AHSW's Director, Trustees, and Members reflect on various aspects of arts, health and wellbeing.

‘Cultural Value’ and ‘Quality’

AHSW Director Alex Coulter was inspired to write this blog as a result of discussions with our partners in the Alternative Visions project:
Bristol Museums, Galleries & Archives and Outside In.

Alternative Visions is grounded in the belief that there is high quality visual artwork being created by artists who are not engaged in the mainstream art world and may feel excluded from it due to health, disability, social circumstance or isolation. Our evaluator, Nell Farrally, has challenged us to articulate how we will determine ‘quality’. She pointed us in the direction of François Matarasso’s article ‘Creative Progression: Reflections on quality in participatory arts’ where he states that ‘quality is a characteristic of things; it does not determine their value.’ I referenced Matarasso’s thinking in a previous blog on ‘Beauty, excellence and quality in arts and health’ in February 2014. Quality as a characteristic is not the same as ‘high quality’ when used as a value judgement. Matarasso quotes the literary critic, John Carey, who states: ‘ not intrinsic in objects, but attributed to them by whoever is doing the valuing.’

I have been reading the AHRC Cultural Value Project (CVP) report in the hope that it will help inform my thinking. The report was written by Professor Geoffrey Crossick and Dr Patrycja Kaszynska and the project involved 70 original pieces of research including literature reviews, new research and specialist workshops. The key conclusion that: ‘emerges from the Cultural Value Project is the imperative to reposition first-hand, individual experience of arts and culture at the heart of enquiry into cultural value’. The CVP attempts to distance the debate from the relatively recent focus on cultural value as a means to influence the allocation of government funding (ie primarily as an advocacy tool for publicly-funded arts) by embracing commercial, third-sector, amateur and participatory practice and experience. It also attempts to broaden the debate beyond the persistent dichotomies embodied in the concern for widening participation and access on the one hand and a preoccupation with excellence and quality on the other.  One of the research projects (Lamarque and Currie) took the assumption that cultural value is dependent upon both aesthetic value and cognitive value and analysed three case studies to explore the question of how the quality of cultural artefacts translates into cultural value. Other projects (Carman, Hoskins) suggest that a more productive approach would focus not on value but on the process of valuing and ‘Hoskins is able to uncover the emotional and phenomenological aspect of valuation which he sees as rendered invisible in the official processes.’ Attempts to consider how value can be recognised phenomenologically from the first-person perspective leads us to felt experience. Froggett analyses how individual points of view can be woven together to give a more ‘collective’ story of cultural value in relation to public art in a coastal town. These discussions show how the phenomenon of experience: ‘is a fundamental dimension of cultural value, and a dimension all too often concealed by dichotomies such as intrinsic and instrumental, high and popular, hedonic and eudemonic, canonical and marginal, and audience and participant.’

The shift in focus is to those who consume and experience culture, re-balancing the power relationship with those who are ‘experts’, whether they be artists, artistic directors, curators, critics, or funders. Those with the dominant voices in the cultural sector collectively influence a consensus on quality, and, along with the market, determine value. But to actually measure the impact, we need to look to those who consume and experience culture, the people it is intended for, the audiences and the participants.

In the Alternative Visions project, artists who feel excluded from the mainstream art world due to health, disability, social circumstance or isolation are invited to submit their work for a touring exhibition. This process will involve the selection of works (approximately 20 pieces) by a small panel which includes an Outside In artist, a contemporary art curator, and members of the project team. All artists submitting work will have their images included in the touring exhibition on a screen, but we, the panel, will need to make value judgements in order to select works that will be on the walls. The evaluation of the project will consider the value of the individual artworks, the value of the exhibition as a whole, the quality of the experience for those participating and for the exhibition visitors and the venues themselves. Feedback from the participating artists and the audiences will be fundamental to the evaluator’s assessment of the value of the project. Personally, I think my approach to selecting the artwork, and therefore making value judgements, will more or less reflect Lamarque and Currie’s assumption that cultural value is dependent upon both aesthetic value and cognitive value. Two of the questions that we will use to select works are: ‘do you like the work personally, on an aesthetic level?’; and ‘does the work convey a message or have an emotional impact on you?’ We are using our first-hand, individual experience to determine the value, informed, of course, by our own knowledge and experience from our professional and personal lives.

The most relevant chapter in the CVP report is on health, ageing and wellbeing. The report draws on the main reviews we are familiar with, such as those by Rosalia Staricoff, Jenny Secker and Norma Daykin, ‘alongside work carried out through the CVP awards, augmented by a very selective use of research papers in a substantial field.’ The report finds that the majority of studies in the reviews concern mental health, but that the separation of mental and physical health is increasingly under scrutiny. There is an emphasis on the need for evaluation models that take into account the situation-specific character of arts interventions. Daykin and Orme argue that by focusing on impact and process, rather than too narrowly-defined outcomes, qualitative research on arts and health can show its value.

The section on community-based arts and health highlights the contradictions and inconsistencies in attempts to distinguish between individual and community benefits and quotes Atkinson and White who explain that: ‘on the one hand, policy analysts observe an individualisation of responsibility and blame for the production of health and ill-health; on the other, attention to social determinants, inequalities and globalisation locate the production of health and ill-health within complex relationships shaped across space and time.’ Of course it isn’t an either-or issue but a complex mix of both.

There is a discussion of the longer-term health benefits of engaging in arts and culture which primarily draws on the CVP research by Dr Rebecca Gordon-Nesbitt, in which she analyses longitudinal cohort studies in Finland, Sweden and Norway. They show an association between long-term arts engagement and positive health outcomes after controlling for relevant social, economic and demographic variables. The report calls for long-term questions about arts and cultural engagement to be included in major UK cohort studies in the future.

On wellbeing, the report quotes a recent study which involved data-mining the Italian Culture and Wellbeing project which found: ‘that cultural access was the second most important determinant of psychological subjective wellbeing after multiple morbidities, outperforming factors such as occupation, age, income and education.’ It states that: ‘there is clear evidence of an association between arts and culture participation and self-reported wellbeing, even when social, economic and lifestyle factors are taken into account.’

Finally, the chapter discusses arts and culture in relation to ageing and dementia. The sustained work in this area by the Baring Foundation is referenced and work by the National Endowment for the Arts in the USA. The NEA finds that: ‘Because arts-based initiatives are multimodal, multilevel, and may produce subtle changes, they are difficult to evaluate with Randomised Controlled Trials.’ Some concern is expressed that assessments of the health benefits of arts participation among older people minimise the perspective of older people themselves. Bernard et al argue that involving older people in co-constructing research might help establish what value participation holds for them. With regard to dementia, research by Hannah Zeilig shows that the most positive effects relate to social and psychological wellbeing and that participative arts may provide unique access to the emotional and physical memories of people living with advanced dementia, even when their cognitive capacities are diminishing.

The chapter ends by discussing the challenge in arts and health of bringing together such disparate institutional cultures, languages and epistemologies. A CVP workshop on arts and mental health showed that: ‘the “artfullness” of these interventions, found in the relational, affective space they create, is lost in the epistemological orthodoxies of clinical and quantitative research methodologies.’ It concludes that we need to step back from the established hierarchy of evidence and that: ‘the best balance of quantitative and qualitative evidence will depend on the nature of the intervention and the character of the knowledge being sought.’ I highly recommend reading this chapter before you embark on any new projects as it will help you to contextualise your work and may lead you to evidence that will support the approach you wish to take.

My observation is that we must be more confident in our use of the evidence that exists and in evaluating the work that we do, in a way that makes sense to practitioners and participants. The hierarchy of evidence, and of research methodologies, that the medical establishment continues to value, with the randomised controlled trial and quantitative approaches at the top, can be very intimidating. To paraphrase Professor Paul Dieppe, a Trustee of AHSW: unlike other scientific disciplines such as physics, medicine still maintains the centrality of cause and effect. This causality confines us to a linear temporality, notions of progress and development that aren’t necessarily helpful. Much that we engage with is cyclical and, or, multi-faceted and multi-layered. We hope to work with Paul, and Exeter University, in exploring more nuanced methodologies for measuring impact, that are better informed by what practitioners and participants believe is happening, thereby responding to: ‘the imperative to reposition first-hand, individual experience of arts and culture at the heart of enquiry into cultural value.’


Alexandra Coulter

Director, Arts & Health South West

August 2016

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