The Science of Arts & Health with Dr. Jill Sonke

Dr. Jill Sonke, a research professor and research director at the University of Florida’s Center for Arts in Medicine, is a leader in arts and health research and policy advocacy nationally and internationally. Her research focuses on population-level health outcomes associated with arts and cultural participation, arts in public health, and the arts in health communication.

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Transcript

SPEAKER_02 0:07

Welcome back to CitySpeak. I'm your host, Lorda Cedas, Director of Health and Wellbeing at the National League of Cities. CitySpeaks gives listeners an insider's view of what local leadership in America means today and features conversations with government leaders and policy experts regarding the biggest issues and challenges facing America's cities, towns, and villages. This week I'm talking to Dr. Jill Sankey, currently serving as U.S. Cultural Policy Fellow at Stanford University and visiting scholar at the Federal Reserve Bank of New York, where she works on policy and economic models for arts and nature prescribing in the U.S. She also serves as a research professor and research director at the University of Florida Center for Arts and Medicine. With 28 years of experience and leadership in the field of arts in health and a PhD in arts and public health from Ulster University in Northern Ireland, Jill is a leader in arts and health research and policy advocacy nationally and internationally. Her research focuses on population-level health outcomes associated with arts and cultural participation, art and public health, and the arts and health communication. Jill is also an artist with a background in professional dance. Thank you. You have a fascinating story. Tell us about yourself, your art, and what you do at the Center for Arts in Medicine.

SPEAKER_00 1:54

Thank you so much, Lourdes. It's just great to be in conversation with you today. So I identify as an artist researcher. I came into the arts and health space in 1994 as a dancer. I was dance faculty at the University of Florida, and I started working as an artist in residence in the UF Health Shans Arts and Medicine program. So I am first and foremost an artist. And over the past 30 years, I have shifted into being a researcher, developing and teaching in the Center for Arts and Medicines academic programs. And the more I research, the more I center my artist identity. So I really, really believe that artists are phenomenal researchers, and the skills and ways of thinking and doing that we bring to our artistic practices have such important places in research, especially in community-based research. I'm also a cultural strategist. And as you mentioned, I'm serving now at the Federal Reserve Bank of New York, which is really exciting work and exciting learning. And I continue to support research initiatives in the Center for Arts and Medicine and run two research labs there, including an NEA research lab called the EpiArts Lab.

SPEAKER_02 3:20

You know, Jill, that's so interesting. Thank you. You know, today for a lot of our listeners, they're probably learning about this connection between the arts and health for the first time. Can you walk us through what your research can teach us about that conversation?

SPEAKER_00 3:38

Yeah, it's such a good question, Lourdes. And I actually think it's it's a more and more exciting question every day, especially as our evidence base grows and the quality of our evidence has really improved. When I started working in this field, there was very little evidence, but we knew because we were human beings and we understood the power of the arts. We knew they had a place in health care. And in the 1990s, when I came into the field, there was a quick acceleration of development of arts programs in hospitals across the United States and around the globe. And it wasn't because there was powerful evidence. It's because human beings just understood that the arts are a way in which we can relax, reflect, connect, and like exercise and other leisure activities, enhance our well-being, our flourishing, and even our health. And this is where the evidence has now really come to bear because over the past 30 years in particular, more and more researchers have dedicated focus to studying the health benefits of the arts using really credible scientific methods. There's a lot of quantitative study, a lot of epidemiological studies right now, mixed method studies, and very important qualitative studies. So we know that all the forms of evidence, all the ways of knowing are very important and valid in this space. But we know things like for people with Parkinson's disease, dancing can have very significant impacts on their symptom management. And some evidence even suggests that it can help slow the progression of the disease. We know things like at the population level, and these statistics come from epidemiological studies that analyze large cohort data sets with tens of thousands of people completing surveys over decades of time. We know that people who participate regularly in the arts, particularly people over the age of 50 who do so just once a month or more, are very significantly less likely to develop depression. They're less likely to develop age-related disability. We know that young people who participate regularly in the arts can have better educational outcomes. They're more likely to have high levels of social well-being and flourishing. And as we're contending with a really problematic epidemic of loneliness and social isolation today, that's really important. And so we know that the arts contribute at individual levels and at population levels to health in very significant ways that we can't really look away from at this point because arts and culture are available resources in communities and they should be taken seriously as resources for our health. Many of our studies now are showing that participating in the arts can have health benefits on par with those of exercise. And I think it's time that we're thinking about the arts as a health behavior and as a health asset, just like we think about exercise and eating well and not smoking and wearing seatbelts, other kind of public health givens that we collectively understand.

SPEAKER_02 7:30

You know, Jill, these are powerful findings with really far-reaching impacts in on population health as well as on individual well-being. But from the perspective of the National League of Cities, we work so closely with cities. And I'm curious to learn from you when it comes to cities, how can these findings help local governments support community health? What should cities be doing with this information, Joe? Yeah.

SPEAKER_00 8:01

So cities should be understanding that local arts and cultural infrastructures, as well as local nature and heritage and volunteering and other social infrastructures should be engaged explicitly for health. In the United States, I think we have kind of a paradigm in which many people view the arts as luxuries and things that you should only do if you're really good at them. Many people don't feel welcome in cultural venues for good reasons. They can be elitist, right? So we've we position the arts in a place that makes them inaccessible for many people. And we actually forget or don't recognize the ways in which our creativity and the arts come to bear in our daily lives. Bringing beauty to setting the breakfast table and cooking and choosing what we're going to wear and singing to our children and reading to our children, singing in the shower. There's so many ways that we engage in creativity. And if we if we relate those activities to our health, I think we might be more apt to do them a little bit more to really lean into them. So city officials, I think, can understand arts and culture as underutilized resources in communities. And at the same time, they need to recognize that the arts have value on par with the sciences and other mechanisms that we value not only socially but economically. Artists, arts organizations, arts and cultural infrastructures need to be supported. Our epidemiological evidence, Lourdes, suggests that in so many ways, people who are engaging in the arts have opportunities for better health outcomes. So we also need to think about that in terms of access. If we know that to be true, which we do, then access to the arts is a social determinant or driver of health. And if we don't ensure equitable access for everyone in our communities, we're actually doing harm in limiting health. So we shouldn't just think of the arts as frosting and extra, a nice thing to add. We really need to think about arts and culture as a part of our social fabric, as a part of our human orientation that can be embraced more seriously as a health asset.

SPEAKER_02 10:41

Thanks so much for sharing it in that way, Jill. That really resonates with me as the director of health and well-being. You and I have worked together, right, on elevating uh the awareness of cities on the social determinants of health. And what you just said really resonated on how increasing access to the arts is a social determinant of health. So it what uh it sounds like what you said really is that we're going for a paradigm shift uh with uh cities to have them look at arts, as you said, as a health behavior. NLC is supporting this by celebrating National Arts and Health Day on July 25th this year. And it's something that uh, you know, we did last year and we're uh and it's a celebration that began in 2024 uh as part of an initiative called Arts for Everybody that you helped to create. Can you tell us uh more about Arts for Everybody, Joel?

SPEAKER_00 11:40

I would love to, Lourdes. And I have to just, you know, bring a shout out to Georgia Gempler on your staff, who is just such an incredible leader in this arts and health space and has driven so much of the work that you're referring to, including Arts and Health Day. Um, but yes, it was such a pleasure to partner with the NLC on the One Nation, One Project, Arts for Everybody initiative. This was a three-year national initiative that really came from the pandemic, right? It was an arts and public health initiative that was designed to leverage the power of the arts in communities to rebuild social fabrics and well-being following the pandemic. It was like a new WPA kind of idea. Like we need the arts now to be well and healthy and to thrive again as cities. And so this initiative invited 18 cities across the United States, large and small, cities with populations in the millions and cities with populations in the hundreds. Um, north, south, east, west, two Hawaiian islands. This was a really beautiful, diverse array of cities. And these cities became and were a cohort and worked together very individually and uniquely to bring the arts to bear to address the health issues that were most significant in their communities, but also as one cohort to learn, to build understanding, and to create a national narrative for how the arts can impact health. So these communities created as many opportunities for arts participation across about 18 months of time for building social cohesion and well-being in those communities. And I had the pleasure of researching what happened in these communities. And it was, it was really quite phenomenal. Um, we found through a very complex mixed method studies using rigorous statistical methods, we were so lucky to have Dr. Ji Hyen Lee, who just uh finished her services as president of the National Statistical or the American Statistical Association. She's at the University of Florida. Ji Hen was our lead statistician. We had an incredible research team of 13 mixed methods, quantitative and qualitative researchers. We undertook 12 studies and we integrated six of them with both quantitative and qualitative methods into one study that created a theory of change for how the arts can build social cohesion and well-being in American cities. And that theory of change was built on our statistical findings. We found that across the 18 cities in this 18-month period of time, in the general population, we didn't study people who participated in the programs. We studied the general populations in the cities. And in these general populations, arts participation increased by 56.4%. And we found people with lower incomes participated more in the arts. And that's different than national statistics tend to be. We also found that across those cities, social cohesion increased by 12.6%. And social cohesion is a very important concept. It's not just social connections, it's about the strength of social connections that allows communities to collaborate together across differences toward common goods like health. We also found dose response relationships between arts participation, social cohesion, and well-being, in that the people who participated most in the arts had the highest levels of social cohesion and well-being, and people with the highest levels of social cohesion had higher well-being. So we built a theory of change that describes, based on those statistics, also qualitatively, what is it about the arts that builds social cohesion? What is it about social cohesion that enhances well-being? So that becomes like a recipe for cities to use. Create arts programs that create that include co-creation, opportunities for people to prepare for a performance together or an exhibit together, because that creates connection and commitment to one another, to the program. That in itself generates more health benefits. So we learned lots of things like that that can provide a roadmap for cities to seriously engage the arts for building social cohesion and well-being.

SPEAKER_02 16:32

Yeah, no, that's uh quite the powerful evidence base that we have now for how uh, you know, the Arts for Everybody was able to lift up these examples. And Jill, you know, I I'm familiar with the initiative. I was engaged with the initiatives, and there are almost infinite ways for local governments to support the arts and artists in their communities. What are some of the creative things you're seeing from around the country and what has their impact been?

SPEAKER_00 17:02

There are so many things, Lourdes. Um, but I'll touch on two that that came from the One Nation Project initiative and are ongoing today and are both very exciting models that I think cities should seriously consider. Um, in Chicago, the Division of Arts and Culture uh created an artist community health worker program. They trained artists as community health workers. Those artists were paid salaries with benefits, living wages, and they were supported to complete a graduate certificate program to become a community health worker, and they added an arts course to that curriculum. So they brought together the role of a community health worker and an artist. And then those artists were embedded in local public health mental health clinics. And so they were facilitating arts programs in those spaces and also creating referrals into community-based programs. So I believe they're now in their second cohort of artist community health workers, and that program has been replicated in other parts of the country already. So it's a really important model in which city arts and public health agencies can collaborate to create an infrastructure for Arts for Health. Not unsimilarly, the Bronx here in New York at Urban Health Plan has created a really exciting arts prescribing model. Arts prescribing is something that is proliferating across the United States as well as around the world. It's a system in which care providers can refer patients to community-based non-clinical resources to support their health and well-being and also for prevention. And many of these programs, which exist in the context of social prescribing, are prescribing to arts and cultural resources. And so in the Bronx, they have a really beautiful arts prescribing program in which they're engaging patients both in programs in the clinic and referring out to the community. So building again an infrastructure, a network of community-based arts, culture, and social resources that can be linked directly to the health system. So they're doing robust evaluation. And the work that I'm doing at the Federal Reserve Bank is about working with them along with New York Health and Hospitals, where there's also a robust arts prescribing program, to develop sustainable economic models and systems for these programs.

SPEAKER_02 19:44

That's fascinating, Jill. And, you know, I must admit a bias. It's such a powerful one, Jill, because it has implications, not just for public health, but uh as far as cities are concerned, this is also creating economic development pathways, right? So it has health implications, it has economic development applic uh implications, uh, which, you know, really gets to the social determinants of health, uh, that Chicago arts and health pilot. I'm really glad you lifted it up. It's a clear.

SPEAKER_00 20:23

Yeah, and can I just add, Lourdes, that that I also think it's really important for cities, for city officials and city leaders to recognize that the evidence that we have related to prevention and wellness around arts participation, right, does have economic implications. So especially when programs like arts prescribing and community health worker programs are reaching people who have far less access to wellness and prevention resources, people who are under and uninsured. The cost to cities of supporting the ramifications of that lack of access to wellness are very, very significant economically. So we need to think about redirecting resources upstream to, and this is this is not a new idea to any city official, of course, right? But what may feel new is recognizing arts and culture as an upstream prevention mechanism. So we need to think about investment, we need to think about policy, and we need to recognize the potential for return on investment. Both Canada and the UK have done very robust national economic ROI studies on social prescribing, and they've both found that for every dollar or pound invested in social prescribing, there is a return of one or sorry, of four dollars or pounds. So it's this is not an equation that's just about new money coming into a new idea. This is about Cost savings as well.

SPEAKER_02 22:03

Thanks for sharing that, Jill, because uh, you know, the audience for this podcast are local city officials who are constantly thinking about how to be good stewards of the public funds that they're entrusted with. And so what you're really speaking to is this is a good investment. This will give you investing in the arts will give you a return on investment. And it's so critical to build that infrastructure and network, as you say, Joe. I'm really glad you lifted that up.

SPEAKER_00 22:32

Yeah, and alongside that, Lourdes, I just have to keep balance here. I am not suggesting that the arts are a panacea and fix all, right? But we need the arts alongside all of the other important things that our health and public health systems and our cities do to promote health in our communities.

SPEAKER_02 22:52

Jill, you've mentioned earlier the importance of codifying arts approaches into policy. Can you share an example of what you've seen?

SPEAKER_00 23:01

Yes, Lourdes, there's one really exciting, very recent example. Just about two months ago, the state of Georgia, the House, unanimously approved House Resolution 1007, which acknowledges the effectiveness of arts-based interventions for addressing mental health and really commits the state to engaging arts-based interventions for mental health. Representative Kim Schofield drove this initiative with other colleagues, including artists in the state of Georgia. And this is a really important model for other states and cities to consider how we can create policy that brings credibility to the arts as a health intervention. I'm also really excited about what's happening in the state of Massachusetts, where there is the first state-level arts prescribing program. Other states and cities are already following suit and working to develop these kinds of initiatives, but there really are opportunities for policy right now that can bring the arts to bear in improving public health in our cities.

SPEAKER_02 24:18

And Jill, for the local leaders who are listening to this and they're excited and they want to embrace the arts to improve community connectedness and health. Where can they get started? Where should they start? What advice would you give to help them do that?

SPEAKER_00 24:35

I think they should look around their community and start having coffee or lunch, you know, with people in the arts sector, in the arts and cultural spaces in the communities and recognize them as partners, right? Often people in city agencies, you know, are looking to people within their agencies or maybe closely related agencies, but I think building bridges between arts and cultural agencies in communities as well as arts and cultural organizations and artists in communities. And I want to really lift up another thing that's important. It's not just about recognizing these very important arts organizations, but it's also recognizing artists, independent artists who do incredible work that contributes to health and are a critical part of the health landscape in a community. And that can be the amazing woman who's been hosting a quilting circle in her home, you know, for 20 years. It can be the guy who woodworks in his garage, right? And it can be professional artists who are really trying to, you know, build practices and communities. So I think pushing the edges of who we go to and who we think of in these spaces is really important.

SPEAKER_02 25:52

You know, that surfaces for me, Jill, this idea of artists as trusted messengers, right? There's uh a lack of trust among residents and institutions more broadly. And often these uh artists, as you point out, are hosting quilting circles in their home. They're already trusted by residents. So they really could be an asset for local governments.

SPEAKER_00 26:15

A hundred percent true. Um, that it that's a really powerful point point. We saw that come into play in the pandemic, right? The CDC engaged in an arts initiative that recognized artists as trusted messengers. I also just want to note alongside that that city officials have to also be aware of what artists stand to lose by leveraging their trust, right? So everybody needs to be trustworthy. It was an issue in the pandemic because people weren't trusting government agencies, right? So we had to be really aware of what we were asking artists to leverage in communities. So we need to bring the deepest respect to the partnerships that we invite with artists from our government spaces.

SPEAKER_02 27:03

That's a really good insight uh to leave local leaders with. Jill, thank you so much for stopping by CitySpeak today. I've really enjoyed talking to you, and I know our listeners will take away a lot about the art. And uh really you've given them a uh a lot to think about and somewhere to get started. So thank you so much, Jill, for stopping by NLC City Speak.

SPEAKER_00 27:27

Thank you, Lourdes. It's been such a pleasure to be in conversation with you today.

NLC 27:38

Thanks for listening to City Speak with Clarence Anthony. If you like this show, let us know. Share this episode with your friends, and make sure to subscribe. We're curious to hear what you think, what you want more of, and how we can improve. If you have feedback or an idea for a guest you'd like Clarence to sit down with, send us your thoughts at Cityspeak Podcast at nlc.org. Join us next month for a new episode. Like and subscribe here or wherever you get your podcast. See you next time.