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Terms like “social justice” and “health equity” trip off the tongues of politicians and civil servants alike. Their speech peppered with aphorisms, those in the public eye frequently offer the sound-bite-weary public, juicy morsels of undeliverable aspirations designed to placate the hungry masses and keep them passive. Utopian ideals are peddled, crowds are satiated and the political bandwagon moves on. This chapter will explore the world of marketing and spin, asking if the arts have any relevance in this political minefield, and if so, are they immune to such hyperbole? I will argue that the arts offer us a potent weapon—double edged sword—a manifestation of free will and self-determination on one hand, but on the other, a utopian elixir offered up to solve all life ills, and as such, a social anaesthetic. From the manipulation of African American jazz musicians, to verbatim theatre born of street riots, this chapter will seek to explore the relevance of the arts and health movement as part of a subversive, self-created narrative born against a backdrop of relentless racial bigotry tied to struggle and oppression, to which economist and social theorist Jacques Attali (1985) attests: “listening to music is listening to all noise, realising that its appropriation and control is a reflection of power, is essentially political” (p. 6). This will be countered by an exploration of the state-sponsored instrumentalism of art and artists to fulfil explicit and covert political agendas in the name of culture and the “free world”.

A Spoonful of Sugar from the Land of the Free

Communities are awash with choirs; elders who have found an alternative to the palliative of organised religion and who in their twilight years, find a cultural panacea to the trials of great age. These ensembles of octogenarians, potentially motivated by research that offers the potential of a sense of community or alleged improvements in respiratory function, in turn, provide researchers with a rich seam of gold in funding and politicians a cheaper alternative to cruel medication and cost-effective solutions to reimagining soulless care homes. Amid the rush to choir practice we need to ask: what are such programmes doing to actualise a broader experience of equity and human rights for older members of our communities?

The story of Henry, a man “who suffered from dementia for a decade and barely said a word to anyone—until Music & MemorySM set up an iPod program at his nursing home” (Music & Memory 2017), is typical of the commercialisation of a simple idea—music is good for you. With over 2.6 million internet hits, this film is compelling. It is simple: a man, apparently in the depths of isolation, is animated by listening to music he enjoyed earlier in his life. Suggesting its work is both “miraculous”’ and “rooted in extensive neuroscience research” (Music & Memory 2017), Music & Memory’s offer is one that taps into deep rooted fears of our own individual mortality through the language of isolation and terror, and all at a cost. With a training package from $250 to $1000 and a DVD to market, its website appears more preoccupied with sales and co-option of its methods and less with the common goods.

As Music & Memory say, their approach is simple, “elegant and effective: We train care professionals how to set up personalized music playlists, delivered on iPods and other digital devices, for those in their care” (Music & Memory 2017).

While the film of Henry is undeniably engaging, there is an uneasy feeling that it is almost like a trick of light, a transient taste of what the person might have been—a moment of individual expression and enjoyment, yes—but by no means a miracle, its effect fleeting, offering the viewer perhaps, their first taste of “dementia porn”.

Like MGM films with its famous opening sequence of a lion’s roar, Music & Memory has registered its work through a “service mark” which, like a trademark, is common in US law, designed to stop infringement by competitors. It is easy to imagine care homes across the USA with rows of elderly residents plugged in and tuned out—anaesthetised and individually contained—or over stimulated by prescribed personalised packages. But if people are “awakened” through this experience, what would the ethical and resource implications be for those charged with meaningfully responding to sentient individuals, suddenly made aware of their plight? Most probably the iPlayer will simply become the pacifiers of the frail and elderly.

Would a younger Henry have consented to his iPlayer inspired “scat” being shared by the millions who have feasted on his remarkable moments of personal pleasure? For every Henry, countless numbers of older people are lonely and isolated and without the resources to access sophisticated and person-centred care and are more likely to end their days in “warehouses of the dying” (Gawande 2010). Has Henry simply been used as the MGM lion of Music & Memory, and do we really need training for something as simple as listening to music?

Before we can really consider the possibilities of what the arts can meaningfully offer us, let us explore the disparity, inequity and political spin that underpin what are described as the social determinants of health—and where better to start, than the land of opportunity and freedom, where inalienable rights are enshrined in the constitution. When Thomas Jefferson penned his first draft of the US Declaration of Independence in 1776, could he have anticipated the levels of selfish individualism that would follow?

We hold these truths to be sacred and undeniable; that all men are created equal and independent, that from that equal creation they derive rights inherent and inalienable, among which are the preservation of life, liberty and the pursuit of happiness (Jefferson cited in Boyd 1950, p. 6)

In recognition of Henry’s African American heritage, perhaps it is fitting to plot inequalities in terms of health and the arts, from what has been described as the Harlem Renaissance of the 1920s, a movement which would go on to empower self-expression, identity and racial pride. Although at the time of the “renaissance”, it had not yet been seen as a movement, but with the term being applied retrospectively, it spawned a body of artists that would exert a powerful influence on future generations.

Through the song Strange Fruit (released in 1939), musician and songwriter Billie Holliday transformed a 1937 poem by Abel Meeropol about the 1930 lynching of Thomas Shipp and Abram Smith in Indiana. This is arguably the first and greatest anti-racism song, in which Holliday viscerally and lyrically used her art form to address one of the most deeply rooted of all inequalities: racism.

Many artists who emerged from the renaissance could not compete against the seemingly mainstream white equivalents who were dominating the Western art world. African American scholars James Weldon Johnson and Houston A. Baker, Jr (1988) believed that the renaissance was a failure and was overlooked due to being “denied access to the avenues of white success” and that “blacks cannot be successful in the ways whites can and too often ‘fail’ when measured by those standard(s)” (Johnson & Baker cited in Howard 1988, p. 638). Johnson and Baker argued that black American modernists had to be entirely conscious and mindful of their cultural past to pursue equality, practice self-expression and advance as a people (Johnson & Baker cited in Howard 1988, p. 638).

When Music Stops Wars

In October 1960 when the American jazz musician Louis “Satchmo” Armstrong arrived in what was then the Belgian Congo, he was carried on a makeshift throne from his limousine that had swiftly taken him from Leopoldville’s airport to a packed out national stadium, where for three hours alongside his All Stars band, Armstrong would perform to all sides of the warring factions in the bloody civil war which was tearing the country apart. From the time he arrived at the airport to the moment he set foot back on his flight out of the country, the war was put on hold, all weapons were laid down. Music had stopped the war, albeit temporarily. Three hours after he left Leopoldville, the war began once more.

Armstrong was part of a US State Department-sponsored tour of African countries: an attempt at cultural diplomacy and positive image-building for the USA during a period of escalating Cold War tension. As early as 1956 Dizzy Gillespie had toured Greece, the Middle East, North Africa, India and the newly partitioned Pakistan; part of what was then referred to as the Northern Perimeter Defence Zone—an invisible line that had the potential to keep the Soviet Union away from oil and mineral rich land masses.

In the BBC (2016) documentary, The Jazz Ambassadors of the Cold War, the jazz pianist Julian Joseph, tells the story of “how some of the biggest jazz musicians toured the world in the name of democracy, only to turn the tables on the US government that had sent them”.

Inequalities and racial divisions were endemic across the USA during this same period and in 1957, three years after the Supreme Court ruled unanimously that separate educational facilities are inherently unequal, nine African American students, now known as the Little Rock Nine, attempted to attend Central High School in Little Rock, Arkansas which until then, had been an all-white school. On the first day of the school term, “a white mob gathered in front of the school, and Governor Orval Faubus deployed the Arkansas National Guard to prevent the black students from entering” (Martin Luther King Jr. and The Global Freedom Struggle n.d., p. 1).

Following the intervention of Dr Martin Luther King, who wrote directly to President Eisenhower requesting a swift resolution, a federal district court injunction to prevent the governor from blocking the students’ entry was won. Following escalating racial tensions, King told the president that if the federal government did not take a stand against the injustice it would “set the process of integration back 50 years. This is a great opportunity for you and the federal government to back up the longings and aspirations of millions of peoples of good will and make law and order a reality” (Martin Luther King Jr. and The Global Freedom Struggle n.d., p. 1).

Amid the public relations campaign being delivered by the Jazz Ambassadors, the Little Rock incident was becoming an international embarrassment, reflecting the true and unequal nature of American society, as Eisenhower ordered troops to guard the students, who were protected for the remainder of the school year. Whilst the racist Governor Faubus closed all of Little Rock’s public high schools rather than proceed with desegregation the following year, in 1959 the Supreme Court ruled that all schools must reopen and resume the process of desegregation.

Joseph recounts that having been approached by the US State Department to play concerts in the Soviet Union, Louis Armstrong watched white children spitting in the faces of black children on TV and commented, “The way they’re treating my people in the south, the government can go to hell”—he would not go to Russia—“How can I tell them about my country?” (BBC 2016).

The reality of contemporary life for high-profile African Americans artists was that they had been excluded from restaurants and public spaces their entire life, so how could they prop up a racist political status quo. By refusing to be part of this soft diplomacy, Armstrong risked his career, with concerts cancelled and gigs lost, until October 1960 when the government and Civil Rights Movement appeared to be making political changes with presidential support, and Armstrong made that visit to Africa.

As an armed political group, the Black Panther Party (BPP)—which emerged in 1966 to monitor police behaviour and brutality—could easily be ignored in a chapter focused on the arts and inequalities, but a brief mention of their role and distorted public perceptions of their concerns, may help contextualise this train of thinking further. Described by the Federal Bureau of Investigation Director J. Edgar Hoover as “the greatest threat to the internal security of the country”, the BPP was placed under an extensive programme of “surveillance, infiltration, perjury, police harassment, and many other tactics designed to undermine Panther leadership, incriminate party members, discredit and criminalise the Party” (Newton 2002).

Whilst the history of the BPP has been polarised as either criminal or heroic, many commentators have ignored the more practical social programmes that were a core activity of party members, from free breakfast for children programmes to community health clinics. Its Ten-Point programme (Wikipedia 2017) called for what we would understand as basic human rights; freedom, employment, housing, education equality and social justice.

Simultaneously, the inherently political Black Arts Movement was the only American literary movement to have at its very heart, a socially engaged aesthetic. It has been argued by Ishmael Reed and others that there would be no multiculturalism movement without Black Arts. (Modern American Poetry n.d.).

Perhaps the US State Department was guilty of exploiting black artists in the name of marketing “brand America” in its Cold War land grab. The Congo’s rich supplies of uranium would go on to be used in the creation of US nuclear bombs, and today the warring militias are more likely to be protecting the industrial interests of global tech giants as they mine for essential mineral components of our digital consumer obsessions.

From its history of importing slaves to promises of a rosy future exporting its sugar coated vision of an equal America, we have seen a distorted version of reality. As the citizens of the USA became more inward looking and confident of the place on the world stage, an increase of everyday anxieties was becoming prevalent. The pursuit of happiness as a constitutional dream appeared fractured and people began to question their individual lot: am I not happy enough, because I am sick?

The emergence of cosmetic surgery offering people the appearance of radiant health was mirrored by the rise in new medications designed to iron out anxiety and depression, and in 1952, the American Psychiatric Association published the first Diagnostic and Statistical Manual of Mental Disorders. This would go on to become the most influential tool for mainstream psychiatry in the diagnosis and treatment of mental illness. I have argued elsewhere (Parkinson 2015) that the pharmaceutical industry largely controls our psychic terrain and that everyday anxieties and pessimism are largely perceived as unacceptable and symptomatic of illness, needing to be treated by the medical weapons of choice: pharmaceuticals.

In a final insult, this same period saw the largest epidemiological study of mental illness ever conducted in the USA. An analysis of the National Institute of Mental Health’s Epidemiological Catchment Area Study (Wilson and Williams 2004) evidenced striking racial differences in anxiety disorders, yet the pharmaceutical giant, Merck Sharp & Dohme was able to capitalise on the booming depression industry, by targeting its anti-depressant Elavil to doctors through a free album called Symposium in Blues in 1966, which consisted of predominately African American musicians’ work. That an album of jazz and blues was being used to sell as an anti-depressant was an ironic and cynical piece of marketing, considering that African Americans accounted for startlingly high numbers of patients incarcerated in mental health units and prisons across the USA.

While on the Other Side of the Pond

As civil discontent in the USA raged on, in post-war Britain, it seemed that things were developing at a far more sedate pace. Aneurin Bevan’s socialist dream of a free National Health Service where no one would live in fear was threatened from its very start by the self-interest of those who governed the hospitals and general practices across the country. As Bevan (1959) struggled to nationalise health services, he described the only way he could break the deal with those in power was to “stuff their mouths with gold”. It appeared that the vested interests of the elite and those governing the country were being undermined by a proposed system of social care and health equity.

The Trinidad-born journalist and activist Claudia Jones (1915–1964) had been deported to Britain from the USA as a result of her political activity. As the founder of Britain’s first major black newspaper, The West Indian Gazette in 1958, she became a driving force behind a proactive movement to embrace cultural change through the arts and, in January 1959, facilitated the first Mardi-Gras carnival in St Pancras Town Hall, which was directed by Edric Connor and featured black artists of renown, and televised by the BBC. These early celebrations gave birth to the slogan: “A people’s art is the genesis of their freedom” (Jones 1959).

These were the roots of what went on to become the Notting Hill Carnival which now attracts crowds of over a million people each year. Guyana’s ambassador to China, the writer and academic, Professor David Dabydeen suggests that historically, “carnival allowed people to dramatise their grievances against the authorities on the street … Notting Hill Carnival single-handedly revived this tradition” (Dabydeen 2010).

This is a powerful idea, and an idea born of the streets themselves, not one devised by government mandate, in fact, one that at its heart challenges the very notion of authority. Those passionate individuals and groups that have made the Notting Hill Carnival possible over the last 40 years have routinely been demonised and vilified by the media, which would come to a political head in the 1968 Rivers of Blood speech by the then Conservative Shadow Defence Secretary, Enoch Powell, criticising commonwealth immigration and anti-discrimination legislation (Powell 1968).

The speech was described as, “the first time that a serious British politician has appealed to racial hatred in this direct way in our postwar history” (Manzoor 2008). This represented an explosive fuel to a country where discontent was on the rise. Powell warned of what he foresaw as the escalation of immigration and the inevitable violent consequences.

The tragic and intractable phenomenon which we watch with horror on the other side of the Atlantic but which is interwoven with the history and existence of the USA itself is coming upon us here by our own volition and our own neglect. Indeed, it has all but come. In numerical terms, it will be of American proportions long before the end of the century (Powell 1968).

In his last speech to the House of Commons architect of the Welfare State on 3 November 1959, Anuerin Bevan described the difficulties of persuading the electorate to support a policy which would make them less well-off in the short term, but more prosperous in the long term. Here, perhaps was the fundamental flaw in the dream of democracy and the utopian socialist ideal of equality for all: selfish individualism.

A Social Poison

Choose Life. Choose a job. Choose a career. Choose a family. Choose a fucking big television, choose washing machines, cars, compact disc players and electrical tin openers. Choose good health, low cholesterol and dental insurance. Choose fixed interest mortgage repayments. Choose a starter home. Choose your friends. Choose leisurewear and matching luggage. Choose a three-piece suite on hire purchase in a range of fucking fabrics. Choose DIY and wondering who the fuck you are on a Sunday morning. Choose sitting on that couch watching mind-numbing, spirit-crushing game shows, stuffing fucking junk food into your mouth. Choose rotting away at the end of it all, pishing your last in a miserable home, nothing more than an embarrassment to the selfish, fucked up brats you spawned to replace yourself. Choose your future. Choose life. (Hodge 1996, pp. 1–4)

John Hodge’s monologue on selfish individualism for the film Trainspotting offers a heroin-flavoured indictment of contemporary life and a spring-board from which I will draw the threads of this chapter to a conclusion.

Echoing Powell’s premonition, riots swept across the UK in the 1980s and in the summer of 2011. In their analysis of the 2011 events, Richard Wilkinson and Kate Pickett (Wilkinson and Pickett 2012) describe the inequalities that lay behind the riots as a social poison. Unpacking the findings of the government inquiry into the riots in a Guardian opinion piece, the authors usefully remind us that, yet again, the contributory factors are well known: “lack of community, family difficulties, low social mobility, poor relations between police and young people, consumerism” (Wilkinson and Pickett 2012), but suggest that we need to understand the causes of these factors, commenting that, “as tobacco is a physiological poison, Britain’s high levels of inequality are a social poison that increases the risks of a wide range of social ills” (Wilkinson and Pickett 2012).

The authors argue that this social poison works by emphasising the disparity between the richest and poorest in society, where money and status become the measure of personal worth. They comment that “among the FTSE 100 companies, many CEOs are paid 300 times as much as their most junior employees. There can be no more powerful way of telling huge swaths of the population that they are almost worthless than to pay them one-third of 1% of their CEOs’ salaries” (Wilkinson and Pickett 2012).

Their argument is simple—if by our very nature, humans are “sensitive to being thought less of, disrespected, put down … … [then inevitably] … loss of face and humiliation are the most common triggers to violence, … antisocial societies cause antisocial behaviour” (Wilkinson and Pickett 2012).

They urge us to be sensitive to inequalities and status which are rooted “in issues of dominance and subordination dating back to pre-human social ranking systems. They shape behaviour because we need different social strategies depending on where we come in the hierarchy, and how hierarchical our society is” (Wilkinson and Pickett 2012).

A disturbing hierarchical picture emerges when we take into account, the political elites’ response to the riots that took place on the Broadwater Farm Estate in London in 1985. When he worked for Margret Thatcher’s Policy Unit, old Etonian Oliver Letwin, co-authored a confidential five-page memo, suggesting that “the riots were caused by bad behaviour not social conditions” (Travis 2015) and arguing against investment in the community, which he proposed would do little more than “subsidise Rastafarian arts and crafts workshops” where black “entrepreneurs will set up in the disco and drug trade” (Travis 2015).

Until July 2016, Letwin was Minister for Government Policy in the Cabinet Office presided over by former Prime Minister David Cameron, and what has been described as a “cabinet of millionaires” (Beattie 2012) of which, in 2012, 18 of the 29 were millionaires, with a combined wealth of over £70 million. In August 2016, Letwin was knighted for recognition of his work in cabinet. It seems inevitable then that when the poorest and most marginalised people see the richest smugly laughing in their faces, it seems inevitable that they will “choose a big fucking television set, compact disc player, or electrical tin can opener” (Hodge 1996, p. 1).

Before any official inquiry took place into the 2011 riots in the UK, writer Gillian Slovo was commissioned by the director of the Tricycle Theatre, Nicolas Kent, to create a piece of verbatim theatre about the events, and their possible causes. Using interviews from politicians, police, rioters and victims involved in the riots, Slovo suggests there was a glimmer of an understanding, arising from what it might have been like to take part: how rage plays a part in mob violence, that it can also be about adrenaline, and even fun. “It’s as if the constraints of life are just … thrown away, and there is relief in acting” (Addley 2010).

Slovo spoke to police officers who told her what massed displays of “hatred for the uniform” (Addley 2010) felt like, while you were wearing one; to the politician Michael Gove, who asked why young people needed the state to pay for services when they could always join the scouts! Theatre critic Michael Billington describes how, “once again, the theatre steals a march on officialdom … and, if the result can hardly be expected to provide any definitive answers, it asks the right questions in a way that is clear, gripping and necessary” (Billington 2011). The Riots offered plurality of views around “a widespread sense of people, and not just the young, seeking revenge on an unjust society, offering information and provoking debate” (Billington 2011).

If the play was an exploration of why the summer riots happened, and what are the lessons we can learn, Billington suggests as a piece of art, it passes a vital test, “it offers us the evidence, and leaves us to form our own opinion as to why there is such anger on Britain’s streets” (Billington 2011).

Perhaps it is with these reflections of a theatre critic that the strands of this chapter begin to coalesce. We have seen how Cold War tactics hijacked the credibility of black musicians, who at the same time were subject to racial abuse and segregation in their own countries, and we have explored the artistic outcomes born of inequalities and injustice through music and carnival, alongside the birth of cynical marketing in the pharmaceutical industry. In the case of the 2011 riots, it was contemporary theatre that preceded any official inquiry.

Incendiary Words

As early as 1819, poems had pulled a heavy political punch. When Percy Shelly responded to the atrocities of the Peterloo Massacre that year, it is hard to imagine that he could have envisaged a single verse from his poem would reach out far into the future, but his non-violent call to action continues to resonate through recent history.

Verse

Verse Rise like lions after slumber In unfathomable number Shake your chains to earth like dew That in sleep have fallen on you Ye are many, they are few. (Shelly 1819)

The poem’s final verse has captured the imaginations of many oppressed groups from striking woman who demonstrated against working conditions in the garment industry of New York in 1909, to Tiananmen Square in 1989, the UK Poll Tax riots in 1990 and Tahrir Square in 2011, where demonstrators adapted the very last line of the poem to, “We Are Many” in explicit reference to working-class solidarity. On many placards of the Stop the War Coalition, the slogan was borne aloft, opposing what was widely regarded as an illegal war based on spurious evidence of the existence of weapons of mass destruction. Weapons which did not exist.

In his exploration of politically related poems, Professor Mark Wallace (n.d.) describes six categories of poems that might translate across other art forms. Wallace refers to calls to action, social/historical investigation, ideological exploration, visioning social transformation, politics of form or literary creation and finally, the personal as political (Wallace n.d.). When the home of Chilean poet Pablo Neruda was raided by the armed forces of General Pinochet in 1973, Neruda adroitly welcomed them in and remarked: “Look around—there’s only one thing of danger for you here—poetry” (Feinstein 2008, p. 39).

An obscure play by the playwright Howard Brenton called Weapons of Happiness in 1976 tells the story of a strike by the workers of a crisp factory—a strike doomed to failure because the workers lack any coherent plan, the unions, police and management all being in each other’s pockets. Michael Billington (2008) recently described the play as being a “blend of post-1968 disillusion and residual utopianism” and significantly that “Brenton’s point is that radical change can only be achieved through organisation” (Billington 2008). In the same year, the desire to address racism in the UK through organised action was exemplified by the birth of the Rock Against Racism campaign.

In the USA, #BlackLivesMatter “has emerged to (re)build the Black liberation movement, following the 2012 murder of seventeen year old Trayvon Martin and subsequent acquittal of George Zimmerman for this crime” (Cullors et al. 2016). Founded by Cullors et al. (2016) as an ideological and political intervention, Black Lives Matter affirms the lives of people who have been marginalised within Black liberation movements placing, “Black queer and trans folks, disabled folks, black-undocumented folks, folks with records, women and all Black lives along the gender spectrum”, at the heart of its movement which is inhabited by cultural workers, artists and designers (Cullors et al. 2016). Following police brutality and murder in the USA, perhaps Black Lives Matter represents a cohesive force for social and cultural change: the organisation and radical change that Brenton calls for.

Neruda and Shelly, Cullors, Tometi and Garza are all calling for the same thing: equality and social justice. That artists address the inequalities that underpin social unrest, attests to the place of the arts in the investigation, ideological exploration and the re-visioning of society. More than that, participation in the arts offers the opportunities for the personal to become political, the individual become the communal—offering multifaceted calls to action. As Billington (2011) emphasises, the arts can offer us evidence, provoking us to form opinions—and just maybe, affect societal change.

The way in which health and well-being are now understood increasingly focuses on competition and not compassion, and into this largely clinical context, the arts and health agenda emerged as a force to humanise healing environments and advance its relationship with medicine, understanding its place in an agenda less focused on civic good and the social determinants of health, but of pathology and disease—as a means to achieving individual health. Whilst arts and social justice might not be as readily understood as arts and health, perhaps if we are to understand our public health agenda in terms of equity and justice, then we might truly engage with the social determinants of health and not simply decorate the edges of our individual lives.

CODA

In a nursing home in 2011, a short film of a man named Henry, enjoying his iPod playlist became a YouTube sensation. Although voyeuristic, it was never intended to offend and was created with good intention. However, watching this man singing along, it is incumbent on us to remember the inequalities that are still endemic across contemporary society in the USA and further afield, and the histories and destinies of people marginalised because of race, religion, gender, ability or sexuality.

Of all the evangelical responses to this Music & Memory YouTube video, the response of ASFALT 21 (2015) has been “liked” by 245 people—more than any other comment. What was the comment? “In the future someone with alzheimers will listen to nicki minaj-anaconda, get up the wheelchair and start twerking in the nursery lol” (ASFALT 21 2015).

A glib response to the human condition perhaps, or the democratisation of music and health? When architect of the National Health Service (NHS) Anuran Bevan wrote In Place of Fear in 1952, he predicted thus: “Soon, if we are not prudent, millions of people will be watching each other starve to death through expensive television sets” (p. 192).

Perhaps this premonition has borne much darker truths. Not only do we watch migration, forced displacement, starvation and death—but we observe the grim reality of inequality and its consequences played out on our own flat screen TVs. When televised prisoners or homeless people sing opera, we feel like the world is somehow improved—prime time viewing for the well-fed masses—but is not this a lazy saccharine-coated exoticisation of others? Does it take a reality TV show to reform those on the streets into the show-ponies of the self-satisfied masses, so we can say we have turned lives around—sanitised the unclean—evangelists peddling some utopian dream.

The arts challenge, provoke and arouse us. Or they should. The arts and health movement seems to be thriving, yet black and ethnic minority artists and cultural leaders are thin on the ground, like black Oscar nominees in Hollywood, working-class actors in the UK and leading roles for disabled actors. The white educated middle classes appear to dominate the arts and health field. Might the arts and health movement become a toothless agenda, inward looking and self-satisfied? Without diversity, the arts and health movement risks are becoming self-congratulatory and worse—a potentially gated community.

In his report, Against Value in the Arts, Dr Samuel Ladkin (2014) suggests, “It is often the staunchest defenders of art who do it the most harm, by suppressing or mollifying its dissenting voice, by neutralizing its painful truths, and by instrumentalising its potentiality, so that rather than expanding the autonomy of thought and feeling of the artist and the audience, it makes art self-satisfied.”

Howard Brenton (1992) suggests alternative culture has failed, and that it has become “hermetically sealed, and surrounded … [where a] … ghetto-like mentality develops. It is surrounded, and, in the end, strangled to death” (Brenton cited in Kershaw 1991, p. 15). Perhaps we have already gone beyond instrumentalising our work, and like the incrementally commercialised health sector, we are weaponising the arts to target all life ills, and it is our arts and health movement, in and of itself, that could undermine its own intrinsic cultural value.

Like those elusive weapons of mass destruction that were figments in the minds of our leaders, deluded and hell-bent on war, happiness is a fickle and elusive state of being—not some by-product of consumerism, and perhaps, as Sederstrom and Spicer (2015) comment, “our superficial quest for happiness is destroying our relationship with what is real” (p. 69).

There is a paradigm shift taking place in the way health and well-being are understood—and I would argue that the arts have a powerful part to play in this cultural change, but our challenge is to remain authentic to our practice, whilst addressing the fact, that the most marginalised people in society may be completely disconnected from the arts.

In the USA, the incarceration rates of men from black and minority ethnic backgrounds are still disproportionately high. According to Sophia Kerby (2012) writing for the Centre for American Progress, “1 in every 15 African American men and 1 in every 36 Hispanic men are incarcerated in comparison to 1 in every 106 white men.” More alarmingly still, “one in three black men can expect to go to prison in their lifetime” (Kerby 2012).

“Ignorance, allied with power”, James Baldwin (1972) said, “is the most ferocious enemy justice can have” (p. 48), and as the UK embarks on a divorce from its place in the European Union and the USA begins a new wave of selfish individualism led by Donald Trump, should we passively brace ourselves for a little horror, or should the arts proactively disrupt inequality of race, gender, disability and sexual identity?

We will never address the health and well-being of communities until we get to grips with the injustices and inequalities that poison our communities—the arts, however, might represent a most potent social determinant of long-term public health and well-being. Yes—art gives us small moments of joy, but art and artists also give us voice to question systems of control and perhaps, the means to question the status quo. In an interview with Studs Terkel, Baldwin (1989) also said that “artists are here to disturb the peace” (p. 21).