Malcolm Rigler and David Loshak outline strategies to improve young people’s health

‘One in 10 boys and one in seven girls are overweight.’ ‘Today’s children eat fewer key nutrients than 50 years ago.’ ‘One in six 15-year olds is obese.’ ‘90% of children’s lunchboxes contain foods high in fat, salt or sugar.’ ‘British children eat less than half the recommended intake of fruit and vegetables.’

The implications of such dispiriting headlines for the present and future health of the British people – young, middle-aged and old – are disquieting. Despite repeated NHS reforms and increased public and personal spending on health, chronic conditions such as cancer, diabetes and cardiovascular disease – have replaced the health challenges of the past. ‘Indeed,’ says Dr Howard Stoate, of the UK All Party Parliamentary Group on Obesity, ‘today’s children and young people may well live shorter, unhealthier lives than their parents.’

Where has it gone so wrong? After all, most chronic diseases are preventable. They stem largely from people’s behaviour and lifestyle choices:

  • poor diet
  • inadequate physical activity
  • smoking
  • drug misuse
  • excessive drinking.

As with so many social issues, the central problem is a failure of communications. The NHS was set up in 1948 without any thought for the learning needs of patients attending GP and hospital consultations. Patients attending GP consultations, including school children, forget half of what is explained to them within hours and almost all of it within days. ‘Simply giving people information and urging them to be healthy does not work’, says Dr Jeff French, director of the National Social Marketing Centre. ‘Alongside providing effective health information and supporting communities and individuals to improve their own health, we need to encourage and release the energy, skills and desire for good health that they already have. The challenge is to put people at the centre of a public health strategy’.

Such perceptions have fostered widening recognition that children and young people themselves, with their innate originality, ingenuity and sheer know-how, should be empowered to further their own health. There are at least three good ways in which that can be done.

Surgeries as museums
First, by reorientating current thinking, GP waiting rooms can become more like museums – ‘institutions of memory’. Many modern museums ‘enhance individuals’ self-esteem and play a direct role in combating poor health’, write Jocelyn Dodd and Richard Sandell of the Department of Museum Studies at the University of Leicester. That has profound public health implications because museums, as the Campaign for Learning through Museums and Galleries points out, ‘have a fundamental place in the community: they rank alongside the school, the church, the village school or community centre’.

At Withymoor Village Surgery in the West Midlands, we have shown that a health centre or GP surgery need not be an off-putting environment where time spent in the waiting room becomes high anxiety time, wasted time, time to feel more ill than on arrival, with thumbed and outdated magazines that would never otherwise be read. Improvements can be made by:

  • making the waiting room a pleasant, welcoming, friendly, interesting and informative, creative space, where specific health messages can be attractively and constructively delivered
  • engaging patients and staff in, for instance, storytelling, drama, movement work or music-making. This is comprehensively therapeutic in that it not just treats disease but uses carefully structured activities to establish a trusting doctor-patient relationship
  • encouraging self-expression and personal discovery to improve patients’ physical and mental functioning and their spiritual wellbeing, thereby reducing stress, boosting confidence and enhancing mental health.

While the role of museums is clearly not to promote health, they do underpin it. This is because health promotion is concerned with how individuals, families, organisations and communities think and feel. Health promotion is to do with:

  • reinforcing individuals’ emotional resilience
  • strengthening communities through greater social inclusion and participation
  • reducing barriers to mental health by promoting access to learning and culture.

The NHS needs buildings that, like museums, are ‘institutions of memory’, where every visit to a clinic or a GP’s waiting room leaves each person remembering whether it felt friendly or not and whether they were treated as a human being rather than just a ‘case’.

Making the most of IT
A second approach is to encourage fuller and more creative use of information technology in the GP consultation process, not just by GPs and practice managers but by patients. Websites such as NHS Direct, DIPEX (the Database of Individual Patient Experiences) and the Samaritans (which provides emotional support at any time of day or night) can all be used by young people before consultation. If an ear or eye or something else is hurting, a quick ‘Google’ image of it would also be a useful preparation for the consultation. And after seeing the doctor, information on all medicines and procedures can be accessed and explained on the net, assisting young people to be aware of side-effects, providing reassurance about treatment or suggesting alternatives if the treatment has proved insufficient or unhelpful. All in all, the worldwide web can give the young deeper understanding of how they can both help themselves to deal effectively with health issues and to avoid similar problems in future.

The arts and healthcare
A third way to empower the young to further their own health is to introduce the arts into healthcare. Huge benefit can derive from creative initiatives with GPs and hospital consultants working with schools, community colleges and museums to promote more humane and effective consultations. There is abundant evidence of the benefits of art activities on mental, emotional and physical wellbeing.

Dr Richard Smith, former editor of the British Medical Journal, has pointed out that devoting only 0.5% of current NHS spending to the arts (£435m a year) would ‘immeasurably improve’ people’s health. That, he argues, is because the physical aspects of health, the prime focus of the consulting room, might, paradoxically, be the least important. ‘Health is not just to do with avoiding illness, loss, hurt and death – it is about accepting those givens, even making sense of them. If health is about adaptation, understanding and acceptance, then the arts may be more potent than anything medicine has to offer’.

That view was eloquently reinforced by the impresario and former director of the proms, John Drummond, who died recently. ‘The arts are central to any civilised society and are not on optional extra or just the icing on the cake,’ he declared. ‘They are as integral to society as the NHS’. That is why Dr Jeff French is among the keenest advocates of involving the arts in health promotion. The arts can be used to intervene in everyday situations to stimulate thought, provoke discussion and promote change. The arts not only entertain but also challenge people to think afresh and see things more clearly and constructively.’

How shameful it is, then, that the UK is the only Western country where there no statutory obligation to set aside a percentage (typically 1-2%) of the building costs of new hospitals for the arts.

The immense benefit of such investment has been strikingly demonstrated. At the Chelsea and Westminster Hospital research into the integration of the visual and performing arts (music, dance, theatre, mime, puppetry, poetry and storytelling) in healthcare has shown that it:

  • significantly improves clinical outcomes
  • reduces anxiety and depression on the cancer, perinatal and day surgery wards
  • lowers heart rate, blood pressure and stress levels
  • cuts the need for analgesics
  • shortens the length of stays
  • improves patient management, enhances staff job satisfaction and raises the quality of service.

According to Professor Paul Robertson founder of the hospital’s Arts and Health Initiative, the power and balm of music, from as early as 16 weeks in the womb, ‘engages parts of the brain that drugs and other therapies just don’t reach. The memories that music can evoke can be the last bulwark against the meaningless of dementia. And for many it is the lifeline out of depression’.

Given this powerful scientific evidence that music can bring about physical changes that improve health, says Professor Robertson, ‘we are approaching the point where a doctor would be negligent not to recommend music as a therapeutic intervention.’ Patients are soothed, distracted, reminded of happier times. Staff are happier too, making it easier to recruit and retain them.

Clearly, this can apply to clinics, health centres and GP consulting rooms no less than to hospitals. So let us have good music in our GP surgeries!

And more. For the clear inference follows that the visual arts too can have a crucial role to play. It is not just a matter of brightening up waiting rooms or corridors. Far more important, paintings, drawings, sculptures, ceramics, even cartoons, can give patients something stimulating to enjoy, contemplate and think about, something to dwell on other than their worries, aches and pains.

Getting schools involved
Ofsted itself has underlined the importance of this for PSHE teachers. As the September 2006 issue of Learning for Life reported, not least among the key health education initiatives already taken by some schools and commended by Ofsted in its publication Healthy Schools, Healthy Children?, has been the creative use of the visual and performing arts to convey health-related messages. Indeed, the very concept of PSHE embodies just what we have been seeking to do for our patients at Withymoor – enter with them on a journey of learning to find how the creative arts can humanise the medical environment, help local people have a voice in their own treatments and in the development of health services, social services and voluntary services.

Moreover, a host of agencies outside schools and GP practices are eager to work with us in this – libraries, museums, galleries, faith communities, sports centres, football clubs and single-issue charities such as MIND and Age Concern.

In addition, young people in schools and colleges could play a vital role in local authoring of patient leaflets. So many of these derive from a white, educated middle-class culture which is gobbledygook for many patients all round the country. But students, working with their teachers in language skills, information technology and the arts, could improve such material by tailoring it, making it reader-friendly for their own neighbourhoods. They could also study subjects to create their own educational resources for patients, such as printed texts, video tapes, CDs or multi-media presentations. These could be available at dedicated patient education centres on the Net such as the Lloydspharmacy CHAT (Community and local Health, social and welfare Advice provided informally by Trained professionals) centres. These provide local communities with the latest information on health, social and welfare topics and also help direct visitors to supporting services in the local community.

Cultural resources and healthcare
Six centuries ago, the great Dutch humanist Erasmus said that prevention is better than cure. But even today that sagacious insight is still more honoured in the breach than in the observance. For instance, the government spends less than 0.5% percent of its tax revenue from tobacco on smoking prevention.

For all the achievement of the NHS, Britain’s health statistics blazon forth that, as a nation, we have much more health promotion work to do. Every year, six million suffer mental illness (which, of course, profoundly affects physical health). Some 10-15% suffer from depression (the world’s leading cause of disability). Most disturbingly of all, one million young people have a mental disorder.

All this underlines the need to bring our full cultural resources to bear upon the healthcare of our people. A country whose future depends upon applying the industries and capacities of the mind – intelligence, innovation, creativity, imagination, invention – should be taking care of those minds, especially its young minds, far more zealously, far more tenaciously, than it has.

Campaign for Learning through Museums and Galleries

Centre for Arts and Humanities in Health and Medicine

Lloydspharmacy CHAT Centre

National Centre for Movement, Learning and Health

National Network for Arts and Health

National Social Marketing Centre

Dr Malcolm Rigler is a GP with a special interest in public health and David Loshak is a health writer and clinical hypnotherapist

First published in Learning for Life, October 2006