Consumer Health Foundation

Some years ago I had the privilege of studying with Parker Palmer, a thought leader in the field of spiritual leadership. He is, perhaps, most known for his work in education and teaching.  One of the things he said, that has stuck with me to this day, is the need to tie a string between your head and your heart. I see the arts as a powerful way to maintain and tighten that connection. Through art, stories are transmitted.  They speak to the heart. They allow us to step into someone else’s reality, and connect us to people whose lived experience is entirely different from our own. Through stories we are able to cross time, place, class, race, ethnicity and culture. We can experience empathy and solidarity. Personal connections, truth, and passion emerge. Community is often developed.  Shared values are forged.  And, in my experience, these are the forces that can lead to great and profound social change.

We have tried to integrate the arts into our work at the Consumer Health Foundation.  This edition of Connections features stories that illustrate the various ways that the arts are being used to change our perceptions, our understanding, our work, and ultimately (and hopefully) our policies in ways that improve community health. In January, the Foundation partnered with Arena Stage to underwrite 200 tickets for Anna Deavere Smith’s performance of Let Me Down Easy. It was not only a powerful performance, but also provided the venue for our community to come together and experience together the stories she portrayed on stage.   After the play, a woman who had attended several earlier performances, shared her observation that the audience that afternoon seemed “different” and she couldn’t quite put her finger on that.  The difference, perhaps, emerged because a majority of the audience that afternoon was comprised of people who share many of the same stories through their work addressing profound health and health care issues in our community.  And what she felt, perhaps, was a silent communication stimulated through that shared experience.

It is my belief that expression through the arts draws us closer to the heart, to the soul, and to our humanity.  In closing, Parker Palmer writes that, “The arts are a civilizing institution that can help us learn to hold tension in a way that leads to life, not death.  A good painting, a good drama, a good novel, and a good musical composition share at least one trait:  they are animated by the tension between their elements, a tension that not only attracts the eye, the ear, and the mind, but draws us into the experience art offers, the reality it has to share.  Entering into the tension of great art, and allowing that tension to pull our hearts and minds open, is a time-honored way of becoming more human.”

Storytelling is an art, but when done well, it has the power to transport us into another person’s world.  In Let Me Down Easy, actress, playwright and author Anna Deavere Smith combines a journalist’s interviewing technique with the ability to tell stories in the voices, dialects and mannerisms of people ranging from Tour de France winner Lance Armstrong to a physician in a New Orleans charity care hospital to an Idaho rodeo bull rider.

The common theme?  Their experiences with the health care system.

Never leaving the stage, Smith uses simple costumes and props to bring to life people whose stories embody the inequity of health care in this country such as actress and model Lauren Hutton, who became sick and had instant access to a range of New York specialists courtesy of her employer, Revlon Cosmetics – contrasted with Hazel Merritt, whose daughter left a hospital covered in blood and wrapped in a sheet after an error with her kidney dialysis.
 
CHF invited more than 200 community members and nonprofit partners to Arena Stage on Sunday, February 6 for the nearly two-hour performance, which tells brief stories from the lives of 20 people from a variety of socioeconomic backgrounds.

The stories illustrated the “stark differences in the experiences of wealthy and privileged consumers of health care and the poor and vulnerable consumers of health care,” said Uma Ahluwlia, head of the Montgomery County Health and Human Services.  “Issues of access, appropriateness of care, the positive or negative contact with health professionals and the sense of optimism in both recovery and in death were all highlighted in vivid detail.”

“Many of the things that happen to us in the health care system happen to us before we get there,” summarized guest speaker Vanessa Northington Gamble, M.D., George Washington University Professor of Medical Humanities, who spoke following the performance.

At times, the audience laughed at Deavere Smith’s uncanny imitations, and at other times, was in tears hearing the accounts about the poor treatment of patients and the feelings of helplessness of a nurse at New Orleans Charity Hospital after Hurricane Katrina.
 
CHF Board Chair Christopher King called the performance “a powerful depiction of the human experience,” noting that Smith “creatively expressed how people's lives and choices are shaped by their own experiences.”

Maria Gomez, executive director at Mary’s Center for Maternal and Child Health, attended the performance with her 15-year-old daughter who, after the show, asked her pointedly how she would make sure she would show her patients compassion and continue to provide quality care despite the fact that the clinic has grown from 250 patients to 23,000 patients over the years.
 
“We can’t take it for granted that people have the time and resources to figure out the right questions to ask their doctors,” Gomez said.  “This is the reason why we – the doctor, the nurse, the nutritionist or whoever makes the most sense – have to spend time with patients.”  
 
CHF’s guests were asked what in the show resonated with them in their everyday lives.  

“Money, power and privilege do lead to better care and treatment,” said Ahluwlia when asked how the performance will translate to her own work.  “The show validated both the equity work we have committed ourselves to and the importance of creating systems, services and infrastructure that help reduce disparities.”

As with many art forms, storytelling and theatre can bring people together on an issue and inspire action.  After the performance, King reflected how the community is evolving in its approach to improving health:   “While investing in initiatives that will improve access to care is crucial, it is equally critical that we work with our partners to address social determinants, which are clearly associated with health status. So, we were thrilled to present this opportunity to our grantees – as we believe it will create dialogue and spark creativity in how we continue to use our resources to improve health and quality of life.”

Various forms of visual media have long been used as an effective strategy for social activism. Here are a few examples of  the ways documentary film, photography, video, theater and even sculpture have been used to educate and promote understanding, as well as provide social commentary:

Using Documentaries to Raise Awareness and Spark Action: Since its release in 2007, the PBS documentary Unnatural Causes:  Is Inequality Making Us Sick? has helped to change people’s perceptions about what actually makes us sick and what makes us healthy by focusing on the social determinants of health.  It has been shown to communities, advocates, and policymakers across the country as both an educational and organizing tool for changing health and healthcare policies.  Locally, the Takoma Park-based organization CHEER (Community Health Empowerment through Education and Research) recently held a series of community viewings of Unnatural Causes in conjunction with a community health assessment of Takoma Park and Long Branch. Other documentaries that have been used to highlight important health and social issues include: Race: The Power of An Illusion, The Other City, Money Driven Medicine

Capturing Community Conditions with a Camera: Last year Planned Parenthood of Metropolitan Washington, in partnership with the STICC (Sexually Transmitted Infection Community Coalition), held a series of meetings among youth health advocates and adults working on issues of reproductive health. The meetings were held to help youth analyze and understand risky behavior data within the larger context of the ways in which socioeconomic inequity impacts community health.  Using the method of PhotoVoice, 40 DC youth took pictures in their communities to highlight issues of poverty and housing, violence, alcohol and drug use, school conditions, teen pregnancy, and nutrition, to raise awareness on the multiple negative conditions that affect their health and lives in hopes of changing the future.  The photos were displayed last summer at the Sumner School and at the Wilson Building where youth testified in front of the DC City Council Committee on Health. A video capturing the Sumner School exhibit can be found here. 

Producing Videos and Plays That Tell Your Story: Sasha Bruce Youthwork’s Media Corps program allows young people to channel their creativity into developing advocacy campaigns.  Through this program, youth have created and produced several videos over the past couple of years that highlight critical social issues affecting them and the lives and health of their community. Topics have included unequal access to Advanced Placement classes for students living East of the River; the availability of safe and accessible green space in Anacostia; and sexual harassment in the schools. Media Corps youth also wrote, produced and staged two original plays that were featured at community events and the Capital Fringe Fest. The plays were based on youth’s personal experiences and focused on issues such as single fatherhood, gentrification and domestic violence. 

Shaping Your Vision of a Just Future: Last year during its annual retreat, Consumer Health Foundation staff experimented with using sculpture as a way to generate new ideas and insights about our work. Our sculpting materials included multi-colored clay, pipe cleaners, little toys and feathers. We used an exercise called “Four Direction Reflection” from the Presencing Institute to guide the process. The basic idea is to sculpt the current situation in your community and the future you want to create, and to include yourself and your organization in the model. Sculpting allowed us to see and feel the ongoing divides in our community by geography, race, class, and accessibility to resources. It also helped us think critically about our role in creating more inclusive communities.

Social Presencing Theater: Social Presencing Theater uses performance to collectively engage communities seeking to bring about profound social change.   It synthesizes a number of practices, including theatre, creative arts, contemplative practices, and dialogue. It is an innovative, art-based method to communicate the essence of social change projects in a way that increases awareness in the community and leads to a commitment to action.   Ultimately, it enables an organization or a community to collectively see itself and its emerging future. More information on the process of Social Presencing Theater can be found here.

By Dr. Gay Hanna

The play Let Me Down Easy, Anna Deavere Smith’s one-person rendition of 20 characters’ experiences of the healthcare system, reminded me of a strong and vibrant trend emerging in contemporary healthcare: person-centered healthcare where the “whole person” is placed at the center of the healing process. Although advanced medical technology and pharmacology play a critical role in curing disease and treating symptoms, what has often been left out of medical care and training is the people who are being treated—who they are as individuals, their personal histories, their relationships, and their cultural background. This is where the humanities and arts are beginning to play significant roles in medical education as well as throughout healthcare systems.

Exactly what do the humanities and arts bring to healthcare specifically? For one, it allows people to express themselves and share who they are through the visual arts, music, dance, drama and writing, including poetry and journaling. Having creative outlets to tell our stories and share our full personhood not only provides insight into the human condition, it also has a profound healing effect on the patient as well as the entire clinical team including providers and caregivers. Ancient as medicine, the arts have been part of the healing process since our tribal roots. Some of the ways in which humanities and the arts are currently being integrated into our healthcare system include:

Medical Education - More medical schools are establishing humanities and arts programs to improve communications between doctors and patients as well as the entire clinical team. Such programs have been cited as building empathy, attentiveness and compassion among healthcare providers, and the personal enrichment derived from these activities also relieves stress. In clinical practice, the medical narrative moves from describing a patient as just a mix of signs, symptoms and a diagnosis, to a fuller story about an individual with strengths and potential. It is these stories along with the caregivers’ that makes the medical interventions successful.

Visual Arts Programs - Hospitals and clinics can look and feel like cold and foreign environments to both patients and visitors alike. Visual arts change the dynamics of a facility by making it more personal and engaging to the patient, visitors and healthcare staff, which can be a touchstone of life beyond illness and treatment. Many hospitals are now commissioning works of art to both improve architecture and interior design as well as to create visual markers and cultural bridges throughout the clinical space. Vanderbilt University’s Medical Center Cultural Enrichment Program and Chicago Children’s Hospital are noted for their vast public art collections. Some hospitals even have “rotating art exhibits” that feature the artwork of local artists and even its healthcare workers. The University of Michigan Health System’s Art Cart rotates throughout the medical center with framed artwork that can be selected by patients to place in their room during their hospital stay. Rotating art exhibits are very popular and is a way of bringing the community into the clinical environment.

Performing Arts Programs - The presence of performance artists from volunteer community groups or professional ensembles can turn a healthcare facility into a cultural center. This transformation certainly happens most often during the holiday season, yet larger healthcare centers have found ways to sustain this important programming yearlong through developing artists-in-residence programs.

Arts Therapy and Medical Care - Bedside arts programs in which artists and arts therapists work with patients have radically shifted the clinical environment. Through artistic self-expression, patients can tell stories about who they are and what they have experienced. Family members can also participate as it allows them to turn their focus away from the constant worries about their loved one’s illness to a time of enjoyment and sharing conversation that is not medical. Arts participation is especially powerful for engaging children and diverting their attention away from medical procedures. The imaging center at St. Peter’s University Hospital in Philadelphia has been transformed into an African safari where children, family and staff follow the tracks of wild animals in ways that keeps the focus on the adventure of the imagination rather than the “scary” medical personnel and X-ray or MRI machines. The arts also has a direct therapeutic effect on patients’ health. Florida State University’s Musical Therapy Department has developed a Surgical Singing Buddies program in which research has shown that patients who listened to the Singing Buddies before surgery and after recovery did better than those who did not have the musical treatment.

Palliative care - The benefits of humanities and the arts is especially important in end-of-life and palliative care. More emphasis is being placed on the importance of providing creative activities for older people that encourages them to reflect, reminisce, and share their lives in order to find meaning and purpose at the end of life. The humanities and the arts allows the elderly to continue living through finding satisfaction in the creative arts, either through personal self-expression or as a viewer, listener or reader. Favorite songs, films, books and poems bring meaning to a time in later life where finding meaning is integral to finding life satisfaction.

Overall, the humanities and arts in healthcare gives hope and encourages recovery among patients while strengthening the caregivers, be they family members or the professional medical staff. It makes the person central in their own healing process and is a natural, productive and cost-efficient way to provide care. Let Me Down Easy is a display of narratives echoing the millions of narratives happening around the world today as humanity struggles to improve quality of life for people in times of illness and care-giving. Let us continue to improve healthcare by continuously illuminating the human condition and sharing it to make all of lives healthier and more meaningful to each other, our families and communities – we are our stories!

For further information contact the Society for Arts in Healthcare and the National Center for Creative Aging. For a list of the National Endowment for the Arts’ Arts in Healthcare Best Practices please visit http://www.nea.gov/resources/accessibility/artsnhealth_top.html.

Gay Hanna, PhD, MFA is the Executive Director of the National Center for Creative Aging whose mission is dedicated to fostering an understanding of the vital relationship between creative expression and the quality of life of older people.

• Grants update: The Consumer Health Foundation made its first-quarter grants to the Commonwealth Institute, the Nonprofit Roundtable of Greater Washington, Defeat Poverty DC, Washington AIDS Partnership, and The Community Foundation for the National Capital Region.
• The National Committee on Responsive Philanthropy released a new report, Toward Transformative Change in Health Care: High Impact Strategies in Philanthropy. The report makes a case for health grantmakers focusing on underserved communities and increasing their investments in advocacy and policy, community organizing and system reform.
• The Institute for Alternative Futures recently released a report on the future of vulnerability and vulnerable populations in the United States, Vulnerability 2030. The report looks at ten key drivers of vulnerability and offers four scenarios that could shape the future. It is a great tool for nonprofits and foundations to use with strategic planning or vision exercises.
• In March, CHF hosted a Structural Racism and Racial Equity in Health training for its health advocacy grantee partners. The two-part training, facilitated by Gita Gulati-Partee and Marisol Jiménez McGee of OpenSource Leadership Strategies, provided participants with a shared understanding of the impact of structural racism on racial health inequities, and how to apply a racial equity lens to their advocacy work.
• Rachel Wick was recently promoted to Director of Policy, Planning and Special Projects. Congratulations Rachel!
• Nivosoa Razafindratsitohaina was recently promoted to Executive Assistant to the President. Congratulations Nivo!
• Jacquelyn Brown, CHF Program Officer by day and vocalist by night, recently released a solo jazz CD, Angel Eyes.