The view from here, wherever here is: Arts, health, inequality and activism

Zama Mbankwa and Lebohang Moroe at the International Conference for Culture, Health & Wellbeing

Seen through the lens of three years in South Africa, the UK’s arts in health world at first looks quite different. In 2013 I gave up my job as the arts manager at a London tertiary hospital trust to move to Johannesburg. I have stayed with arts in health, but it has different names now: Community Music; Medical Humanities; Theatre in Education; Applied Drama. I would emphasise that the work is exactly the same, but in the UK we have developed parameters for an arts-in-health ‘sector’ – which now seem in many ways quite specific to our context and the resources it affords. Over 20 years I have watched the energy of this sector flow from hospital-based arts programmes, to social prescribing, creative ageing, museums and health, and so on… but it seems to me that the predominant trend has – happily – been towards the bigger picture, to see this work less and less as a Nice Thing to Do When You’re Not Well, and more and more as a challenge – not just to biomedical norms, but to wider social trends and inequalities. To understand access to culture and particularly participatory creative work as an essential component of a healthy society.

We were lucky enough, thanks to the generous support of the International Conference for Culture, Health and Wellbeing, to bring Blood Sugars to Bristol from Johannesburg as a keynote a few days ago: a Wellcome-funded South African applied drama project on health communication and diabetes. The traditions that coalesce in our UK-SA project are different – community theatre, political activism, and social development versus (in my case) hospital based arts practice and social sciences; and the socio-political history that informs the work is different too – in a context where public resources are under pressures we can only fear and regard with a distant sympathy in the UK. But the aspirations are in many ways the same: the arts give voice to the unheard, challenge assumptions, push us to consider what we consider to constitute being ‘well’, what gives meaning to life, and (I say this thinking of Clive Parkinson’s recent blog on this site) what is least countable or reducible about it. And the problems that plague us are similar – credibility, the need to prove, the challenge of sustainability, cross-disciplinary clashes, territorialism, different truths vying for attention.

I was struck for the nth time watching the Q&A after Blood Sugars with our director, Faith Busika, by her use of the word ‘activist’ to describe the people with whom we worked to produce the play. Indeed this was questioned by one of the audience members. It’s a word that I haven’t always found comfortable, it’s not one I would have used in the UK; I would have said ‘participant’, possibly ‘collaborator’ if I was feeling particularly confident; a social scientist might have said ‘interlocutor’. The implications of ‘activist’ are complex. Yet, Faith is right when she says that people choosing to tell their stories to educate the rest of us, to break down prejudice and ignorance, is of course activism. There is a parallel here with a conversation I have a few hours later with an old arts-and-health friend, who talks about the increasing need to ‘speak our truth’ in (I infer at the time) a world where leaders and the structures that prop them up seem (with a few notable exceptions) ever more duplicitous and un-true.

Faith Busika and Masiza Mbali at the Blood Sugars Q&A at the International Conferene for Culture, Health & Wellbeing
Faith Busika and Masiza Mbali at the Blood Sugars Q&A at the International Conference for Culture, Health & Wellbeing

The South African team is quicker to use what might be called political terminology (‘activism’) in relation to this work. It’s dangerous of course to generalise about this, but there is something here that we perhaps need to catch up on in the UK. Our work is a political act. From the conference chair, Dr Paul Dieppe, I heard again and again the call to challenge the persistently reductive norms of medicine. Indeed we have all been saying this on repeat in different ways over the last few decades. This is nothing if not a political act. It is about overturning hierarchies, revolutionising our sense of what makes one healthy or well, and moving this out of the profit-making, measurable sphere and into something more amorphous and complex, but also more true. This is where Clive Parkinson and Vic McEwan’s work, The Harmonic Oscillator, so aptly the final presentation of the international conference, somehow managed to reflect everything about this area of work that makes it worthwhile: experimental, anarchic, actively mad – “off the hinges”, as Faith would say. And revealing something so profound about the limitations, the humanity, and the possibilities of hospital care. And broad, cross-disciplinary, entirely ignorant of any boundary between research, poetry, publication, practical support, land art, film.

From a South African perspective, arts in health here is awash with resources. The very idea that an arts health organisation could have three years of funding seems impossible where the major governmental arts funder has ceased to supply any funding to anyone lasting longer than a year. And the idea of a percent for art is a distant dream, certainly for any state facility. And yet, I know all too well that organisations in the UK who grew a decade ago have shrunk and sometimes closed in recent years. We should take heed. The Ebacc is quite literally destroying the arts in education. Cultural events may still be funded as a kind of tourist attraction and a flagship for the fiscal ‘growth’ with which we remain perversely obsessed – already in the recent ministerial restructure, the arts and culture have been aligned with tourism and heritage, and split from digital culture (which apparently means broadcasting and the creative industries) – but if we don’t watch out, the arts will be drawn backwards into a conservative (I use the word advisedly) shoring up of old hierarchies and establishments, maintaining the splits between classes, people, and disciplines, too, which in a broader political sense mirror our anti-empathic tendencies and allow divisions to become entrenched and dangerous. Downton Abbeys and other classist nightmares will proliferate (as they already do) on our screens, offset by the screaming, empty lunacy of endless competitions. I saw an article in the Telegraph recently based on research from New Zealand looking at the potential of craft to support our mental wellbeing. However solid the research, perhaps it’s paranoia and a tribal dislike of the Telegraph, but I swear I caught a whiff of old-fashioned gender stereotyping underlying the article and its presentation, as well as a kind of stick-to-your-knitting and don’t worry about the state of the world vibe. As Clive says, we have to beware the Rattlesnake King. He may come with the promise of good publicity for the sector. But we have to remember what we’re doing. If working with Faith has taught me anything, it is that we should not be afraid to call it activism.

The conference, Creativity and Wellbeing Week, Alice Thwaite’s report Growing the Creative Ageing Movement: International lessons for the UK, and doubtless many other pieces of work of which I’m not aware, all represent what feels like a relatively new confidence in our openness to other disciplines, and international work, to critically appraising what we do in the UK in the light of other countries’ and sectors’ priorities and struggles. As Paul Dieppe put it, taking part in Julian West and Neil Valentine’s inclusive musical performance/presentation/composition on the last day of the conference, we all at that conference – all 22 countries of us – became a community. Inspired by our differences of experience and knowledge.

There may be increasing financial and political pressures on the real revolutionary (yes) core of arts in health work, but we must not be tempted to turn inwards on ourselves and protect our assets by obsessing about measurable outcomes and jumping through fiscally-oriented hoops. We have to make bigger arguments than that. It is confident, critical openness that will keep us going – the drawing in and collaboration with disciplines other than our own, the anti-parochialness, if you like. And it is our solidarity with other organisations, regions and countries in the push against global inequalities[1] that will allow us to survive – and thrive – as a cultural force.


[1] For more on global inequalities and solidarity, see this Little Atoms podcast with Jason Hickel, and his new book, The Divide.

Victoria Hume is a singer-songwriter and composer, as well as an arts manager and researcher specialising in the meeting points between the arts, medicine and health. She is currently based at the University of the Witwatersrand, Johannesburg, working with the medical humanities initiative at WiSER (Wits Institute for Social & Economic Research), the Health Communication Research Unit, and the Wits School of Arts. Before this she was an arts manager in the NHS for 15 years. She recently received a distinction for a Masters in Music and Health Communication focused on hospital-induced delirium. Her most recent EP, Closing (released on Lost Map records), featured on Lauren Laverne’s best of 2016 playlist (BBC Radio6 Music).



The author is writing in a personal capacity. The views contained in this article do not necessarily reflect those of LAHF or the organisations described therein. Copyright is retained by the author. 







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