Sunday, August 26, 2012

Health Inequalities? Choose Life...

This week the Kings Fund published its report on health inequalities citing what we probably knew in our heart-of-hearts: the poorer you are, the worse your life expectancy: the wealthier you are, the more likely you are to have followed government advice on reducing dangerous lifestyles - thus you’ll live longer. So this isn’t wind-surfing and abseiling we’re talking about, but what you eat, drink and puff on - and if you spend your days sat on the sofa soaking up daytime TV and playing on the computer. It seems that the public health messages have been driven home successfully to those already interested in their health, but people who are disengaged for whatever reason (poverty?) will statistically die earlier. 

Over this same period, we’ve had two rather tragic legal cases being played out in the media: that of Tony Nicklinson who wanted to choose how and when he died, and more importantly, he fought for the legal right to end his life and make any doctor that helped him be immune from prosecution. The other story is that of the anonymous Mr L from Greater Manchester who reportedly is in a persistent vegetative state following a series of heart attacks, and is being cared for by Pennine Acute Hospitals NHS Trust who feel that it’s in his best interest not to be resuscitated, if he succumbs to infection, further heart attack or stroke. However, his family want to prolong his life, whatever the quality, for as long as possible. What a terrible situation. These painful cases illustrate the need to discuss the manner in which we die, much earlier in our lives and as a society, we seem loath to ever discuss the manner of our deaths, until we are in a terminal health crisis. Even sadder, is that following the High Court’s rejection of Tony Nicklinson’s case, he gave up his fight and succumbed to pneumonia.

It seems a whole-life approach to talking about death and dying could be easily achieved through the introduction of something very similar to a Birth Plan, which expectant mothers routinely develop with their partner and midwives. Wouldn’t something similar in the manner of an Advanced Directive, be a simple and useful resource to develop? Could Health Visitor’s and Palliative Care Nurse’s be a more visible part of this conversation, earlier in our lives?

Admittedly, this doesn’t take into account the political and social ramifications of assisted dying, voluntary euthanasia, or more generally our right to die in a manner and at a time of our choosing, but nevertheless it introduces and normalises conversations about life and death - something to which we seem culturally divorced from.

I’m pleased to say I’ll be working with a new Arts for Health intern for 12 months alongside MA Contemporary Curating, and we’ll be exploring some of these very issues: issues which I began to discuss in relation to culture and the arts last year, in my opening paper; Towards Sentience, at the 4th International Arts and Health Conference at the National Gallery of Australia. We’ll be holding an exhibition here at The Holden Gallery in July 2013, which will be accompanied by a series of events and discussions, and is being developed under the working title of ‘Imagining Death’.

Inequalities & death - blimey, seems insurmountable doesn’t it? Well, death certainly is, but inequalities, quality of life and the manner in which we die are something we can most definitely have some control over. Whilst we struggle blindly to make sense of seemingly immovable inequalities, we miss their connection to poverty of aspiration and wide-spread disillusionment at politics; we miss the connection to apathy and blind acceptance of inequalities. The Bank of England’s Quantitative Easing has helped the wealthier citizens of the UK markedly, but has been invisible to the majority of us - unacceptable. Poorer people die earlier than wealthier people? Sorry - this is outrageous. 

Quantitative Easing is having limited impact on the austerity we’re all facing, the Kings Fund have illustrated the failure of policy to impact on the poorest in the UK, our high streets are increasingly boarded-up; grocers, bakers and butchers being replaced by fast-food outlets, betting shops, coffee chains and mobile-phone and charity shops. The banks and building societies seem to be surviving, albeit in a fortified manner, but other than the proliferation of increasing necessary charity shops, our high streets represent something of the 21st century drug peddler. There’s no shortage of plasma screens for our telephone-based talent shows; computer games to feed our short attention span; alcopops, caffeine and fried gizzards. All you can eat for £2.99 - not bad eh? Short cut to a state sponsored short life...

I worry that some of the blindingly superb work of arts/health practitioners/projects, whilst cushioning and supporting marginalised and displaced individuals, frequently fails to engage the very same people - often miraculously turned around, in engagement with the political process. What we do so unequivocally, is enable people to grow and thrive - give people a voice - but doesn’t this singular voice need to be connected to that of others? If we are meaningfully lifting people from isolation, depression or giving voice to people affected by homelessness - what next: just put them right back into a system that feeds on such divisions? How can we connect our practice and facilitate real change? Well for a start, we can acknowledge that both our health and wellbeing, and the arts, are political.

So, as an antidote to all this, and with our home-spun Olympian NHS Saviour in mind, Danny Boyle, lets remind ourselves of his interpretation of the Irvine Welsh novel Trainspotting. The following brief extract from the film, offers something of a poem to our consumer addiction. Be warned though, it is peppered with expletives that are appropriate, but that might offend. Text below and video, by clicking on the film.

Choose Life. 

Choose a job. Choose a career. Choose a family. Choose a fucking big television, choose washing machines, cars, compact disc players and electrical tin openers. Choose good health, low cholesterol, and dental insurance. Choose fixed interest mortage repayments. Choose a starter home. Choose your friends. Choose leisurewear and matching luggage. Choose a three-piece suite on hire purchase in a range of fucking fabrics. Choose DIY and wondering who the fuck you are on a Sunday morning. Choose sitting on that couch watching mind-numbing, spirit-crushing game shows, stuffing fucking junk food into your mouth. Choose rotting away at the end of it all, pishing your last in a miserable home, nothing more than an embarrassment to the selfish, fucked up brats you spawned to replace yourself.

Choose your future.

Choose life...                                     John Hodge/Irvine Welsh  

Volunteering in the Arts Toolkit Launch
You are invited to the launch of the Volunteering in the Arts Toolkit September 10th at the GMCVO centre, Ardwick Green, Manchester. Full details, including how to book can be found by clicking on the ice-cream van.

We have been working with Arts Council England and Volunteering England on the production of the Toolkit. It developed as a result of an audit of Arts Council funded organisations s who currently work with volunteers. The toolkit is aimed at professional arts organisations to support them in the recruitment, management and retention of volunteers with the aim of improving the volunteer experience for both host organisation and volunteer. This really useful resource comes with case studies, guides and a whole range of relevant information including health and safety, safeguarding, working with volunteers on benefits and advice on how to avoid using volunteers as substitutes for paid workers. The toolkit is free and will be downloadable from the Voluntary Arts website.

The State of Arts and Health in England and Further Afield...
In 2009 and alongside colleagues from the field, I contributed to the introductory essay, the State of Arts and Health in England, to Arts and Health: An International Journal for Research, Policy and Practice. Since this paper was written the face of arts/health practice and research has evolved at a fast pace. Taking into account the political landscape of the UK and the ongoing changes within the public sector, I am working with colleagues in Europe to better understand the changing field, and am revisiting this paper. I am particularly keen to hear from you in relation to mapping and research undertaken between 2009 and 2012 and am also keen to hear from international research projects. Please email me directly at 

Networking Event
BANG...out of the blue, a brand new one-off event. No agenda. No guest speaker. Just us having the opportunity to chew the fat, and perhaps hatch some plans! Thursday 27th September 6:00 - 8:00PMSo email if you want to come along, and the venue at MMU will be emailed to you the week before.

Thank you...C.P