Artists and the Determinants of Health | 2018

One way to understand the concern with artists’ health is to understand what makes artists sick. There are occupational hazards which include, but go beyond, toxic materials and risky sets (think of the death and multiple injuries in the making of Spider-Man: Turn Off the Dark).

Working at Artists’ Health Alliance, I found that financial precarity was artists’ number one health risk. This lead to my recommendation of adopting a Public Health approach to artists’ health, key to which was understanding how artists relate to the determinants of health.

The determinants of health are a set of interrelated forces which help us understand that health is impacted by and impacts upon all areas of life and provides a framework for the causes of good and ill health. These forces determine health directly and indirectly, and are seen as the causes of the causes of illness.

Canada has been central to the development of the determinants of health framework. While these continue to be refined, the Public Health Agency of Canada lists the determinants of health as: income and social status; social support networks; education; employment/ working conditions; social environments; physical environments; personal health practices and coping skills; healthy child development; biology and genetic endowment; health services; gender; and culture.

The rest of this blog offers some notes towards understanding how the determinants of health apply to artists, as prepared for my work at Artists’ Health Alliance.

Some important qualifiers:

  1. While this post refers to artists as one group, there is inequity amongst artists. Even a cursory look at the determinants of health makes clear that not all artists are equally vulnerable. Indigenous artists, for example, are more likely to face geographic, financial and cultural barriers when trying to access to health services than are settler artists. Anyone concerned with artists’ wellbeing must recognize that society-wide inequities are reproduced within artist populations. Failure to address this is detrimental to the project of health equity for artists. In order to pursue health for all artists, we must also work towards health equity amongst artists.
  2. The determinants of health framework does not apply the same way in every context. The exact relationship between these factors and the health of a population is complex and nuanced. Which determinants are relevant may differ by context, as well. For example, other conceptions of it specify housing as a determinant.
  3. The determinants of health framework is more descriptive than prescriptive. While it is enormously useful to identify and articulate these broad forces, doing so does not automatically point to effective interventions.[1]

The notes below are primarily from three sources:

  1. Public Health Agency of Canada’s descriptions of each determinant of health
  2. Kelly Hill and Kathleen Capriotti’s A Statistical Profile of Artists in Canada Based on the 2006 Census. An up-to-date analysis is called for, but there is little reason to think that an artist in 2018 (when this report was first produced) is faring better than in 2006
  3. My own conversations and discussions with artists through my work as the Program & Education Manager at Artists’ Health Alliance

Other sources are used, and are cited.

[1] Exworthy, “Policy to Tackle the Social Determinants of Health.”


Income and Social Status

Notes on Public Health Agency of Canada Definition

  • Considered far and above the most important determinant of health
  • Determines living conditions (ex. housing, food)
  • Determines how much control people have over the life, especially in stressful conditions.
  • The effects of poverty-induced stress are far-reaching

Notes on Canadian Artists

  • Artists’ median earnings are 38% below the low‐income cut off of larger urban areas[1]
  • In six arts occupations, median earnings are $10,000 or less[1]
  • Canadian artists who live in a single-person household typically live in poverty[1]
  • Stress was consistently the most common health concern I heard artists express

[1]Hill and Capriotti, “A Statistical Profile of Artists in Canada Based on the 2006 Census.”


Social Support Networks

Notes on Public Health Agency of Canada Definition

  • Social support can come from friends and family
  • Social support networks buffer against ill health
  • They help an individual deal with adversity and maintain control in one’s life
  • Nurturing relationships are valuable to health in themselves

Notes on Canadian Artists

  • Family and friend support for someone’s artistic pursuits can vary
  • In conversation, artists identified social media as a source of stress and insecurity, fostering competitiveness, comparison and self-doubt
  • Isolation has been expressed as a big problem for many artists, particularly those whose art is practiced alone (ex. writers)
  • Strong taboos around illness exist in every arts industry and many arts communities, exacerbating isolation and acting as a barrier to getting help
  • Conversations with artists have brought to light that long-term romantic relationships can be difficult to establish, in part due to scheduling precarity and low income

Education and Literacy

Notes on Public Health Agency of Canada Definition

  • Equips people with skills and knowledge needed to solve problems and have a sense of control over one’s life
  • Increases satisfaction and security at work
  • Equips people with the skills needed to make healthy choices on an ongoing basis
  • Effective children’s education and lifelong learning (not necessarily post-secondary credentials) are identified as the key forms of education linked to higher health status

Notes on Canadian Artists

  • Artists are among the most highly educated labour group in Canada,[1] yet are a highly vulnerable workforce.
  • Compared with the overall labour force, the difference in earnings is highest for the most highly educated artists. Artists with university credentials at or above the bachelor’s level earn an average of $30,300, which is less than half the average earnings of workers in the overall labour force with the same education ($66,500).[1]
  • It is possible that after a certain level of education, attaining higher levels of formal education does not correspond to gains in health. This may be particular to artists because the work they perform is chronically devalued and because their particular financial structures (granting system) cannot provide enough stable income. It is also possible that artists are the canary in the coal mine for Canadian workers, as more Canadians achieve high levels of education and are met with increasingly precarious working conditions.
  • A study in Finland found that higher levels of education did not lessen the health impact of precarity (though it made it less likely that someone would experience precarity in the first place)[2]

[1]Hill and Capriotti, “A Statistical Profile of Artists in Canada Based on the 2006 Census.”
[2] Kokkinen and Munaner, “Precarious Employment and Mortality in a Social Democratic Labour Market.”


Employment/Working Conditions

Notes on Public Health Agency of Canada Definition

  • Stressful work and unsafe work are associated with poorer health
  • Unemployment and underemployment are associated with poorer health
  • Lack of control over working conditions associated with poorer health
  • Employment and working conditions can affect mortality rates and age of death for populations
  • Unpaid work is included here, such as household labour typically performed by women

Notes on Canadian Artists

  • Artists commonly experience multiple forms of precarity: employment, income, scheduling, task, location, rights & benefits, employment relations. Precarity refers to a pernicious form of uncertainty which strips an individual, household or community of self-determination
  • Though precarity and poverty often go hand-in-hand, it is not always the case. One question is if artists experience precarity at all income levels.
  • Another question is if precarity or employment/working conditions varies between arts sectors, industries or settings (ex. being a visual artist in Toronto vs. in Regina; wealthy musician vs. wealthy author, etc)
  • Employment precarity is strongly associated with poorer mental health, [1] something we see in the Artists’ Health Alliance’s financial assistance program.

[1] Lewchuk et al., “The Precarity Penalty: The Impact of Employment Precarity on Individuals, Households and Communities – and What to Do about It,” 76.


Social Environments

Notes on Public Health Agency of Canada Definition

  • Formal and informal community structures, institutions, organizations, and practices make up a social environment. It also includes values and norms of a society
  • Very influential over individual health behaviour
  • Can add resources or involve activities which support health
  • May involve civic engagement, volunteering and other forms of community participation

Notes on Canadian Artists

  • Artist communities can be very tight-knit and sources of strength. They can also be competitive and involve toxic and abusive relationships
  • Social environments in the arts can be siloed, have strong cliques and be difficult to break into; conversely, others may be very open
  • Several arts sectors are known for normalizing unhealthy behaviour like drug use; they may also support healthy behaviour, like self-care
  • Artistic communities commonly overlap with other communities (ex. communities of queer artists)
  • Many participants in Artists’ Health Alliance programs say that the most valuable thing about them is hearing from other artists and relating to each other’s stories & struggles. This is an example of setting up a positive social environment/temporary community

Physical Environments

Notes on Public Health Agency of Canada Definition

  • Physical (ex. air quality) and built (ex. housing, green spaces) environments impacts upon health

Notes on Canadian Artists

  • Artists tend to cluster in particular neighborhoods, [1] sharing the effects of the built environment
  • Many artistic disciplines involve health hazards from the physical environment (ex. hazardous material for visual artists; safety hazards on theatre sets). Best practices, regulations and educational material have been developed for many of these, though application may be uneven

[1]Silver, “From the Ground Up: Growing Toronto’s Cultural Sector,” 4.


Personal Health Practices and Coping Skills

Notes on Public Health Agency of Canada Definition

  • Actions by individuals to foster well-being and address illness
  • Heavily influenced by all other determinants of health, since they shape an individual’s personal life skills, stress, culture, social relationships and belonging, and a sense of control, which in turn shapes their personal health practices
  • One of the most effective ways to intervene in personal health practices is to create supportive environments

Notes on Canadian Artists

  • Artists’ level of health knowledge is unclear and can vary
  • It is unclear how commonly artists use non-evidence-based health practices (ex. healing crystals), and if it is used in conjunction with evidence-based health practices
  • Anecdotally, artists seem to have a love-hate relationship with the notion of self-care

Healthy Child Development

Notes on Public Health Agency of Canada Definition

  • Brain development, school readiness and later-life health are shaped early in life
  • Heavily influenced by all other determinants of health

Notes on Canadian Artists

  • This is less of a concern for Artists’ Health Alliance. It comes up mainly in the form of a stereotype: the common idea that artists experienced childhood traumas

Biology and Genetic Endowment

Notes on Public Health Agency of Canada Definition

  • Basic biology, including inherited predispositions to illnesses
  • Interacts with other determinants of health

Notes on Canadian Artists

  • Again, less of a concern for Artists’ Health Alliance. Again, it comes up mainly in the form of a stereotype: the idea that artists commonly experience mental illness

Health Services

Notes on Public Health Agency of Canada Definition

  • Prevention, promotion, maintenance and restoration of health
  • Continuum of care includes primary, secondary, tertiary and quaternary care
  • Relatively low on the list of importance

Notes on Canadian Artists

  • Artists face difficulty accessing appropriate care with practitioners who understand the particulars of artists’ health. Arts medicine practitioners can be found in some metropolitan areas, but are not especially common
  • Many artists do not have additional insurance, and so lack access to other essential health services such as eye care, dentistry, prescription drugs
  • Navigating the healthcare system can be difficult for those experiencing precarity and without a strong social support network

Gender

Notes on Public Health Agency of Canada Definition

  • Society-determined roles, attitudes, values, relative power, influence etc. that society ascribes to sexes unequally
  • Affects the degree of control a person has over their life, including health services (ex. women’s pain commonly dismissed when seeking medical help)

Notes on Canadian Artists

  • According to the 2006 census, 53% of artists were women, compared to 48% in the overall labour force.[1]
  • #MeToo brought attention to the threat of sexual assault & harassment women face in every arts sector. This is a health issue related to working/employment conditions

[1] Hill and Capriotti, “A Statistical Profile of Artists in Canada Based on the 2006 Census”


Culture

Notes on Public Health Agency of Canada Definition

  • Discrimination and marginalization based on cultural differences
  • Loss of culture, language, community experienced by cultural minorities
  • Access to culturally-appropriate healthcare
  • In Canada, Indigenous people are an especially vulnerable group

Notes on Canadian Artists

  • According to the 2006 census, Indigenous people and visible minorities are somewhat under-represented among artists compared to the overall workforce[1]
  • According to the 2006 census, Indigenous, visible minority & immigrant artists earn less than other artists, and earn less than Indigenous, visible minority & immigrant non-artists[1]

[1] Hill and Capriotti, “A Statistical Profile of Artists in Canada Based on the 2006 Census”


Sources

Exworthy, Mark. “Policy to Tackle the Social Determinants of Health: Using Conceptual Models to Understand the Policy Process.” Health Policy and Planning 23, no. 5 (September 1, 2008): 318–27. https://doi.org/10.1093/heapol/czn022.

Hill, Kelly, and Kathleen Capriotti. “A Statistical Profile of Artists in Canada Based on the 2006 Census.” Statistical analysis. Statistical Insights on the Arts. Hamilton: Hill Strategies, February 2009. http://www.hillstrategies.com/sites/default/files/Artists_Canada2006.pdf.

Kokkinen, Lauri, and Dr. Carles Munaner. “Precarious Employment and Mortality in a Social Democratic Labour Market.” Conference Paper presented at the IMAGINE Health Adocacy Conference – Decent Work for All: Taking action to address the health impacts of precarious work, Dalla Lana School of Public Health, University of Toronto, April 29, 2018.

Lewchuk, Wayne, Michelynn Lafleche, Stephanie Procyk, Charlene Cook, Diane Dyson, Karen Lior, Alan Meisner, John Shields, Anthony Tambureno, and Peter Viducis. “The Precarity Penalty: The Impact of Employment Precarity on Individuals, Households and Communities – and What to Do about It.” Poverty and Employment Precarity in Southern Ontario. Hamilton: McMaster University, May 2015. https://pepso.ca/documents/precarity-penalty.pdf.

Public Health Agency of Canada. “What Makes Canadians Healthy or Unhealthy?” Policies. Ottawa: Public Health Agency of Canada, November 25, 2001. https://www.canada.ca/en/public-health/services/health-promotion/population-health/what-determines-health/what-makes-canadians-healthy-unhealthy.html#defining.

Silver, Daniel. “From the Ground Up: Growing Toronto’s Cultural Sector.” Toronto: City of Toronto, 2011.

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