Since my return last month from Uganda and my blog about how participation in music making has impacted the health of local communities there, I’ve had several fascinating conversations with people here in the UK who are actively developing arts programmes as an essential ingredient of healthy placemaking.
One conversation was with an organisation called Sound Diplomacy who are working with the Earls Court Development Company on the creation of a cultural strategy for the regeneration of Earls Court in west London. Key to this was integrating health and wellbeing initiatives into the “cultural fabric” of the new development, which helped to define a “15-Minute Cultural City” for Earls Court to support its masterplan development, exploring ways to enhance accessibility and cultural experiences for future tenants, residents and visitors.
Another was with the Town & Country Planning Association, which recently held an event to celebrate the role of the creative industries in placemaking. In its campaign for a new generation of Garden Cities the TCPA has emphasised the
social value that arises from improving cultural infrastructure and facilities, with participation in the arts and creative industries a key foundation for healthy, connected communities.
And then I heard about a podcast called Creative Health Stories hosted by Laura Bailey, a specialist in creative health and wellbeing who initiated and led a cultural programme at Ebbsfleet Garden City. Her interviews with Sir Michael Marmot and Professor Kevin Fenton highlighted the importance of the arts in health equity, public health and placemaking, and so I approached her to learn more about this.
Here is my interview with Laura.
What is "Creative Health”?
‘Creative Health’ or ‘Arts and Health’ is growing as a global movement. Essentially these terms refer to the broad health and wellbeing benefits of participating in or experiencing the many forms of art, culture, heritage, creativity, design and nature in an array of different contexts and through different approaches.
Creative Health is also about the policy, strategy, infrastructure and assets, which inform and support delivery of this work, and fundamentally, creative health is about reducing health inequalities. There is much work going on in academia, in policy and at a grassroots level and there is incredible evidence about the benefits.
What is its importance in local communities?
Health systems in the UK are in crisis. There is a culture of waiting to be ill and too much reliance on the NHS to ‘fix’ us. Evidence from the work of Michael Marmot and the Institute of Health Equity also shows that health inequalities have worsened over the past 14 years and life expectancy within some poorer communities is shorter. This is not a good situation for a so-called wealthy country like the UK.
We need to shift some of the resources, funding, value and effort into a more preventative approach, but this can’t be done without addressing the social determinants of health.
Creative Health can support both of these things. Culture and the arts can play a role in improving the environments where people live. Within early years and school settings they contribute to children’s confidence, resilience, critical thinking and skills. They support connectedness and social capital within communities and can improve working environments.
There is significant evidence that engaging in creative activities supports our general health and wellbeing and so in terms of a shift towards preventative health approaches, the creative sector is already doing this in communities. Whether it's a knit and natter group, a local choir or photography group, a museum, or professional dance performances, the creative sector is out there making a difference to people’s quality of life. Cultural assets are community assets, so the creative sector has a huge role to play in community health.
Can Creative health be developed through placemaking?
Absolutely, creative health is about the policies, assets, infrastructure, networks, activities and engagement in places.
In terms of the built environment, how buildings and spaces are designed has a huge impact on our health and wellbeing and our ability to connect to other people. Everything from our homes, streets, parks, health centres, schools and so on should all be designed to support our health. For example, new health centres should be designed to prioritise community-based activities and non-clinical services. Bromley-by Bow Centre is a good example of this and one which has fully embraced arts and culture as a key part of its offer. In a regeneration context, we should be asking... how can these old buildings and spaces be transformed into spaces where people can flourish through creativity and community activities or which support jobs in a positive, accessible environment.
Genuine placemaking involves local people in decision making about the spaces in which they live, work, rest and play. This helps them to feel a sense of belonging and a desire to take good care of where they live, which also improves people’s quality of life. Health should underpin all placemaking approaches because the health of a place directly affects the wealth of a place. If we are well, we are more likely to engage in community life and more likely to have a job.
Artists and creative professionals should be part of multidisciplinary placemaking teams. They can contribute to the visioning and design of a place and help to engage people in the development and planning process. Investing in cultural, creative and community infrastructure, and engagement supports our health and the economy. What's not to like about that.
All of this requires health to be a priority objective locally and nationally through the planning framework.
Where and how have you seen this done well?
There are pockets of good work and a range of organisations who really care about this stuff – arts organisations, architecture practices, think tanks, academics, consultancies etc. In terms of advancing creative health policy, Greater Manchester, London and West Yorkshire are 3 regions leading the way, but many other areas are keen to work with their creative sector because they recognise the value it brings – to health and the economy.
I’ve just started to manage a new network of representatives from 10 Metro Mayor regions across England to help them embed creative health into local policy and practice. Collectively they represent more than 20 million people and nearly 50% of England’s GDP, so there is a huge opportunity for creativity to play a greater role.
In terms of creative health practice, there is very good work being done everywhere, but I think there needs to be a stronger relationship built between the creative, health and built environment sectors. I’m not sure that anywhere is taking a whole place approach to creative, healthy placemaking.
How has Ebbsfleet embedded Creative Health practice into its development?
In 2018, I was seconded to Ebbsfleet Garden City to embed creativity into the Healthy New Town Programme, which was national pilot funded by NHS England to better understand how to design health into new developments. We looked at new models of care which align with what I said earlier about health centres being more community focused, with only 30% clinical services and 70% non-clinical and community based.
Through an international landscape design competition, we investigated how you design health into new parks and open spaces which enable people to make healthier choices about how they travel, exercise and use outdoor spaces for a wider variety of things. We also looked at community activation through food growing, creative and physical activities. Examples included Edible Ebbsfleet a community food growing initiative based on Incredible Edible in Todmorden, and a Creative Wellbeing festival called Cloud9.
Much of this work was then embedded into the mainstream work of the Placemaking Team. We created a Culture Strategy from which we developed a significant programme working in partnership with arts organisations like Creative Estuary, Cement Fields and Blueprint Arts. The work focussed on community-led approaches, co-locating cultural facilities within planned infrastructure and developing life and work skills through culture, especially with young people. Creative Health was a component of the work but not always explicit.
Does this set an example for future new towns?
In the 6.5 years I was at Ebbsfleet we did some great work and shared our learning with other new towns. We tested a lot of things, worked with incredibly passionate professionals from different disciplines and with local residents through co-design, projects and events.
We came up with ideas and approaches, many of them costed and viable. I got to work with wonderful colleagues. It felt very exciting, like we could genuinely make Ebbsfleet a healthy and creative new place, whilst also supporting and integrating with established neighbourhoods.
However, large-scale, long-term developments are complex, and Ebbsfleet more so than many. Some of the approaches and principles we developed have been embedded and Ebbsfleet Development Corporation (EDC) (which is sponsored by Government to lead the development) has a range of strategies to support healthy placemaking. It continues to invest in community and creative projects and events, many of which are linked to health and wellbeing. But there were numerous challenges with Ebbsfleet fully embracing a creative, healthy placemaking approach. Swathes of the whole development site had existing planning consents which EDC inherited. So in these areas, EDC only has an influencing role. There are numerous developers and housebuilders in operation with varying attitudes to good placemaking. The planning and design teams at EDC have done some great work in pushing for better quality and in the more recent parcels to be built out, you can see a big difference.
The Covid-19 pandemic caused a host of challenges of course, Brexit, the volatility in the UK Government, and the rise in the cost of materials globally meant projects were no longer financially viable, some scrapped altogether, others cost-engineered and re-worked into something so far from the original vision. The short-term nature of funding settlements from Government is also a huge challenge in capital projects like this.
But more than this, to create a new town model for the future, to push boundaries and make positive change takes a kind of courage and vision which I don’t think Ebbslfeet has. It's a very risk averse organisation, heavily controlled by Government via its Board and, particularly in relation to Ebbsfleet Central – the future urban heart of the development – it doesn’t seem to be able to imagine what its USP will be.
As the first in a new generation of garden settlements, I think Ebbsfleet has a lot to share, especially in terms of placemaking with the community and working in a complex environment, geographically, ecologically, politically. There is no blueprint for how to develop a new town fit for the future, which prioritises excellent design, community, health, wellbeing and the environment along with jobs and meeting housing targets, but I don’t think Ebbsfleet will be writing it.
What are the essential ingredients for creative health? Does arts education play a significant role?
Creative Health needs a creative sector which is well resourced and valued. Arts education needs to play a big role in this, but as creative subjects have been pushed out of the curriculum over a sustained period, this may have created a problem for the future of the sector and creative skills. Creative subjects teach children much more than the artistic skill itself. They teach confidence, resilience, creative and critical thinking; about relationships, emotions and much more. If children are not learning these things, this will have a knock-on effect on their health in adulthood and more so for children from less affluent backgrounds whose parents can’t afford to pay for creative experiences outside of school or where it doesn’t happen at home.
Creative health also needs good cross sector relationships and partnerships to thrive. The arts alone cannot solve all health issues, but working collaboratively with other specialist and grassroots organisations can lead to better health outcomes. Creative health needs sustained investment and supporting infrastructure for the work to take place. Funding is a challenge as there is less moving around for more and more demand in health and social care. This is another reason why partnerships are important. Current health services and systems are not working, and the creative sector can help do things differently, but that means the money has to be used differently too.
Creativity needs to be taken seriously as part of a community and health offer. There is so much evidence as to its benefits in keeping people well and in the treatment and recovery from long-term health conditions. It needs to be written into policy and strategy – health, economic, planning, cultural – they are all interlinked.
The creative sector still has a problem with diversity and for creative health to be equitable, this needs addressing, so that everyone’s needs are heard and represented, and the opportunites are culturally appropriate. Creativity can play a big role in messaging and reducing stigma around health issues and so we need a workforce which reflects all communities in order to reach everyone and improve health outcomes.
At a time of declining funding for arts education, how do you build creative health into new towns, places and neighbourhoods?
The creative sector must be able to work collaboratively. It has a role to play across multiple agendas, which I’ve referred to already – health, economy, education, jobs, skills – and their subsectors. It needs to see itself as part of the wider business, voluntary, community, faith and social enterprise sectors. This doesn’t take away from its specialism; its uniqueness and its brilliance just for being. I know a lot of people don’t like the instrumentalisation of the arts, but I don’t think it's one or the other. Art will always exist just for its beauty, to communicate, question and make sense of the world. But those things also happen to make people feel good, feel belonging, connectedness and bring about positive change.
Many of these other sectors, including health, are looking to the creative sector for help to find new solutions and new approaches. In doing this, the creative sector can access a lot of support, training, funding and wider relationships that can enable creative health to happen in places. Artists and arts infrastructure are part of the assets in communities and neighbourhoods. People will always convene around creativity and culture, they are what make a place interesting and vibrant, and they tell its stories.
Funding is really hard right now, small organisations are struggling to exist, and creative practitioners are amongst those finding it hard to make ends meet, often freelance on very low income. So I’m not going to sit here and say ... hey, it will all be fine, art always prevails, we make stuff happen with whatever is available, because that's not good enough. Artists need to be paid for the great work that we all enjoy and benefit from.
New towns have the opportunity to embed creativity and health into plans right from the early visioning stages and to build co-designed community and workspaces, parks and public realm that enable creative and nature-based activities to take place and encourage healthy behaviours and participation. Co-locating culture with health and other services and businesses is an option if it's hard to make the case for a new arts centre for example. This is something we developed plans for at Ebbsfleet so that creativity could be available and accessible for everyone right from the early stages of development.
Communities need to be able to access funding and resources to make things happen for themselves, on their terms.
Many thanks to Laura for the interview.
Clare Delmar
Listen to Locals
November 13 2024
