From Absence to Presence: Arts and Culture Help Us Redefine “Health”

This post is part of the series, Future of the Field: Cross-Sector Creative Placemaking Series.

When giving talks around the U.S., I often ask residents, health care providers, youth, artists, researchers, anyone: “How do you know when a community is thriving?” Without fail, people answer by talking about the presence of music and musicians, varieties of food, religious or cultural celebrations, collective traditions and rituals, people helping one another, beautiful or meaningful places, artists and artisans, a sense of pride and belonging, occasions and places to gather, art galleries and exhibits, a shared understanding of history, a shared positive narrative of the community, etc. Lists go on.

Despite the long lists, no one has yet said, “I know a community is thriving if rates of [a given health condition] are low.”

Don’t get me wrong; the people I meet are always interested in reducing rates of disease, violence, incarceration, and other forms of acute or chronic suffering. But folx tend to see such reductions as an aspect of baseline health. Thriving, by contrast, appears to encompass something more. It isn’t about what’s absent; it’s about what’s here.

This question of “what’s here” stands out as I look over ArtPlace’s reports from the Translating Outcomes initiative. They point to the vital presence of identity, connection, agency, collaboration, well-being, power, imagination, resources, place, and of course, arts and culture. In doing so, they highlight two core health concepts that, despite a lot of talk, we’ve been unable to truly move into practice. The first is the 1946 World Health Organization (WHO) definition of health, which is “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” (This definition recognizes that health includes the presence of well-being. It’s about what’s here.) The second is the “social determinants of health,” a phrase referring to contextual factors—systems, policies, environments, dominant norms—that have a far greater influence on our health than individual biology or behaviors. Despite having had the WHO’s definition of health for 75 years, and despite ever-increasing evidence that health is primarily determined by environments and systems, health education and practice continue to emphasize the absence of disease…via individual-level strategies.

Against the background of this stubborn, limited take on health, ArtPlace’s work offers three important takeaways. First, the community-based initiatives described in its reports address social and structural determinants of health, rather than offering individual-level interventions. And they were grounded in arts- and culture-based strategies—indicating the importance of intentional creativity and innovation in transforming how we do health. To walk the talk about social determinants of health, we must intentionally transform dominant approaches, and ArtPlace’s effort indicates that arts and culture can provide a starting point. These place-based initiatives were inherently creative; they relied upon and embraced the power and practical utility of collective imagination. As a result, they effected concrete change across determinants such as transportation, housing, food, public health, public safety, youth development, and more.

Second, harking to the WHO definition of health, ArtPlace’s initiative highlights the difference between health as an absence versus health as a presence. And here’s the thing: The definition of health that we prioritize may be the biggest health determinant of all. Our definition(s) of health determine what we consider to be worth our collective time, resources, tax dollars, spaces, places. If we’ve failed in the U.S. to address upstream determinants of health (and we have), that failure is traceable at least in part to our dominant understanding of health—which devalues or completely ignores well-being. Embracing a holistic definition of health is imperative for advancing health and health equity. ArtPlace’s work indicates that 1) it’s fully possible for communities, leaders, and various population groups to take up this dual approach to health (absence and presence); and 2) arts and culture may be critical to that approach.

Third, this work has the potential to enrich how we think of well-being itself. ArtPlace notes that arts and culture can “bridge differences,” “build collective power,” “imagine new approaches,” “reflect community identity,” etc. These processes are clearly aspects of community thriving, but they aren’t exactly quick dopamine hits. They don’t always feel great. In this way, they mirror art itself—which isn’t always beautiful, joyful, kind, or soothing. Art is often provocative, cutting, tragic, challenging. Sometimes our engagement with art is less about alleviating a difficult experience than accompanying or articulating it. In other words, art doesn’t exist merely to make us feel good, yet humans have long looked to art to help us be well. What might this distinction mean for how we understand health and well-being?

This distinction emerges in common answers to my questions about thriving—when audiences reply that a community is thriving when residents help one another in difficult times. To these audiences, a “thriving” community doesn’t mean that residents never have difficulties. It means that any difficulties are accompanied by access to well-being: relationships, support, engagement. Echoing this, much of the work ArtPlace has documented speaks to communities’ desire and capacity to generate collectives, narratives, actions, and places that support residents’ capacities to hear, navigate, and transform suffering. As we all work to alter damaging systems and structures, and as we address acute tragedies and phenomena that threaten physical and mental health, we must recognize the critical health value of the connections and experiences that support humans in being well—even when and as we face difficulties. These too are determinants of health.

Summing up, here’s what I see illuminated by ArtPlace’s culminating project: Arts and culture do not simply offer an innovative way to achieve the conventional, limited definition of health. That limited definition is limiting our health every day, and we know it. Instead, arts- and culture-based strategies operate from a definition of health that includes the presence of well-being. It includes a capacity to be well—to find meaning, connection, engagement—not only in place of suffering but as a means of navigating it. In other words, the contribution of arts and culture to human well-being is not just the reimagination of what it takes to achieve health, but of what health is, and how we know whether we’ve attained it. Moving forward, ArtPlace and related initiatives offer a creative prompt to health sectors, public systems, policymakers, and society as a whole: What does it mean for a community to thrive? What will we create? And, knowing that we’ve always had a choice in how we define health, what definition will we choose?

It’s not just about what’s absent. What’s here?

Tasha Golden, PhD is director of Research, International Arts + Mind Lab at Johns Hopkins University School of Medicine and adjunct faculty in the Center for Arts in Medicine at University of Florida.