improve our quality of life and our experiences of services. Design also communicates the value we give to the user of a building, space or service.

I won’t be able to do justice to this breadth so I will first focus on what culture does in the pursuit of social justice and what it can do to add value in terms of treatment. Before moving on to Paisley. I am an advocate for arts and culture, not an evangelist. There is no one answer to the multiple and complex health and inequality challenges that we face and that many, too many, are living with every day. Culture and creativity can add value to other disciplines and sectors and can help us to think differently about prevention in the long term.

Some examples from across sectors

The work of organisations like Glasgow based Vox Liminis re-imagines societal challenges like rehabilitation and reintegration by bringing people together to connect, communicate and have positive experiences. At a mental health conference, the Open Mind Summit, in October I heard more about their project KIN. In Scotland, it’s estimated that more young people are affected by the imprisonment of a parent every year than those affected by divorce. Each sentence impacts way beyond the prison walls with the stigma leading to young people feeling cut off from their families and often from wider society. KIN is a close knit arts collective of young people who have all experienced having a parent or sibling in prison. Turning stigma into solidarity, they have developed their own distinct artistic voice challenging labels given by society and reflecting their collective desire to not be defined by that experience alone.

With One Voice works across the UK and internationally to strengthen the arts and homelessness sector through exchanges in practice and policy. People who have experienced homelessness face challenges that are not just about housing. They can often suffer chronic social isolation, poor physical and mental health and lack of autonomy. With One Voice has developed a model based on a jigsaw to communicate the importance of the arts in the support of people who have experienced homelessness as part of Manchester City Council’s Homelessness Strategy. The Jigsaw attempts to address the hierarchical nature of support where the most urgent and practical need is addressed first. It sets out an alternative where multiple needs can be addressed by multiple solutions at the same time, including the arts to help develop confidence, self-expression, increase well-being and greater social inclusion.

Create London is a progressive organisation in the east end of London that focuses on social change and equality. One project called You Are What You Eat is with eleven-year olds from at a multi-ethnic school in Tottenham that is experiencing rapid urban development and where levels of childhood obesity are at a national high. Although titled You Are What you Eat the project is not about offering direction to people about what to eat when they are living in environments where the fast food culture dominates. Rather, the project uses film-making to empower children through self-representation, using imagination and storytelling to interrogate and explore how our food, our communities, our urban surroundings and our cultures create supportive environments for both our bodies and our health. Create also established Chicken Town, an alternative fried chicken bar developed with artists, chefs, architects and local schools. Where the chicken was reared on local urban farms and cooked well. Within a mile of the restaurant there are 34 fast food outlets offering cheap, calorific food that is accessible, affordable and for many young people a key part of their regular diet. In the context of increasing obesity, the project offered young people the opportunity to explore a healthier way of enjoying fast food and encouraged them to think about the origins of what they are eating

What is the impact of cultural participation and expression?

When I was working at the Scottish Government, many of the conversations that we were having centred on ideas around culture as both a human and community right where every citizen has a right to participate in culture of their choice and to express their own creativity. Culture can be a way for communities and residents to grow in confidence, to feel empowered and to influence the course of their own life rather than it being socially determined. Evidence from the Scottish Household Survey shows that people who participate in culture are more likely to report good health and life satisfaction than those who do not. It also shows those who engage in cultural activity in earlier years are more likely to participate and attend when they are adults.

Figures for engagement in culture are growing, but evidence shows that there are deep inequalities within this increasing engagement. Those living in poverty, people living with long-term physical or mental health conditions and those who do not have university degrees are not engaging in culture to the same extent as the larger population, as we currently measure it. Those living in poverty or on a low income often have less opportunity to engage in certain types of culture than their wealthier counterparts. This applies to cultural activities that although free to access include hidden costs like transport or food, and of course barriers aren’t just economic. It’s therefore vital that we create the conditions to enable people to access and engage in culture in their own communities, towns and city centres across a range of environments including schools, care and community centres from as early as possible, and for as long as possible.

Culture and creativity can help young people grow confidently as citizens. Creative learning fosters young people’s critical thinking and problem-solving skills. It can lead to positive learning experiences which can change the way young people feel about themselves, school and education and the aspirations they have. Of course, it’s not just young people who benefit through cultural participation. The benefits of taking part in creative activities as we grow and age are becoming increasingly clear, with positive impacts on health, wellbeing and on addressing isolation and loneliness. The Scotland wide Luminate festival celebrates the huge contribution that older people make to the cultural life of our country. The festival features projects that bring young and old together and presents work that explores what it means to all of us that society is ageing. An ageing population presents challenges: however, it also brings with it many advantages, and culture can help to challenge perceptions of age by celebrating age as a powerful dynamic in society.

Culture can support medical treatment

The 2017 Creative Health report published by Westminster’s All Party Parliamentary Committee on Arts, Health and Wellbeing makes a compelling case for the role that culture and creativity have in helping us to stay well longer, recover faster, manage longer term conditions better and have a better quality of life. From the perspective of Realistic Medicine all national strategies should consider health as a policy priority. Realistic Medicine states that as a society we are over medicating, that other avenues need to be explored and that there is evidence that arts and culture can contribute to this.

Again, there are so many examples that I could offer. The range of organisations working in arts and health is enormous. With many embedding their approaches to autism, dementia, Parkinson’s, mental health and inter- generational activity into their core programmes. And with some entirely focussed on health, like the Scottish Mental Health Arts Festival that explores the relationship between creativity and the mind, and promotes positive mental health and wellbeing. Scottish Ballet and Dance Base’s Dance for Parkinson’s programme focuses on enabling those with Parkinson’s to experience the benefits of dance and creativity, improving balance, spatial awareness, confidence and movement. Scottish Opera’s Memory Spinners is a group that meets weekly in Airdire, Glasgow and Edinburgh. The group uses music, storytelling, movement and the visual arts, to help people with dementia and their carers to relax, be creative and form new support networks. The Cheyne Gang choir was started in Edinburgh by nurses with groups also now in the Borders and Glasgow’s east end. The choir explores the potential of whether singing techniques, including breath control, and the practice of singing can improve the wellbeing of those with debilitating breathing conditions.

Is there any evidence?

There are numerous reports and studies that evaluate the positive impacts of cultural activities on health and wellbeing. It is a complex area with great variation in what is being evaluated and there is a challenge in demonstrating a clear line of causality between intervention or activity and impact. This can be especially difficult with long term preventative approaches, but should that stop us trying? Perhaps the ways we research, evaluate and require evidence need to change to accommodate the potential of prevention. It is hard for us, as a sector, to demonstrate impact and causality. Looking at contribution to outcomes in the context of theory of change models may offer a way forward. As could giving the stories and qualitative evidence the same value as numbers.

In recent weeks WHO Europe published its scoping review What is the Evidence on the Role of the Arts in Improving Health and Wellbeing? The report helpfully synthesizes the global evidence on the role of the arts in improving health and well-being. It’s clear in its message – results from over 3,000 studies identified a major role for the arts in the prevention of ill health, the promotion of health, and management and treatment of illness across a lifespan. It goes further, noting that the beneficial impact of the arts could be furthered through acknowledging and acting on the growing evidence base; promoting arts engagement at the individual, local and national levels and supporting cross-sectoral collaboration across health, social care and cultural sectors. Examples cited range from the use of recorded music pre-surgery to calm patients, arts as an activity for people with dementia, social prescribing, and supporting the inclusion of arts and humanities education within the training of health-care professionals. Through to exploring where large-scale arts interventions can promote health and alter health behaviours at individual and community levels.

Sistema Scotland is perhaps an example from close to home of a long term intervention. Sistema aims to transform lives through music. The evaluation work aims to demonstrate the role that the arts can play in regeneration, grassroots positive social change, and improving the health and wellbeing of communities. Glasgow Centre for Population Health’s Sistema Scotland Evaluation Research Findings, and the effect on their communities, shows a range of positive outcomes from better school attendance to projected whole-life benefits for participants, such as greater community cohesion as well as economic gains over the medium and longer term. At the heart of all that Sistema does though are relationships, the relationship between a musician and a child, the child and an instrument, the child and an orchestra and the orchestra and the wider community. It will take years to truly understand the impact of this and that its perhaps through the development of relationships that often start with an individual that the most profound social change can occur.

So, to Paisley

Paisley is Scotland’s largest town, with a population of around 78,000 and with the second highest concentration of listed buildings in Scotland after Edinburgh. It’s a place of learning and training with the University of West of Scotland and West College Scotland both having major campus in the town. Some of the UK’s biggest engineering, technology and logistics companies are based there, close to Glasgow Airport. The National Manufacturing Institute Scotland is in Renfrewshire and has ambitions to be Scotland’s centre for advanced manufacturing.

Paisley was a small market town that transformed into one of the most productive towns in the world as an international textile producer. Giant mills, car plants, manufacturers and other industries employed thousands of people well into the 20th century. The workforce was skilled and renowned for its campaigning for social justice, fair employment and access to education and culture. By the mid-1990s the mills and car plants had shut, bringing unemployment, de-skilling, and disempowering communities. As well as changing the social, physical, economic and cultural landscape of the town and leaving a long-lasting legacy of systemic poverty in some neighbourhoods.

Today in Paisley, 34,000 live in deprivation and one in three children live in poverty. 10% of Paisley’s population live in the 5% most deprived communities in Scotland. Health inequality is a major issue – 72% of the population live in areas with a higher than average number of emergency stays in hospital. There are high levels of prescribed drugs for depression and anxiety, especially amongst younger people. There were 50 drug-related deaths in Renfrewshire in 2018: this was the largest number recorded in the past decade and the number of alcohol-related deaths in Renfrewshire in 2018 reached 50. We have set up an Alcohol and Drugs Commission to approach the challenges in a different way and to explore new ways of tackling the issue for individuals and families affected in the short and long term.

The work I am leading is called Future Paisley. As I mentioned, it builds from the success of the UK City of Culture bid process that Paisley took part in in 2017. The bid journey built confidence in the town and envisioned new possibilities for Paisley’s future. There is now a clear sense of optimism and momentum for change across communities and partners. The approach is underpinned by a partnership of local, Scottish and UK partners to harness the power of culture to generate greater equality of opportunity. In taking a broad view, our approach promotes cultural regeneration as a means of effecting economic, environmental and social change, when it is integrated as part of a holistic, multi-disciplinary approach involving different views, areas of expertise and perspectives working together.

What we are doing?

The approach is underpinned by an investment of over £100 million from Renfrewshire Council and partners that runs from 2018 until the end of 2022. Six step changes act as outcomes, guiding all activity and providing a structure that evaluation and research will be grounded in.

Establish Paisley as a centre of excellence for cultural regeneration through leadership, partnership, participation and collaboration
Lift Paisley’s communities out of poverty
Paisley will be recognised for its cultural excellence
Transform Paisley into a vibrant cultural town centre
Grow a significant new dimension to Paisley’s economy
Radically change Paisley’s image and reputation in Scotland, the UK and internationally

Under each of these step changes is a range of activity.

Establish Paisley as a centre of excellence for cultural regeneration through leadership, partnership, participation and collaboration

In March 2019 we established the Centre for Culture, Sport and Events (CCSE) as a new research centre in Paisley. It’s a partnership between the University of the West of Scotland and Renfrewshire Council. It’s working to ensure that research and evaluation are fundamental and embedded parts of the Future Paisley Partnership’s overall approach.

As part of the centre we have three fully funded PhDs focussed on:

Culture, media and the transformation of place impressions – is everything we are doing changing people’s perceptions of the town internally and externally and making any difference? Paisley is often seen as poster town for poverty and retail decline
Poverty, Health and Action Research in Cultural Regeneration – exploring the relationship between culture and the systems and structures that keep people in poverty
Direct and indirect contribution of developing creative industries, cultural sector and events as a core of Paisley’s inclusive economy; are we creating economic opportunities for all?

Lift communities out of poverty

This step change will have no doubt caught your attention. It is the most audacious by far and the toughest for us to achieve – its audacity though has been a rallying call for partners to come together to address inequality in Paisley. In time, we will also reflect on the language and tone of this step change to ensure that it isn’t reinforcing unhelpful narratives.

At the heart of this outcome is the Art, Culture, Health and Social Care Network. The network is both strategic and operational – it’d supporting the embedding of arts, culture and creativity within the Health & Social Care Partnership. The programme ranges from Community Connectors to art in hospital, a cultural buddies’ scheme, a significant focus on creativity and young people’s mental health, and a Young Producers development programme with the care system, as well as supporting Social and Cultural prescribing in deep end GP practices.

Education and learning are also a priority. Renfrewshire is one of nine ‘challenge authorities’ in the Scottish Attainment Challenge, aiming to close the attainment gap between those living in Scotland’s least and most deprived areas. In early 2019, Education Scotland published its inspection report finding significant year-on-year improvements in listening, talking, reading, writing and numeracy, with the attainment gap closing across all measures. Part of our approach is a huge focus on creativity in terms of how literacy and numeracy are taught, with music part of everyday school life for every pupil. As well as this we are developing creative partnerships with schools.

Castlehead School of Creativity is in a 10 year partnership with Glasgow School of Art. The partnership aims to develop creative, confident and curious young people. Castlehead High School feeds from Ferguslie Park. At Castlehead High School creativity is at the heart of the school and the potential and aspirations of each young person is valued. With Glasgow School of Art, studio-based teaching and learning techniques are applied and integrated across many disciplines to encourage innovative thinking, increase attainment and to develop skills needed to thrive both in the world of work and in broader society. Pupils from S1 up experience a range of subjects and specialisms through trips to the art school and art school staff support in service training at the school as well as pupils having access to GSA portfolio classes. This partnership is about more than building aspiration, its also about opening up economic opportunities and reimagining education.

There are some very visible physical changes underway in the town. With the transformation of major cultural venues framed by a reimagining of the High Street as a cultural, social, civic and economic gathering place, we are preparing a post retail town centre.

Finally

Although, cultural regeneration in Paisley is about much more than buildings, the transformation of the museum, opening a High Street Museum Store, renovating the town hall and designing a new central library at the heart of the High Street are important emblems of change and hope for Paisley and Renfrewshire. They illustrate the value that we are giving to culture as a fundamental part of a place and of a person’s life. Our understanding of culture extends beyond formal venues into what happens on streets, in squares, in homes, nurseries, schools, hospitals, care settings, in neighbourhoods and in the workplace.

There isn’t any one solution or thing that will make Scotland more socially just. Culture and creativity can add value, open up new possibilities, new relationships and they can give a person, a community, a sense of their own agency and value so that they have hope, experience joy and have the confidence to determine their own future. We saw that in Paisley with the bid. As well as this, culture can shift our gaze and offer ways to scrutinize the systems and structures that exist that often reinforce the inequalities we are all trying to address. In Paisley, we value culture and creativity not as ornamental but as a fundamental – not only in offering positive experiences throughout life, no matter who we are or where we are from. But because they can also encourage us to go further – to imagine what a better society could be and what ideas, system, structural and attitude changes, can get us there.