[Ed: Under Coming Events, the date for SPARC has been corrected.]
III Key Learnings
IV Application in the Field
V Conclusions and Next Steps
--submitted by Frédéric Julien, Canadian Arts Presenting Association (CAPACOA)
In Canada, some 1,400 organizations present performing arts series and festivals in communities of all sizes. Half are arts organizations and half are community organizations, their role is to provide Canadians of all socio-economic backgrounds access to professional performances ranging from classical music to contemporary theatre, from dance to storytelling. These organizations are led by people who care about the arts and who also care about the "transformative" effect the arts have on audiences (learn more about performing arts presentation in this short Canadian Geographic video: http://vimeo.com/628849210.
In 2008, a group of presenters and service organizations decided it was time to find out what effect the performing arts have on people’s lives and on their communities. An advisory committee was formed and, three years later, the Canadian Arts Presenting Association (CAPACOA) conducted a large-scale study in order to identify and communicate the value and benefits of performing arts presentation on Canadians, the communities they live in and society at large.
This article presents selected findings from a social determinants of health perspective, and considers potential applications in the domain of health promotion.
The Value of Presenting: A Study of Performing Arts Presentation in Canada (available at http://www.capacoa.ca/en/services/valueofpresenting) employed a participatory action research framework where data and information were shared in draft form throughout the two-year project on a dedicated project website (available at http://www.diffusionartspresenting.ca/). Research activities were carried out between May 2011 and January 2013 by Strategic Moves and EKOS Research Associates. This included a literature review, in-depth interviews, two pan-Canadian surveys and 23 workshops and webinars with more than 1,000 participants. Among many things, the research sought to explore the relationships that performing arts presenters have with other sectors, such as health. A significant portion of the literature review and several interviews sought to shed light on the links between performing arts attendance and health.
III Key Learnings
The final report of The Value of Presenting: A Study of Performing Arts Presentation in Canada  was released in April 2013. It revealed that performing arts are valued by the vast majority of Canadians – across socio-economic statuses – and it provided new generational perspectives on Canadians’ interest in live performing arts. Most importantly, the study identified a broad range of public benefits associated with performing arts presentation, including better health and well-being, greater energy and vitality in communities, and a more caring and cohesive society. Following are some of these individual and collective benefits, as they relate to health promotion.
Canadians who attend performing arts events are first and foremost looking for a fun, entertaining experience (84%). They are also seeking emotional, intellectual or spiritual stimulation (58%), as well as the opportunity to experience or learn something new (57%), exposure to different cultures (45%) and the opportunity to socialize (44%).
Many individual benefits of arts attendance have been identified in this and in other studies. Some of these appear to positively influence determinants of health. Arts attendance as an entertaining experience could be a means of coping with stress for some people. The socializing benefit of arts attendance, which was associated with social bonding and social bridging in a recent U.S. study,  likely contributes to maintaining and reinforcing social support networks.
There is strong evidence of links between arts attendance and several health indicators such as self-reported health, mental health and longevity.
The literature review covered many studies which had found correlations between arts attendance and health factors, even after other factors had been controlled. A Norwegian study  involving 50,797 adult participants found that attendance at concerts, theatre or film was significantly associated with good perceived health, and low anxiety and depression scores, even with a logistic regression model adjusting for relevant cofactors. A long-term study in Sweden that followed more than 12,600 people in a nine-year interval found that people who rarely attended theatre, concerts and live music performances, museums, arts exhibition and cinema ran a nearly 60% higher mortality risk than those attending most often.  A recent Canadian study using data from Statistics Canada's 2010 General Social Survey  identified strong correlations between attending the performing arts and health and well-being. As an example, theatre attendance is strongly associated with better health, better mental health, volunteering, having done a favour for a neighbour in the past month, and feeling less trapped in a daily routine. More specifically, theatre goers are 32% more likely to report very good or excellent health and 30% more likely to report very strong satisfaction with life, even after controlling for other factors. While behaviours such as volunteering, helping neighbours and feeling less trapped in daily routine seem to allude to induced effects on social determinants of health, the rigorous controls and large samples used in these studies suggest that some direct mechanisms could be at play in these arts and health correlations.
Canadians believe that the presentation of performing arts equally benefits the individual who attends and the community as a whole.
When asked who benefits more from the presentation of performing arts in their community, 36% of Canadians responded that both community and attendees benefit equally, 29% responded that the community as whole benefits more, and 29% responded that individual attendees benefit more. This finding challenges the common belief that performing arts benefits only those who attend, which is interesting from a public health point of view.
For Canadians, the highest-rated benefit of performing arts presentation in their communities is increased energy and vitality in the community.
When asked to select up to three collective benefits of performing arts presentation in a series of eleven answers, 42% of respondents chose “bringing energy and vitality in the community” as their top benefit. The link between arts participation and vitality was also observed at the individual level in studies presented at the Trondheim Health Promotion Research Forum.  For instance, a study  on providing cultural activities to improve the work place environment found evidence of participants’ increased self-rated vitality as a result of attending theatre and music. Another study  on cultural participation and health among medical staff found that fine arts stimulation including attending concerts improved perceived physical health, social functioning and vitality.x
Arts participation fosters social bonding, social bridging and, ultimately, social cohesion.
Ninety-two percent of Canadians believe that arts experiences are a valuable way of bringing together people from different languages and cultural traditions.  Recognition of diversity and social cohesion provide a supportive society that reduces or avoids many potential risks to good health.
Two in three Canadians who earn less than $40,000 per year or who do not have university education reported attending a live performance by professional artists in 2011.
Rather than merely catering to a small elite-segment of the population, the performing arts reach across income and education levels. Considering this broad reach and the potential direct effects of the arts on health, performing arts presentation could be considered as another health intervention tool with the capacity to reach a majority of lower-income, lower-education Canadians.
IV Application in the Field
The Value of Presenting paves the way to innovative benefits-based programming and initiatives involving both presenters and health practitioners. Such initiatives are already taking place: nearly all performing arts presenting organizations report working regularly in partnerships and, among those who have partnerships outside of the arts sector, 29% partner with the health sector. Here are a few examples of initiatives led by presenting organizations that have positive influence on social determinants of health:
- A growing number of presenters offer programming for elementary school and even preschool age children. Early childhood programming is typically offered at a steeply discounted price, because presenters believe in the impact it has on children’s development and they want families to be able to attend
- Some presenters partner with community organizations to offer free tickets to people with precarious socio-economic status, in the hope of enriching their lives and helping to alleviate stress for a time at
- Other presenters have programming for at-risk youth in low-income neighbourhoods. They work with artists in order to provide youth options for coping with challenges and to learn life-skills through the arts.
- Some associations are recognizing the large gaps in access to professional performances for the aging population and are presenting performances in long-term care facilities.
Health promotion and health care practitioners should seek out their local performing arts presenter and approach them with ideas for benefits-based collaboration: they will likely meet open-minded people who will gladly accept to embark on a win-win partnership.
V Conclusions and Next Steps
The Value of Presenting makes clear that there is far more to performing arts presentation than entertainment. The performing arts contribute to the quality of life of Canadians, and they could increasingly become a purpose-built factor in promoting good individual health and in intervening on population health.
However, questions remain as to the precise nature of the link between arts attendance and health. First, even though correlation is undeniable, we don’t have strong evidence of a cause-and-effect relationship. Causality was observed in small-scale pilot research, but we still need robust methodologies and larger samples to demonstrate cause-and-effect. Second, when causality is better understood, then, we would need to understand the mechanisms through which health effects occur. While it is clear that performing arts presentation contributes to positive social environments and provides participants with opportunities to increase the degree of control over their life, a determinant of health framework doesn’t suffice to explain the health effects of performing arts presentation – even though there may be ground to specifically name art within the social determinant of health.  Over the last decade, however, Canadian and international research on the neurochemistry of music  has uncovered many mechanisms that could explain health effects of arts participation. More research in this area could be extremely useful.
The Value of Presenting study was, for CAPACOA and the Canadian performing arts presenting field, a first step in investigating and promoting the public benefits of the performing arts, including the health benefits. The next steps will involve monitoring the latest research on arts and health as well as awareness raising activities within both the performing arts and the health sectors. Activities will include presentations at Canadian and U.S. conferences, publication of articles on performing arts and health, and participation in the Coalition for Public Health in the 21st Century.
- Inga Petri, The Value of Presenting: A Study of Performing Arts Presentation in Canada, CAPACOA: Ottawa (2013). Available at http://www.capacoa.ca/en/services/valueofpresenting/final-report.
- Theatre Bay Area and WolfBrown, Counting New Beans: Intrinsic Impact and the Value of Art, San Francisco (2012). Available at http://theatrebayarea.org/Programs/Intrinsic-Impact.cfm.
- Koenraad Cuypers, et al. “Patterns of receptive and creative cultural activities and their association with perceived health, anxiety, depression and satisfaction with life among adults: the HUNT study, Norway,” Journal of Epidemiology & Community Health, jech.2010.113571 (2011). Available at http://jech.bmj.com/content/early/2011/05/04/jech.2010.113571.
- Lars Olov Bygren, et al. “Attendance at cultural events, reading books or periodicals, and making music or singing in a choir as determinants for survival,” BMJ (1996) 313:1577. Available at http://www.bmj.com/content/313/7072/1577.full.
- Hill Strategies, The Arts and Individual Well-Being in Canada 2010, Hamilton (2013). Available at http://www.hillstrategies.com/content/arts-and-individual-well-being-canada.
- This international forum was held August 6-9, 2012 in Trondheim, Norway. A summary of the main findings that pertained to the arts can be found at http://www.capacoa.ca/en/services/arts-promotion/news/345-vitality
- T. Theorell, et al. “A note on designing evaluations of health effects of cultural activities at work,” Arts & Health: An International Journal for Research, Policy and Practice 1, 1 (2009). Available at http://www.tandfonline.com/doi/abs/10.1080/17533010802527993.
- Lars Olov Bygren, et al. “Cultural Participation and Health: A Randomized Controlled Trial Among Medical Care Staff,” Psychosomatic Medicine Journal 71, 4 (2009). Available at http://www.psychosomaticmedicine.org/content/71/4/469.full.pdf+html.
- Phoenix Strategic Perspectives, The Arts and Heritage in Canada – Access and Availability 2012. Available at http://epe.lac-bac.gc.ca/100/200/301/pwgsc-tpsgc/por-ef/canadian_heritag...
- Dorothy A. Lander and John R. Graham-Pole, Art as a Determinant of Health, Antigonish, Nova Scotia: National Collaborating Centre – Determinants of Health (2008). Available at http://artshealthnetwork.ca/resources/art-determinant-health
- Mona Lisa Chanda and Daniel J. Levitin, “The Neurochemistry of Music,” Trends in Cognitive Sciences 17, 4 (2013). https://www.mcgill.ca/newsroom/channels/news/major-health-benefits-music...
CAPACOA website includes news, services, information for members, newsletter and job postings http://www.capacoa.ca/. The Value of Presenting: A Study of Performing Arts Presentation in Canada is available at http://www.capacoa.ca/en/services/valueofpresenting.
Arts Health Network Canada advances understanding of the many ways that arts-based activities contribute to individual and community health and health care. The resource section of the website provides access to articles, publications and other material relating to arts and health: http://artshealthnetwork.ca/.
Power of the Arts National Forum, Carleton University, Ottawa, September 27 to 29, 2013: http://www2.carleton.ca/fass/power-of-the-arts-forum/
Symposium on Performing Arts in Rural Communities, Haliburton Highlands, April 24-27, 2014: http://www.sparcperformingarts.com/
[Date corrected, September 20, 4:30 p.m.]