Hands, from Michelangelo’s “Creation of Adam,” at Italianrenaissance.org

In Createquity’s view, a healthy arts ecosystem maximizes the arts’ capacity to improve the lives of human beings in concrete and meaningful ways. As such, we have sought to better understand the various means by which one measures such improvements, the current state of research across areas of impact, and where there’s room to grow.

Why We Care

Since the evidence base for the benefits of the arts is continually developing and evolving, our investigations in this area have been fairly expansive. We began by grounding our work in the concept of wellbeing – an emerging, interdisciplinary field of study in the social sciences centering on a holistic definition of individual and societal health – to look at the impact of the arts across multiple dimensions of human life. We wanted to better understand how other sectors define and measure wellbeing and quality of life, and how arts and culture might fit into these existing frameworks. This foundational investigation led to a subsequent inquiry into the following questions:

• What are particular claims to the benefits of arts participation?
• Does the majority of available evidence support each claim?
• How strong is the quality of evidence?

What We Know

Grounding our research in the concept of wellbeing helped to shape our definition of meaningful benefits as a result of arts participation. We learned that although most wellbeing frameworks do not explicitly include arts and culture, some do. The one most closely matching Createquity’s worldview is the capability approach originally proposed by economist Amartya Sen, which frames wellbeing in the context of human beings’ freedom to make choices about how to live their lives. Philosopher Martha Nussbaum’s elaboration of the capability approach embraces the arts’ influence on overall wellbeing both directly and indirectly via the capabilities of “senses, imagination, and thought” and “play,”  which may include active arts participation and creation, as well as observation, reflection, absorption and enjoyment of arts experiences.

Our subsequent review of research into arts and wellbeing – focusing on the benefits of the arts on a range of different wellbeing impact areas – fits into four broad areas of impact: physical and mental health, education and personal development, economic vitality, and social cohesion. Following is a list of benefits claimed for arts participation across these areas, categorized based on the strength of the evidence backing those claims.

We are highly confident that:

• Participatory arts activities help to maintain the health and quality of life of older adults.  There is evidence that singing improves mental health and subjective wellbeing; taking dance classes bolsters cognition and motor skills; dancing and playing a musical instrument reduce the risk of dementia; and visual arts generate increases in self-esteem, psychological health, and social engagement.
• Arts therapies contribute to positive clinical outcomes, such as reduction in anxiety, stress, and pain for patients. Music interventions tend to dominate studies in this area, mostly characterized by passive forms of participation (e.g., listening to music).
• Arts participation in early childhood promotes social and emotional development. For example, teachers report fewer instances of shy, aggressive, and anxious behavior among preschoolers taking dance classes, and toddlers receiving music instruction demonstrate increased social cooperation with other children.
• Student participation in structured arts activities enhances cognitive abilities and social skills that support learning, such as memory, problem-solving, and communication. (While arts participation may improve academic attainment as well, any effects are fairly small. Traditional scholastic measures such as standardized tests and grades have produced mixed evidence.)

We are moderately confident that:

• Community arts activities probably contribute to healthy living habits and improved understandings of health. A few mixed-methods studies have found among participants increases in healthy eating, physical activity, positive feelings, and other areas of personal development. However, it is difficult to know if these habits were sustained over time. Even in the case of sustained arts engagement, there is mixed evidence that it reduces mortality risk in adults.
• Arts and cultural participation probably improves subjective wellbeing (self-reported happiness or life satisfaction). Studies among large population samples cite both passive and active forms of art participation as important determinants of psychological wellbeing.
• Low-income students probably benefit disproportionately from access to arts education. Benefits such as improved cognitive abilities from music participation, or improved measures of tolerance for museum attendees, tend to be higher for students from low-SES households.

We have lower levels of confidence in the arts’ contributions to social cohesion and economic vitality, based on research we reviewed. For example,  participation in the arts may promote pro-social or civic behaviors like voting and volunteering, but the direction of the relationship is unclear – i.e., do pro-civic behaviors engender arts participation or vice versa, or is there is an underlying hidden value driving both behaviors? Evidence suggests that cultural participation may also contribute to economic growth through promotion of innovative workforce, and urban regeneration, but economic impact research is complicated by various confounding factors (e.g., planning policy, availability of jobs, general health of economy), making it difficult to really isolate the specific relationship and intensity of benefits.

What We Don’t Know

• In the absence of longitudinal studies, it is difficult to know the longer-term effects of arts participation. This is most true in the areas of health and early childhood education.
• The potential to make the case for the benefits of the arts suffers from a paucity of experimental and quasi-experimental designs, particularly in the areas of economic vitality and social cohesion.
• Generally, measuring effects at a community level is difficult to do when there are confounding factors. However, greater understanding of how the arts promote quality of life at the community or regional level could help to illuminate potential strategies or interventions that might work at scale to support a healthy ecosystem.
• Createquity’s investigations on the benefits of the arts have focused broadly on general effects on a general population. It is likely that there is quite a bit of variation between disciplines, between different modes of artistic participation (e.g., passive, active, solitary, communal), and between participants (comparing demographic and other differences). Research syntheses and comparative studies looking across these differences are generally lacking.

How to Use this Information

A few action items to consider:

For funders:

• The potential of the arts to improve lives for older adults and those in clinical settings seems under-invested in relative to the strength of the evidence. Consider how age and health fit into your strategy for improving lives through the arts.
• Similarly, consider what proportion of your arts funding portfolio reaches very young children (pre-K and younger), as some of the strongest available evidence indicates benefits for that population.
• Invest in longitudinal studies into benefits of the arts, especially those that involve diverse population samples, varying geographies, and embrace multiple disciplines.
• Consider funding more meta-analyses that take stock of the current spate of literature already in existence. British researchers have published a few of these, but there is much more to be done, and research coming out all the time that could be added to the mix.

For researchers:

• Conduct studies looking at the impact of the arts in comparison to other leisure-time activities, to make effect sizes in the arts more intelligible.
• Seek ways to assess impacts of arts participation across longer time frames, and embrace more experimental study designs if possible.
• There is currently very little research on the benefits of subsidizing the arts, as opposed to the benefits of arts participation. In other words, what proportion of the benefit realized from arts programming can be specifically attributed to grants or donations with that purpose in mind?
• Be transparent in discussing methods and limitations of arts participation, to allow others to learn directly from the research experience (in other words, don’t give undue credit to the arts if there isn’t enough supporting evidence).
• Further explore hierarchies of evidence in arts research, including examples of rigorous qualitative designs.

For arts organizations:

• Foster partnerships with other sectors that might benefit from your arts organization’s work (e.g., community and civic engagement, public health, social justice), and work together to further the arts’ contributions for community-wide benefit.
• Use the evidence that is available to help guide your programming to be as impactful as possible in providing benefits to individuals in your communities.

Resource List

Everything We Know about Whether and How the Arts Improve Lives (2016)
The research could still use an upgrade in many areas. But what we know so far should cheer any arts advocate.
A summary of the benefits of various arts endeavors including participatory activities, arts therapies, and arts engagement by young children and students.

(Eng)Aging with the Arts Has its Benefits  (2016)
In fact, the best evidence we have of the arts’ impact is that they make older adults feel better.
Recent studies indicate that  the most compelling evidence of the value of the arts revolves around improving the lives of older adults.

Are the Arts the Answer to Our TV Obsession? (2016)
Television can wreak havoc on the brain and the body. But people who watch it the most don’t seem to mind.
This article explores how, from obesity to apathy, the side effects of America’s national pastime (watching the tube) are taking their toll. What else to do?

Part of Your World: On the Arts and Wellbeing (2015)
A concept that’s been making the rounds in other fields for decades provides fresh ideas about how to think about the benefits of the arts.
This piece explains how the relationship between the arts and wellbeing could earn the former a proper seat at the table in conversations about human progress.

Capsule Review: The Impacts of Culture and Sport (2017)
What are the relationships between cultural engagement, sports participation, and social wellbeing? A recent study sheds light.
A British study examines the impact of sports and cultural participation on outcomes including measurements of health, education, civic participation, and personal wellbeing.

Capsule Review: Music, Singing, and Wellbeing (2017)
Three reports explore the effects of music on quality of life.
The UK’s What Works Centre for Wellbeing recently commissioned one of the most thorough research syntheses we’ve seen on the benefits of the arts.

A New Way to Think about Intrinsic vs. Instrumental Benefits of the Arts (2015)
Which matters more, art for art’s sake or art for people’s sake? Neither, according to a recent report.
A Philadelphia-based study reveals patterns between cultural participation, economic and geographic factors, and wellbeing among citizens.

“2012 Olympic Games” by Flickr user Republic of Korea

Title(s): Quantifying the Social Impacts of Culture and Sport; Quantifying and Valuing the Wellbeing Impacts of Culture and Sport (two reports)

Author(s): Daniel Fujiwara, Laura Kudrna, and Paul Dolan.

Publisher: UK Department for Culture, Media & Sport

Year: 2014

URL: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/304896/Quantifying_the_Social_Impacts_of_Culture_and_Sport.pdf

https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/304899/Quantifying_and_valuing_the_wellbeing_impacts_of_sport_and_culture.pdf

Topics: cultural engagement, sports participation, social outcomes, subjective wellbeing, cost savings

Methods: Regression analysis of survey data gathered between 2010 and 2011 among a nationally representative sample of 40,000 UK households (Understanding Society, Wave 2). Additional data in analysis drawn from British Household Panel Survey (Understanding Society survey predecessor with smaller sample size but more detailed income-related data).

What it says: The authors examine the relationship between sports and cultural participation and 1) various social outcomes, specifically measures of health, education, employment, and civic participation; and 2) subjective wellbeing (i.e., life satisfaction). They also estimate cost savings and financial values associated with the social and wellbeing impacts of sports and cultural engagement, which was defined by the following variables: participation in arts and cultural activities; attendance at arts and cultural events; participation in team and individual sports; and museum, heritage site, and library visitation.

Examining impacts on self-reported health, the authors found that those who participate in sports are 14 percent more likely to report good health than those who do not, whereas only 5 percent of art goers are more likely to report good health. Unlike arts attendance, arts participation (i.e., active modes of engagement) was found to have a negative association with health, although researchers suggest this could be attributed to reverse causality: the possibility that unhealthy people may be more likely to actively engage in the arts. Overall, the impacts of sports and culture on health were constant across gender, age, income, and geography, except the the impact of team sports on health was greater for younger people, and arts participation had more of an effect on health for older adults.

In terms of education, the authors examined the reported likelihood of 16- to 18-year-olds going into higher education (sample size of 900). There was a 14 percent increase in likelihood for those who participate in the arts, generally, and a 7 percent increase in likelihood for those who participate in swimming, which was the only sports variable to have a significant effect. There was a 13 percent increase in likelihood for those who attended dance events, and a smaller 8 percent increase in likelihood for those who actively participate in music. Given the smaller sample size, the authors did not examine distributional impacts across age, gender, etc.

The authors also examined the effects of sports and culture on job satisfaction and job search behavior. They found that participation in team sports is associated with an increase in job satisfaction, although this association only exists among people with high income. They found that participation in any sport is associated with an 11 percent increase in the likelihood of having looked for a job in the last four weeks. This figure was fairly similar for engagement in the arts (12 percent). The increase in the likelihood of looking for a job was slightly higher for people who participate in drama (11 percent) versus those who were members of an arts audience (8 percent). Those who participate in individual sports and those with higher incomes were 9.5 percent less likely to have looked for a job.

For civic participation, the authors examined correlations between sports and arts engagement and frequent volunteerism and charitable giving. They found that sports engagement is associated with a 3 percent increase in frequent volunteerism (defined as once every two weeks) whereas arts engagement (that is, both attendance and participation) is associated with a 7 percent increase. Participation in drama was more strongly correlated with frequent volunteerism (8 percent) than the next highest associated arts-related activity – attending an exhibition (3 percent). Increased charitable giving was twice as high among those who engage in the arts (£50 increase; although effects are modified by gender, with more charitable donations among men) versus those who engage in sports (£25 increase). Participation in drama was most strongly correlated with increased charitable giving (£83) than the next highest arts-related activity – attendance at dance events (£35).

As for wellbeing, the authors found that sports engagement, arts participation, and arts attendance all had a significant, positive association with life satisfaction. In particular, team sports and swimming had the greatest effect of all sports activities; drama and crafts produced the greatest effects within the arts participation category; and attending musical events and plays and visiting libraries were most effective of all attendance activities. Conversely, the researchers found that fitness and performing music had negative associations with life satisfaction. While there were few significant differences among different population groups, the report indicates that arts participation and individual sports’ positive effects on life satisfaction were larger for people over the age of 46.

Regarding cost savings and financial impacts, the authors looked at the association between self-reported health and use of medical services. Per person cost savings were highest for those who participate in sports (£98) versus those who attended arts events (£37). Arts participation had negative cost savings (-£32). It is important to note that these preliminary estimates do not consider other behavioral factors that may offset health benefits, such as quitting smoking, which may lead to weight gain. The authors then roughly estimated increases in lifetime earnings associated with sports and cultural engagement, which was highest for dance attendees (£56,400) and lowest for swimmers (£26,800). The authors also estimated monetary values (i.e., how much money one would need to derive wellbeing impacts) for arts and sports-related variables with statistically significant wellbeing impacts. The highest values were attributed to participation in dance (£1,671, per person, per year), swimming (£1,630), and library visits (£1,359). Assuming a twice-per-week engagement in sports, the authors estimate an annual value of £1,127 and a per-activity value of £11. For the arts, based on average engagement of 15 to 20 times-per-year, they estimate an annual value of £935 and per-activity value of £47.

What I think about it: The authors control for as many factors as possible using regression analysis, but acknowledge that they cannot fully attribute causality. Prior to conducting these analyses, the authors conducted a literature review to 1) ensure there was existing evidence of positive associations between sports and culture and, for example, improved health outcomes and volunteerism; and 2) determine what to control for in their analyses, which was fairly comprehensive. Also, the analyses seem particularly strong given the large, representative sample. It is important to note that the income data from the British Household Panel Survey and data from the Understanding Society survey come from different time periods, so impacts that may have changed over time are not accounted for in these analyses. In addition, Understanding Society data does not indicate the frequency of respondents’ participation in specific sports and cultural activities (e.g., fitness, swimming, music, dance). Rather, they derive a per-activity value for sports and cultural engagement, generally. In actuality, these values may vary based on the specific activity.

What it all means: Both reports indicate there are strong correlations between sports and cultural engagement and social impact – e.g., arts attendance and improved health; arts participation and volunteerism – and life satisfaction. Although these are not causal relationships, the analyses are useful for determining appropriate policy interventions, including estimating the costs and benefits associated with such changes and in comparison to other areas of leisurely engagement. Indeed, these reports could be helpful in allowing government to determine how best to allocate public dollars. The wellbeing valuation seems more fitting than use of market data (or preference-based valuation) since it examines the impact of a range of factors on wellbeing, including the income needed to achieve particular impact. As the researchers suggest for the future, issues of causality should be addressed through use of experimental methods, such as random assignments for sports and culture engagement, to single out effects and perhaps establish a control group with which to compare results.

“Europe” by flickr user Charles Clegg

Title: Culture, Cities, and Identity in Europe

Author(s): from Culture Action Europe: Katherine Heid, Mehdi Arfaoiu, Luca Bergamo, Natalie Giorgadze; from Agenda 21 for Culture – UCLG: Carina Lopes, Jordi Balta Portoles, Jordi Pascual; Simon Mundy

Publisher: European Economic and Social Committee

Year: 2016

URL: http://www.eesc.europa.eu/resources/docs/qe-01-16-463-en-n.pdf

Topics: urban planning, creative placemaking, cities, Europe, economic development, community revitalization, social cohesion, community identity

Methods: narrative literature review, case studies

What it says: The report aims to assess what is known about the relationship between culture (defined as “cultural industries, visual and performing arts, heritage and the creative industries”) and cities along four dimensions, as follows:

• Culture as a vehicle for economic growth: exploring traditional economic impact and value-added studies on the cultural and creative industries, heritage, cultural events, communications technologies, and “cultural routes,” the study concludes that “the benefits of culture for the economy follow a multidimensional path, having first a direct impact by creating jobs to support cultural production, then attracting tourists and amateurs as culture is being exhibited and promoted, and lastly sustaining regional investments and growth as the cultural value and knowledge of the region is recognised and exploited.”
• Culture as an instrument for reconverting cities: exploring literature on culture and urban regeneration, spillover effects of cultural activities, and the European Capitals of Culture program, the study stresses the importance of citizen participation in planning initiatives and an integrated approach, and recommends the adoption of culture/heritage impact studies.
• Culture as a tool for integration and inclusiveness: exploring literature on intercultural dialogue and migration, gender, and special needs (i.e, disability), the report emphasizes the importance of diversifying organizational management, programming, and audience development strategies.
• Culture as a pillar of European identity within Europe and beyond: examining the literature on the contribution of cities and regions to European identity, the role of non-European cities in maintaining cultural relations with Europe, cross-border cooperation and mobility, city networks, and cultural rights, the study discusses at length the notion of “global cultural citizenship.”

Within each section, the authors offer several case studies of “good practices” representing on-the-ground approaches toward achieving the goals in question.

This main part of the report is preceded by a brief review of data on cultural participation in Europe, the role that culture plays in society as perceived by citizens, and economic data on the creative industries. The report concludes with a set of 17 recommendations to the European Economic and Social Committee for its future work in cultural policy. These recommendations encompass five themes:

1. Recognize cultural rights as fundamental to human development: Envision culture as an enabler of dialogue and exchange, promote cultural diversity in the framework of human rights, and deepen exploration of the relationship between culture and human rights.
2. Acknowledge culture as necessary for sustainable development: Make culture a separate category of concern in sustainable development conversations, recognize the impact of culture on public and private initiatives, and incorporate culture into social cohesion strategies.
3. Include new players in the democratic governance of culture: Bring civil society organizations into dialogue around policymaking, and recognize the importance of grassroots cultural initiatives.
4. Support exchange between cultures to foster social and economic development: Emphasize cross-border cooperation and mobility, encourage collaboration among cities in and beyond Europe, allow migration to be part of the solution, and support the role of cities in international sustainable development.
5. Empower cities’ decisions on culture to shape our future: Use cultural spaces to shape participation, engage communities on the periphery of cities, use culture to active public spaces for increased security, fund cultural processes, and reinvest cultural benefits in cultural ecosystems.

What I think about it: Despite the relevance and importance of its subject matter, “Culture, Cities, and Identity in Europe” is a prime example of the limitations of narrative-style literature review. Because it makes little effort to distinguish between the studies it cites or synthesize across them, the central portion of the report reads mainly as a series of disconnected (and lengthy) quotes from other authors. To its credit, the report does attempt to offer takeaways in the set of policy recommendations advanced at the end of the document. Some of the ideas offered are worth exploring – in particular, the idea of integrating dialogue and communities of practice around culture and human rights – and the holistic/integrationist stance of the authors very much matches Createquity’s. However, the language of the recommendations is often so vague and general as to significantly undermine their usefulness.

What it all means: Though it doesn’t offer much in the way of striking insights on its subject matter, “Culture, Cities, and Identity in Europe” will be useful to someone looking for a bibliography on the topics covered, particularly from a European perspective. It’s also worthwhile to compare this pan-European take on culture and urban policy to American approaches; of particular interest from a US perspective is the bid to redefine European identity as tied to an inclusive, globally conscious notion of cultural citizenship rather than any particular set of ethnicities or national origins.

from the United Nations: “UNMISS and Partners Conduct Human Rights Community Awareness Programmme”

Title: Understanding the Contributions of the Humanities to Human Development: A Methodological White Paper

Author(s): Danielle Allen, Chris Dean, Maggie Schein, Sheena Kang, Melanie Webb, Annie Walton Doyle

Publisher: Harvard University

Year: 2016

URL: http://www.pz.harvard.edu/sites/default/files/HULAWhitepaper.pdf

Topics: humanities, education, impact evaluations, assessment tools, evaluation as assessment

Methods: assuming/defining theoretical concepts about education, coding the learning pathways of the humanities, and then correlating the “logic” of the learning pathways with comparable logical constructs from the study of psychology

What it says: In this white paper, the Humanities and Liberal Arts Assessment (HULA) group at Harvard University proposes a theoretical and methodological framework for understanding and assessing the contributions of the humanities to human development, based on preliminary analysis of qualitative materials from partner organizations and other researchers.* The theoretical framework builds upon two different concepts about education: 1) education as a system of institutions, which is maintained by the state to serve utilitarian purposes (such as cultivating civic service or civic responsibility); and 2) education as individual acts of instruction, which relates to personal development. The practice of humanities is then likened to the practice of “crafts” that help advance education and contribute to human development. The methodological framework treats the humanities as “crafts” that follow certain “craft logics” (pathways by which the craft is practiced, towards the achievement of the goals of the craft). The main idea is that if each humanities practice could be broken down according to categorical logics of its practice, then each tool used and each step of progress achieved in undertaking the practice could be coded in a standardized way to help researchers assess its utility or value.

What I think about it: As a layman, I found the presentation of the language and construction of the HULA methodology too abstract and too academic, which could harm its mass adoption. The definitions and applications of the methodology need to be greatly simplified for the value of the concept to shine through. I am not entirely convinced that it is necessary to make so many parallel comparisons (humanities as “crafts,” each craft as an “artifact,” manner and purpose of humanities practices according to “craft logics,” each logic pathway translated from some comparable construct in psychology) as it could be more effective to simply make a strong case that every practice of the humanities could be coded according to certain logics, and define these logics in an easy-to-understand code book of sorts. I proposed a simplified summary of the main idea above, which could be a good place to start unpacking some of these concepts in a way that even non-experts like me can better understand and then adopt.

What it all means: HULA argues that gathering, coding and analyzing humanities as “crafts” that follow “craft logic” can help us break down the elements that make up a craft, order the elements in a logical developmental pathway, and ultimately understand how humanities practices lead to the achievement of particular educational or human development outcomes. Assumptions are made about each humanities practice in terms of the elements it comprises, how it works, what it is trying to achieve, and which skills it develops – and the effect or effectiveness of each of these components are then coded categorically. Applying the HULA methodology according to the proposed definitions and categorizations requires that the user is familiar with or can easily understand concepts that are rather academic and often abstract, which may ultimately limit its adoption by the wider public.

* It is unclear from this white paper how many partner organizations have been consulted, although the paper did explicitly note that the study sample included at least a “30-year archive of successful grant applications to the Illinois Humanities Council.”

Methodology for Rating Evidence

We use the following definitions for placement on the graph and for describing benefits in the document.

Does the evidence indicate that the benefit exists?

• Yes: the majority of the available evidence supports the claim
• No: the majority of the available evidence opposes the claim
• Mixed: neither of the above conditions is true

How strong is the quality of the evidence?

• High: multiple studies with causal designs (experimental or quasi-experimental)
• Medium: a single study with a causal design, or multiple studies that otherwise make a compelling case for causal interpretation in the judgment of our team
• Low: neither of the above conditions is met

In cases where the supporting, mixed, and opposing evidence is of differing strength, the stronger evidence is given more weight in determining whether the evidence supports the claim.

In the body of the article, we use the qualifier “probably” to describe effects in the Yes/Medium cell of the matrix, “may” to describe effects in the Yes/Low, No/Low, and all Mixed cells of the matrix, “probably not” to describe effects in the No/Medium cell of the matrix, and “does not” to describe effects in the No/High cell of the matrix.

Note: in general, we support methodological diversity, and are not dogmatic about valuing “gold standard” study designs such as randomized controlled trials at the expense of all other types of research. However, in practice, studies with causal designs tend to be much rarer than descriptive and case-study-based research, and therefore more valuable due to their scarcity and the fact that they are typically more challenging to conduct. In addition, given that the questions explored in this review are inherently causal in nature – can we trust that an activity or intervention makes some kind of benefit more likely – it is appropriate to privilege designs that make a convincing attempt to rule out alternative hypotheses for any observed effects. Our rating of evidence strength takes these considerations into account.

Full Bibliography

Below is a full list of resources which informed this research investigation. Much of our research focused on literature reviews or meta-analyses, and we have included here works that were consulted directly, as well as resources that were encountered within a review and factored into our findings. Works that received a thorough review from Createquity are marked with an asterisk (*).

Arts Council England. (2006). The Power of Art. Visual arts: evidence of impact. Part 2. London. Retrieved from www.artscouncil.org.uk/media/uploads/ documents/publications/phpOCmaHq.pdf

Arts Council England. (2014). The Value of Arts and Culture to People and Society: An Evidence Review. Retrieved from http://www.artscouncil.org.uk/sites/default/files/download-file/Value_arts_culture_evidence_review.pdf

Arts Midwest, & Metropolitan Group. (2015). Creating Connection: Research Findings and Proposed Message Framework to Build Public Will for Arts and Culture. Retrieved from http://www.artsmidwest.org/sites/default/files/ArtsMidwest_BPWReport.pdf

Asbury, C. H., & Rich, B. (2008). Learning, arts, and the brain: The dana consortium report on arts and cognition. Dana Press.

Bakhshi, H., Freeman, A., & Higgs, P.. (2013). Dynamic Mapping of The UK’s Creative Industries. NESTA. Retrieved from www.nesta. org.uk/publications/dynamic-mapping-uks-creative-industries

Baxter, C., Tyler, P., Moore, B., Morrison, N., McGaffin, R., & Otero-Garcia, M. (2005). Enterprising Places: Sustaining Competitive Locations for Knowledge-Based Business. Cambridge, UK: Cambridge–MIT Institute.

BOP Consulting. (2011). Edinburgh Festivals Impact Study. Final Report. London. Retrieved from www.eventscotland.org/ resources/downloads/get/56.pdf

*Brown, A. (2006). An Architecture of Value. GIA Reader, 17(1). Retrieved from http://www.giarts.org/article/architecture-value

Brown, E. D., & Sax, K. L. (2013). Arts enrichment and preschool emotions for low-income children at risk. Early Childhood Research Quarterly, 28(2), 337–346.

Bygren, L. O., Johansson, S.-E., Konlaan, B. B., Grjibovski, A. M., Wilkinson, A. V., & Sjöström, M. (2009). Attending cultural events and cancer mortality: A Swedish cohort study. Arts & Health, 1(1), 64–73.

Carnwath, J. D., & Brown, A. S. (2014). Understanding the Value and Impacts of Cultural Experiences: A Literature Review. WolfBrown and Arts Council England. Retrieved from http://www.artscouncil.org.uk/media/uploads/pdf/Understanding_the_value_and_impacts_of_cultural_experiences.pdf

CASE programme: understanding the drivers, impacts and value of engagement in culture and sport. (2010). Retrieved from https://www.gov.uk/government/publications/case-programme-understanding-the-drivers-impacts-and-value-of-engagement-in-culture-and-sport

CEBR. (2013). The contribution of the arts and culture to the national economy. London. Retrieved from www.artscouncil.org.uk/media/uploads/pdf/CEBR_economic_ report_web_version_0513.pdf

Clarke, E., DeNora, T., & Vuoskoski, J. (n.d.). Music, Empathy, and Cultural Understanding. 2014: Arts & Humanities Research Council.

Clawson, H. J., & Coolbaugh, K. (2001). The YouthARTS Development Project. Juvenile Justice Bulletin. Washington, D.C.: Department of Justice, Office of Juvenile Justice and Delinquency Prevention. Retrieved from http://eric.ed.gov/?id=ED454130

Clift, S, Hancox, G, Morrison, I, Hess, B, Stewart, D, & Kreutz, G. (2008). Choral Singing, Wellbeing and Health: Summary of Findings from a Cross-national Survey. Sidney De Haan Research Centre for Arts and Health, Canterbury Christ Church University. Retrieved from https://www.canterbury. ac.uk/health-and-wellbeing/sidney-de-haan-research-centre/ documents/choral-singing-summary-report.pdf

Clift, S., Skingley, A., Coulton, S., & Rodriguez, J. (2012). A controlled evaluation of the health benefits of a participative community singing programme for older people (Silver Song Clubs). Sidney De Haan

*Crossick, G., & Kaszynska, P. (2016). Understanding the Value of Arts and Culture: The AHRC Cultural Value Project. United Kingdom: Arts & Humanities Research Council. Retrieved from http://www.ahrc.ac.uk/documents/publications/cultural-value-project-final-report/

Research Centre for Arts and Health, Canterbury Christ Church University, Folkestone, Kent, UK. Canterbury Christ Church University, Folkestone, Kent, UK: Retrieved from http://www. Ahsw. Org. uk/userfiles/Other_Resources/SSCRCTsummaryreportOct12. Pdf

Daykin, N., & Byrne, E. (2006). The impact of visual arts and design on the health and wellbeing of patients and staff in mental health care: A systematic review of the literature. University of the West of England.

Development Services Group, Inc. (2016). Arts-Based Programs and Arts Therapies for At-Risk, Justice-Involved, and Traumatized Youths. Washington, D.C.: Office of Juvenile Justice and Delinquency Prevention. Retrieved from http://www.ojjdp.gov/mpg/litreviews/Arts-Based-Programs-for-Youth.pdf

Education Endowment Foundation. (2016). Hallé SHINE on Manchester: Evaluation report and executive summary. Retrieved from https://educationendowmentfoundation.org.uk/our-work/projects/shine-on-manchester/

Everitt, A., Hamilton, R., & White, M. (2003). Arts, health and community: A study of five arts in community health projects. University of Durham.

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“Catalog” by Flickr user Beyond DC

The platitudes are on the lips of every arts supporter, ready to be recalled at the first sign of a public hearing or potential funding cut. “The arts are essential – a necessity, not a luxury.” “The arts help kids learn.” “The arts are the foundation of the knowledge economy.” It feels good to say those things, especially if you’re someone who has spent a life in the arts. But are they actually true? Are we pulling a fast one on ourselves and our audience by saying them? Or are we doing a service to the world by spreading the good news?

Over the past half century, hundreds of researchers have spent thousands of hours and millions of dollars grappling with these questions. And while the literature still has a ways to go before we can consider the answers definitive, it is becoming clear in at least several arenas that it’s not just our imagination: arts participation really does improve lives. In particular:

• Participatory arts activities help to maintain the health and quality of life of older adults. As discussed in our previous feature, singing improves mental health and subjective wellbeing; taking dance classes bolsters cognition and motor skills; dancing and playing a musical instrument reduce the risk of dementia; and visual arts generate increases in self-esteem, psychological health, and social engagement.

• Arts therapies contribute to positive clinical outcomes, such as reduction in anxiety, stress, and pain for patients. Music interventions tend to dominate studies in this area, mostly characterized by passive forms of participation (e.g., listening to music).

• Arts participation in early childhood promotes social and emotional development. For example, teachers report fewer instances of shy, aggressive, and anxious behavior among preschoolers taking dance classes, and toddlers receiving music instruction demonstrate increased social cooperation with other children.

• Student participation in structured arts activities enhances cognitive abilities and social skills that support learning, such as memory, problem-solving, and communication. (While arts participation may improve academic attainment as well, any effects are fairly small.)

We’ve catalogued these and other benefits in an interactive graphic we’ve created – the first of its kind – that explores the various benefits claimed for arts participation along with the strength of evidence backing those claims. See how the benefits stack up against each other at a glance, or zoom in to read what the research has to say about specific questions. (Read about our methodology here.) We recommend viewing in full-screen mode for best results.

Before we dive in further, a little context-setting is in order. The first thing to note is that what you’re going to read below is a work in progress. The literature on the effects of arts participation is vast and of highly uneven quality. To arrive at the conclusions we express here, we’ve relied heavily on existing literature reviews and meta-analyses on the topics in question, which means that any errors of interpretation or questionable judgments in those reviews are likely repeated here. Over time, we intend to get to know the underlying studies and publications and fill in gaps or make corrections as needed. In addition, new research on these topics comes out on a regular basis, and sometimes it challenges conclusions that we had previously drawn about a topic. For both of these reasons, you can expect that we will make tweaks both to the interactive and the content below as we gain access to new information going forward.

Second, it’s important to remember that the focus of this review is quite broad, and looks for general effects on a general population. It’s likely that in practice, there is quite a bit of variation between disciplines, between different modes of artistic participation, and between participants (e.g., different personality types). We can already say, for example, that music is both the most-studied intervention and the one that seems to have the most robust evidence behind it. As we get to know the literature better via the process described above, we’ll be able to identify these kinds of nuances with more precision.

Readers interested in the details behind the evidence in the article are encouraged to take a look at our capsule reviews on participatory arts for older adults, cultural arts and dementia, arts and early childhood, and arts and at-risk youth, all of which are based on in-depth literature and systematic reviews conducted by others and outline common methodological shortcomings and recommendations for future research. Of particular note is our capsule review on the Cultural Value Project (CVP), which shares the results of the UK-based Arts and Humanities Research Council’s three-year investigation into the value of culture. While the full bibliography to this article is far more extensive, our investigation relied heavily on the above sources.

Feelin’ Good: Physical and Mental Health

Of the four broad areas of arts impact that we identified in our review, the most robust research has taken place in the areas of education and personal development and physical and mental health. In fact, the evidence underlying the benefits of the arts for older adults is so compelling that we decided to write a whole separate article about it. A variety of participatory arts activities improve older adults’ mental and physical health, and in some cases, lessen the likelihood of developing dementia later in life. For instance, weekly singing has been shown to decrease anxiety and depression; weekly dance has been shown to improve cognition and attention, posture and balance, and hand and motor skills; and lifelong engagement with music, particularly playing an instrument, is correlated with improved memory among older adults. The arts also play a role in improving the overall quality of life for older adults more generally, such as attitudes toward social life.

While this was some of the most compelling evidence uncovered by our review, older adults aren’t the only beneficiaries. Arts therapies have been shown to improve clinical outcomes among patients. For example, a 2004 review of more than 400 pieces of literature exploring the arts’ and humanities’ relationship to healthcare and the arts’ effects on health identified a number of impacts for arts therapies. This includes visual art and music helping to reduce anxiety and depression among cancer patients undergoing chemotherapy, an association between music and reduction in anxiety and blood pressure in cardiovascular care, and reduction in use of pain medicine following surgery. Music tends to dominate these studies, with a generally positive effect on anxiety, stress, and pain reduction among patients. Another strain of studies has explored the related claim that visual art and design may help to improve the quality of healthcare settings, thus improving patient satisfaction and clinical outcomes. While the methodological quality of the evidence in this area is considerably weaker than that described above, initial results support the claim..

The arts may also generate health impacts beyond dedicated healthcare settings. We found that community arts activities probably contribute to healthy living habits and improved understanding of health. Using a mixed-methods approach that included a community-randomized design, an evaluation of 100 small participatory arts projects across impoverished parts of London found increases among participants in healthy eating, physical activity, and positive feelings. Similarly, a 2003 mixed-methods evaluation of the Wrekenton Lanterns Project, a community arts project drawing attention to coronary heart disease, suggested that arts activities contributed to healthy personal development, including healthy eating and mothering, mental health improvements, and increased absorption of health information. In the absence of longitudinal studies, however, it is difficult to know if participants sustained these habits over time.

The strongest and most consistent evidence for the health impacts of the arts relate specifically to mental health: in particular, reductions in depression and anxiety. It should come as no surprise, then, that arts participation is associated with subjective wellbeing, or one’s perceived quality of life. Over the past several decades, growing scholarship on wellbeing has sought to address just how well a person thinks they’re doing, with ongoing development of indicator systems that, in more recent years, have begun to incorporate measures related to arts, culture, and creativity. Createquity has been interested in the connection between arts participation and subjective wellbeing for some time. In our own analysis of data from the 2012 General Social Survey, we found no relationship between having attended an exhibit or performance in the past year and one’s satisfaction with life. However, a subsequent research spotlight revealed that among a large sample of Americans, more active forms of cultural participation including playing a musical instrument, gardening, and craft-making were positively associated with life satisfaction.

Our current review of the literature suggests that while causal attribution remains difficult to pin down, arts and cultural participation probably improves self-reported happiness or life satisfaction. A 2010 study of 1,500 randomly selected Italians analyzed two data sets on general wellbeing and cultural participation, yielding surprising results: cultural experiences – in this instance, passive modes of participation such as cinema, theatre, concert, and museum going – were the second most important determinant of psychological wellbeing, second only to the incidence of diseases, and ranking above factors like job, income, and education. And while not all arts participants are necessarily “doing well,” there is some evidence that unhappy people might be worse off it not for their cultural activities. For instance, a 2008 study of 1,124 choral singers in England, Germany, and Australia found that among respondents who scored on the lowest third of the psychological wellbeing scale, singing in a choir had a significant impact on their ability to cope with physical and mental health issues, among other personal challenges. There is some work being done to explore these issues in the US, but existing data sets on wellbeing and arts participation are not as easy to cross-reference. For instance, a 2014 study found an association between arts participation and wellbeing, but the study design made it difficult to determine if it was indeed attributed to arts participation and not other factors.

From Jungle Gyms to Jobs: Education and Personal Development

Although some of the strongest evidence we’ve come across speaks to the value of participatory arts for older adults, one doesn’t have to be a senior citizen, or for that matter even an adult at all, to benefit. On balance, the evidence suggests that the impact of arts and culture on psychological wellbeing is consistent across the lifespan, as far back even as early childhood.

A recent NEA literature review found ample evidence that arts participation in early childhood (birth to eight years) promotes social and emotional development. For example, a 2013 randomized controlled trial of 102 toddlers found that those participating in classroom-based music education were more likely to increase their level of social cooperation, interaction, and independence (as reported by their teachers) than a control group that did not receive a music education program. Similarly, a 2006 study of 40 preschoolers found that those that met with a dance group for eight weeks had stronger improvements in social skills and showed noticeable reductions in shy, anxious and aggressive behavior compared to a control group.

For slightly older kids, student participation in structured arts activities enhances cognitive abilities and social skills that support learning (e.g., memory, problem-solving, and communication). A 2010 systematic review of the Culture and Sport Evidence (CASE) database in the UK concluded that participation in “structured arts activities” could increase young people’s performance on a range of indicators of cognitive and social ability. Perhaps even more importantly, there is good reason to believe that arts education programs are disproportionately impactful for lower-income children. The NEA literature review on early childhood mentioned above includes a Head Start arts education experiment with 88 preschoolers from low socioeconomic status families. Those who participated in music activities showed improved cognitive abilities and increased ability to pay attention than children in the control group that received regular Head Start instruction. According to the NEA literature review, other specific benefits to lower-income youth include increases in confidence, student behavior and social skills. These findings are consistent with those from the well-known randomized controlled trial to measure the impact of field trips to the Crystal Bridges Museum of American Art. Benefits such as enhanced critical thinking skills and improved measures of tolerance were two or three times higher for children attending schools in rural areas or that served predominantly low-income households.

An earlier systematic literature review of 188 studies, the landmark 2001 Reviewing Education and the Arts Project (REAP) study, offers another perspective on the evidence base for non-arts academic outcomes of arts education. After comparing 275 effect sizes across groups of comparable studies, the researchers found strong causal evidence for the impact of music listening on spatial-temporal reasoning; learning to play music on spatial reasoning; and classroom drama instruction on verbal skills. However, the evidence was weaker in several other areas, including most effects on reading and math performance.

Indeed, one puzzle embedded in the extensive literature on arts education is how little the aforementioned benefits to learning and cognitive capabilities seem to translate to traditional measures of academic attainment such as standardized tests. Evidence from a wide body of literature suggests that even if there is a positive effect, it is so small as to be practically meaningless. The CASE systematic review cited above found that overall, participation in structured arts activities only improved attainment in high-school-aged students (as measured by standardized tests) by one to two percent. Similarly, a review from the Education Endowment Foundation in the UK concluded that arts participation had “positive but low” effects on academic learning in English, math, and science.

A major drawback within this literature is a lack of longitudinal studies. Short-term experimental designs that assign some students to an arts program and others to a control group are useful for isolating the effects of that particular program, but they usually only measure temporary effects on participants. Both the NEA’s early childhood literature review and the Cultural Value Project note the dearth of research that might isolate the long-term effects of arts participation in childhood over a lifetime.

Arts as Economic Engine, Sort of

In contrast to the health and educational literature described above, research on the economic and social impacts of the arts does not paint as straightforward a picture of benefit to society. In some cases this is because the available research simply is not very robust (unsurprising, given that measuring effects at a community level is far more difficult than doing so at an individual level); in others, it is because the evidence is conflicting, or the implications of it unclear.

Arguably the most convincing case to be made here is that cultural assets (organizations, venues, etc.) probably contribute to higher real estate values at a neighborhood level, but this insight is complicated by questions around the potential negative impacts of gentrification. For instance, a 2013 study on how cultural districts reshape neighborhoods found evidence that cultural districts “have significant impacts on property values,” although the evidence of effects on poverty, education, and families was weaker. A 2006 case study of MASS MoCA and its surrounding neighborhood in rural Massachusetts found significant increases in property values following the opening of the contemporary art museum. Similarly, between 2006 and 2008, a multi-pronged investigation by Mark Stern and Susan Seifert’s Social Impact of the Arts Project (SIAP) revealed a relationship between concentrated cultural assets and rising real estate values. It remains unclear, however, whether this effect generates benefits for existing, non-property-owning residents, like rising income levels or job prospects, or alternatively, brings potential harm through disruption of existing population dynamics. Perhaps surprisingly, there is a general lack of evidence that the arts contribute to concrete negative neighborhood revitalization impacts like displacement, but little attention has been devoted to “fuzzier” outcomes like feeling a loss of ownership.

Another common type of research in cultural economics is the much-touted (and much-criticized) economic impact study. If you work in the arts, chances are you’ve seen a press release at some point in the past decade announcing that the arts generate some large dollar amount in revenue and impressive number of jobs in your community. Claims of this nature may be true in a literal sense, but are usually far less meaningful than they first appear. Sure, the arts industry creates jobs, but so does literally every other industry. The more relevant question is this: “do the arts spur spending in the economy that wouldn’t have happened otherwise?” Evidence for that more ambitious proposal is mixed. For example, a review of 36 studies by the UK-based What Works Centre for Local Economic Growth found that the effects of large-scale facilities on local employment are limited at best; however, the review included both cultural and sports facilities, and was heavily weighted toward the latter.

Speaking of employment, one of the few studies that examines the longer-term effects of arts and cultural participation suggests that cultural participation may contribute to capacity for innovation within the workforce. In an analysis of the 1979 National Longitudinal Survey of Youth, Laura Niemi compared more than 7,000 Americans’ history of arts participation as children to their career history as adults. Niemi found a strong association between interest in the visual arts in adolescence and later innovation and entrepreneurship, which held true even when controlling for personality traits associated with innovation (like a willingness to take risks) and educational attainment. Family income, however, was not tested as a control factor.

If the arts help produce more innovative individuals, it stands to reason that the presence of arts and cultural activities and creative industries in a region may contribute to increased productivity and innovation in other industries in that region. For example, a 2015 empirical study of 2,000 creative enterprises in Austria found evidence to support three theories for how creative industries affect an economy’s overall innovation performance: being a major source of innovative ideas, products and services; offering services that lend themselves to innovative activities in other enterprises; and using new technologies to encourage further development in tech production. Do creative industries similarly make a region wealthier? Maybe: a 2011 study examining the relationship between manufacturing, service, and creative industry agglomerations and the wealth of 250 European regions found that for every percent increase in employment in the creative industries, there is a little over a half-percent increase in GDP. As with much of this literature, though, including that seeking to test Richard Florida’s hypothesis that creative industries draw talented workers and employers to a region and increase wealth that way, causation and correlation are difficult to tease out.

Come Together: On the Arts and Social Cohesion

The state of the evidence is even muddier when it comes to the impact of the arts on the social fabric between and among communities. As with economic vitality, evidence in this arena suffers from a lack of experimental and quasi-experimental designs that would help us better understand the social benefits of the arts. However, much of the difficulty is also rooted in the theoretical complexities that complicate coming to a shared definition of terms in this area. Social benefits of the arts have been described by many names, including social capital, social wellbeing, social inclusion, arts for social change, and more. We even struggled with what label to use to describe benefits in this area, and consider “social cohesion” to be a preliminary designation.

One of the better-studied research topics in this area is the relationship between participation in the arts and pro-social or civic behaviors like voting, volunteering, or attending community meetings. A 2014 Arts Council England evidence review found “growing evidence that children and young people’s engagement with arts and culture has a knock-on impact on their wider social and civic participation.” More specifically, based on British and American systematic reviews, high school students who participate in the arts “are twice as likely to volunteer than those that don’t…and 20 percent more likely to vote as young adults.” However, the major problem with research of this nature is that it does not test the very plausible counter-hypothesis that a common personality trait or set of values drives both arts engagement and civic behavior. Experimental work in this area would be extremely valuable for answering that question.

What about the relationship between arts assets and indicators of social wellbeing at a neighborhood level? The best work on this front has been conducted by SIAP’s Stern and Seifert, who attempted in a recent project to analyze multiple dimensions of economic and social wellbeing in Philadelphia. Their investigation, however, failed to find correlations between cultural assets and most indicators of social wellbeing after controlling for race and economic vitality, casting significant doubt on this effect.

Can the arts help increase trust and understanding between people of different backgrounds through dialogue or creating spaces for storytelling? In the United States, Animating Democracy and SIAP have both conducted qualitative and descriptive research into this phenomenon. However, the literature is almost entirely bereft of control groups, making it difficult to draw firm conclusions. One of the few exceptions is the aforementioned Crystal Bridges study on field trip attendance, which reported an increase in tolerance and “historical empathy” among students who attended the museum compared to students who didn’t. It’s difficult to know, however, how meaningful the proxy measure used in this study is in practice. Furthermore, one of the problems for this area of research is that it seemingly matters a lot what messages are being communicated through the artwork when it comes to building bridges across social divides, complicating attempts like this one to assess in general terms whether this type of intervention “works.”

What It All Adds Up To

Last year, Createquity explored the literature on wellbeing and quality of life in general, and noted that culture is often missing from frameworks that seek to capture a holistic definition of wellbeing. This investigation, and the ongoing work that will flow from it, demonstrates how and where the arts fit most naturally into such a framework.

• Arts participation contributes directly to quality of life by increasing self-reported happiness and life satisfaction. This is probably the case for the population in general, and is almost certainly true for the subset of that population that pursues sustained engagement in arts activities over time. In addition, robust effects of arts participation on reducing anxiety and depression have been demonstrated for people in healthcare settings and older adults, two potentially vulnerable populations. This research validates Createquity’s thematic focus on ensuring equitable access to opportunities to participate in the arts across society as a whole.
• Arts participation contributes indirectly to wellbeing via, at a minimum, its effects on education and personal development (particularly the development of emotional and social skills in early childhood, and the development of cognitive capabilities and communication skills in later childhood), and physical health (particularly in healthcare settings). Other indirect effects to wellbeing may exist as well, but the research is not yet at a place where these can be demonstrated conclusively.

This review likewise highlights where additional investments in research would be especially productive. Experimental and quasi-experimental designs are extremely rare in the research on the economic and social impacts of the arts; initiatives to fill this gap, though likely expensive and difficult to implement, would prove enormously helpful in resolving many of the causation vs. correlation conundrums that currently pervade this literature. Even in the health and education areas where these techniques are more common, however, there remains considerable room for further research and greater methodological ambition. There is a strong need in these areas for studies that examine the effects of arts participation over a long period of time, and for randomized controlled trials that use larger sample sizes.

As stated in the beginning of this article, both the research literature itself and our understanding of it are works in progress. We will continue to update and adjust the infographic describing benefits as new research comes to light in the months and years to come. As we learn more about how the arts benefit lives, the knowledge will inform our ongoing inquiry into the most important issues in the arts and what we can do about them.

“Human Brain Sections” by flickr user GorissenM

Title: “Shall I Compare Thee to a Dose of Donepezil?”: Cultural Arts Interventions in Dementia Care Research

Author(s): Kate de Medeiros and Anne Basting

Publisher: The Gerontologist, 54(3)

Year: 2013

URL: http://gerontologist.oxfordjournals.org/content/early/2013/06/07/geront.gnt055.full.pdf

Topics: Arts participation, older adults, dementia, arts therapy

Methods: Literature review (of systematic reviews)

What it says: This article reviews 27 systematic and integrative reviews of pharmacologic, psychosocial and cultural arts interventions in dementia care for older adults. (The authors use philosopher Susanne K. Langer’s 1966 definition of cultural arts as “the practice of creating perceptible forms expressive of human feeling,” accounting for the role of imagination more so than the outward senses.) Although individual studies of cultural arts interventions demonstrate positive outcomes, most are excluded from systematic reviews due to weaknesses in research design, such as small sample sizes and the lack of randomization or control groups. Only reviews published in English between January 2000 and September 2012 were included. Studies that didn’t involve humans or focused on biological aspects of dementia were excluded.

The authors grouped results of pharmacologic, psychosocial and cultural arts interventions into three categories: 1) cognition; 2) problematic behaviors or symptoms, such as agitation, anxiety or apathy; and 3) quality of life. Drug trials involving donepezil led to improvements in cognitive function and self-reported quality of life for people with mild to moderate dementia. Otherwise, pharmacologic interventions demonstrated minimal benefit in dementia care compared to psychosocial and cultural arts interventions. Psychosocial interventions involving cognitive training and stimulation led to improvements in cognition, and those involving reminiscence led to improvements in autobiographical memory. A wide variety of psychosocial interventions such as aromatherapy, group validation, and reminiscence were most effective in reducing problematic behaviors such as wandering, irritability, and disruptiveness, respectively. Some also led to improvements in quality of life, as reported by people with dementia and their caregivers.

There were no cultural arts interventions included in the studies that adequately measured changes in cognition. Some music therapies led to reduction in problematic behaviors such as irritability, aggressiveness, agitation, and inappropriate vocalization, although application of the therapies varied widely. One study involving visual arts interventions distinguished between individual and group activities, noting higher levels of fear and verbal agitation for people with dementia assigned to individual art projects compared to those in weekly art classes. Results regarding improvements in self-reported quality of life varied widely for cultural arts interventions, with many facing methodological limitations. Those involving dance/movement therapy found increases in communication and quality of life as reported by participants and their caregivers, however, no validated assessment tools were used. One study involving storytelling similarly demonstrated improvements in communication and “expressions of pleasure,” but no significant change in wellbeing. Although lacking standardized outcome measures, visual arts interventions demonstrated similar improvements in participants’ expressions of pleasure. Music interventions also had positive outcomes, such as increases in self-reported quality of life, but with limitations in sample sizes, non-validated measures, and poorly defined outcomes.

The authors note that reviews were selected for inclusion based on topic, so the quality of individual studies was not evaluated. In addition, the authors clearly indicate inconsistencies amongst reviews, such as definitions of key outcomes, variability in measures used, and the level of detail offered in each study. Based on their review, the authors conclude that the quality of a study should be based on what is being measured and how, rather than its adherence to randomized controlled trial designs, since the latter does not necessarily capture changes in affect or meaningfulness. The authors also call for the consideration of the individual nature of cultural arts, noting that outcomes may differ significantly from person to person, but also note the importance of including the larger social network of people with dementia that play a role in improving their social connectedness.

What I think about it:

Although measures vary widely and findings are not suitable for direct comparison, this review is helpful in situating arts interventions among a broader pool of interventions for treating dementia, most of which are medically oriented. Much like other studies investigating the health impacts of arts and cultural participation, the authors point to the need for improved research designs. Perhaps the most notable takeaway from this review is the recommendation to move away from interventions that fall into the boundaries of traditional arts disciplines, and towards better understanding what the actual activities comprise, how they’re delivered, and to whom specifically. In other words, the priority should not be to determine which art form is most effective but instead, seeking clarity around what exactly it is that the arts offer in this realm that non-arts interventions with similar characteristics do not.

What it all means:

Given the relative weakness of drug interventions in this review, overall findings begin to suggest that cultural arts and psychosocial interventions may be viable alternatives to drug treatment. It offers a broad perspective of promising outcomes for people with dementia, and asks important questions about whether or not the clinical trial model suits arts interventions. This is consistent with the methodological limitations cited in the Cultural Value Project, namely its recommendation to better understand where rigorous qualitative methods, which are often more suitable for arts interventions, might fit within traditional hierarchies of evidence that prize RCTs. An appropriate next step would be to design research studies that begin to answer the what, how, and who questions previously outlined by de Medeiros and Basting.

“Youth” by flickr user CN

Title: Arts-Based Programs and Arts Therapies for At-Risk, Justice-Involved, and Traumatized Youths

Author(s): Development Services Group, Inc

Publisher: Office of Juvenile Justice and Delinquency Prevention.

Year: 2016

URL: http://www.ojjdp.gov/mpg/litreviews/Arts-Based-Programs-for-Youth.pdf

Topics: Arts participation, arts programs, arts therapy, youth development, at-risk youth, justice-involved youth, traumatized youth

Methods: Literature Review

What it says: This study presents a review of recent research on arts programs for three types of youth: 1)at-risk youth, or those with risk factors that increase likelihood of delinquency or other problem behaviors; 2) system-involved youth who are currently in the juvenile justice system; and 3) traumatized youth, identified based on their personal experiences. The review focuses on two types of intervention: 1) art-based programs where arts engagement are considered a type of therapy, and 2) arts therapy programs where arts approaches are part of a therapeutic process.

The review does not find clear evidence on the outcomes of arts interventions for these categories of youth in the literature, because of methodological deficiencies such as small sample sizes, lack of comparison groups, short follow-up periods, and reliance on self-reported measures. They also note that studies of programs with multiple components do not isolate the effects of each component, meaning that there is no evidence on the outcome of the arts element specifically. They conclude that more research is needed to understand the the potential impacts of these interventions, and to understand differences between the impacts of interventions using different arts disciplines.

The report does note that arts participation has been found to be associated with strong social and emotional skills among youth generally (Menzer, 2016), and that there are theoretical foundations for the efficacy of such interventions. Cognitive behavioral theory promotes changing dysfunctional beliefs, thoughts, and behaviors by helping people change the way they think. The reflective nature of many arts based approaches is well suited to this kind of therapy. Positive Youth Development theory focuses on developing the positive assets of youth by providing opportunities for pro-social involvement, such as arts programs with a social element. Additionally, multiple theoretical frameworks support the use of arts therapies with traumatized children.

The report concludes with a summary of a select number of arts-based programs that have demonstrated positive impacts on youth, including Reading for Life, Project Venture, and Cognitive Behavioral Intervention for Trauma in Schools (CBITS).

What I think about it: The authors of this review provide a useful summary of the theory and practice surrounding arts-based programs and therapies for these specific categories of youth, as well as a clear summary of the available evidence and its limitations. In spite of a lack of conclusive evidence, this research provides a good overview of how such programs are theorized to work. The review would benefit from a clearer explanation of how works were identified and included in the review, in order to provide more context for the findings.

What it all means: The positive outcomes noted in individual programs (even with the methodological problems cited), as well as the strong theoretical basis of such programs, points towards the usefulness of further research aimed at identifying specific outcomes of arts programs for at-risk, justice-involved, and traumatized youth. Such research could also help isolate the characteristics of effective programs. This knowledge could both inform program design, and help to justify spending on such programs in the future.

• Singing improves mental health and subjective wellbeing (i.e., perceived quality of life)
• Taking dance classes bolsters cognition and motor skills, and even lessens the likelihood of developing dementia later in life
• Playing a musical instrument has myriad positive effects, including dementia risk reduction
• Visual arts practice generates increases in social engagement, psychological health and self-esteem

Just how the arts benefit society is one of the most studied topics in arts research, to the extent that multiple literature reviews, most notably the RAND Corporation’s decade-old landmark Gifts of the Muse, have sought to compile our collective knowledge on the subject. In recent years, several important initiatives and publications have added to this evidence base, including the final report earlier this year from the UK-based Arts and Humanities Research Council’s Cultural Value Project and National Endowment for the Arts’s 2011 literature review on the arts and human development. Over the past few months, Createquity has been reviewing these and other publications with an eye toward creating a continually-updated catalogue of demonstrated impacts for arts activities. What are all of the ways in which the arts contribute to or detract from wellbeing, and how strong is the evidence supporting each of those claims?

Our review of the literature addressing these questions yielded a surprising result: the most compelling evidence of the value of the arts revolves around improving the lives of older adults. Better understanding the relationship between the arts and aging may help to identify areas for improvement in future research into wellbeing, as well as opportunities for investing in the quality of life of older individuals.

Painter — photo by Flickr user M-n-M

The global population is aging in unprecedented numbers and living longer than ever. Between 1980 and 2010, a period marking most of millennials’ present lifetimes, the number of U.S. centenarians increased by nearly two-thirds! Longer lifespans bring immediate implications for many and eventual implications for us all, if we’re lucky. While extending the so-called golden years can be a blessing, challenges include deteriorating health, social isolation, loss of loved ones, and life transitions.

Fortunately, research shows that arts-related interventions can help (in some cases, more so than traditional Western medicine). In particular, there is substantial causal evidence that participatory arts activities help to maintain the health and quality of life of older adults. These benefits, detailed below, include improvements in cognitive and tactile abilities, subjective wellbeing, and dementia risk reduction (although the effects on managing dementia are less clear).

Jamming and Grooving Towards Better Health

The literature on the effects of participatory arts engagement within aging populations is significant not only for the breadth of demonstrated benefits to older adults, but also the relatively high quality of evidence supporting these claims.

Most of the literature we encountered involved making music, although a number were focused on dance. Music and movement activities (playing instruments, singing, dancing) have been shown to improve mental and physical health among older adults. In a randomized controlled trial of 212 British adults over the age of 60, those who participated in weekly singing groups over three months were found to have had improved mental health (decreased anxiety and depression) compared to those who didn’t. These health effects were mostly sustained over a period of at least three months after the weekly singing ended. By contrast, the positive effects of instrument playing do not always persist over the longer term following participation, unless participants have trained or practiced over an extended period of their lives. This might explain why lifelong engagement with music, particularly playing an instrument, is correlated with improved memory among older adults ─ and why some older musicians, like Herbie Hancock at a solid 76, still perform with as much gusto now as they did in their prime. Despite a smaller sample size, another randomized controlled trial of 35 adults aged 60 and over suggested health benefits of dance for older adults. Those who took weekly dance classes over a six-month period showed improved cognition and attention, posture and balance, and hand/motor skills like steadiness and aim in comparison to the control group.

Other research points to the role of the arts in improving overall quality of life for older adults more generally, such as attitudes toward social life. For example, an evaluation of a different, yearlong weekly singing program for adults aged 60 and over revealed marked improvements in emotional wellbeing, especially for those who had been widowed. A mixed-methods study of the effects of painting lessons among older adults in the same age range documented similar improvements in both mental health and social wellbeing. After having participated in these professionally conducted lessons, participants noted increases in social engagement, their sense of belonging, and self awareness and understanding. Likewise, a randomized controlled trial of 50 older adults who participated in 12 visual art sessions over a month showed improvements in self-esteem and anxiety reduction. No wonder your grandmother was always in a good mood after watercoloring class, treating you to ice cream when you picked her up!

Doses of Art to Stay Lucid?

Every 66 seconds, an American develops Alzheimer’s disease. It is the sixth leading cause of death in the United States, and kills more people than breast cancer and prostate cancer combined. As the population ages, millions will be affected: the number of Americans with the disease will double between 2015 and 2050. With soaring diagnoses come soaring costs ─ financial, emotional, and social ─ for patients and their caregivers. Establishment of accessible and cost-effective methods of delaying Alzheimer’s disease and other dementia-related illnesses is crucial.

A 21-year longitudinal study of 469 older adults aged 75 and over published in 2003 found that playing an instrument, reading, and playing board games were strongly associated with lower incidence of dementia. In fact, those who scored in the highest third on the study’s cognitive-activity scale had a 63 percent lower risk of dementia than those in the lowest third. Dancing was the only physical activity to show similar effects.

Arts engagement also seems to benefit older adults who already have dementia, providing improved communication, cognitive function, self-esteem and social participation. TimeSlips, a creative storytelling program for people with dementia, appears to promote engagement, alertness and social interaction among participating adults, as well as improved attitudes among caregivers towards their patients. On the other hand, a 2013 report from the National Endowment for the Arts cites a review of 24 studies that presents a more mixed picture of the evidence, with music interventions leading to both positive and negative outcomes for individuals in severe stages of dementia-related illness. It’s also important to note that methodological challenges abound in this area of research, including confounding external factors related to social context, interrelated variables, and inconsistent outcome measures, all of which makes drawing firm conclusions difficult.

In fact, a separate literature review by Tony Noice et al. notes similar shortcomings in a broader set of research on participatory arts for older adults. As a general rule, research on the benefits of the arts lags behind the level of rigor frequently encountered in the broader universe of scientific research. So while the evidence described above is quite strong by arts research standards, it nevertheless has limitations. Other opportunities for improvement, according to Noice et al., include introducing more standardized assessment of interventions across art forms and measuring effects over a longer period of time. Though the work to date has been promising, until studies on the effectiveness of arts interventions for older adults more consistently meet rigorous standards, their ability to shape perception of the value of such programs will remain limited.

Music has powers — photo by Flickr user Jinx McCombs

As mentioned earlier, we discovered this wealth of literature on arts and aging as part of a larger inquiry into the benefits of the arts in general. That inquiry, in turn, extends a longer-term initiative on Createquity’s part to reconcile the benefits of arts and culture with broader theories of wellbeing (or quality of life), such as the capability approach. Our next article will explore some of the other areas of benefit that have been claimed for arts participation, along with an assessment of the evidence backing up those claims.

In the meantime, rest assured knowing the older people in your life who participate in the arts are not just pursuing a silly pastime. For some, it might just be the key to a worry-free life or a still-taut mind ─ all the more reason to encourage them to channel their inner Aretha, Baryshnikov, or Picasso.

“An open letter to an art agent or manager / Wide Eyed” by flickr user Surian Soosay

Title: Artful Living: Examining the Relationship between Artistic Practice and Subjective Wellbeing Across Three National Surveys

Author(s): Steven J. Tepper, with contributions from Blake Sisk, Ryan Johnson, Leah Vanderwerp, Genevieve Gale, and Min Gao.

Publisher: The Curb Center for Art, Enterprise, and Public Policy at Vanderbilt University

Year: 2014

URL: https://www.arts.gov/sites/default/files/Research-Art-Works-Vanderbilt.pdf

Topics: arts and wellbeing, life satisfaction

Methods: Regression analysis of data from three national surveys: the DDB Needham Life Style Survey, which measures consumer attitudes; the Double Major Student Survey, among 1,700 college seniors at four comprehensive institutions and five liberal arts colleges; and the Strategic National Arts Alumni Project (SNAAP), among 4,031 graduates from 76 art colleges.

What it says: “Artful Living” explores the hypothesis that the arts are essential to a high quality of life. Examining data from three national surveys, the authors find strong evidence that artistic and creative practice is associated with wellbeing, including “higher levels of life satisfaction, a more positive self image, less anxiety about change, a more tolerant and open approach to diverse others, and, in some cases, less focus on materialistic values and the acquisition of goods.” The effect of artistic practice on life satisfaction is statistically significant but small, explaining only a little of the variance between people. Nevertheless, its correlation to wellbeing is comparable to that of being married, having children, or country of residence. The authors found that the relationship between artistic practice and wellbeing depends on the frequency and intensity of participation, the type of creative practice, and participants’ demographics. For instance, effects are strengthened with intensity and frequency of artistic practice, and with nonwhite adults and women. Among the general population sample, playing music had the strongest effect (compared to crafts and gardening). This again holds true for former arts students (compared to dance and visual arts), for whom the effect of artistic practice, generally, is mediated by their expectations for how much time they need to work on their art and whether those expectations are being met. Differential effects by discipline (across all surveys): visual arts and crafts have a consistent association, music in some cases, and theater not at all. The research does not demonstrate causation, although the literature review cites some qualitative studies that provide support for a causal theory, and the authors argue that the fact that the effect increases with frequency of engagement is suggestive of causation.

What I think about it: The regression analyses seem well designed on the whole. Survey-based approaches are always tricky, and of the three cited here, the DDB Needham survey analysis is the most compelling given its large, representative population sample. (The Double Major survey has a highly specialized audience and SNAAP responses may be confounded by expectations for creative practice, both of which limit external validity.) However, the DDB Needham survey does not capture many different artistic practices (only three in comparison to the ten included in the SNAAP survey). Warranting most caution are the effect sizes, which are typically 3-10% of a standard deviation in wellbeing scores. Clearly, it’s not like participation in the arts is some magical elixir that will solve all your problems. That said, when stacking conditions on top of each other, e.g. in the case of an African American female who engages frequently in gardening, the effect could be more impressive.

What it all means: The paper demonstrates fairly convincingly the existence of a relationship between artistic practice and various outcomes of interest, though the effect should not be overstated. However, in the absence of an experimental approach, there is little here to say that participation in the arts causes people to be happier, and some reason to think that might not be the case. For example, there is evidence that much of subjective wellbeing is genetically determined by temperament. There’s even less of a causal case to make when examining values like tolerance or anti-materialism, which may well lead someone into artistic practice rather than result from it. Overall, the data is consistent with the hypothesis that expectations and whether they are being fulfilled have more to do with subjective wellbeing than the specifics of what those expectations are. This evidence is supportive of the “Eye of the Beholder” principle in Createquity’s healthy arts ecosystem definition and our general embrace of the capability approach.