The volume of research and potential applications is promising. But critics believe it is ‘premature’ to include the arts in health policy across the board. Their view, which calls for more-robust evaluation, is that the evidence base is not solid enough to justify widespread adoption.

Misgivings center on the standard of evidence that should guide policy. Some scientists argue that formal systematic reviews would be better than the scoping reviews commissioned by the WHO and others, which they say are more vulnerable to bias6. “If it's a policy question [being asked], then you would want a systematic review,” says Christina Davies, director of the Centre for Arts, Mental Health and Wellbeing at the University of Western Australia.

“The evidence is strong for some aspects of the ‘arts–mental health relationship’ and ‘arts–social health relationship’,” Davies notes, “so this should/could be included in health policy and used in health practice depending on the question being asked.”

Fancourt defends the choice of a scoping review for the WHO report4. A systematic review was not the right methodology for the brief, she argues, and it would have been impractical.

Just how strong is the science? “I think that's a complex question,” says Sajnani. “It's a great deal of variance in the evidence base, at least at the time [of] that scoping review.” Writing in The British Medical Journal on the release of the WHO report, Fancourt acknowledges that the quality of studies varies, as in any area of research7. But she points to a growing number of randomized controlled trials comparing the arts not only with control conditions but also with other medical and non-medical interventions.

Critics’ doubts extend beyond the standard of evidence. “There are actually few studies that report the positives and the negatives,” says Davies, and this risks leading to simplistic notions that everyone will benefit from engaging with the arts. “A positive for mental well-being might be people talk[ing] about happiness, joy, relaxation. But a negative might be frustration with your activity.”

Poor implementation is another concern. Programs may lack ethical guidelines or may simply fail. Communication between the health and arts sectors can be hit or miss, with confusion on where responsibility lies. The mode and ‘dose’ of artistic engagement that should be prescribed is another open question.

The WHO report concedes there are cases in which engaging with the arts can cause harm or make almost no difference to health4.

“We have more to gain by leaning into the arts as a health resource than we have to lose,” argues Sajnani. The WHO sees arts-based interventions as a low-cost, low-risk and holistic tool that aligns with its definition of health as not merely the absence of disease.

Culture ministries are enthusiastic, embracing better health as one of the ways the arts add value to society. Health ministries have proved more cautious so far, says Sajnani, but that is slowly changing.

A report commissioned by the UK government recently found that being a consumer of the arts and culture is good for health and productivity8. Using Fancourt’s research to estimate £8 billion per year worth of benefits, it strengthens the economic argument for investment.

Funding is vital to sustain the arts in public health. But it could also take resources from more established interventions, Davies points out. Would such a shift in how money is allocated be “rigorous and believable” on the basis of the science? “At the moment, that's the question that we're asking,” she says.