Let’s Get Radically Creative About Public Health And The Future
Like medicine, public health considers itself science-based. Although true in both cases, it is only a partial truth. Just as in medicine, solving problems and taking action require broader forms of knowledge and more diverse approaches to intervention. One might even say both medicine and public health need to wise up and wisdom has roots in more than science. Storytelling, the arts, and humanities can all enrich the nature of evidence and enliven vehicles for action. Life’s character is both subjective and objective. And aesthetics, as well as ethics and epistemology, have value in holistic notions of health, which are the only ideas about health we should entertain. Health is more than avoiding a panoply of diseases.
Public health concerns the biological and psychological well-being of individual human beings in social and natural communities and involves research, education, and service. The arts include diverse aspects of human individual and collective behavior including visual arts, music, dance, theater, and architecture. The humanities are broad-ranging disciplines, including literature, history, and philosophy that overlap in scope the arts, as well as the social sciences, including sociology, anthropology, economics, and political science. At the core, the arts and humanities are involved in personal growth, community development, cultural transformation, and critical reflection. Their methods are diverse but most often include narrative in one form or another.
Narrative medicine is already a growing part of health care. Art, music, and dance therapies already have a current place in treatment. Some have argued that art (homo aestheticus) and narrative (homo narrans) are a fundamental part of human evolution. Studies of the brain, particularly neuroimaging, suggest that experiencing and participating in the arts creates changes in the brain (not unexpectedly). Art as a concept has changed over the centuries, influenced, for example, by the roles of nature and religion in societies.
As we have continued to engage the broader cultural conversation between modernism and postmodernism, we find fuzzy boundaries, for example, between modern and contemporary art. For example, fine art can be seen as elite, professionalized, and museum- and gallery-based. Folk art is deeply connected to daily life to the point of being difficult to differentiate from life itself. Art is often deeply reflective of itself and its very essence. Art creates special places in society often overlapping with the individual importance and social role of play and even spirituality. Perhaps we are as much homo ludens as often failing but aspiring homo sapiens. Although art may seek universals it is often deeply embedded in a specific sense of place. So too health is about the global and the local.
The arts and humanities have a complex, multifaceted relationship to health, especially when system models of health are used (as they are in public health) such as eco-psychosocial formulations connected to well-being. They can also reflect the spiritual and religious aspects of health. Art and humanities focus on pattern recognition, address contextual complexity, and incorporate holistic considerations. They bear intimate relationships to culture and social change.
Divided into specialized bodies of knowledge, biomedicine focuses on individual health and even sometimes just at organ and molecular details. It is a culture oriented towards specific diagnoses and pharmaceutical or other technological solutions. Public health challenges narrow reductionist biomedical approaches to disease, focuses on how to change the behavior of individual and communities, and asks deep questions about the nature and purpose of good health, the arts and humanities have been and can remain powerful allies and constructive critics. The arts and humanities create understanding about how the fabrics of cultural activities evolve, such knowledge being important to both individual and population health efforts. In a time when aging and chronic disease are emerging as powerful drivers of our health systems, nonscientific fields can ask us how we should conceptualize aging and death. In an era of fascination with neuroscience and the diseases of the brain, the arts and humanities can as us from where our (often unrealistic) optimism for technoscientific solutions emanates and how we can distinguish true and false hope.
Some argue that we have entered the fifth wave of public health. Health challenges of today are different reflecting overpopulation, climate change, changing demographics and patterns of disease. Focusing on obesity, inequality and loss of well-being proponents of the fifth wave, like the four previous ones that started with the Industrial Revolution, reflects the historical and cultural times. But the health challenges facing this fifth wave will not be addressable by technological solutions but will require major cultural shifts. We need to think of health and wealth in profoundly different ways. Modernism itself needs fundamental change as economic and political systems become increasingly unstable and unsustainable. These dramatic cultural shifts are essential for the survival of our civilizations, if not species. Transforming health can be a focus for cultural change, and the arts and humanities offer powerful lenses for critical viewing and create imaginariums for the future.
The humanities themselves are in a dynamic evolution. The digital and neuro-humanities are fostering new thinking and values, as well as new methodologies. Are the humanities being coopted by the sciences? The term “health humanities” may itself be replacing “medical humanities” recognizing the need to be more inclusive of lay people and different professionals besides medical doctors. Some see the new health humanities has also having a closer relationship to both the arts and public health. Yet perhaps the term “medical humanities” retains a stronger critical stance towards the power of medicine.
Ethics is strongly related to the arts and humanities. The evolution of bioethics has created some distancing from the humanities as bioethicists located in health care organizations and funded through the NIH ELSI (Ethical, Legal, and Social Issues) programs have sometimes displaced practitioners of the humanities from teaching health students and other roles in academic health centers. Moreover, concerns have been raised that bioethics itself has become disjointed and even co-opted by medicine.
Empirical methods seem to have displaced other ways of knowing, such as critical reflection and narrative methods. The whole idea of evidence should be enriched by broader ways of thinking than just scientific approaches. A specific focus on the arts and humanities may be critical to regaining the breadth, integration, and skepticism necessary for a vital presence of ethics in public health. Aesthetics can join forcefully with ethics (and epistemology) in advancing the course of human (and other living creature) health.
These findings are described in the article entitled Global perspectives on dementia and art: An international discussion about changing public health policy, recently published in the journal Dementia.