 So, welcome to NEMO's eighth webinar, which we are again presenting in collaboration with NEMIC, the New Media Center for Cultural Heritage, and MICC, Media Integration and Communication Center. NEMO is, as hopefully all of you know, the network of European Museum Organizations, and we aim to offer a variety of activities to museum professionals as well as museum organizations. And we are very happy to deliver relevant content to you, the organizations, to individual museum professionals, and then make this information also accessible to a larger audience. Our members consist of national museum organizations, other cultural institutions and networks as well as individual museums, and we're interested to support all of them. And we do this by advocating, by collaborating, by sharing and training, and also offer this to our members and non-members. And the webinars are just one example of the different offers that we have. Today, Mark O'Neill, the former director of policy and research for Glasgow Life, if you don't know what Glasgow Life is, it's a charity that delivers arts, museums, libraries and sports services for the city of Glasgow. Mark will facilitate the webinar today, as you all know, probably it's called Museums Health and Well-Being. And I think, or we at NEMO think, that the role of museums for society has been evident ever since the first museums came to be. And if you've been following us, the last webinar by Masimou Negri was about the great revolution of museums, and he talked about how the perception of that role that museums have for society has changed over time. And Mark will just focus on one of those aspects, and look at it in regard or with regard to health. Because Mark is a much better expert on the history as well as the current issues in that regard, I will give the virtual stage to Mark in just a moment. Before that, just a few organizational remarks. Mark's presentation will be uploaded on our website after the webinar, and we will also upload the recording. So if you have trouble following, or if you just want to revisit it, or if you thought it was really great, and you want to recommend it to others, we will upload it in the next few weeks to our YouTube channel and also then embed it on our website. If you have questions throughout the webinar, please just write them in the chat, and Mark will answer them at the end of the session. If you have any other problems, technical issues, please also write them in the chat, and we'll try to give you answers. Of course, it's troublesome to do troubleshooting from afar, but we'll try our best. And when I say we try our best, we of course value your feedback. So if you have anything that you'd like to say after the webinar about the quality, the content, if you have any kinds of requests, please write them down in the chat or send them to us via email. Well, welcome to this international, temporary community and cyberspace. It's great so many people have signed up for this exploration of a museum's health and well-being. I'm going to talk for about 40 minutes, and then I'll try to answer any questions you may have. So the structure of my talk first, many museum staff intuitively believe museums make a positive contribution to people's health and well-being. Museums are increasingly developing activities, projects, and services which seek to enhance their impact in this area. This webinar aims to review the current state of museums and health and look beyond individual projects and services in order to offer a framework for realizing the potential contribution of museums to human well-being. My presentation is divided into three parts. The first part will begin with a brief overview of what museums are doing in relation to health and well-being just now, and what we know about evaluation and impact. In order to put this in a wider, more strategic context, I'll take a brief look at the history of public museums and public health over the past 150 years, and I hope to show that there is more of a shared history than you might expect. I will then review the evidence for health benefits of museum visiting in work carried out by epidemiologists or medical statisticians. This section will conclude with a summary of what we know about the health benefits of museums. The second part of my talk would begin with an account of what some public health academics are calling the health crisis of modernity, in which they argue it requires a new wave of public health in order to address the diseases of modernity like mental ill health, loneliness, and obesity. This new wave of public health, they argue, requires a more holistic approach based on fostering social trust and inclusive narratives, which enhance people's sense of leading meaningful lives. I think this will enable us also to understand better the underlying reasons why museums are looking at health and well-being just now. I'll then move on to suggesting a strategic approach to museums' health and well-being. This is a tentative framework, so I'll be very interested to hear what you think in cyberspace think about it. I'll also try to say a bit about resources. So museums' health and well-being now, projects and services, across Europe, museums are beginning to explore issues of museums and health. Faro, at the top of the slide here, the Flemish Centre for Cultural Heritage has published a report and a pilot about using museum collections in health and well-being activities. The bottom left is a report by the University of Zurich about museums in older people, especially those with dementia, while the bottom right of the slide is about a program for people suffering from this terrible disease in the Belvedere Museum in Vienna. One of the largest museum services anywhere focusing on dementia is the National Museums of Liverpool, where they have redefined the function of museums as the preserver of memories, whether they're in the museum, in the museum objects, or in people's minds. They have produced a wide range of resources, including a free app which you can download, which can be used by individuals and families, as well as people in care homes. Arch museums can run a significant number of services. For example, here you can see programs run by the Metropolitan Museum in New York, which comprises tours for visitors with dementia and precarious. There's tours for people who are deaf and have hearing impairment, tours for people with visual impairments and those with learning disabilities. All of these programs involve significant external fundraising and extensive use of trained volunteers. Many museums also undertake projects for people whose health is vulnerable. For example, we in Glasgow have undertaken health-related projects with patients in the mental hospital, with prisoners who are in jail and with survivors of torture. These projects often require significant resources and are usually only possible with external funding also. While they can have a big impact on small numbers of people, it's often difficult to continue to meet the needs of these groups and for the museum as a whole to learn from them. Other museums run similar time-limited projects with refugees and asylum seekers, with teenagers and children, with older people, a whole range of people whose health is at risk. This is an American Association of Museums 2013 report which gathered information about the wide range of areas of health care in which museums are involved. As you can see, the projects and services range from providing information which improves people's knowledge about health and nutrition, to working in hospitals with patients and medical staff, and from working with people with visual impairments and learning disabilities to people with Alzheimer's. University College London is an international leader in research about the impact of museums and health, and they have worked with 30 museums to develop a tool for assessing the impact of health-related museum service. This is available to download free from the University College London website. One of the authors of this instrument is also a co-author of this book, the only book I know of dedicated to the subject of museums health and wellbeing, Helen Chatterjee and Guy Noble. It summarises 10 years of research on health and wellbeing, which shows that museums benefit health in the following ways. Positive social experiences in museums can lead to reduced social isolation. Museums provide opportunities for learning and for acquiring new skills. Museums provide calming experiences which can help reduce anxiety, and they can provide increased positive emotions such as optimism, hope and enjoyment. Museums have been shown to increase self-esteem and a sense of identity. They can increase inspiration and opportunities for meaning making. They can be, when provided for people with diagnosed conditions, be a distraction from clinical environments such as hospitals and care homes, and they can improve communication between families, carers and health professionals. So that's the summary of the kind of activities that museums are engaging in now and the evidence base for it. I would now like to step back from this picture of the present and take a brief look at the sometimes shared and sometimes parallel history of museums and public health. According to a leading public health academic, Professor Phil Hanlon in Glasgow University, there have been four great waves in public health history from the 1850s onwards, and he now says that we are entering, or rather that we need to enter a fifth wave which takes a more holistic approach to well-being. These waves are cumulative, they don't replace each other, but what I would do is I would run briefly through these periods, say how museums relate to public health improvements. I've got to spend most of the time on the first wave, which is when public health museums first emerged, and part of my argument will be that in their pioneering days museums were often part of a holistic vision of a healthy society today. The first wave of public health involves solving major physical problems of industrial cities, including building sores and providing clean water, as you can see in the cartoon in the top of my slide. Museums in this period were set up for many reasons to express imperial or national identity, but also to educate a broad public or civilizing the masses as it would have been called then. These educational intentions were often paternalistic, but before universal free state-funded public schools, museums were an important progressive contribution to public learning, and you can see in the cartoons in the bottom of my slide from the 1860s the supposed benefit from visiting a museum on a Sunday, compared to the alternative recreations the cartoon shows a wife pleading with her husband to come home from a pub instead of being improved by looking at objects in a museum. More broadly, in this period, museums, along with public libraries and public parks were part of a holistic vision of the city, as authorities tried to address the appalling conditions of Victorian industrial centres. Many museums, parks and libraries were relatively democratic learning spaces where people could gather safely in the presence of strangers, becoming, however briefly, members of the same community. And in case you think I'm projecting the link between public health museums back from the present, this is a quotation from the speech by a leading city council in 1891, when talking about planning for Glasgow's local hipster museums, the People's Palace, which opened in 1898. In his 1891 lecture, he asked, is it possible for any public health, any public body to deal effectively with institutions and conditions of life, apparently so widely removed as public health and municipal art, and the capital letters are in the original publication of his lecture. So this question of the answer was, quote, a resounding yes. To create a healthy city, all aspects of human wellbeing had to be addressed, whether by clean water or by a great art. And in terms of actually treating the sick, these are quotations from Florence Nightingale, who invented professional nursing in Britain during the Crimean War of the 1850s. She believed that beautiful objects were not only improved the atmosphere of hospital wards, but actually contributed to the cure of the sick and wounded. A wider reason for the foundation of museums in the mid-Victorian period related to human wellbeing was a response to major trends like urbanization, secularization, immigration, which undermined traditional sources of meaning, leading to what Emil Darkheim called ennemy. This was most visible in the creation of open-air museums, which reflected a sense of loss of a whole way of life as people migrated to cities and farming became industrialized. It is possible to see museums more generally as compensating for the destructiveness of the market economy by meeting the human need for communal needs. Nor was this approach restricted to regional or rural museums. The founder of the V&A in London, Henry Cole, was committed to radical access and was explicit about his commitment to making walking-class families welcome in museums, opening the V&A late through using gas lighting specifically to do so, and he wrote eloquently about how London's national gallery was compared to the V&A. In the second wave of public health from about 1890 to 1950, scientific expertise was the dominant mode, solving many medical problems, creating vaccines, and later on antibiotics. In this period, museums were also professionalized and their expertise recognized and codified, and in many cases, however, lost their pioneering, democratic and experimental impulses so that they served educated classes rather than aiming to educate the wider population. They lost their holistic perspective and became narrowly, professionally focused. When people talk about traditional museums, what they're often talking about is this later elitist model which developed along with aestheticism and modernism, partly in response to mass democratization. So, for example, when Henry Cole, the founding director of the V&A, retired, the curators who took over completely withdrew the commitment to public engagement and it became the elitist institutions which it remains today. I'm not going to walk through the next two stages of public health in detail. As I said, they overlap and they're cumulative, with major efforts after World War II to address what were then called the social evils of poverty, ill health and ignorance. Through Universal, state provided free education and healthcare, the welfare state as we call it now. Again, there were huge advances in science, including, for example, proof that tobacco was dangerous with subsequent state control. In the museum world, this was a period of massive expansion with numbers increasing exponentially over the period. This is the world we live in now, where museums have a strong professional ethos of collections care, combined with marketing, blockbuster exhibitions, very well developed education service, disabled access, outreach to deprived communities, as well as a continuation in parallel of the elite model of museum provision based on prestige. So, after this brief look at museum history, which suggests to me anyway that the Victorians had great ambitions from museums to improve people's lives, I would like to look at the evidence from medical epidemiologists, these medical statisticians, on the impact of museum visiting, or in other words, were the Victorians right about museums improving people's lives. There are about 20 of these studies that I've referred to, which demonstrate that museum visiting, not participating in any intensive activities or workshops, simply visiting museums or attending other cultural activities, like going to the cinema or live music, make people live longer. This study, for example, showed that visiting museums in the cinema had an impact on people's, the length of people's lives on a large scale. The study involved over 14 years involved 10,000 people and was controlled for gender-smoking economic status, education and chronic illness. The key question, of course, is whether, which way the causal vector runs? Is it that healthier people visit museums more often, or that people who visit museums become healthier? This was addressed in a 2001 study by Johansson, Conlon and Byron, which aimed to assess, quote, how changes of inhabit of attending cultural events in the community might predict self-reported help. They studied just under 3,800 adults over a 12-year period and found that, quote, those who became culturally less active between the first and second occasions, or those who were culturally inactive on both occasions, ran a 65% increased risk of impaired, perceived health compared to those who were culturally active on both occasions. The study further found that those who changed from being culturally less active to being more active had about the same level of perceived risk as those on both occasions. They concluded that these results could be in agreement with the causal influence of cultural stimulation. This is another study, this time not about museum visiting but about reading, because one of the questions is, is it just the social experience of museum visiting, or is it just walking around to visit a museum? This study found that among 70-year-old men living in Israel in community, not in care homes, found that men who read for 20 minutes a day lived longer than those who didn't. And the final study I'm going to refer to, again, by Bygren Johansson and Conlan and others, assessed the health impact, health differences of impact between those who rarely attended cultural events, the events listed here, cinema, theater, art galleries, museums and live music, where defined as under five, moderate, six to 12, and frequently over 12. And they found that in, again, a very large number of people, I think 8,000 people, followed up 12 years later, rare attendees were over three times, and moderate attendees were nearly three times, more likely to die of cancer than frequent attendees. So to summarize, the impact of museum visiting from these 20 studies and museum visiting along with other cultural activities, there's growing evidence for the health impact of simply visiting museums, and that this is not just a reflection of income class or education. There's also evidence that a state will visit museums more often, but that visiting museums generates improved health. The evidence is that, like exercise, the benefit of museum visiting is ephemeral, and it can be lost or regained if cultural attendance is stopped or started. If you would like more information about this research, I've written an article which summarizes it. If you Google my name and mental health and museum, it should come up. If you can't find it, contact me via LinkedIn, and I can send you a copy. So to bring the two kinds of evidence together from a Chatterjee and Moose book and from the medical epidemiologist, we can say that museums provide a wide range of benefits to individuals, small groups, and large populations, so that we can be confident that museums have a significant role in public health. What I would now like to do is to join up the small projects and the larger population impact as part of our contribution to the new wave of public health impact. This requires, I think, a strategic approach, whether your museum is heavily involved already in health related activities or whether you're just about to begin. So the final section of my talk, no, sorry, it's only the second section of my talk, is about the fifth wave of public health and the crisis of modernity. So this is a slide about globalization. I'm sure you could make up your own about the huge changes that are happening in the world across all sectors and the huge stresses they place on people. The impact of deindustrialization, globalization, and particularly the pressure to consume, the competitive pressure on people to constantly upgrade their consumer products and the pressures of media culture, are giving us new freedoms, new choices, but also creating new pressure reducing social support and eroding traditional sources of individual family and communal meaning and leading to new sources of chronic ill health, poverty and demoralization. The crisis therefore of modernity in terms of health is causing huge inequalities and increasing inequalities in health and new sources of ill health. The main causes of illness and early death are no longer contagious or infectious diseases, but a consumerist culture, particularly the consumerist food culture which promotes obesity, an intensification of individualism which leads to further loss of meaning and to the disease conditions of our time, mental ill health, suicide, loneliness, addictions and substance abuse. As statistics show that in last year more people committed suicide than were killed in war or in violent crime and as more and more people live alone research suggests that chronic loneliness is going to become as great a cause of early death as smoking. This is a chart from a foresight report by the British government, huge scientific study of what enables well-being and the key thing that comes across from it is complexity and working out where to intervene is one of the big problems for museums. Luckily a UK think tank called the New Economics Foundation has summarized the implications of the foresight report with this advice for people. It's the equivalent of five a day portions of fruit and vegetables for physical health. In effect these are five a day for mental well-being. The advice is that people need to connect because people are important for our well-being, crucial for our well-being. People need to be active because being active not only improves our physical health but improves our mood and helps us sleep better. Taking notice, practicing awareness of sensations, thoughts and feelings helps us improve our well-being, keeping learning because this is good for our self-esteem, gives us skills for life and keeps us mentally fit, give volunteering, generosity, improve our mood and our self-esteem as is receiving people also need to learn to receive more. Regularly engaging in these activities not only gives us a feeling of well-being and a more satisfying life, they also build our resources, our mental capital, keeping us more mentally alert and more resilient in the face of adversity and I think you can see immediately how he's fit into much of what museums do already and have potential for expansion. Professor Hamlin sets out what he sees as the characteristic of the emerging wave of public health. I'm not going to go into this in detail here but the underlying philosophy is for institutions to support people's resilience so they can resist consumerist culture and also not rely on state prohibitions, building a healthier society through promoting positive good relationships based on trust and mutual acceptance and I'll come back to this in terms of the structure of strategic framework for museums. This is, as Hamlin defines it, the aspiration for the fifth wave of public health and it seems to me to provide a very useful way for looking at the potential contribution of museums to health and well-being rather than thinking of museums as a site for medical treatment. Museums which are outside the market and we resist the pressures of the market and we remain part of the public sphere as long as we continue to do this and also reject the elitist traditions, be genuine and inclusive. If we do all of these things, museums can be sites of hope, motivation and consciousness raising. We can approach the health and well-being of our communities on our own terms, make a contribution to addressing the disease conditions of our time as I said mental ill health, suicide, loneliness, addiction, substance misuse, social isolation. We can do this on our own terms not by trying to provide treatment for small numbers of people in our venues but through renewing our commitment to radical access so that we can be sites for the recovery of meaning and catalysts for rebuilding social trust, mutual awareness and acceptance. So I think this gives us a wider sense of why museums are engaging with health and well-being now. Part of it is about the constant increasing pressure to justify what we do and to demonstrate in new roles where we add value but I also have tried to show today that part of our tradition, one tradition of museums going right back to the origins of public museums in the Victorian period is a part of a holistic vision of a healthy society which recovers meaning and creates community and also we are intuitively responding to the health crisis of modernity. So in order to develop a strategic approach I think we need to move from projects and services to a wider strategy but before we do that I'd just like quickly to remind you of the whole range of health benefits from museums which you can see on the left and the idea that it's a behavior that people need to repeat over and over again to gain the benefit. A significant number of health related projects have a beginning and an end and don't generate new visitors to museums which I think is where the large-scale potential for a health impact is. So one way of trying to create a framework is to look at it in terms of spectrum of engagement. On the left hand side you have formal therapy where health professionals treating people in a museum for example with art therapy for people with a mental health problem. This is relatively rare. Museums most often work in this second column on projects and the third column services focusing on people with a diagnosed condition like dementia, depression or autism. These are usually carried out in partnership with health organizations or in column 3 targeting vulnerable groups like refugees and asylum seekers. There is good evidence for the benefits of these projects for these parties. The wider next stage of a strategic approach is set out in columns 4 and 5 given the evidence that regular museum visiting without intensive activity as a significant museums on health. The key question is how can we promote museum visiting amongst people whose health is vulnerable whether because of poverty, minority stages or mental health. I think at least part of the answer is to join up small-scale projects and services to activities targeting large populations of vulnerable or elderly people. It's possible to envisage a cycle where a museum begins with small projects focusing on a particular population group whether it's the elderly, socially isolated people, refugees or whoever. This would of course be co-produced where representatives of that group community. The key for me then is the next stage where the whole museum not just the outreach or education department learns how the museum needs to change to make large numbers from this group more welcome. This might mean training for front-of-house staff for example in dementia or autism awareness or how to welcome people who don't speak the majority of them. It might mean changing the displays so that disabled people or different cultural groups are represented in the museum. The next stage would be to mobilize this wider population group the target population through large-scale events. It's easier for novice visitors to visit a museum if there's a large-scale event which they can intend informally with their family and friends rather than going in it with a small group of a member or family member or a friend. These can be used to foster a sense of ownership of the museum as well as more specific actions like signing people up to receive information about future events. Ultimately the aim of the activity is not simply to treat a small number of people but to generate new regular visitors from a large population group. The museum can then begin the cycle again with a new group building partnerships and audiences and learning as it adapts to different needs. So this is what I think a framework for museums health and well-being might look like. At the center is what people can do to help sustain their mental health and build their resilience to five a day from mental well-being which as I said fit very well with the functions and assets of museums and other cultural institutions. Museums need to work with social partners to create these activities not only for the expertise of the partners but to reach people whose health is vulnerable and for whom museum visiting is not already part of their lives. Through a process of organizational learning based on deep experience of working with these target groups the whole museum can gradually adapt to welcome new visitors from these communities with programs of event supporting novice audiences. The museum the museum's role in all of this then becomes more actively to build new relationships of trust acceptance awareness so that it becomes a catalyst for hope meaning and social connection. So that's the end of the presentation but I just wanted to say a few words about some key books. I've been looking to see what's available in languages other than English. The Cultura e Salute book in Italian is about culture and health quite general and in some ways quite theoretical but it shows that there are people working in this field. Culture and health is a Swedish publication a wider horizon available free online. Museums and health by Helen Chatterjee and Guy Noble is a 2013 book the only monograph devoted to museums and health and more recently the larger book the Oxford Textbook of Creative Arts, Health and Wellbeing by Pete Paul Kamek and Stephen Cliff is a definitive overview of arts health and well-being. It has a chapter by Helen Chatterjee on museums so it's fairly up to date and it has a chapter by Professor Hanlon on the five waves of public health. If anybody knows of other books in other languages about museums health and well-being or other publications I'd be delighted to hear about them but to I think go back to finish on this slide about a strategic framework I would be very interested to know if people think this would provide enough organising structure for people to enable museums to reach larger numbers of people. Thank you very much. So the first question the questions are coming through on the chat line and I'm going to read them out and then try to answer them. One is from Arianna Friedcourt and it's about the 2001 Johansson study about culture activities in general cinema museums and asked about museums themselves is there any specific study museums compared to other cultural activities and other cultural domains. There are studies that include museums in Helen Chatterjee's book sorry that are specific to museums in Helen Chatterjee's book. I'm not as concerned about the specifics of museums. Some of the statistical articles speculate about the mechanism and one of them is that museum visiting and going to the cinema have in common that they're powerful visual experiences generally non-verbal and can reach the subconscious almost in a direct way but if you connect with me through LinkedIn I will send you the list of all the articles in this domain University College London have done studies about handling museum objects and their impact on health and those references are in the 2013 book. The next question is also about the specifics of museums. I don't about whether there's evidence that different types of museums have more capacity for providing well-being. I don't know of any study that has done this. So the next question is more of a comment about museums with more open staff and more capacity to walk with communities and their well-being. Yes, humane museums that have a capacity for empathy in general I think make a more positive contribution to society as a whole. There's a question about museums and with difficult subjects like the holocaust and army museums. The research at the population level is broad and statistical. It's about tens of thousands of people doing something repeatedly and I don't know of any studies of specific museums and I think it will be very difficult to do studies of specific museums. The kind of effect that the medical studies make up I don't think is detectable in project studies. It's a much wider impact than that. I think army museums and holocaust museums it really depends on how the display is done. If the army museum are very old-fashioned and technical in nature it's unlikely to inspire empathy to move people. If it's about the human stories of conflict you can see how it would reach the subconscious where stress can be relieved and empathy can be developed. I don't think that there's any issue with painful subjects like the holocaust. I think they strike directly at our humanity and they seem very likely to improve our well-being but I don't know of any direct evidence for that. Someone is asking through the chat if anybody has experiences of using the health and well-being to described by UCL. I don't know if anybody's responding to that but the study was developed in partnership with 30 museums so the study includes the list of those 30 museums so you can see who was involved in actually creating the study and they were also all have experience of using it. The screen is now buffering. Is there another question coming through? Are there studies of any of the role of national museums in the framework of health and well-being? Again the studies don't distinguish between the different types of museums. I think this is an interesting theme that is emerging from the question. People seem really concerned that their type of museum won't be effective or might be more especially effective. I think the framework will work for any museum. If you look at the center the five the five a day for well-being it's impossible to imagine a good museum that wasn't able to enable people to connect with people to learn something to be able to notice more to be more self-aware to be reflective and to keep learning and to volunteer. So I think I suppose one of our professional vices is that we want to be special and that we want our kind of museum to be especially effective. I think what we're talking about is objects of a huge range which are rich in meaning rich in resonance which engage people and they can be a focus for positive human meaningful activities. Equally you can imagine museums that promote a narrow restrictive ideological sense of identity that limits people's sense of well-being or capacity to grow. So I don't think the genre of the museum or the size of the museum is the issue. I think it's about whether it wants to contribute to a holistic sense of society, society for well-being or whether it wants to be a kind of specialist niche. Which brings me back to in a sense the first question that was on cultural activities. What again in other vices of museums is that they want to do things in isolation. We want to do that project with asylum seekers and we want to do it on our own when actually the asylum seekers or the older people would benefit from a wide range of cultural activities. So it's very unusual for museums to partner with cinemas to partner with live music and but if all of these benefit people it seems to me that these should be natural partners for developing well-being promoting activities. So we have a question from Elizabeth Theonides who's at the National Museum of Contemporary Art and Athens who heard a pilot art psychotherapy program on the museum premises with an art psychotherapist and she's offering a study of on art therapy and contemporary art for those who are interested in studies of art therapy and museums and she says you can find information in the bibliography at atmag.org so that's an offer of extra information. Okay we have another one Victoria Victoria is asking if anybody knows of specific studies of the impact of museums and cancer patients. The and Anne is asking me that I mentioned statistics about the frequency of visits and reduction of cancer. Okay the there are studies of art therapy about for cancer patients that show that reminiscence work improves people's morale there's no evidence that it affects the cancer but it improves people's mental resilience and capacity to deal with having cancer. The study that I mentioned is about people whether or not people get cancer in the first place but again the team of specifics the having art therapy museum talking about museum visiting and cancer these are treatment these are treatment models and what I'm arguing for is that we shouldn't be thinking of treatment models and the numbers you can reach are tiny and it's perfectly reasonable if there's an art therapist who can organize art therapy in the museum or the art gallery and use the resources for the museum but if that takes up a lot of staff time I would argue it would be much better for the museum to use that staff time to increase regular visiting among people whose health is vulnerable so trying to walk out a way that museums can treat cancer patients would might after a very ex-study result in treating 10 or 20 people over six months whereas for the same resource you could get tens of thousands of people visiting the museum and helping them prevent prevent them becoming unwell in the first place and this is why I think the spectrum of engagement is crucial I think trying to do treatment model are us wanting to do things that we're not good at all the people can do them but again as I say you can have these activities in the museum just like you might have a technical lecture but I don't think that's where the biggest potential for the health in the eyes the detailed study of museums as a form of treatment in hospitals as well as in the museum is covered by Helen Chatterjee's chapter in the Oxford textbook on the arts culture and public health so so Arianna Friedcourt is asking are there studies that would show the visiting a museum I cannot clear what it means people who are on medication would improve or worsen the health state of someone with psychological or physical problem I think what the epidemiological research that I summarized shows is that it does improve the health of people who have a pre-existing condition the studies were controlled as I said for age, gender, smoking, class, education but also for chronic illness so if people have a if people in general have a pre-existing condition residential or physical museum visiting does does seem to improve their health just waiting to see if there are any more questions and the screen is buffering so there's no question no further questions everyone okay well thank you so much for the opportunity to raise these issues and to offer some ideas some very initial draft framework on this topic I hope to hear from some of you as you in your follow-up thinking and the best of that with your efforts in changing the role of museums to be more positive for helping thank you very much