Toward a Culture of Health in the United States: Introducing the HPP Arts in Public Health Supplement

In 2017, ArtPlace America and the University of Florida Center for Arts in Medicine established a partnership designed to promote and facilitate collaboration between the arts and public health sectors, or in what became the shorthand of the Creating Healthy Communities: Arts + Public Health in America initiative, to make arts in public health “a thing” in the United States. It was clear that the time had come. For more than 30 years, arts programs had been proliferating in hospitals across the country, contributing to the built environment and providing patients, staff, and visitors with opportunities for creative engagement. More and more research demonstrated significant health benefits of arts participation (Fancourt & Finn, 2019). And the community development and creative placemaking sectors were exemplifying how cross-sector collaboration with arts and culture could build stronger and healthier communities (Sonke et al., 2019).

Concurrently, the public health sector was calling for a fifth wave in public health—a new paradigm emphasizing the need for cultural change in which an entire socioecological environment can generate health through a collaborative frame (Davies et al., 2014; Plough, 2015). This vision recognizes that development of a cross-cutting, health-promoting culture in the United States requires cross-sector collaboration, innovation, and the development of common language among interdisciplinary colleagues.

American Public Health Association president, Lisa Carlson, wrapped up her opening address at the November 2020 national conference with a call for cross-sector collaboration. She said, “If we [the public health sector] are going to tackle huge issues that impact health like poverty and racism, the truth is, we can’t do that alone. The future of public health is cross sectors.” This special Health Promotion Practice (HPP) supplement on arts in public health answers this call.

The arts—and the arts and culture sector—offer fertile ground for the kind of collaboration and innovation needed to achieve a culture of health. The arts and artists have always been agents of the kind of change we need today to realize this vision and to address the most critical public health issues we are contending with, including COVID-19 and racism. The arts have long been a means for engaging people in dialogue, influencing behaviors, disrupting paradigms, and fueling social movements. The arts uncover and illuminate issues. They engage us emotionally and intellectually. They challenge assumptions. They call out injustice. They drive collective action. They heal—making arts + public health collaboration so much more relevant in this historic moment.

We have seen this in the AIDS quilt of the 1980s, which raised awareness of the scale and impact of HIV and the Broadway play RENT in the 1990s, which played a major role in reducing stigma and increasing HIV testing. We saw it in the knitted pink hats in 2018, which cultivated solidarity and protest of the widespread deprecation of women by men in power. We see it in the long-standing tradition of music that inspired the civil rights movement and today in the music, videos, design, and murals that fuel the #MeToo and #BlackLivesMatter movements.

In this supplement, you will find powerful examples and evidence of how cross-sector collaboration between public health and the arts can advance health promotion goals and impacts, and how it can make health promotion programs not only more accessible to diverse populations but also more equitable and effective in addressing the upstream systems, policies and structures that create health disparities. You will see how the arts can empower health communication, support health literacy, provide direct and measurable health benefits to individuals and communities, and support coping and resilience in response to COVID-19. This issue itself exemplifies cross-sector collaboration, as it was created through partnership between HPP, the Society for Public Health Education, ArtPlace America, and the University of Florida Center for Arts in Medicine, and presents voices from across the public health, arts, and community development sectors.

Sandro Galea, a major force in the field of public health and long a proponent of the importance of the arts in public health, opens this issue with a compelling articulation of how the arts stand to play a central role in a modern conception of public health. He rallies a call, with specific action steps, for closing the gaps between the arts and public health sectors. We then hear from a rising force in public health, Shanaé Burch, a health and behavior studies doctoral student at Columbia University. Shanaé’s commentary rallies a call for the collective moral responsibility of leveraging arts and culture for health promotion, and the role that ethical storytelling can play in reframing how health educators promote health. The piece offers critical reflections on the impacts of racism, White supremacy, and anti-Blackness in public health practice.

“Poetry as praxis” follows, with Ryan Petteway offering a critical analysis—in the form of a poem and a commentary in prose—of the intersections of COVID-19, structural racism, and racialized police violence. This powerful writing calls for an epistemically just health promotion guided by poetry as praxis and for health promotion to be more responsive to people’s realities in these times when “love and resistance must be simultaneous acts.”

Two authors highlight practice with generous insight. Bonnie Edmondson’s youth-developed, art-based, and culturally informed Tell Me What You See program explores the impacts and challenges of a novel partnership between an arts program and state departments of education, public health, and correction to address sexually transmitted disease prevention among incarcerated youth through the arts. And Jeffrey Pufahl and colleagues share the Theatre Connect program, a weekly theatre workshop for transitioning LGTBQ (lesbian, gay, bisexual, transgender, and queer) kids in Florida.

Cross-sector collaboration is examined by Sarah Febres-Cordero and her team, who worked with a local artist and community members in the Little Five Points community in Atlanta, Georgia, to develop a graphic novel to address and translate the experiences of service industry workers related to the opioid epidemic.

The supplement also offers two recent evidence synthesis projects. Julie Leis and her team present the compelling findings of an integrated review of arts-based strategies for addressing pain and substance use disorder during the opioid crisis, including that music can contribute to pain management. And Jill Sonke’s team at the University of Florida share a systematic review of how the arts can be used to address suicide prevention and survivorship in four countries.

The supplement offers two new frameworks for practice. David Leventhal and Maria Kelly share how their renowned Dance for PD program responded to COVID-19 by developing online dance classes in order to provide people with Parkinson’s disease with the well-documented health impacts of dance amidst lockdown. Theo Edmonds and his collaborators in Louisville, Kentucky, share a culturally responsive, theory-grounded framework for public health communication and innovation designed to promote health equity through the cultivation of relationships between artists, community members, and public health agencies and researchers.

Stacey Springs and her team in Rhode Island offer a new framework for research, with insights into how they integrated artists into their research team in a case study of a partnership between the Rhode Island Department of Health and Rhode Island State Council on the Arts. And Nancy Epstein and colleagues do so as well with an example of a community-based cross-sector collaboration in Philadelphia that shows us how such efforts can support health, expose inequities, imagine structural change, and advance justice and equity.

Echoing the calls for equity, four articles highlight research in practice. Carolyn Rubin and her team examine equitable community engagement in their work in the Chinatown community in Boston, Massachusetts, where they are using the arts as a strategy for countering the negative social impacts of gentrification and for enhancing social cohesion in immigrant communities. Ewelina Swierad and her team share how they created a scalable physical activity breaks resource called H.Y.P.E. The Breaks! Offering a view from outside of the United States, Sara Bauman and her team explore the role of community art in the aftermath of the mega-earthquakes in Nepal. And Deborah Reed’s Farm Dinner Theatre addresses the health and safety of farmers through theatre performances made by and for Southern farmers.

In a final commentary, Maria Jackson offers a compelling call to action for the public health sector. This piece explores the confluence of public health, community development, and the arts, drawing attention to the roles the arts can play in reframing community concerns and conditions, and in finding more effective ways of working toward repairing the historic and current harm experienced in low-income and historically marginalized communities.

Individually, these pieces address an array of critical and timely issues. Collectively, they provide fuel to ignite a culture of health. We hope that the voices and work presented in this supplement will inspire and enable cross-sector partnership and drive engagement of the arts and cultural resources that exist in every community to promote and enhance health. We hope that in reading this collection of articles, you will delight in the poetry, art, and narratives that you encounter. And that, in doing so, you will be reminded of the power of the arts to produce health and well-being in your own life as well as in the communities you serve.

As co–guest editors of this special supplement, we echo the calls made by the contributing authors for cross-sector collaboration and for the centering of antiracism and equity in health promotion practice, research, community building, and education. We also add a specific call for the consideration of arts and culture in Healthy People 2040 and in other frameworks and policies. We recognize the undeniable power of the arts, and invite you to bring your creativity to bear in our collective efforts toward realizing health and health equity for all. Onward, y ¡Adelante!