Tuesday May 24 2011
It's hard to tell if culture affects health or vice versa
“Cultural activities good for men’s health and happiness,” reported The Daily Telegraph. The newspaper said that, “simply observing culture improves the physical health and wellbeing of men more than attempting to be creative”. Women were reported to benefit ‘more from taking part in artistic activities than just watching them’.
The news story was based on a study of wellbeing and cultural activities in a rural region of Norway. The study found that both men and women engaging in cultural activities, such as museum visits and sports, reported having better health and satisfaction with life, as well as lower anxiety and depression. Positive effects were associated with both passive activities, such as watching films at the cinema, and active pastimes such as playing music.
Participants were surveyed on one occasion meaning it is not possible to say whether cultural activities caused improved health or whether people who felt healthier were more likely to choose to participate in cultural activities. Furthermore, the study measured participants’ perceived health rather than specific medical outcomes so we cannot be sure that their opinions actually reflected their physical health.
This study provided some knowledge about association between better physical and mental health, but overall it did not inform us as to how this relationship might work or how whether similar results would be seen in the UK population.
Where did the story come from?
The study was carried out by researchers from the Nord-Trøndelag Health Study Research Center, Norway and was funded by the Public County Council Nord Trondelag, Norway. The study was published in the peer-reviewed Journal of Epidemiology and Community Health.
Newspapers have accurately reported the findings of this study, although they have not made it clear that only limited implications can be drawn from this research. For example, the study cannot tell us about the association between cultural activities and actual physical health because the researchers just looked at perceived health. Also, the study did not assess whether better physical and mental health was caused by cultural activities or whether people who were feeling content were more likely to take part in cultural activities.
What kind of research was this?
This was a cross-sectional study in whether participating in cultural activities could be associated with improved perceived health, anxiety, depression and satisfaction with life. It was carried out in a region of Norway called Nord Trøndelag County, which the researchers consider to be representative of the whole of Norway in terms of geography, demographics and the occupation of its inhabitants. However, it lacks a large city and the average income and mean educational level are slightly lower than the national average.
What did the research involve?
The researchers used data from three surveys conducted as part of an on-going population study called the HUNT study. The third of these surveys was carried out between 2006 and 2008. For this current study on cultural activity, 27,754 women and 23,043 men aged 20 years or older were included. The first HUNT questionnaire contained questions on perceived health, physical and mental health and life habits, such as how often they exercised.
The second questionnaire included questions about cultural participation. The participants were asked how often they engaged in certain receptive cultural activities, including going to a museum or art exhibition, a concert, theatre or film, going to a church or chapel, or going to a sports event. They were also asked about how often they actively participated in ‘creative cultural activities’ including an association activity or club meeting, music, singing, theatre, parish work, outdoor activities, dance, working out at the gym or sport.
The researchers used a technique called logistic regression to work out the extent that engaging in cultural activities influenced physical and mental health. The researchers adjusted the results for other factors that may affect health, such as chronic disease, the amount of exercise the participant did, social contact, smoking, body mass index (BMI) and alcohol consumption.
What were the basic results?
The researchers had complete data available on 17,932 women and 14,928 men. More men than women reported good or very good perceived health and low anxiety. Reports of depression and satisfaction with life were similar in men and women.
In both genders, across all ages and socioeconomic groups:
- more people participated in cultural activities then went to watch or listen to cultural events
- increasing age was associated with increased participation in both creative and receptive cultural events up to the age group 40-49
- fewer people of lower socioeconomic status participated in creative and receptive events
The researchers then looked at how gender and each individual's activities related to the various health outcomes.
All receptive cultural activities were associated with good or very good perceived health in men. In women, only one activity (attending a sporting event) was associated with good or very good perceived health.
Going to church or a sports event was associated with a good level of satisfaction with life in women. In men, taking part in any cultural activity was associated with good satisfaction with life. Women who participated in association meetings, singing, music, theatre, outdoor activity, dance and working out or sports, reported higher satisfaction with life. Men who participated in association meetings, dancing, an outdoor activity, working out or sports also reported a good satisfaction with life.
Lower anxiety scores were observed in women who went to museums, art exhibitions, concerts, the theatre or films, and this was also found in men who participated in any receptive activities. In women, participation in association meetings, outdoor activities, dance and working out or playing sports, was associated with low anxiety. Men who participated in association meetings, outdoor activities, worked out or played sports reported lower anxiety scores.
In women, taking part in any of the receptive cultural activities was associated with low depression scores. In men, going to a museum, a concert, the theatre, a film or a sports event was associated with low depression scores. Women who participated in association meetings, outdoor activity, dance and working out or sports, reported lower depression scores. Men who participated in association meetings, music, singing, theatre, outdoor activity and working out or sports had lower depression scores.
How did the researchers interpret the results?
The researchers said that in both women and men, ‘participation in both receptive and creative cultural activities was associated with good health, good satisfaction with life, a low anxiety score and a low depression score’. They also said that men who engaged specifically in receptive, rather than creative, cultural activities reported better health-related outcomes.
This Norwegian research has demonstrated that attending or participating in a wide range of cultural and sporting activities can have a positive effect on perceived health, satisfaction of life, anxiety and depression.
As this was a cross-sectional study, where data on each outcome was collected at only a single point in time, it is not possible to say whether participating in cultural activities leads to better reported health or vice versa. For example, just as participating in cultural activities might cause people to report better physical and mental health, it is just as plausible that people who feel healthier were more likely to engage in cultural activities.
The study also showed that people of lower socioeconomic status were less likely to attend or participate in cultural activities. While the study did attempt to adjust for a range of factors, such as socioeconomic status (which is known to have an effect on health), the researchers themselves highlight that ‘the associations between cultural participation and public health outcomes are probably more complicated than any study design and range of variables may grasp’.
The study also used one measure of perceived health as a measure of how healthy the participants were. As this study used a questionnaire, it is not possible to determine whether cultural activities are associated with medically assessed health and health over the course of a lifetime.
This study was carried out in rural Norway, and the population surveyed may not reflect the British population. Further research is needed to see whether cultural activities are associated with better physical and mental health over the long term.