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The health benefits of arts,
cultural and community
engagement
Dr Marie Polley
Abby Sabey
A short guide for link workers
Acknowledgements:
This report was produced by Marie Polley Consultancy Ltd in collaboration with researchers
from the Department of Behavioural Science and Health at University College London. We
are particularly grateful to the ESRC for funding this work through the WELLCOMM project
[ES/T006994/1].
How to cite this report:
Polley M and Sabey A (2022). The health benefits of arts, cultural and community
engagement - A short guide for link workers. Marie Polley Consultancy Ltd, England.
Main contact
Questions or comments about the guide can be directed to:
marie@mariepolleyconsultancy.com
About the authors:
Dr Marie Polley BSc, PhD, is Director of Marie Polley Consultancy Ltd and works as a
freelance research consultant. Marie is a biomedical scientist and has a PhD in molecular
biology of how cancer develops. In 2015, Marie co-founded the Social Prescribing Network,
which has led a social movement around the use of non-medical activities to support people’s
wider determinants of health and provide additional routes of support to traditional
pharmaceutical prescribing. Social Prescribing has now been adopted by the NHS in England
and is being taken up internationally. Marie led the team to write the first national guidance
for social prescribing, the first economic overview of social prescribing on health service
usage and recently mapped all outcomes associated with social prescribing to support
discussion on inclusive ways of researching and evaluating this growing field. Marie is also
Co-Founder and Co-Director of Meaningful Measures Ltd.
Abigail Sabey is a Freelance Research Associate of Marie Polley Consultancy Ltd and
is also a senior lecturer in research methods at the University of the West of England where
she teaches on the MSc in Public Health. She has extensive experience of teaching research
and evidence-based practice to health and social care professionals at the University of the
West of England, combined with a background in health services and medical education
research, using both quantitative and qualitative methods. She currently leads a training
programme for NIHR ARC West to promote research and evaluation skills for the workforce
in health and social care.
2
Table of Contents
WHO IS THIS GUIDE FOR? ............................................................................................................. 3
WHAT ARE COMMUNITY ASSETS? ................................................................................................ 3
WHAT’S THE SCIENTIFIC EVIDENCE? ............................................................................................ 5
ARTS, CULTURE AND MENTAL HEALTH: RECENT EVIDENCE FROM THE UK ................................... 7
HOW DOES THE LEVEL OF ENGAGEMENT CHANGE ACROSS DIFFERENT GROUPS?......................... 8
WHAT DO WE KNOW ABOUT THE ENABLERS AND BARRIERS ASSOCIATED WITH ENGAGEMENT? .. 10
WHAT CAN I DO AS A LINK WORKER? ......................................................................................... 12
REFERENCES ............................................................................................................................. 17
3
Who is this guide for?
This guide is for link workers and serves as an introduction to scientific research on how
people can manage and improve their health by engaging in arts and cultural activities.
Link workers can use this guide to encourage their clients to take part in activities offered by
their communities. The research summarised in the following pages provides evidence for
how engaging in the arts and culture can improve both physical and mental health. It also
explains why many people may be prevented from taking part in such activities and how link
workers can help their clients overcome some of these difficulties. We hope this guide will
enable link workers to open up conversations on how arts and cultural assets can be powerful
tools for health.
What are community assets?
Community assets are resources within your community. They include individuals with
specific skills and knowledge, as well as community and voluntary associations, public and
private organisations, and physical environments. For example, libraries, writing groups,
archives, gardens, exercise classes, sporting events, volunteering and charitable groups,
youth services, trade unions, and religious groups are all community assets.
4
What is arts and cultural engagement?
Engagement in arts and culture encompasses the many ways that individuals take part in
arts and cultural activities. People do so passively (e.g., watching a performance in-person
or on TV) or actively (e.g., drawing, singing, writing, performing, or dancing). The terminology
around arts, culture and community engagement is often mixed and matched, so we have
provided examples below.
Assets
Examples
Arts
assets
Performing arts (music or theatre), visual arts (painting, drawing,
sculpture), design, crafts, writing or reading groups and digital or
electronic arts.
Heritage
assets
Historic buildings such as monuments and castles, museums,
galleries, theatres, public or private buildings, historic parks, historic
places of worship, archaeological sites, landscapes, and spaces.
Cultural
assets
Theatres, concerts, opera, museums, galleries, *heritage sites, and
informal events and activities that reflect local culture.
Volunteers
Volunteers are also a community asset. Volunteering can be done
formally or informally and often involves social action.
*One example of ‘mixing and matching’ is between cultural assets and heritage. The heritage
sector specifically applies to historic buildings, landscapes and spaces and is part of our wider
‘cultural’ assets. Sometimes, however, heritage is listed separately from culture. Similarly,
the arts are listed as their own categories, but could also fit under the category of cultural
assets or vice versa.
5
What’s the scientific evidence?
The World Health Organisation commissioned a team of researchers at University College
London, led by Dr Daisy Fancourt, to review evidence from around the world on the benefits
of the arts and culture on health1. The studies covered a diverse range of arts activities
delivered in a variety of settings, ranging from the home and community to healthcare
settings.
People of all ages who engaged in the arts reported benefits to both their physical and mental
health. Sometimes studies looked at managing and treating health conditions. Other times
the research looked at the role of arts in preventing the onset of conditions or the worsening
of existing conditions (see examples below). Generally, evidence shows that more benefit is
derived when a person actively participates in a community asset. For example, drawing,
singing, writing, performing, or dancing might have more effect than being a passive recipient
of similar cultural assets. There are always exceptions to this rule though! This may be
useful to bear in mind when you are suggesting local community engagement activities to
your clients.
To help to prevent illness
and promote health, the
arts can…
To help to manage and treat
health conditions, the arts
can…
support child development
help those who are experiencing both mild to
severe mental illness
impact the social determinants of health
such as social cohesion
support care for people in hospital with acute
conditions
encourage health-promoting behaviours
such as a healthy lifestyle
assist with the management of chronic
conditions such as cancer, diabetes and heart
disease
help prevent ill health through enhancing
wellbeing and mental health, as well as
reducing risk of cognitive decline and
frailty
help to support people with
neurodevelopmental and neurological
conditions e.g. autism, cerebral palsy, stroke,
dementia
support caregiving by professionals and
informal carers.
support end of life care.
6
A different review of research specifically investigating the benefits of the heritage sector also
showed positive impacts on people who engaged with this sector and their communities2.
As a link worker, you will be meeting people with a diverse range of physical and mental
conditions so the list above may help you when thinking about who of your clients could
benefit from engaging with art-based assets in your community.
7
Arts, culture and mental health: Recent
evidence from the UK
Dr Fancourt and her team have recently analysed data from 108,000 people to understand
the impact of engaging with community arts and cultural activities on mental health.
There were some really interesting findings that may help you justify why engaging in arts
and cultural activities are helpful to people.
● Mental distress, mental health functioning and how satisfied a person was with their
life all improved when people engaged with arts or cultural activities in their
communities3,4. There were significant improvements seen particularly if people
attended an activity more than once a week3.
● Even attending a cultural event once or twice a year still improved people’s level of
satisfaction with their lives3 and improved their physical and social functioning as well
as their general health5.
● Taking part in reading for pleasure as well as arts and crafts activities during the
pandemic helped people reduce their depression and anxiety symptoms as well as
improve their life satisfaction6. These were all things people tended to do at home, so
not all activities offered to your clients need to be activities in the community.
● Participatory music engagement was a powerful tool for people who find it hard to
express emotional aspects of their life. Participants reported improvements in
confidence, self-worth, sense of purpose and emotional wellbeing. It was also helpful
for providing diversion and distraction and for making social connections7.
Participatory music engagement could be very supportive and relevant for people with
ongoing or acute mental health challenges.
● Volunteering was associated with lower levels of mental distress and higher levels of
quality of life, with greater effects found amongst people who were born before 1945
or were part of the Baby Boomer generation8.
8
How does the level of engagement change
across different groups?
Dr Fancourt and her team have started to identify different patterns of engagement in arts
and cultural activities across the UK. Some of these patterns may seem obvious or
predictable to you. Nevertheless, if you know some of your clients are less likely to engage
or may need more motivation and support, you can tailor your conversation accordingly.
Who was less likely to engage in arts, culture and community
activities?
● People with poor mental health, who were lonely or lived alone9
● People with low levels of happiness10
● People in the North of England had lower engagement that people in the South of
England11
● ‘Industrious communities’ engage less than those in ‘cosmopolitan student’
neighbourhoods11
● People living in areas of greater deprivation14
● Non-White people were less likely to engage in cultural activities12
● Asian and Asian British people were less likely to engage in arts-based activities12
● Children from ethnic minority backgrounds were less likely to visit an archive, museum
or heritage site outside of school compared to children from White backgrounds13
● People living in multicultural areas had lower levels of engagement 11
9
Who was more likely to engage in arts, culture and
community activities?
● Among school-age children, girls are more likely to engage in the arts
outside of school than boys13.
● Children in rural areas are more likely to engage in arts, crafts and design
activities outside of school13.
● Among school-age children, arts engagement outside school is more
likely among those whose parents engaged in arts activities either
recently or as children themselves13.
● Arts and cultural activities, and performing arts in particular, are more
likely to be taken up by women than men12.
● Cultural activities are more likely to be taken up by older people12.
● Cultural engagement is more likely among those in rural settings
compared to urban areas11.
● During the Covid-19 pandemic, neighbourhood volunteering was more
likely among older people and females, but this may not reflect
volunteering more widely8.
● During the Covid-19 pandemic, online and digital arts activities were
popular among people with a disability or mental health condition, which
may suggest new patterns of engagement in the future if more arts
activities are transitioned to online platforms.
10
What do we know about the enablers and
barriers associated with engagement?
As social prescribing schemes become more widespread in the UK, research is revealing
information that helps us understand what barriers may prevent engagement and what
factors enable engagement in arts, culture and community assets. As a link worker, you can
help break down barriers and reinforce enablers where possible.
Socioeconomic status
Socioeconomic status is a measure of a person's social and economic status in relation to
others. It relates to income, education and occupation. You may be aware that a low
socioeconomic status means a person is more likely to experience inequalities and these can
have a negative effect on their health. As link workers you no doubt become very aware of
someone’s socioeconomic status as your conversations progress and barriers become
apparent.
Low socioeconomic status affects how people engage in arts activities9,11,12,14. People who
live in social housing, have a low level of education or a low grade of employment are less
likely to engage in arts activities15,12. This might be because people may not be able to afford
to attend activities, or they may not have time to attend, or they may never have been
provided with the opportunity to engage, so the idea is very foreign9,10. Patterns of
engagement may also reflect a lack of cultural resonance in available arts and cultural
activities for non-White groups12 for instance. In areas of high deprivation, link workers have
found it hard to motivate patients with complex social issues16.
Supporting healthcare professionals to refer into social
prescribing schemes
Researchers17 have found that GPs are keen to use new pathways such as social prescribing
to support patients’ unmet needs and to de-medicalise social problems17. GPs who are
already using social prescribing found it rewarding and liked to get regular informal feedback
from link workers17. Up until now, however, GPs and other health professionals haven’t had
any education on the benefits of non-medical interventions. Therefore, their own beliefs and
lack of knowledge about the benefits of engaging in arts, culture and community activities
can be a barrier17.
11
Wider issues
Since social prescribing was rolled out, funding for the Voluntary, Community and Social
Enterprise (VCSE) sector has been precarious17,19, which affects the availability of projects
in local areas. As a link worker, until this stabilises you need to know what organisations are
still operating.
12
What can I do as a link worker?
Key considerations when talking with your clients
● Introduce the topic of arts and cultural activities if your clients haven’t mentioned it
themselves.
● Gently and sympathetically explain the benefits of engagement and what is available
locally. This can be instrumental in helping a person give something a go.
● Remember that people living in areas of high deprivation and people with low
socioeconomic status are less likely to have engaged in arts and cultural activities
before, but they are likely to benefit the most from these activities.
● For people with low socioeconomic status the accessibility of activities is extremely
important to explore.
● You can help a person to feel less pressured about having the capability to engage
in the arts by focusing on how they will feel while engaging in the arts.
● Emphasise that a health professional has referred your client to you to show that it is
socially acceptable and encouraged to take part in arts and cultural activities to
support health.
● Start by suggesting a home-based activity such as reading or arts and crafts,
particularly as these support anxiety and depression6.
● Support your clients in attending a community activity or accompany them so that
they can get the additional benefit of social interaction.
● Show your client a short video clip of someone sharing their experience of benefitting
from an arts or cultural activity.
● Think about how you could tailor your conversation based on the groups of people
who are more or less likely to engage in different arts and cultural activities. Some
activities may be more likely to be taken up over others.
● Keep on top of which organisations are providing activities especially whilst funding
for the VCSE sector is precarious.
13
Key considerations when talking with healthcare professionals
Be aware that many healthcare professionals don’t know about the scientific evidence that
has been collected on the benefits of engaging in arts, cultural and community activities.
Neither was this topic covered in the medical curriculums of GPs who are working with you
at the moment.
Provide them this summary document and refer them to the publications in the reference
section below if they would like further reading. They can also sign up to the Social
Prescribing Network which circulates research evidence for social prescribing each month.
Offer GPs informal updates on patients, as they don’t often hear how patients are getting on
after they have referred them to social prescribing link workers. This is a great incentive for
GPs to continue referring to you as link workers.
Check out what currently exists in your local community
Part of a link worker’s role is to keep abreast of what activities are available in the local area.
It is understood, however, that the amount of time in which link workers have to do this varies
greatly.
For many people the cultural appropriateness of a community activity can be a ‘make or
break’ situation. So, it is important to offer culturally appropriate activities to people where
possible, particularly for your non-White clients and patients. As more organisations are
starting to open up and offer both in-person and online activities again, there may be more
choice for your clients. The bottom line is that non-White clients and patients should be
offered an activity that speaks to their culture as this will increase the likelihood that they will
try it out.
The importance of opening up the conversation
We hope that by reading this document you are more aware of how people can benefit from
community engagement in the arts and cultural sector. Many of your clients, patients, and
colleagues may not be aware of this compelling evidence. We live in a society where the arts
and culture have been seen as ‘soft and woolly’ while medical approaches have ruled.
Some of your clients and patients may not even consider engaging in a community arts or
cultural activity as it may not have been part of their experience growing up. Yet from the
evidence it is clear that their health could really benefit from it. By even opening up the
14
conversation you are making a valuable step to increasing a person’s awareness of the
benefit of arts and cultural engagement.
Inclusivity
This is especially the case for people with lower socioeconomic status and for the non-White
population. What has been accessible or meaningful for the White population may mean little
to a non-White population. As a link worker you have the opportunity to overcome a hidden
barrier. You can start the conversation, explore clients’ feelings about engaging in the arts,
explain the known benefits and then help to find something that could be most appropriate to
them as an individual. It’s also important to remember that people in more deprived areas
may benefit the most from community cultural engagement4,10. Even if these groups of people
don’t engage currently, they stand to gain the most.
Did you know that if parents engage in arts activities, their children are more likely to engage
and therefore benefit? Especially in terms of their mental health? This could be another
motivating fact to tell your clients.
Also, online activities can also be helpful for people who are unable to leave the house much.
Research during the pandemic has shown that the provision of online activities was really
helpful for people with physical conditions or with disabilities. So understanding how the
activities are provided, whether in-person or digitally, and tailoring this to your client can
increase the proportion of your clients and patients who could benefit15.
The other aspect to consider is which activities have a cost and which are free. You are no
doubt seeing a rise in the number of your clients who are needing to use foodbanks and are
having financial difficulties. Therefore being able to offer free activities is more important than
ever.
The power of support and encouragement
Finally, an important part of your role is encouragement. As link workers you know that
your clients and patients are more likely to engage in any activity as their mental health
improves, and engaging with arts and cultural activities will improve their mental health.
One research study specifically identified that clients with anxiety and depression were
more likely to engage in an activity if they felt supported and encouraged to do so, if they
knew other people that were in the group, and if it was socially acceptable to do this type of
activity18.
15
So when opening up the conversation, try to offer a short explanation in a very open way:
“We have talked about your loneliness [or isolation /depression
/mental health etc.]. Did you know that research now shows that
you may really benefit from trying some activities such as [add
in the community groups and activities that are locally available
in the arts and cultural sector]?”
“You mentioned that you were feeling depressed [or
anxious/low in mood]. Have you thought of doing any activities
at home? In a research study, people who read for pleasure or
did some sort of arts and crafts activity at home found it helped
their anxiety and depression?”
Can you think of other ways to open up the conversation? Showing empathy and respect
for your clients, as well as awareness of their situations, will go a long way.
16
We hope that the research summarised in this guide will help you to introduce more of your
clients to the health benefits of arts and cultural engagement. If you want to find out more
about the research and evaluation that is happening in this area, you can look at the
following websites:
Social Prescribing Network - Here you will find an open access google sheet archive of
reports in social prescribing. The monthly social prescribing newsletter will keep you up to
date with social prescribing news, reports and events.
Culture Health and Wellbeing Alliance - The Culture, Health and Wellbeing Alliance CIC
(CHWA) is a national, free-to-join membership organisation supporting everyone who
believes that culture and creativity can transform our health and wellbeing.
National Academy for Social Prescribing, Thriving Communities - Thriving Communities is a
new national support programme for voluntary, community, faith and social enterprise
groups, supporting communities impacted by COVID19 in England, working alongside
social prescribing link workers.
Happy Social Prescribing!
17
References
(1) Fancourt D, Finn S. What is the evidence on the role of the arts in improving health and well-being? A scoping review. Copenhagen: WHO
Regional Office for Europe; 2019 (Health Evidence Network (HEN) synthesis report 67).
(2) Pennington A, Jones R, Bagnall A-M, South J, Corcoran R (2019) The impact of historic places and assets on community wellbeing - a
scoping review. London: What Works Centre for Wellbeing
(3) Wang, S., Mak, H.W. & Fancourt, D. Arts, mental distress, mental health functioning & life satisfaction: fixed-effects analyses of a nationally-
representative panel study. BMC Public Health 20, 208 (2020). https://doi.org/10.1186/s12889-019-8109-y
(4) Mak, H.W., Coulter, R. & Fancourt, D. (2021). Associations between community cultural engagement and life satisfaction, mental distress
and mental health functioning using data from the UK Household Longitudinal Study (UKHLS): are associations moderated by area
deprivation? BMJ Open. doi:10.1136/ bmjopen-2020-045512
(5) Elsden, E., Bu, F., Fancourt, D. & Mak, H.W. (under review). Frequency of leisure activity engagement and health functioning using SF-36
over a 4-year period: a population-based study amongst middle-aged adults. Social Science & Medicine.
(6) Bu, F., Steptoe, A., Mak, H., & Fancourt, D. (2021). Time use and mental health in UK adults during an 11-week COVID-19 lockdown: A
panel analysis. The British Journal of Psychiatry, 219(4), 551-556. doi:10.1192/bjp.2021.44
(7) Perkins, R., Mason-Bertrand, A., Fancourt, D., Baxter, L., & Williamon, A. (2020). How Participatory Music Engagement Supports Mental
Well-being: A Meta-Ethnography. Qualitative Health Research, 30(12), 1924–1940. https://doi.org/10.1177/1049732320944142
(8) Mak, H., & Fancourt, D. (2021). Predictors of engaging in voluntary work during the COVID-19 pandemic: analyses of data from 31,890
adults in the UK. Perspectives in Public Health. https://doi.org/10.1177/1757913921994146
(9) Fancourt D, Mak HW (2020) What barriers do people experience to engaging in the arts? Structural equation modelling of the relationship
between individual characteristics and capabilities, opportunities, and motivations to engage. PLoS ONE 15(3): e0230487.
https://doi.org/10.1371/journal.pone.0230487
(10) Fancourt, D., & Baxter, L. (2020). Differential participation in community cultural activities amongst those with poor mental health: Analyses
of the UK Taking Part Survey. Social Science & Medicine,261; 113221.
(11) Mak HW, Coulter R, Fancourt D. Does arts and cultural engagement vary geographically? Evidence from the UK household longitudinal
study. Public Health. 2020 Aug;185:119-126. DOI: 10.1016/j.puhe.2020.04.029. PMID: 32619767; PMCID: PMC7456771.
(12) World Health Organization. Regional Office for Europe, Mak HW, Coulter R & Fancourt D. (2020). Patterns of social inequality in arts and
cultural participation: findings from a nationally representative sample of adults living in the United Kingdom of Great Britain and Northern
Ireland. Public Health Panorama, 6 (1), 55 - 68. World Health Organization. Regional Office for Europe.
https://apps.who.int/iris/handle/10665/331566. License: CC BY-NC-SA 3.0 IGO
(13) Mak HW, Fancourt D (2021) Do socio-demographic factors predict children’s engagement in arts and culture? Comparisons of in-school and
out-of-school participation in the Taking Part Survey. PLoS ONE 16(2): e0246936. https://doi.org/10.1371/journal.pone.0246936
(14) Mak HW, Coulter R, Fancourt D. Associations between neighbourhood deprivation and engagement in arts, culture and heritage: evidence
from two nationally-representative samples. BMC Public Health. 2021 Sep;21(1):1685. DOI: 10.1186/s12889-021-11740-6. PMID:
34530782; PMCID: PMC8444412.
(15) Bu F, Mak HW, Bone JK, Fancourt D. Longitudinal changes in home-based arts engagement during and following the first national lockdown
due to the COVID-19 pandemic in the United Kingdom. medRxiv; 2021. DOI: 10.1101/2021.05.14.21257233.
(16) Fixsen, A., Seers, H., Polley, M. et al. Applying critical systems thinking to social prescribing: a relational model of stakeholder “buy-in”. BMC
Health Serv Res 20, 580 (2020). https://doi.org/10.1186/s12913-020-05443-8
(17) Aughterson, H., Baxter, L. & Fancourt, D. Social prescribing for individuals with mental health problems: a qualitative study of barriers and
enablers experienced by general practitioners. BMC Fam Pract 21, 194 (2020). https://doi.org/10.1186/s12875-020-01264-0
(18) Fancourt, D., Baxter, L. & Lorencatto, F. Barriers and enablers to engagement in participatory arts activities amongst individuals with
depression and anxiety: quantitative analyses using a behaviour change framework. BMC Public Health 20, 272 (2020).
https://doi.org/10.1186/s12889-020-8337-1
(19) Baxter L, Fancourt D (2020) What are the barriers to, and enablers of, working with people with lived experience of mental illness amongst
community and voluntary sector organisations? A qualitative study. PLoS ONE 15(7): e0235334.
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