Il presente contributo introduce i riferimenti teorici alla base del progetto Cultura, wellbeing e salute, che si sviluppa grazie alla collaborazione tra l’Università di Modena e Reggio Emilia, l’Università di Siena, varie istituzioni culturali e socio-sanitarie, tra cui la Fondazione Palazzo Magnani di Reggio Emilia, l’Archivio di Stato di Modena, la Biblioteca Panizzi, il Centro Demenze e Alzheimer di Modena, e centri e associazioni locali (Centro di Neuroscienze Anemos, Associazione via Roma 0, ProArena e Avis di Arena (VV), ProLoco di Enna, PAN Patrimonio Arte e Natura). Il progetto, in corso di sviluppo, prevede una serie di casi pilota volti a sviluppare indicatori e metodologie per misurare l’impatto sociale della cultura nella società, con particolare riferimento a anziani e persone con patologie, disabilità e fragilità.
Framework europeo
Il contributo introduce il framework europeo di riferimento e prosegue con una selezione di contributi internazionali sul tema.
Il Framework for actions in Cultural Heritage (2018) prende significativamente in esame come il patrimonio culturale possa rivestire un ruolo centrale nelle società, in termini di integrazione, educazione, diffusione della conoscenza e delle interpretazioni. Nel Pilastro 1, Cultural Heritage and Inclusive Europe, viene esplicitamente indicato il potenziale valore che il patrimonio culturale può esercitare anche sul livello di benessere e inclusione sociale dei cittadini e delle società. La New European Agenda for Culture individua, tra le cinque priorità delle politiche europee di cooperazione, sia la coesione sociale sia il benessere degli individui. L’Agenda 2030 per lo sviluppo sostenibile rappresenta un importante strumento programmatico per combattere la povertà e per dirigere le strategie dei paesi verso uno sviluppo sostenibile.
Tra i 17 Sustainable Development Goals (SDGs), l’obiettivo 3 “Ensure healthy lives and promote well-being for all at all ages highlights the promotion of social inclusion through improved access to social, cultural and recreational services” (European Commission’s Directorate-General for International Cooperation and Development).
Il concetto di benessere include molteplici fattori quali la qualità della vita e delle relazioni, le emozioni e la resilienza, ma anche la salute fisica e mentale e quella auto-percepita. In questa direzione, il patrimonio culturale può diventare un mezzo per elevare i livelli di benessere, in quanto è generatore di consapevolezza, creatività, identità e coesione sociale. Se il patrimonio culturale produce valori key drivers per la performance umana, le esperienze culturali devono essere valorizzate anche per il loro potenziale di integrazione nell’assistenza sanitaria, come supporti terapeutici, non farmacologici, a sostegno il benessere e della salute dei cittadini.

Una definizione complessa di salute
La World Health Organization (WHO) ha definito la salute come uno “state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity” (Constitution of WHO 1946). La definizione del WHO include quindi la componente del benessere come rilevante per definire il livello di salute di un individuo. La consapevolezza del peso della componente culturale in termini di salute emerge anche nell’adozione del programma Health 2020, il quadro della politica sanitaria europea, in cui viene posta forte enfasi sul benessere percepito dalle popolazioni europee. L’Ufficio Regionale per l’Europa dell’OMS ha recentemente avviato un progetto sui contesti culturali della salute con un’analisi approfondita di come i fattori culturali influenzano la salute e il benessere.
In particolare, nel 2008, il Foresight Mental Capital and Wellbeing Project ha definito il benessere mentale come un “dynamic state in which the individual is able to develop his/her potential work productively and creatively, build strong and positive relationships whit other and contribute to their community. It is enhanced when an individual is able to fulfil their personal and social goals and to achieve a sense of purpose in society”. La salute fa parte del capitale umano, è una risorsa anche per la prosperità economica e lo sviluppo sociale. I musei e le istituzioni culturali, attraverso le loro attività culturali e creative, possono esercitare un forte potenziale terapeutico nella società. Le istituzioni culturali offrono ambienti inclusivi e terapeutici in grado di esercitare benefici psico-fisici ed emotivi, il loro ruolo è particolarmente saliente nel contesto attuale di crisi dell’emergenza COVID 19 e nei futuri scenari post-pandemici.
Lo stato dell’arte
Lo stato dell’arte proposto riporta una rassegna di studi che confermano le relazioni esistenti tra cultura, benessere e salute. Gli studi appartenenti a molteplici ambiti disciplinari (indagini mediche e psicologiche, esperimenti neuroscientifici, ricerche, strumenti e pratiche avviate da istituzioni culturali) dimostrano che il rapporto tra benessere e salute è rilevabile sia nelle esperienze che introducono la cultura negli ambienti di cura, sia nei casi in cui le esperienze culturali svolte in musei, gallerie, siti archeologici vengono rivolte a individui con patologie e fragilità.

Rassegna degli studi essenziali che hanno previsto la valutazione dell’impatto delle attività culturali su differenti pubblici all’interno di musei, gallerie, siti archeologici
Groups of patients involved | Benefits | |
Patients with cancer undergoing chemotherapy treatments. Hospitalized patients awaiting surgery and Patients undergoing flexible sigmoidoscopy. | Decrease in depression and reduction in the perception of tiredness in patients during chemotherapy treatments; Reduction of anxiety during the pre-surgical phase. | Bar-Sela G., Atid L., Dans S., Gabay N., Epelbaum P. 2007. Art therapy improved depression and influenced fatigue levels in cancer patients on chemotherapy. Psychoonocology, 16, 980–984. Kain Z.N., Wang S.M., Mayes L.C., Krivutza D.M., Teague B.A. 2001. Sensory stimuli and anxiety in children undergoing surgery: A randomized, controlled trial. Anesthesia & Analgesia, 92(4), 897–903. |
Patients with cancer. Women with cancer. | Decrease Anxiety; Enhancement to emotional expression, spirituality, and psychological well-being; Increased quality and lifespan in people diagnosed with end-stage cancer; Reduction of symptoms of discomfort and improvement of the quality of life for woman with cancer. | Deane K., Fitch F., Carman M. 2000; An innovative art therapy program for cancer patients. Canadian Oncology Nursing Journal 10(4):147-51. Walsh S. M., Martin S. C., Schmidt L. A. 2004. Testing the efficacy of a creative arts intervention with family caregivers of patients with cancer. J. Nurs Scholarsh. 36(3): 214-219. Puig A., Lee S. M., Goodwin L., Sherrard P. 2006. The efficacy of creative arts therapies to enhance emotional expression, spirituality, and psychological well-being of newly diagnosed stage I and stage II breast cancer patients: a preliminary study. Arts Psychother. 33(3): 218-228. Nainis N., Paice J. A., Wirth J. H., Lai J., Shott S. 2006. Relieving symptoms in cancer: innovative use of art therapy. J Pain Symptom Manage 31(2): 162-165. Crogan N.L., Evans B.C., Bendel R., 2008, Storytelling Intervention for Patients with Cancer: Part 2 – Pilot Testering. Oncology Nursign Foru. Vol. 35, Issue 2: 265-272. Monti D. A. et al. 2006. A randomized, controlled trial of mindfulness based art therapy (MBAT) for woman with cancer. Psychooncology. 15(5):363-373. Fancourt D., Aufegger L., Williamon A. 2015. Low-stress and high stress singing have contrasting effects on glucocorticoid response. Front Psichol 6. Portnoy S., Girling I., Fredman G. 2016. Supporting young people living with cancer to tell their stories in ways that make them stronger: The Beads of Life approach. Clinical Child Psychology and Psychiatry 21(2). Hilliard R.E. 2003. The Effects of Music Therapy on the Quality and Length of Life of People Diagnosed With Terminal Cancer. Clinical TrialJ Music Ther, 40(2):113-37. Monti D. A. et al. 2006. A randomized, controlled trial of mindfulness based art therapy (MBAT) for woman with cancer. Psychooncology. 15(5):363-373 |
Patients undergoing hemodialysis. | Reduction of hemodialysis parameters. | Ross E. A., Hollen T. L., Fitzgerald B. M. 2006. Observational study of an art in medicine program in an outpatient hemodialysis unit. Am J Kidney Dis. 47(3): 462-468. |
Hospitalize patients. | Reduction of sedatives during intervention and hospitalization procedures. Salivary increase in immunoglobulin A (IgA), (an antibody that provides defense against various infections). Increase in patient wellbeing and sustainability of care; reduction in the use of painkillers and the average duration of hospitalizations, increase in responses to treatments. | Loewy J., Hallan C., Friedman E., Martinez C. 2005. Sleep/sedation in children undergoing EEG testing: A comparison of chloral hydrate and music therapy. Journal of PeriAnesthesia Nursing, 20(5), 323–332. Walworth D. 2005. Procedural-support music therapy in the healthcare setting: A cost-effectiveness analysis. Journal of Pediatric Nursing, 20(4), 276–284. Lane D. 1990. The effect of a single music therapy session on hospitalized children as measured by salivary immunoglobin A, speech pause time, and a patient opinion Likert scale. Unpublished doctoral dissertation. Case Western Reserve University, Cleveland, OH. KCI Research and Evaluation (2002). Satisfaction and outcomes assessment hospital artist-in-residence program of The Creative Center arts for people with cancer. Accessed April 28, 2005 from www.thecreativecenter.org |
Patient post operatory. | Increase the level of post-operative comfort. | Pölkki T., Vehviläinen-Julkunen K., Pietilä A-M. 2001) Nonpharmacological methods in relieving children’s postoperative pain: A survey on hospital nurses in Finland. Journal of Advanced Nursing, 34(4), 483-492. |
Hospitalize children and children post-operatory. | Release of endorphins and reduction of catecholamines, heart rate and blood pressure; Decrease in pain (linked to oxygen saturation levels). | Henry L. L. 1995. Music therapy: a nursing intervention for the control of pain and anxiety in the ICU. A review of the research literature. Dimes Crit Care Nurs. 14: 295-304. Hatem T.P., Lira P.I.C., Mattos S.S.2006). The therapeutic effects of music in children following cardiac surgery. Jorn de Pediatria, 82(3), 186-192. Boso M., Politi P., Barale F., Emanuele E. 2006. Neurophysiology and neurobiology of the musical experience. Functional Neurology 21(4), 187. Collins S., Kuck K. 1991. Music therapy in the neonatal intensive care unit. Neonatal Network, 9(6), 23–26. Standley J., Moore R. 1995. Therapeutic effects of music and mother’s voice on premature infants. Pediatric Nursing, 21(6), 509-512, 574. |
Children with prosthetic. | Children following cardiac surgery. Reduction of anxiety in children undergoing operations. | Thamine P. H., Lira P. I., Mattos S. S. 2006. The therapeutic effects of music in children following cardiac surgery. Journal de Pediatria Vol. 82, No. 3, 187-192. Brice J., Barclay J. 2007. Music eases anxiety of children in cast room. Journal of Pediatric Orthopedics, 27, 831–833. |
Children with cystic fibrosis. | Benefits in therapy for children with cystic fibrosis. | Grasso M., Button B., Allison D., Sawyer S. 2000. Benefits of music therapy as an adjunct to chest physiotherapy in infants and toddler with cystic fibrosis. Pediatric Pulmonology, 29(5), 371–381. |
Stroke Survivors’ in Rehabilitation. | Benefits during pulmonary rehabilitation in adults with COPD. Psychological and social benefits. | Bauldoff G., Hoffman L., Thomas G., Zullo T., Sciurba F. 2002. Exercise maintenance following pulmonary rehabilitation. Chest, 122, 948–954. Chow E.O.W. 2015. Narrative Therapy an Evaluated Intervention to improve Stroke Survivor’ and Emotional Adaption. Clinical Rehabilitation, august20-2015. |
Premature Infants. | Increased heart rate and improved behavioral responses in premature infants from the neonatal intensive care unit; Decrease in the incidence of respiratory pauses in premature infants and reduction of length of hospitalization in the intensive care units. | Arnon S., Shapsa A., Forman L., Regev R., Bauer S., Litmanovitz I., et al. 2006. Live music is beneficial to preterm infants in the neonatal intensive care unit environment. Birth, 33(2), 131–136. Shepley M., 2006. The role of positive distraction in neonatal intensive care unit settings. Journal of Perinatology, 26, S34–S37. |
Children with pediatric trauma. | Reduction of acute stress symptoms in Pediatric Trauma Patients. | Chapman L., Morabito D., Ladakakos C., Schreier H., Knudson M. 2007. The effectiveness of art therapy interventions in reducing post-traumatic stress disorder (PTSD) symptoms in pediatric trauma patients. Journal of The American Art Therapy Association, 18, 100–104. |
Onco-Hematological children. | Improvement interpersonal relationships/communication and well-being. | Margherita G., Martino M. L., Recano F., Camera F. 2013. Invented fairy tales in groups with onco-hematological children. Child: care, health and development. 40, 3, 426-434. |
Patients undergoing stem cell transplants. | Reduction of anxiety, depression and mood disorders in patients undergoing stem cell transplants. | Cassileth B.R., Vickers A.J., Magill A.M. 2003.Music Therapy for Mood Disturbance During Hospitalization for Autologous Stem Cell Transplantation: A Randomized Controlled Trial. Cancer 5;98(12):2723-9 |
Patients with anxiety, mental disorder and PTSD depression. | Reduction of states of depression, anxiety, and improvement of interactional skills. | Ezell C. M. 2017,Touch Painting: An Art Therapy Intervention on Anxiety in Older Adults. Expressive Therapies Dissertations. 2. ttps://digitalcommons.lesley.edu/expressive_dissertations/2; Choi A., Lee M., Lim H. 2008. De Lucia J.M. 2016. Art Therapy Service to Support Veterans’ Transition to Civil Life: The Studio and the Gallery. Art Therapy Journal of American Art Therapy Ass. 33,4-12. |
Patients with myocardial infarction. | Lower heart and respiratory rates, and the need for oxygen. | White J.M. 1999. Effects of relaxing music on cardiac autonomic balance and anxiety after acute myocardial infarction. American Journal of Critical Care, 8(4), 220–230. |
Pregnant women. | Decrease in blood pressure levels. | Staricoff R.L., Duncan J., Wright M., Loppert S., Scott J. 2001. A study of the effects of visual and performing arts in healthcare. Hospital Development, 32, 25–28. Duncan JP, Staricoff RL., White M. 2003. A study of the effects of visual and performing arts in health care Chelsea and Westminster Hospital Arts. https://www.artshealthresources.org.uk/docs/a-study-of-the-effects-of-visual-and-performing-arts-in-healthcare/ |
Patients undergoing surgery. Adults undergoing bone marrow transplantation, surgery, after anesthesia or chemotherapy. | Reduction of pain perception during intramuscular injection, during bone marrow aspiration, and after surgery; Reduction of nausea and vomiting in adults undergoing bone marrow transplantation, surgery, after anesthesia or chemotherapy. | Pfaff V., Smith K., Gowan D. 1989. The effects of music-assisted relaxation on the distress of pediatric cancer patients undergoing bone marrow aspirations. Children’s Health Care, 18, 232–236. Steinke W. 1991. The use of music, relaxation and imagery in the management of postsurgical pain for scoliosis. In C. Maranto (Ed.), Applications of Music in Medicine (pp. 141–162). Washington, DC: National Association for Music Therapy, Inc. Standley J. 1992. Clinical applications of music and chemotherapy: The effects on nausea and emesis. Music Therapy Perspectives, 10, 27–35. Keller V. 1995. Management of nausea and vomiting in children. Journal of Pediatric Nursing, 10(5), 280–286. Ezzone S., Baker C., Rosselet R., Terepka E. 1998. Music as an adjunct to antiemetic therapy. Oncology Nursing Forum, 25(9), 1551–1556. Gabriels R., Wamboldt M., McCormick D., Adams T., McTaggart S. 2000. Children’s illness drawings and asthma symptom awareness. Journal of Asthma, 37(7), 565–574. |
Outpatient hemodialysis unit; Patients with Rheumatoid Arthritis. | Increased level of well-being, with benefits on depression Pain reduction in people with rheumatoid arthritis. | Ross E. A., Hollen T. L., Fitzgerald B. M. 2006. Observational study of an art in medicine program in an outpatient hemodialysis unit. Am J Kidney Dis. 47(3): 462-468. Schorr J.A. 199. Music and pattern change in chronic pain. Advances in Nursing Science 15(4). 27–36. |
Alzheimer and Dementia’s Patients. | Increased brain’s plastic processes; Positive impact on feeling and sociality, on cognitive capacities and improvement of quality of life. | Steward G. E. M. 2011. Art Therapy and Neuroscience Blend: Working with Patients who have dementia. Art Therapy, 21(3). Ehresman C. 2014; From rendering to remembering: Art therapy for people with Alzheimer’s disease. International Journal of Art Therapy, 19(1: Art Therapy and Neuroscience). Young R. et al. 2016. The Impact of Community-based arts and Health Interventions on Cognition in People with dementia: A systematic Literature Review. Aging & Mental Health, 20 (4). |
Patients with Coronary Heart Diseases. | Greater control of anxiety during post stroke therapies in coronary heart diseases. | Nilsson U. 2009. Soothing music can increase oxytocin levels during bed rest after open heart surgery: a randomized control trial. J Clin Nurs 18(15), |
Selezione di progetti, programmi, buone pratiche e strumenti di valutazione del benessere e della salute nei contesti culturali
CHEurope project, WP. 4 Heritage and wellbeing. http://cheurope-project.eu/themes/wp-4/#wp-people-title |
MA & Alzheimer (ERASMUS +): http://www.maaproject.eu/moodle/ |
APPG 2017a, Creative Health: The Arts for Health and Wellbeing. Inquiry report. https://www.culturehealthandwellbeing.org.uk/appg-inquiry/ APPG 2017b, The Role of the Arts and Culture in Social Care. Inquiry report. https://www.culturehealthandwellbeing.org.uk/appg-inquiry/ APPG 2017c, The Role of the Arts and Cultural Organization in Health and Wellbeing. Inquiry report. https://www.culturehealthandwellbeing.org.uk/appg-inquiry/ |
MoMa 2009. The MoMa Alzheimer’s Project: Making art accessible to People with Dementia. A guide for museums. New York: MoMa. |
Clift S. 2012. Creative arts as a public health resource: moving from practice-based research to evidence-based practice. Perspective in Public Health 132, No. 3. |
Programme of Center for arts in Medicine, Florida University https://arts.ufl.edu/academics/center-for-arts-in-medicine |
Thompson L. J., Chatterjee H. J. 2013. UCL Museum Wellbeing Measures Toolkit. London UCL. |
Breaking Ground Heritage project (Archeological experience for veterans and measuring toolkit) https://www.breakinggroundheritage.org.uk/index.html |
Lista selezionata degli studi. Impatto della lettura e storytelling sul wellbeing e la salute
Stroke survivors’ | Chow E.O.W. 2015. Narrative Therapy an Evaluated Intervention to improve Stroke Survivor’ and Emotional Adaption. |
Children with autism | Delano M, Snell ME. 2006. The effects of social stories on the social engagement of children with autism. J Positive Behav Int. 8 (1): 29- 42. Rust J, Smith A. 2006. How should the effectiveness of Social Stories to modify the behavior of children on the autistic spectrum be tested? Autism J. 10 (2): 125- 138. Giuliano F., Couchepin Marchetti B., Perrenoud V., El Korh P. 2016. Is Storytelling Therapy Useful for Children With Autism Spectrum Disorders and Severe Mental Retardation? In Adv. Tech. Biol. Med 4:166. Nasiri R, Mohammad Esmail E, Amiri G, Nasiri M. 2017. The study of storytelling effectiveness on social interaction of boys with autism spectrum disorder. ZUMSJ. 25 (109):100-108. Manzari, Tavakoli, Hosseini S.E., KarimiL. 2018. The effect of Social Storytelling on Motor Skills and Verbal Communication among children and Adolescents (5-17 years old) with Several Autism Spectrum Disorder. Report of Health Care Journal, 4(2): 28-37. |
Patients with Dementia | Holm, A.K., Lepp M., Ringsberg K.C. 2005, Dementia: involving patients in storytelling: a caring intervention. A pilot study. J. Clin. Nurs., 14(2): 256-63. Hyde L.-C.2013. Storytelling in dementia: Embodiment as a resource. Dementia, 12(3): 359:367. Margherita G. et al. 2013, op. cit. |
Adults | Liu C., Keeling D. I., 2015, Strategies Narratives and Wellbeing Challenges: The Role of Everyday Self-Presentation. Journal of Business Research 69(1): 234-43. |
Children and Adolescents | Subbotsky E. 2012. Surviving in the world of the machines: The developmental psychologist’s account of magical belief in the age of science. In Hendrix S. E., Shannon T. J. eds. Magic and the Supernatural. Oxford: Inter-disciplinary Press, 89-99. Suzuki W. A., et al. 2019, Dialogues: The Science and Power of Storytelling, “Journal Neuroscience”, oct 31, 38 (44): 9468-9470. |
Onco-hematological children | Margherita G., Martino M. L., Recano F., Camera F. 2013. Invented fairy tales in groups with onco-hematological children. Child: care, health and development. 40, 3, 426-434. |
Patients with Cancer | Portnoy S., Girling I., Fredman G. 2016, op. cit. |
Pediatric Oncology Patients’ | Wilson D. K. 2015. Exploring the Role of Digital Storytelling in Pediatric Oncology Patients’ Perspective Regarding Diagnosis: A Literature Review. SAGE Open, January-March 2015: 1-10. |