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Sherds has recently been working on a response to the Welsh Government’s consultation on its draft Culture Strategy. This has been an opportunity for the arts, heritage, and culture sector to reflect on questions that are not just relevant to Wales.
Many people have commented on the fact that the strategy makes no mention of the existing institutions that form the bedrock of the nation’s outstanding contribution to world culture: the BBC National Orchestra of Wales, the Welsh National Opera, the Hay Festival of Literature and Arts, Green Man, Brecon Jazz, BBC Cardiff Singer of the World, the National Eisteddfod, and numerous smaller festivals, such as Presteigne, Machynlleth, and St Davids. Wales teems with world-famous musicians, writers, and artists, and has numerous companies specialising in all aspects of TV, film, and theatre production. Modesty forbids adding the Royal Commission to that list, but it surely must include Cadw, the National Library of Wales, and the seven museums that make up the National Museum of Wales.
Instead, the strategy consists of a number of statements, and respondents are asked to comment on the relevance of each, starting with ‘culture is inclusive, accessible and diverse’ and ‘cultural democracy and cultural rights are central to culture in Wales’. We can all agree with those statements, but the strategy has been published against the background of a decade of cuts to the budgets of every one of the nation’s cultural institutions. Country Life magazine, in its editorial comment on the strategy, pointed out that you cannot create a more diverse workforce in the cultural sector if you are cutting hundreds of posts rather than recruiting people to sustainable jobs with competitive salaries.
Most of the responses to the consultation have been along the lines of ‘decent objectives: now give us the tools to deliver’. This raises the question of whether those of us who work in the sector are, as many a politician and Treasury official has asserted in the past, too reliant on government subsidy – we have a ‘dependency’ culture, they argue. Leaving aside the fact that the government has statutory responsibilities for the care of the historic environment, that is a question that gets us deep into the philosophical issue of the role of government in funding what economists call ‘public, social, or collective’ goods and services, like roads, railways, policing… and, yes, libraries, museums, archives, and archaeological services are surely to be included, along with stewardship of the environment – both natural and historic.
Heritage and health
But it is not all take on our part. We give back benefits that are out of all proportion to our funding. The problem is that this is extremely difficult to prove. How do you separate out and measure the influence of a high-quality environment from all the other factors that enhance the quality of everyone’s lives and contribute to human health, happiness, and creativity?
In Wales, this question is especially pertinent, because there has been a highly emotive public battle in the Senedd, the Welsh Parliament, over spending priorities. Welsh Government ministers have painted heritage and culture as ‘nice to have’, but not a priority for spending in the face of pressures on the NHS. Any suggestion that culture and heritage can make a positive difference to people’s health is dismissed as an opinion, not an established fact. That is the challenge we face: providing evidence that the cultural sector makes a measurable contribution to preventative public health.
Many attempts have been made in recent years to demonstrate that there is a link between health and heritage activities. The award-winning Operation Nightingale, for example, has shown that archaeology is effective in aiding the wellbeing of service personnel injured in recent conflicts. In Wales, the Pendinas hillfort excavations, run by the Royal Commission and Heneb: the Trust for Welsh Archaeology, has welcomed as volunteers people living with the significant challenges of neurodiversity, grief, loneliness, and stress, as well as the partially mobile and children with special educational needs. In an audit conducted by social research specialists Wavehill, our Pendinas volunteers spoke warmly of the therapeutic benefits of working in the open air (despite the rain), the companionship of fellow volunteers, learning new skills in an enjoyable way, and the sense of making a valued contribution to the project.
Another experiment currently under way is called Barts Heritage – essentially a project to restore the ‘heritage jewels’ of the St Batholomew’s Hospital site in London’s Smithfield, including the Henry VIII Gatehouse (1703), the North Wing (1732), and the Hogarth Stair (dominated by the artist’s huge painting of the Good Samaritan). However, the medical staff see this work as having benefits beyond conservation and talk about ‘a new model of heritage-based support for wellbeing’, whereby ‘hospital staff and visitors can rest, recuperate, and access a range of activities to aid psychological recovery’. The project aims to show ‘how a heritage hub in these beautiful historic spaces can offer a restorative change from the clinical environment of the working hospital’.
Prescription projects
Excellent as these projects are, they could be accused of lacking a convincing analysis of how heritage impacts health and therefore what would work best if replicated and scaled up. That is a reflection on our lack of understanding of the precise mechanisms by which cultural engagement impacts the mind, body, and spirit. There is also evidence to the contrary: musicians, writers, and sports participants don’t live longer than anyone else, or suffer any the less from the slings and arrows of outrageous fortune, such as degenerative brain disease. Genes, environment, diet, and lifestyle are powerful factors in general health.
Culture is therefore not a pill that can be manufactured and prescribed to modify specific aspects of human physiology or psychology. However, some physicians are now arguing that cultural activity can be better than a whole bottle of tablets. Social prescribing – whereby patients are encouraged to take part in social activities as an alternative to a pharmaceutical prescription – has been pioneered by GPs in the west of England, and two academics at the University of Exeter Medical School have now published a study of its impact – namely Professor Ruth Garside, Professor in Evidence Synthesis (using quantitative and qualitative research methods to investigate a range of policy-relevant health and social-care questions), and her colleague Dr Rebecca Lovell, Senior Lecturer, Biodiversity, Health and Policy.
In what is thought to be the largest such project in the world so far, their research tracked the outcomes from seven social-prescribing pilot projects, which began in 2020 with £5.7m of government funding. GPs, mental-health teams, and social workers helped some 8,000 people to take part in heritage volunteering work, nature walks, community gardening, tree planting, and wild swimming. The pilot projects took place in Humberside, South Yorkshire, Derbyshire, Nottinghamshire, Manchester, Surrey, and the West Country, with 21% of participants from ethnic minority populations and 57% from economically deprived areas.
The participants were assessed before and after taking part. Their happiness scores went from 5.3 out of 10 to 7.5 (close to the national average) and their sense that life is worthwhile rose from 4.7 to 6.8, while levels of anxiety fell from 4.8 to 3.4 – all of which are considered to be statistically significant signs of improvement.
To set against those positive results, the authors warn that the best outcomes come from combining social prescribing with formal counselling or therapy; that it works best with adults experiencing social isolation, loneliness, and anxiety, rather than physical illness; and that it must consist of more than ‘an enjoyable experience’ by being combined with an element of skills learning or creative activity. They found that current provision is greatly subsidised by the charities and third-sector bodies that deliver the service, that capacity is a long way short of demand, that provider organisations need better training to deliver suitable opportunities, and that there is little or no coordination between the different agencies involved in social prescribing. Interventions tend to be too brief (typically ending after 12 weeks) and we don’t know enough about the longer-term impact: in general, much further research is needed into what works for whom and why.
Clearly then, there is an opportunity here for the heritage and cultural sector, even if there is a long way to go before this becomes an established part of medical practice. The mantra of the cultural sector for the last 20 years has been ‘access’. Surely we can all agree that that objective has largely been achieved, so we can now turn our attention to health and wellbeing. This would not involve extra government spending: we would happily take a tiny slice of the Department of Health and Social Care’s £182bn budget – NHS England ended 2023/2024 with an underspend of £30m, according to their draft accounts. We’d happily settle for that.
