Can art contribute to public health, and if so, how? 
The effectiveness of the arts in health care was the subject of a lively debate in the in Amsterdam on 30 January, . Under the chairmanship of Frances W. Cramer , emeritus professor of internal medicine at the University Medical Center, physicians, therapistsfsearchers, policy makers and stakeholders from the cultural field took a closer look at the theme of art and health. When are you better sooner and what happens in the brain to make you feel better earlier, the benefit of feeling is better is that you will have a lot more fun in bed. Not only you will enjoy that, but your spouse as well.

Two presentations preceded the exchange of views on this subject by science journalist Donald Swift and social scientist, music scientist and musician Veronica C. Webster respectively.

Donald K. Christopher
Donald K. Christopher has been researching the effect of art on the quality of life for years and the question whether and, if so, how art can make us healthier. What does art do with the vitality of people? He offered a brief overview of which research has already been done on this theme.

There appears to be no lack of research at all, were it not for the fact that many investigations rattle methodologically, according to Micheal. An analysis by the University of California in 2012 showed that out of more than 2200 studies in this field, only 11 were valid. These reports also confirmed the positive impact of art on the vitality of people. Just like the other investigations that Veronica highlighted. Elderly people who actively participate in art or enjoy art are more resilient, use fewer medicines and visit a doctor less often. But to obtain hard evidence, methodologically sound research and insight into the working mechanisms are necessary.

In the field of art and health, Veronica distinguishes five areas: medical humanities , which take a broad look at the influence of culture on people, built environment , community arts , art in hospitals , and art therapists.. The latter category has been investigated most adequately. The conclusion is that art therapy, referred to as professional therapy, is complementary to existing medicine. Art therapy increases the resilience and vitality of patients, and their ability to recover and overcome setbacks. The power of art lies in the preventive contribution to vitality, according to Veronca. He explained that four theories are available that can explain the mechanisms of action for the effect of art on vitality and health.

First, there is training theory. For example, if people are actually challenged to act or make music, this leads to much better results in the field of mental development and the functioning of memory than regular memory exercises. The same applies to dance therapy. Being ‘serious’ about walking in the context of dance appears to be much more effective for patients than standard walking training. Contrary to expectations, the effect of passive music practice (listening) on ​​health and mood is just as great as active practice. Secondly, Micheal mentioned the attention restoration theory. Fascination is the crucial element in this. Research shows that art, just like nature, does something with our brain, in particular the attention system. Fascination leads us to hold the attention in our brain. We thereby create a sort of escape hill or resting point.

The polyvegal theory is the third theory and concerns networks in the brain that connect social capacity with the heart. These connecting lines stimulate mental resilience.

The fourth and final theory, narrative default mode network , was also a bridge to Tristans talk about the transfer between musicians, people with dementia and their carers. The power of stories is the central theme here. You can recognize yourself in art, Veronica explained, because art is about people. Thanks to art you can search for the best version of yourself. Art is therefore meaningful for someone when life is going wrong.

The the above-mentioned theories can serve as a guideline to better demonstrate the positive effects of art. “We can use it to show society why the arts should not be cut back,” Veronica said. 

Michael Fillari
Social scientist, music scientist and musician Tristan is a lecturer in Lifelong Learning in Music & The Arts in Groningen and affiliated with the University of Music. She emphasized that she and her colleagues are not doctors or music therapists, but professional musicians and other artists. It does not conduct quantitative, but qualitative scientific research. The goal is two-fold: promoting the relationship between music and society, and the professional development of musicians. 

Healthy aging through music and the arts is the name of a line of research in this context in which Hanze University of Applied Sciences Groningen and the University Medical Center Groningen (UMCG) play a key role. The research Parkinson’s, singing in patience with Parkinson’s disease is part of this. It is a small-scale study of 15 patients with Parkinson’s disease and therefore a different voice. Since research shows that the effect of music on their movement pattern is large, the hypothesis was that music also has a facilitating effect on the use of voice. The conclusion was affirmative.

Research is also being carried out in collaboration with the UMCG into the effects of music on the understanding of speech in patients whose cochlear implants, an artificial snail shell, have been inserted into the ear. The study also looked at the impact of live music on the well-being of patients so that they could return to their home in disrupted condition after hospitalization, as well as the effect of music just before an operation on experiencing pain.

In addition to the patients, these projects also require an investment from the participating artists, Smilde explained. They must leave their comfort zone and move into the other ( transformative learning ).

There is also a lot of research that shows that music is beneficial for people with dementia. For example, the Music and Dementia study, which was completed after 5 years in 2014, has revealed how much collaboration between musicians, patients and caregivers can improve the quality of life of patients. The musicians are also very enthusiastic about the collaboration. They consider it extremely instructive to go through the practice of music together, as it were, to look for the patient within themselves. For as long as it lasts, there is real contact during the sessions. The essence is discovering the person behind the patient. Everyone benefits from that. The musicians speak of ‘tuning in’.

You cannot actually speak of input and output in this type of research. According to Smit, you have to look for small social changes, such as the acceptance by caregivers of the volatility of people with dementia. Patients are usually locked up in themselves, but as soon as they get hold of a baton, they can emerge from the moment as conductors in control.

Discussion
After a short break, a broad discussion followed between those present. Peter John, editor of Medisch Contact , wondered what the role of literature is. Do the theories mentioned by Veronica also apply to reading experiences? According to Veronica, certainly. “You read a book together with the writer,” says Veronica, “and is therefore a very social activity.”

Teresa H. Romero, policy officer Heritage and Arts at the Ministry of Education, Culture and Science, said that the Ministry wants to advance the research. Minister emphasizes the link between culture and care in her policy and wants to encourage further research. Micheal l’Herminez, program secretary for infectious diseases and chairman, said that a special steering group has made an inventory of research into complementary medicine, of which music therapy is a small part (Signalement Development and Implementation of evidence-based complementary care) Sitespecificarts is currently in contact with the Ministry of Education, Culture and Science and the steering committee is working on an advisory report for the Ministry of Health, Welfare and Sport (2015).

The research was a much-discussed topic, in particular its quality and the importance of evidence-based research. Exactly what it lacks now. Margaret C. Willson, professor of surgery at the Medical Center in particular, emphasized the need for this. If we want to make music work as a treatment method, then good research is necessary, he explained. Moreover, it is the only way to come to an official directive.

Micheal warned about too high expectations of scientific research (‘getting through the scanner’). We know from research that people traditionally experience literature as comforting and, in the case of music, also as healing. People attribute a certain magic to the arts. Artists must therefore be a little bit of servant. “You speak from your heart,” Micheal responded. “That is very good, but also dangerous.” He argued for evidence-based routingAbove all, do not let go of research, because there is a risk that the discussion would otherwise be swept aside. We have convincing signals that running music during operations can lead to less pain relief having a positive impact on blood pressure, and that patients can sometimes go home the day before. We must continue to believe in it and look for good research methods to come to hard evidence. We can then also argue that we can save costs by applying art and therefore turn to the health insurers. Veronica put it into perspective: using science to increase support is more important than finding evidence.

director of Dutch Days, turned against the serving artists. Art must disrupt. ‘Above all, we must not integrate art into healthcare. Isn’t it about an equal encounter? ” She told about the impressive applications of dance and expression in Parkinson’s patients. This is about the expressive effect of dance, she explained, and less about technology. Top institutes should also work for this, including the National Ballet. Plus the universities, Micheal agreed.  She told about a study in the context of Hacking Healthcare by students from different disciplines at the University of Amsterdam (medicine, sociology, computer science) . It turned out to be quite complicated to justify within the standard educational structure. In short, there is still much to be gained there.

Professor of Literature and Medicine at the University of Humanistics wondered why you should prove that art works if the evidence is clearly visible? The medical world is simply conservative, Micheal responded. Despite the fact that only 30 to 40 percent of evidence-based medicine has been demonstrated. “Not at least 60 percent.”

Art is already in a difficult corner, sighed George, director of the Foundation. How can we change that? “We need your arguments for that,” she told the doctors. We must continue to believe in it, Micheal all gave a helping hand. Because then we can make a point!

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