Arts can improve health. Global South Arts in Health Week shows us how
Authors: Hannah Macpherson and Shibaji Bose
From singing to participatory theatre, the arts are a proven tool used to facilitate increases in Water, sanitation and hygiene (WASH) awareness and improve public health.
In the Towards Brown Gold project, we are taking this a step further. We are using the arts to engage people and communities living in rapidly urbanising towns and cities with so called ‘second generation’ sanitation challenges. This includes showing the value of shit (faecal sludge) as a resource, sharing the importance of safe faecal sludge management in non-sewered ‘off-grid’ toilets and making visible marginalised communities who are often the worst affected by poor sanitation.
Inclusive artist Alice Fox and consultants Hannah Macpherson and Shibaji Bose, attended the Global South Arts in Health Week (GSAHW) to share the work they are doing on the project and to learn more about the value of the arts in improving population health.
Through presentations and practical workshops, we explored how the arts (including songs, crafts, drama, dance, and visual arts) can reach parts of the world and our body that other sorts of interventions can’t reach. We discussed how arts can provide low-cost and high-reach approaches to improving health. Examples of this work included arts with people living with dementia, arts for peace, inclusive arts with neurodiverse groups and people with learning disabilities, and the crucial roles of song and drama in promoting women’s health in India. We also learnt the acronym ‘WEIRD’ can stand for Western, Educated, Industrialized, Rich and Democratic. This acronym can be a useful tool in decolonising arts in health thinking through enabling recognition that the ‘WEIRD’ are just one slice of humanity’s cultural diversity.
Arts can provide low-cost, high-reach approaches to improving population health
Safely managed sanitation is pivotal for human well-being, productivity and health. Still, rapidly urbanising areas are often characterised by poor or unsafe excreta disposal, inadequate faecal sludge management (FSM) and inadequate sewage and wastewater treatment infrastructure. This, combined with poverty and intersecting gender, class and related exclusions, make water and health in rapidly urbanising areas an urgent global challenge.
Arts interventions can offer important tools for promoting the use and uptake safe sustainable sanitation systems, and there is significant evidence for song promoting handwashing and toilet use. However, we have also been seeking to explore how a diverse array of creative activities might advocate the rights of marginalised communities and sanitation workers and improve understanding current sanitation challenges, including safe faecal sludge management (FSM).
Our ‘arts in sanitation’ approaches used in the Towards Brown Gold project, and which we shared at GSAHW, are available in our policy brief ‘Arts Interventions for Sustainable Sanitation and Resource Recovery’.
The importance of a ‘one health’ approach
A holistic approach such as ‘one health’ is also a crucial element of Towards Brown Gold, which recognises the need for safe, sustainable, people-centred, inclusive, equitable off-grid sanitation systems that also contribute to economic growth. Faecal sludge is rich in water, nutrients, and organic compounds, but this ‘brown gold’ usually remains hidden in the sludge. We were pleased to see that the World Health Organisation (WHO) are adopting a ‘one health’ approach that recognises such links between planetary and human health.
We need to decolonise arts in health research
The Towards Brown Gold photovoice study centred on the perspectives of researchers from low- and middle-income countries (LMICs) and community voices. The aim was to catalyse collective action in the sub-sector of WASH and global health in ‘off-grid’ sanitation areas in Africa and Asia. For the whole Towards Brown Gold team, developing trust and recognising a need to decolonise methods has been crucial in delivering our work and research. This includes developing locally appropriate, culturally relevant creative partnerships with commissioners, communities, and other stakeholders.
The stories drawn from ‘lived sanitation experiences’ in off-grid towns moved beyond understanding research knowledge of participant-produced visuals. It discussed how participatory visual research and action-oriented methodologies can be a valuable tool to generate community-led awareness.
We explored this issue at GSAHW and supported a wider conversation around building trust in creative partnerships with health practitioners and academics working in the arts in health sectors across the Global South. This included an energising and creative trust-building activity with 45 participants. We taped around each other’s bodies and then filled the tape bodies with post it notes with ideas of how to know when there is trust. We then moved around the room to make connections between the 8 different bodies.
We asked participants ‘how do we know when trust is present in creative arts in health partnerships?’ Answers from our diverse international group included:
- There is willingness to learn another’s games
- Your heart beats slower
- You feel free to express feelings and opinions
- You feel connected
- You can talk freely
- There is good listening
- There is confidence in another person
Photo-voice and culturally relevant arts interventions (including song, performance and murals) can help make visible marginalised voices in the sanitation chain, promote understanding of the problems of poorly managed waste systems (such as toilets), and the discharge of untreated faecal sludge.
Art will, however, only achieve meaningful change for sanitation equity and improved population health if the wider mechanisms and funding are in place to support marginalised communities to make the necessary adaptations to their current sanitation systems.
