Kulturminister Åse Kleveland

Culture and Health: Political challenges

Oslo, 28 September 1995

Dear guests.

"Arts in Hospital" - what does it mean to us? Does it refer to art on the walls of the hospitals, sculptures, beautiful architecture, manicured grounds, and access to books, music and theatre? This is often the case and is certainly desirable. In some places art is systematically used as a form of therapy. There are proponents, both in and outside hospitals, who achieve important and good results. A minority do it as part of their profession - others in addition to their real field. They believe in what they do, and often seek more in terms of latitude and recognition. We often hear of the dilemmas they face because culture is not given priority in conjunction with the main goal, which is to cure the patient as quickly as possible with the correct treatment. The expectations we all have of medical miracles and continual advances give little room for other approaches to the sick. But many health workers want - and try - something else. This applies in particular to health professionals who work in long-term care, where the situation and needs differ from acute care hospitals. The fact that we have decided to call the conference "Culture and Health" is by itself a signal that we are also looking outside hospital corridors.

We have taken the liberty of carrying this idea further and have arrived at the conclusion that "culture brings health". Can culturel activities expressious used as a means to an end, improve the health of people? Will we be more healthy? It is not easy to give clear answers to these questions, but perhaps it will enable us, despite illness and injuries, to live better and master everyday life in a better way?

For how do we define health? WHO, the World Health Organisation, says that health is not just the absence of disease and disability, but a condition of complete physical, mental and social well-being. Is this realistic? Who can say that they are well on all counts? Our interpretation, "culture brings health", will impart greater meaning to this definition.

Intuitively, we know that positive culture fosters health - we have always known this. Art and culture are manifestations of mental and social processes, and are thus capable of reinforcing these aspects of health. What do we associate with the concept of culture? A central theme of the cultural policy White Papers from the seventies is the expanded concept of culture. This means that cultural activities not only encompass traditional areas such as protection of our cultural heritage, literature, visual arts, or other art forms, but that corporal culture - sport and physical training - is also part of the concept of culture.

The most recent White Paper on cultural policy, "Culture for our time", submitted in the autumn of 1992, states: "Ideally speaking, cultural life shall be open to everyone. No one shall be barred from the activities provided, and no one shall be hindered from expressing themselves in a cultural way. In its discussion of the Paper, Norway's national assembly, the Storting, confirmed this fundamental opinion.

What does this mean in relation to the project "Culture and Health"?

It means that we believe that everyone, regardless of functional level and life situation, will enjoy and benefit from cultural offerings and activities, either as spectators or through individual involvement. Culture and art bind people together in a community. As one enthusiastic chorus member once put it: "Choruses must be the country's biggest health movement!"

Politically speaking, we have not wanted to limit the concept of culture, in deference to our goal that the Norwegian welfare state's responsibilities and values must go beyond the social and economic sector. But this also means that cultural policy enters into and interacts with all other policies.

Although it is rarely desirable to define the content of cultural expressions, discussing the concept of culture has intrinsic value. In Norwegian cultural policy we have found it fruitful to divide between the value-oriented and the descriptive concept of culture.

The value-oriented concept is linked to the root meaning of the word: to cultivate or refine.

The descriptive concept of culture embraces the overall contents of a society. This was summed up as early as 1871 by the anthropologist E.B. Taylor as: "The values and norms, codes and symbols that a person inherits from the previous generation and attempts to pass on - often slightly altered - to the next generation." This interpretation is also valid today, and embraces our understanding of right, wrong, ugly and beautiful, and ultimately the meaning of life, or lack of meaning. Our artistic and cultural heritage, transmitted through common values, common language and common living conditions, forms the basis of a common identity.

Technological development today is rapid, and the fact that people are often replaced by machines has helped change and often weaken direct interaction between people. The structure of our lives has changed so fast, that the time has come to assess the consequences of this development on cultural policy. In times of rapid transformation, people have a need to find a firm foothold. It is easy to lose sight of one's sense of community in a society in which interests often concentrate on individualistic and replaceable concerns and perceptions. Such a situation often yields negative consequences in the form of isolation, loneliness and a preoccupation with material goods alone. This in turn will easily lead to disappointment and stress, which may have harmful effects on health. These are challenges requiring a proactive response by the government and others.

As politicians we must ask ourselves what we are doing to correct such trends in society and in the working environment in the public sector. The health care system is a large and important part of the public sector and our public environment. The previously mentioned White Paper on cultural policy emphasises that the government will pursue the cultural dimension in all areas of public planning.

Our society's most important growth potential is the sum of our individual creative forces, expertise and ability to solve problems. A cultural policy for the nineties must therefore provide room for daring and challenging ideas. Progress depends on people's ability to find new solutions to old problems, and discovering new challenges in time. Including the cultural dimension as a driving and productive force in various areas of society, will help widen today's concept of value creation.

We are absolutely convinced that culture is conducive to health, not only by ensuring aesthetically pleasing hospital environments, but also as part of the rehabilitative process, and not least through preventive work. Greater cultural participation will help us find "the good life", a state where people are aware that they can influence their health through choices of lifestyle, and what they do in their free time. Seeing what culture means to oppressed peoples gives us an idea of the importance of the cultural dimension in coping with a difficult life situation.

It is evident that active individual involvement is crucial if we are to alleviate health problems in today's stressful society. In recent years we have become acutely aware of the importance of physical activity in mastering not only physical pain, but also psychological and social stress.

Sport and physical activity are a part of the expanded Norwegian concept of culture, and it is therefore natural to highlight the importance of nature as both a health-promoting and preventive factor. For Norwegians nature is perhaps the main source of cultural experiences and recreation. About 80 per cent of all Norwegians enjoy walking, summer and winter alike. This is perhaps not so surprising considering the abundant walkways, paths and trails at our disposal. Some people say that Norway is more nature than culture.

In recent years comprehensive studies have been carried out underlining the importance of physical activity. Today, physical activity is accepted as part of the treatment of psychological problems such as anxiety and depression, physical ailments such as diabetes, asthma, epilepsy, mobility-related disorders, and lifestylerelated illnesses.

The Norwegian Research Council is currently involved in a research programme entitled "Environment-conditioned quality of life", whose main goal is to increase our basic understanding of the connection between the natural environment and people's enjoyment, health, quality of life, attitudes and actions. The result of this project will be interesting with respect to future priorities in both cultural and health policy.

Adapted physical activity is actually not a new development, borne of modern times. Several ancient cultures understood the importance of using body conditioning to treat and prevent injury and disease. The trail stretches far back in time and the best known example is the Chinese form of exercise called T'ai Chi, which is said to have been introduced by Emperor Hoang Ti in 2698 B.C. He believed that illnesses were the result of unhealthy accumulations and blockages in certain organs, which could be released through exercises. Chinese thinking in this area is accepted and is practised perhaps even more widely today, throughout the world, than ever before.

Norway's efforts in this area began on a small scale with systematic physical activity programmes, at the institutions for the mentally retarded and psyciatric pasients. Since outdoor recreation has such a strong position in Norwegian life, it was natural that the first cultural initiative in the health sector came in this area.

Beginning in 1960 this work gained speed. Courses and conferences were organized by the government. Health professionals soon saw that what they were doing worked, and that the mentally retarded benefited greatly from these programmes. As a result, special recreation leaders were employed by the institutions. Other cultural activities such as music groups, amateur theatre, painting classes and the like sprang up alongside the physical activity programmes. What we witnessed was the start-up of activities in one area of culture spreading to other areas. In this case from outdoor recreation and sports to more traditional cultural activities. We also see that politically based initiatives approved at the central level have spread to counties, municipalities and volunteer organisations. Today, local music schools, amateur theatre and sports organisations offer various integrated programmes also for the mentally retarded.

Fortunately, most people are in good physical and mental health, though age will catch up with us sooner or later. We are currently in the midst of a project aimed at increasing the opportunities elderly people have for staying physically active longer. When physiotherapists gather nursing home residents around in a circle for joint "play", the sessions provide more exercise than individual treatment and are furthermore valuable for the socialising and fun they bring.

In Norway today there are scattered attempts at tapping the potential of culture in disease prevention programmes. A video presentation of a project in Oslo will be shown to you later on today. The main goal of the project is to create a healthy local community, where a comprehensive but none the less varied set of activities is available to all residents.

This entails far broader thinking and new challenges, which call for a new way of organising our measures. Culture cannot replace medicines and good medical care, but culture can enhance the quality of life, which in turn can lead to a more full life, despite disease and disability. The greatest challenge and benefit in the relation between "culture and health" or the claim "culture brings health" will lie within preventive work. Public health policy has much to learn here through closer co-operation with cultural policy

The No. 1 affliction today is loneliness. The significance of creating inviting joint facilities where people can sit down, go for a leisurely stroll, see beautiful sights or objects or perhaps meet another person will therefore be important.

It will also be important to increase efforts related to designing attractive external environments. Physical surroundings provide a structure for social life. Well-built houses and beautiful parks and commons do not by themselves create happier people, but we know that they increase enjoyment and well-being, add interest to life and facilitate healthy social interaction.

The challenge lies in achieving a successful intersectoral cultural policy that generates widespread commitment to cultural measures, which in turn produce positive social spin-offs for many years afterwards. Proponents cannot do all the work by themselves, the issue must be put on the political agenda.

I wish you every success with the conference, and hope that the UNESCO project "Arts in Hospital" reinforces our political ability to see the connection between culture and health in our societies more clearly.