Art and health: reducing inequalities through cultural participation

The artistic and creative experience has always gone hand in hand with our social lives, driving evolution. The scientific literature now recognises that the arts contain various “active ingredients” with health-promoting effects.

Embedding art and culture into care pathways   

A study published in 2022 by Katey Warran, Alexandra Burton and Daisy Fancourt of the Department of Behavioural Science and Health at University College London, set out to produce a comprehensive mapping of the mechanisms of action through which arts and cultural interventions can positively impact health. Understanding these mechanisms promotes their systematic integration into care and prevention pathways, bringing the arts and culture sector closer and closer to that of healthcare, so that art and culture can become determinants of health and wellbeing, just like exercise and diet.

Tools for measuring the impact of cultural participation: 

Despite the many recognised benefits of cultural participation, there is a lack of shared tools to systematically measure its impacts. This is a gap that is attracting growing interest in studies, as shown by the brand new Arts and Health Evaluation Toolkit (AHET): a practical guide designed to evaluate the most common and relevant health outcomes of arts and cultural programmes.

Launched in July 2025, this toolkit was developed by the Centre for Music and Health in collaboration with Dr Jean Liu (Centre for Evidence and Implementation) and Dr Nisha Sajnani (Jameel Arts & Health Lab, New York University), and supported by the National Arts Council (NAC) and Tote Board of Singapore.

AHET offers practical means for clarifying the goals of evaluation, choosing feasible study designs and selecting validated quantitative tools capable of measuring outcomes for mental health, wellbeing, social connection and physical health.

While it recognises the importance of qualitative methods, the guide focuses primarily on quantitative approaches that are more aligned with the standards of medicine. In doing so, it aims to strengthen the scientific evidence base for the impact of arts, with a view to fostering growth in the field by giving it greater credibility and the ability to influence policies and funding. 

Inequalities in cultural participation  

If culture is good for health, then levels of participation, which are currently hugely uneven across the world, need to be increased. Eurostat has been monitoring the levels of artistic and cultural participation in over 30 European countries since 2015, taking into account activities such as going to the cinema, attending live performances, visiting cultural sites, playing a musical instrument, singing, dancing or painting.

According to the latest data, for 2022, the highest levels are recorded in Western and Nordic European countries: in Luxembourg, 77.7% of the adult population reported having participated in at least one cultural activity in the last year, in Denmark 77.3%, followed by the Netherlands, Finland, Sweden, Ireland and Estonia. At the other end of the scale, less than a quarter of the population in Romania and Bulgaria had taken part in at least one activity in the previous 12 months. Italy is third from the bottom.

Although limited to the European context, these statistics highlight major disparities in artistic and cultural participation, even between countries that share the same cultural, social, economic and political values.

Why are there disparities in cultural participation? 

To explain the underlying reasons for higher or lower levels of artistic and cultural participation, it is also worth examining the profiles of the people involved.

A number of sociological, economic and epidemiological studies have shed light on the existence of a social gradient in artistic enjoyment and practice: individuals with higher qualifications and from privileged socioeconomic backgrounds tend to participate more frequently in cultural activities. This trend closely resembles the one seen in healthcare, where people who are better off generally enjoy better health.

With this in mind, the differences in access to and participation in the arts become critical, as they risk exacerbating existing social and health inequalities.

That is why it is paramount to identify the social determinants of arts engagement, in order to plan interventions and international cultural policies that ensure equal access to art and culture and, consequently, to health and wellbeing.

Global inequalities in access to art 

A scientific article published in August 2025 in BMC Global and Public Health, based on the work of an international team of researchers including Nils Fietje (World Health Organization Regional Office for Europe) and Daisy Fancourt (Department of Behavioural Science & Health, University College London), offers new insights into factors that promote or hinder artistic and cultural participation around the world.

The international study is based on an analysis of data from the World Values Survey – an international survey that studies variations in values, attitudes, behaviours and subjective wellbeing of the population in almost 100 countries. The research used data from Wave 7 (2017–2023), producing a final analytical sample of 73,825 participants from 51 countries.

To achieve a more effective measurement, the researchers focused in particular on participation in activities offered by musical, creative and educational organisations, often based in the local community.

As well as offering cultural and social experiences, these settings also bring health benefits through the opportunities they provide for interaction and connection.

The results confirm the uneven levels of artistic and cultural participation globally. On average, the highest rates of arts organisation membership were seen in Kenya (53.7%), Uzbekistan (47.7%), Colombia (44.2%), India and Guatemala (both 42.3%), followed by Thailand (41.6%), Mongolia (39.6%), Nigeria and Libya (both 38.8%). At the other end of the scale, the lowest levels were recorded in Vietnam (5.2%), Jordan (4,8%), the Czech Republic (4.6%) and Egypt (3.2%).

The importance of socioeconomic status 

With regard to socioeconomic status, people with no or only primary education are 51% less likely to be members of arts organisations, whereas those with secondary or post-secondary education have lower odds, of 44% and 31%, respectively.

This association is particularly strong in Europe and Central Asia, where education may foster participation in several ways: by giving people access to cultural capital and other assets, raising awareness of opportunities through social connections, and building the cognitive skills needed to create, interpret and enjoy the arts.

Income disparities  

Similar disparities also emerge in relation to income: people with less money are less willing to join an arts organisation, probably due to limited resources, such as not being able to afford membership fees. By contrast, those in higher income brackets may feel they have a higher social standing and view arts engagement as an expectation that aligns with their status, although this also depends on the individual’s cultural background and values.

In this vein, participation should be incentivised, especially in countries with greater income inequality, where arts organisations can serve as instruments for social cohesion, as well as fostering fairer national development.

Ethnic and cultural diversity as an enabling factor

The research shows how people are more likely to be members of an arts organisation if they live in countries with a positive net migration rate, in other words with more people entering than leaving the country. Countries that are more ethnically and culturally diverse are more likely to offer a wide and varied range of arts organisations. Moreover, for many people, membership of these organisations can be a way of building their social identity and reinforcing a sense of belonging to a community.

Prospects and opportunities for artistic and cultural participation

The global inequalities in access to and participation in arts and cultural activities brought to light by the research raise a number of critical points:

• The artistic experience is a health-promoting behaviour comparable to other determinants, such as exercise, and is an important predictor of health.
• Lower levels of engagement in arts and culture are associated with greater vulnerability to poor physical and mental health and overall wellbeing.
• Ensuring equal access to and participation in the arts may help reduce health inequalities by closing the social and cultural gap.
  
  

The findings of this study offer useful insights to guide local, national and international bodies in the definition of public health policies and interventions that can promote access to the arts as a strategy for improving population health.

By Catterina Seia (Presidente CCW – Cultural Welfare Centre) and Elena Rosica ( Cultural Welfare Center (CCW), Research Area)

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