Engagement in cultural activity and public health: The HUNT Study, Norway

Abstract

Cultural life and engagement in cultural activity have been part of human daily life throughout the ages. In recent years, interest has increased in the public health significance of engagement in cultural activity and more than 3000 studies have identified possible impacts of participation in culture and arts. However, despite growing public awareness, there is limited evidence of whether such engagement affects public health because most research into factors affecting engagement has focused on individual-level characteristics. 'Passive' and 'active' engagement modes, attending as an observer or audience (receptive) vs active participation (creative) may have different health effects. Earlier research is characterized by diverging approaches and often lacks consideration of a broad spectrum of activities, broad age groups, and gender differences. Some studies suggest that engagement in cultural activity enhances longevity and may protect against cause-specific mortality, although knowledge about this is limited and insufficient. It has been suggested that high consumers of health services are often low consumers of cultural engagement. However, this association appears to be undocumented.

The overall objective of this thesis was to study receptive and creative engagement with cultural activity and its relationship with all-cause and cause-specific mortality and with general practitioner consultations. Further, the aim was to explore possible gender differences in both receptive and creative engagement. Data were obtained from the Trnndelag Health Study (The HUNT Study) in Norway. All citizens aged 20 years and older were invited, and participation was voluntary. Data from the HUNT3 survey (2006-08) were extracted, which contained self­ reported information on engagement with a variety of receptive and creative activities, and relevant covariates. These data were linked to the Cause of Death registry (Paper I and II), and to an administrative register using activity data from all general practitioners' (GP) offices nationwide (Paper lll) and up to the end of 2015.

The first aim was to examine the activities, number of different activities (variety) and the frequency of engagement in cultural activity that protected against all-cause mortality (Paper I). A total of I 905 participants died during the mean 8.15-year follow-up. The variety of activities seems to enhance longevity cumulatively with an increasing number of different activities, to a greater extent than weekly frequency. When the number of receptive activities was associated with all-cause mortality, reduced mortality risk occurred. Gender-specific analyses suggest the association was attributable to men. Gender-specific analyses showed a clear gradient of the protective effect of participation in creative activity both in terms of variety and frequency, for both women and men.

The second aim was to explore the association between activities, variety, and frequency of engagement in cultural activity and cardiovascular disease (CVD) and cancer-related mortality (Paper 11). During an average of 8.15 years of follow-up, there were 563 cardiovascular-disease and 752 cancer-related deaths in the sample. Cultural engagement in creative activities less than once a week, and less than twice per week was associated with a reduced risk of CVD mortality. However, gender-specific findings show that men had a risk reduction when participating less than once a week For the overall sample, participating between two to nine times per week in combined receptive and creative activities may reduce cancer-related mortality. Participation in creative activity from once up to less than twice per week, may lower the risk of cancer­ related mortality. The total variety of activities lowers the CVD and cancer-related mortality risk for all participants, whereas reduction in cancer-related mortality was evident in men.

The final aim was to investigate the associations between activities, variety and the frequency of cultural activity engagement and the number of GP consultations an individual had (Paper lll). In total 31 847 participants, aged 30-79, were included in a seven-year follow-up with a mean of 3.57 GP consultations. Findings revealed that participating in creative activities and a combination of receptive and creative activities was associated with lower demand for GP consultation among men who participated, compared to non-engaged men. However, no such findings were found among the engaged women. The variety of activities seem to lower GP consultations to a greater extent than weekly frequency, and the total variety (combined receptive and creative activities) may lower the likelihood of GP consultations among the engaged men.

In conclusion, the findings indicate that people who are engaged in cultural activities have lower mortality overall, and lower mortality from cardiovascular disease and cancer-related diseases specifically. Men who are engaged in cultural activities also have fewer GP consultations. However, given the limitations of the studies, there is no evidence to claim that there is a causal relationship between any of these associations.

Based on these findings, future public health policy and initiatives that facilitate citizens' participation may be health promoting. But it is important to note that our studies are observational and not intervention studies. The results do not say anything for certain about what effects measures to increase culteral participatation in society will have on health. It is also imporatnt that there is a real opportunity for the entire population to become involved in cultural activities, regardless fo socioeconomic living conditions.