The Public Health Outcomes Framework[i] outlines the government’s vision for public health, with two overarching outcomes:
- Increased healthy life expectancy.
- Reduced differences in life expectancy and healthy life expectancy between communities.
As a measurement of how well we’re doing, in relation to achieving these outcomes, a set of supporting indicators was devised.
These indicators are split into four domains.
- Wider determinants
- Health improvement
- Health protection
- Healthcare and premature mortality
Nine of these indicators are listed below; these indicators have been chosen, due to the accompanying evidence base that demonstrates the impact that arts and creativity can have on these public health outcomes. A summary of the evidence base is provided in the table:
| Indicator | Domain | Evidence |
|---|---|---|
| Reduction in the attainment gap | Wider determinants PHOF Indicator- B02 | Since 2019, the disadvantage gap index has increased from 2.91 to 3.23 in 2022 (the highest level since 2012)[i]. This suggests that the disruption to learning, due to COVID-19, has had a greater impact on disadvantaged pupils. Studies (qualitative, quantitative and some RCTs), involving music interventions, suggest engagement with the arts and creativity may improve educational attainment18. It’s also suggested that early childhood engagement in arts activities can predict academic performance12. |
| A reduction in 16–17-year-olds not in education, employment, or training (NEET) or whose activity is not known. | Wider determinants PHOF Indicator-B05 | Approximately 10.5% of 16–24-year-olds in England were not in education, employment, or training (NEET) in 2021[ii]. Encouraging young people who are NEET to get involved in the arts and creative activities can help to develop their social skills, confidence, and self-esteem. This may result in them moving into education, employment, or training[iii]. |
| Pupil absence, Persons, 5-15 years | Wider determinants PHOF Indicator-B03 | According to the most recent national statistics, 1.6 million pupils were persistently absent from school (missing 10% or more of their possible sessions) during the 2021/22 term[iv]. Several studies have suggested that pupil participation in music programmes can reduce truancy and increase school attendance[v],[vi]. |
| The percentage of adults who feel less lonely (lonely often / always or some of the time, Persons, 16+ years) | Wider determinants PHOF Indicator-B19 | According to the 2020/21 Community Life Survey, approximately 3 million people in England said they felt lonely, “often” or “always”[vii]. There is strong evidence to suggest that engagement with the arts and creativity can improve aspects of social cohesion including reducing the feeling of loneliness18. These interventions have proved particularly successful amongst those living in rural or disadvantaged areas[viii],[ix],[x]and in people with dementia[xi],[xii]. |
| Self-reported wellbeing – people with a low satisfaction score | Health Improvement PHOF Indicator-C28a | According to the Office for National Statistics (ONS), approximately 5% of the population of England have a low satisfaction score in relation to their self-reported wellbeing[xiii]. A report that synthesised the findings from over 3,500 studies relating to the role of arts and creativity in the prevention, management and treatment of ill-health and health promotion, suggested that there was strong evidence relating to the use of the arts to improve wellbeing in adults and that this evidence can be trusted to guide policy development. The evidence relating to children and young people is also promising18. An example of an intervention that was reported to improve self-reported wellbeing was tai-chi for older adults[xiv]. |
| Frailty & MSK indicators | Health improvement PHOF Indicator-C27 | Frailty in older age increases the risk of falls, fractures, disability, and premature death[xv]. Arts and creativity engagement may reduce the risk of frailty in older age12. Studies demonstrating this have focused on dance as an art form. However, other studies have demonstrated that engagement in music sessions, within inpatient settings, is associated with a decreased risk of falls[xvi],[xvii] and attending the theatre, concerts, museums, galleries, and the cinema within the community can slow the rate of frailty progression[xviii]. |
| GP time and repeat visits | Health improvement PHOF Indicator-N/A | It is estimated around 20% of patients consult their GP for social issues[xix]. Social prescribing (including the prescription of arts and creativity-related activities) has been shown to reduce the number of GP visits made by recipients[xx]. |
| Depression and self-reported happiness | Health improvement PHOF Indicator-C28c Depression- QOF presence and incidence (18+ years) | Approximately 1 in 6 (17%) adults experienced some form of depression in the summer of 2021, this is an increase of 7% in comparison to pre-pandemic levels[xxi]. Engagement with the arts and creativity has been shown to both prevent the onset of depression[xxii] and reduce depressive symptoms in those with the illness[xxiii]. Positive effects can be physical (increased muscle strength and neurochemical effects), cognitive (stimulation of memory), social (increased social connectedness), personal (self-esteem) and cultural (creative expression) 58. |
| Anxiety (self-reported) | Health improvement PHOF Indicator-C28d | Despite improvements in the last year, average ratings for anxiety across the UK are still greater than they were before the start of the COVID-19 pandemic[xxiv]. There is a wealth of evidence demonstrating the benefits that creativity and arts engagement and participation has on anxiety across all age groups (children, adults, and older people). Studies have also been conducted in people with chronic conditions, such as cancer[xxv],[xxvi],[xxvii],[xxviii] and coronary heart disease[xxix],[xxx], those with non-psychotic mental health disorders[xxxi],[xxxii],[xxxiii],[xxxiv],[xxxv] and in marginalised groups including migrants and refugees[xxxvi], prison populations[xxxvii] and the homeless4. All have demonstrated that arts and creativity-related interventions can reduce anxiety in participants. |
| Isolation and social networks | Wider Determinants PHOF Indicator- B18a, B18b | There is strong evidence to suggest that engagement in the arts and creativity can both reduce isolation19,13 and act as a protective factor particularly for groups at a higher risk of isolation such as individuals with a neurological disease[xxxviii],[xxxix],[xl],[xli]. Participation in group singing and music activities was found to enhanced wellbeing, development of new skills, positive relationships, a sense of belonging and increased social networks in older people[xlii]. |
| Self-esteem | N/A | Increased self-esteem is one of the most frequently reported outcomes of arts and creativity engagement interventions. There is robust evidence demonstrating impact across the life course (children13, adolescents19, adults13 and older people[xliii]) and in higher risk groups including those experiencing mental ill-health[xliv],[xlv], stroke patients[xlvi], adult prisoners[xlvii] and young offenders[xlviii]. |
| Sense of life purpose | Health Improvement PHOF Indicator – C28b | A study commissioned by the Arts Council found that using public libraries had a positive impact on wellbeing (higher life satisfaction, higher happiness, and higher sense of purpose in life) as well as finding library users more likely to report good general health[xlix]. A review of the literature on creative arts and healing showed that, music has been evidenced to enhance mood and sense of purpose[l]. |
References
[i] Office for Health Improvement & Disparities, Public Health Outcomes Framework. Available at: Public Health Outcomes Framework – OHID (phe.org.uk)
[i] GOV.UK (2022) Key stage 2 attainment, Academic Year 2021/22. Available at: Key stage 2 attainment, Academic Year 2021/22 – Explore education statistics – GOV.UK (explore-education-statistics.service.gov.uk)
[ii] GOV.UK (2021) NEET age 16-24, Calendar Year 2021. Available at: NEET age 16 to 24, Calendar Year 2021 – Explore education statistics – GOV.UK (explore-education-statistics.service.gov.uk)
[iii] LGA (2021) Education to Employment – Supporting Youth Participation. Available at: Education to Employment – Supporting Youth Participation | Local Government Association
[iv] GOV.UK (2022) Pupil absence in schools in England: autumn and spring terms. Available at: Pupil absence in schools in England: autumn and spring terms, Autumn and Spring Term 2021/22 – Explore education statistics – GOV.UK (explore-education-statistics.service.gov.uk)
[v] Cain M, Lakhani A, Istvandity L. (2016) Short and long term outcomes for culturally and linguistically diverse (cald) and at-risk communities in participatory music programs: a systematic review.
Arts Health;8(2):105–24. doi: Short and long term outcomes for culturally and linguistically diverse (CALD) and at-risk communities in participatory music programs: A systematic review: Arts & Health: Vol 8, No 2 (tandfonline.com)
[vi] Heyning L. (2010) The enhancement of musical and other learning for both teachers and students through a weekly choir session. Australian Journal of Music Education, 1. Available at: The enhancement of musical and other learning for both teachers and students through a weekly choir session – Southern Cross University (scu.edu.au)
[vii] GOV.UK (2021) Community Life Survey 2020/21- Wellbeing and Loneliness. Available at: Community Life Survey 2020/21 – Wellbeing and Loneliness – GOV.UK (www.gov.uk)
[viii] MacLeod A, Skinner MW, Wilkinson F, Reid H. Connecting socially isolated older rural adults with older volunteers through expressive arts. Can J Aging. 2016;35(1):14–27. doi: 10.1017/S071498081500063X
[ix] Murrock CJ, Graor CH. Depression, social isolation, and the lived experience of dancing in disadvantaged adults. Arch Psychiatr Nurs. 2016;30(1):27–34. doi: 10.1016/j.apnu.2015.10.010.
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[xiii] Office for Health Improvement & Disparities Public health profiles. Available at: Public health profiles – OHID (phe.org.uk)
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[xv] Kojima G, Liljas AEM, Iliffe S. Frailty syndrome: implications and challenges for health care policy. Risk Manag Healthc Policy. 2019 Feb 14;12:23-30. doi: 10.2147/RMHP.S168750. PMID: 30858741; PMCID: PMC6385767.
[xvi] Chabot J, Beauchet O, Fung S, Peretz I. Decreased risk of falls in patients attending music sessions on an acute geriatric ward: results from a retrospective cohort study. BMC Complement Altern Med. 2019;19(1):76. doi: 10.1186/s12906-019-2484-x.
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[xix] Husk et al. (2019) Social Prescribing: where is the evidence?. Br J Gen Pract, 69(678), 6-7. https://doi.org/10.3399%2Fbjgp19X700325
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[xxi] Office for National Statistics (2021) Coronavirus and depression in adults, Great Britain: July to August 2021. Available at: Coronavirus and depression in adults, Great Britain – Office for National Statistics (ons.gov.uk)
[xxii] Kim J. Effects of community-based group music therapy for children exposed to ongoing child maltreatment and poverty in South Korea: a block randomized controlled trial. Arts Psychother. 2017;54:69–77. doi: 10.1016/j.aip.2017.01.001.
[xxiii] Stickley, Wright and Slade (2018) The art of recovery: outcomes from participatory arts activities for people using mental health services. Journal of mental health
[xxiv] Office for National Statistics (2021) Personal well-being in the UK: April 2021 to March 2022. Available at: Personal well-being in the UK – Office for National Statistics (ons.gov.uk)
[xxv] Hirsch S, Meckes D. Treatment of the whole person: incorporating emergent perspectives in collaborative medicine, empowerment, and music therapy. J Psychosoc Oncol 2000;18(2)
[xxvi] Haun M, Mainous R, Looney S. Effect of music on anxiety of women awaiting breast biopsy. Behav Med 2001
[xxvii] Weber S, Nuessler V, Wilmanns W. A pilot study on the influence of receptive music listening on cancer patients receiving chemotherapy. Int J Crit Care 1997;8
[xxviii] Morrison P, Nishimoto PW, Kim JB, Medina-Dupaix C, Bantum EO. Perceived Impact of Participation in a One-Time Expressive Arts Workshop. Mil Med. 2019 May 1;184(5-6)
[xxix] Collins R, Hunt A, Quinn C, Martyr A, Pentecost C, Clare L. Methods and approaches for enhancing communication with people with moderate-to-severe dementia that can facilitate their inclusion in research and service evaluation: Findings from the IDEAL programme. Dementia. February 2022
[xxx] White JM. Effects of relaxing music on cardiac autonomic balance and anxiety after acute myocardial infarction. Am J Crit Care 1999;8
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[xxxii] Uttley et al (2015) Systematic review and economic modelling of the clinical effectiveness and cost-effectiveness of art therapy among people with non-psychotic mental health disorders Health Technology Assessment, No. 19.1
[xxxiii] Lawson J, Reynolds F, Bryant W, Wilson L. ‘It’s like having a day of freedom, a day off from being ill’: exploring the experiences of people living with mental health problems who attend a community-based arts project, using interpretative phenomenological analysis. J Health Psychol. 2014 Jun;19(6)
[xxxiv] Margrove KL, Heydinrych K, Secker J. Waiting list-controlled evaluation of a participatory arts course for people experiencing mental health problems. Perspectives in Public Health. 2013;133(1):28-35.
[xxxv] Martin, L. et al (2018) Creative arts interventions for stress management and prevention – a systematic review. Journal of Behavioural Sciences https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5836011/
[xxxvi] Nilay Ugurlu, Leyla Akca & Ceren Acarturk (2016) An art therapy intervention for symptoms of post-traumatic stress, depression and anxiety among Syrian refugee children, Vulnerable Children and Youth Studies, 11:2, 89-102
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[xxxviii] Ali, K., Gammidge, T., & Waller, D. (2014). Fight like a ferret: a novel approach of using art therapy to reduce anxiety in stroke patients undergoing hospital rehabilitation.Medical humanities,40(1), 56–60. https://doi.org/10.1136/medhum-2013-010448
[xxxix] Morris, J. H., Kelly, C., Toma, M., et al. (2014). Feasibility study of the effects of art as a creative engagement intervention during stroke rehabilitation on improvement of psychosocial outcomes: study protocol for a single blind randomized controlled trial: the ACES study.Trials,15, 380. https://doi.org/10.1186/1745-6215-15-380
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[xlvii] Arts Council England (2018) Arts and culture in health and wellbeing and in the criminal justice system: a summary of the evidence. Available at: https://www.artscouncil.org.uk/sites/default/files/download-file/Arts%20and%20Culture%20in%20Health%20and%20Wellbeing%20and%20in%20the%20Criminal%20Justice%20system-%20a%20summary%20of%20evidence.pdf
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[l] Daykin, N., Mansfield, L., Meads, C et al. (2018). What works for wellbeing? A systematic review of wellbeing outcomes for music and singing in adults.Perspectives in public health,138(1), 39–46. https://doi.org/10.1177/1757913917740391