HEALTH PROMOTION WITHIN MUSIC SCHOOLS

There seems to be increasing recognition of the importance of health education aimed at preventing injuries sustained by musicians while they are enrolled in post-school music education programs. This is related to the two-way duty of care inherent in Workplace Health and Safety legislation -- the responsibility of the school to educate students on healthcare and injury management, and also the student's responsibility not to knowingly put themselves or others at risk of injury.

Music health promotion is quite different to music health education and dealing with the health concerns of individuals. Health promotion addresses factors that are related to certain populations, such as social attitudes, equitable distribution of resources, health literacy, building capacity, and social inclusion. Since 'Health for all' is everyone's responsibility, then it is essential that we ensure competent and responsible management of health for music students and also promote healthy patterns of living throughout the lifespan. Music health promotion starts in the home and continues throughout life -- at every stage of people's involvement with music. The attitudes that we display are just as important as the words that we speak in bringing about health promoting schools of music. Music teachers/instrumental instructors, students, performers, architects, sound technology engineers, accompanists and health professionals have very important roles to play. Some articles that are relevant to this discussion are listed below.

Music Health Australia provides educational workshops, music health consultations for students and teachers, and advice to music schools about establishing Music Health programs, courses and health/rehabilitation services. Medical insurance rebates may be available to students for individual and group consultations with occupational therapists and other registered health professionals who specialise in music.

References:

. 

Chesky K, Dawson W & Manchester R. (2006). Health promotion in schools of music: initial recommendations for schools of music. Medical Problems of Performing Artists 21.3 (Sept 2006): pp 142-145. 

Manchester R. (2007). Health promotion courses for music students: Part III.(Special Article)(Report).Medical Problems of Performing Artists 22.3: pp116-120. 

Manchester R. (2007). Health promotion courses for music students: Part II.(Special Article)(Report).Medical Problems of Performing Artists 22.2: pp 80-82. 

Manchester R. (2007). Health promotion courses for music students: Part 1.(Report). Medical Problems of Performing Artists 22.1: pp 26-30. 

Manchester R (2006). Promoting health in post-secondary music schools.(From the Editor)(Editorial)(Report).. Medical Problems of Performing Artists 21.3: pp 95-97. 

Voltmer E, Schauer I, Schroder H & Spahn C. (2008). Musicians and physicians--a comparison of psychosocial strain patterns and resources. Medical Problems of Performing Artists 23.4 (Dec 2008): pp 164-169. 

MUSIC HEALTH PROMOTION - SOCIETAL LEVEL

The 7th Global Conference on Health Promotion was held on October 26-30, 2009 in Nairobi. Information can be accessed via the social networking site www.connect2change.org




There are several conventions that are relevant to providing music health programs that have societal benefits. Conventions will be reviewed from the international to more local levels, starting with human rights to health, primary health care, health promotion charters, social responsibility standards, and music/health policies for at-risk population groups.

Human rights to health
Human rights to health are enshrined in various United Nations and international agreements. The agreements are the basis on which public policy is created.

Article 25.1 of the Universal Declaration of Human Rights (1948) states that
"Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemploymnet, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control."

This declaration has influenced the development of rights to health that are stated in other conventions:

Article 12.1 of the International Convenant on Economic, Social and Cultural Rights (1966).

Article 5 (e) (iv) of the International Convention on the Elimination of All Forms of Racial Discrimination (1965).

Articles 11.1(f) and 12 of the Convention on the Elimination of All Forms of Discrimination Against Women (1979).

Article 24 of the Convention on the Rights of the Child (1989).

These conventions have been ratified by Australia. They deal with the socio-economic determinants of health, as well as access to health services, so impel the government to direct public health policy and strategy toward improving social determinants of health - especially for disadvantaged, minority, or marginalised population groups.

Primary Health Care - United Nations Declaration of Alma-Ata

The International Conference on Primary Health Care, Alma-Ata, USSR, 6-12 September 1978, resulted in the declaration of Alma-Ata. The 10 principal points are summarised as:

         I.            Health is a state of complete physical, mental and social well-being and is a fundamental human right. Attaining the highest possible level of health is a worldwide social goal that requires the action of many sectors.

       II.            The existing gross inequality in people’s health status is unacceptable and is of common concern to all countries and people.

     III.            Economic and social development is essential to attaining health for all, and health is essential to sustained development and world peace.

     IV.            People have the right and duty to participate in planning and implementing health care.

       V.            A main goal of governments and the international community should be the attainment by all peoples by the year 2000 of a level of health that will permit them to lead a socially and economically productive life. Primary health care is the key to attaining this goal.

     VI.            Primary health care is based on practical, scientifically sound and socially acceptable methods and technology made universally accessible through people’s full participation and at a cost that the community and country can afford. It is the central function of the health system and its first level of contact, bringing health care as close as possible to where people live and work.

   VII.            Primary health care evolves from a country’s own conditions and addresses the main health problems in the community. It should lead to progressive improvement of health care for all while giving priority to those most in need.

 VIII.            Governments should formulate policies and plans of action to make primary health care part of a comprehensive national health system, in coordination with other sectors. This requires political will to mobilize domestic and external resources.

      IX.            The attainment of health in any one country directly concerns and benefits every other country. All countries should cooperate in the development and operation of primary health care throughout the world.

        X.            An acceptable level of health for all people by 2000 can be attained through better use of the world's resources, much of which is spent on military conflict.

"The International Conference on Primary Health Care calls for urgent and effective national and international action to develop and implement primary health care throughout the world and particularly in developing countries in a spirit of technical cooperation and in keeping with a New International Economic Order. It urges governments, WHO and UNICEF, and other international organizations, as well as multilateral and bilateral agencies, nongovernmental organizations, funding agencies, all health workers and the whole world community…to collaborate in introducing, developing and maintaining primary health care in accordance with the spirit and content of this Declaration."

Health promotion charters
Further health promotion conventions resulted from international conferences on primary health care.

The World Health Organisation Global Conference on Health Promotion website outlines important health promotion charters that were developed from 1978 to present (http://www.who.int/healthpromotion/conferences/en/index.html). The Ottawa Charter of Health Promotion (1986) was signifiicant in that it outlined resources, key actions and basic strategies to pursue. The prerequisties for health were identified as: peace, a stable ecosystem, social justice and equity, and resources such as education, food and income. Key actions to promote health included building healthy public policy, creating supportive environments, strengthening community actions, developing personal skills, and reorienting health services.

Further international health promotion conferences were held, and in 1997 The Jakarta Declaration on Leading Health Promotion into the 21st Century established five priorities that were confirmed by the WHO Assembly in 1998.
1. Promoting social responsibility for health
2. Increasing community capacity and empowering the individual
3. Expanding and consolidating partnerships for health
4. Increasing investment for health development
5. Securing an infrastructure for health promotion.

All of these priorities are very significant to supporting and enabling communities to manage their own music heritage and culture. Community music may be one possible strategy for promoting people's self management of health and well-being. Music is well accepted as a modality that allows people's active participation across generations. Unlike sports, perhaps, music can reach people's heart and soul. Victor Hugo said that "Music expresses that which cannot be said and on which it is impossible to be silent." Oscar Wilde said, "Music is the art which is most nigh to tears and memory." People may instinctively know this from moving experiences of music.

Inter-professional collaboration to achieve "Health for All"

UQ Health Care Team Challenge 

The implications of the primary health care declarations are that health is of vital importance to everyone involved with music and/or health services, not just health professionals. To achieve "Health for All" all people and corporations need to act in a socially responsible manner. 

An example of how this has been done, is through inter-professional co-operation, such as demonstrated in the University of Queensland Health Care Team Challenge. Students from various health professions work together to deal with people's concerns through a creative problem solving process. The diversity of their professional backgrounds allows them to consider various issues and solutions, some of which may have been overlooked by a single profession.

The UQ Health Care Team Challenge is a competition that allows each multi-disciplinary team to explain their professional reasoning about how they propose to solve people's problems through working together. What would happen if a whole range of professionals such as music therapists, musicians, environmentalists, were added to the team? Would the solutions be any different? Perhaps readers could suggest an issue/challenge for Music and Health professionals to solve through creative collaboration. Read more...

Statement of continued support for the UN Global Compact

Music Health Australia is exploring how to best implement the principles of the UN Global Compact through formation of an inter-professional e-mail group to address health promotion issues in relation to music.

WHAT IS THE GLOBAL COMPACT? 
This link connects to the United Nations Global Compact Network (Asia Pacific) that explains that "the Global Compact is a voluntary initiative bringing together the private sector, civil society organizations, trade unions, UN agencies, and other stakeholders to advance ten universally accepted principles."

Human Rights
Principle 1: Businesses should support and respect the protection of internationally proclaimed human rights; and
Principle 2: make sure that they are not complicit in human rights abuses.

Labour Standards
Principle 3: Businesses should uphold the freedom of association and the effective recognition of the right to collective bargaining;
Principle 4: the elimination of all forms of forced and compulsory labour:
Principle 5: the effective abolition of child labour; and
Principle 6: the elimination of discrimination in respect of employment and occupation.

Environment
Principle 7: Businesses should support a precautionary approach to environmental challenges;
Principle 8: undertake initiatives to promote greater environmental responsibility; and
Principle 9: encourage the development and diffusion of environmentally friendly technologies.

Anti-Corruption
Principle 10: Businesses should work against corruption in all its forms, including extortion and bribery.

References to Music Health initiatives that support and uphold the principles of the Global Compact are to be posted on this website (case studies, tools, links, experts) under each of the following categories:

Human rights (Principles 1-2)

Labour standards (Principles 3-6)

Employment (Principles 7-9)

Anti-corruption (Principle 10)

Feedback and discussion is invited in the response box below.

Corporate social responsibility standards
A search of Australian Standards reveals that corporate social responsibility is covered under the Quality Management Systems guidelines of AS/NZS ISO 9001:2008. The diagram on page 7 of this document shows a process-based quality management system.

AS8003-2003: Corporate Governance - Community Social Responsibility provides guidance on establishing, implementing and maintaining effective community social responsibility programs.

Health promotion programs in community music may be a possible way in which corporations can meet community social responsibility goals. Place-based planning can involve discussion of partnerships with private corporations or government.

Indigenous health framework agreements

There is the need to consider the health and welfare of minority, disadvantaged or marginalised population groups as the first priority of concern in human rights to health.

The Council of Australian Governments (COAG) was formed in 1995, and this marked a renewed attempt to develop a more collaborative approach between the Commonweath and the states. Inter-governmental agreements in Indigenous health followed. The first round of agreements were signed from 1998-1999, usually by the Commonwealth minister, the state minister, a representative of community-controlled health organisations in a particular jurisdiction, and the Aboriginal and Torres Strait Islander Commission (Anderson, 2004, 265-271).

Other developments included the agreement by the Australian Health Ministers Advisory Council (AHMAC) to a set of National Performance Indicators in 1998, which was a new initiative to establish a national performance-monitoring frameworks in Indigenous health. This has been superceded by the Indigenous Health Performance Measurement Framework (2004). The National Aboriginal and Torres Strait Islander Health Information Plan was agreed to in 1997, and this set out priorities for the development of quality health information systems. The Commonwealth Primary Health Care Access Program (PHCAP) directed some resources into collaboration and planning, and this provided the means for developing the capacity of primary health services for Indigenous Australians (Anderson 2004, pp. 270-272).

AHMAC  established the National Indigenous Health Workforce Development Strategy in 2002, and the revised version of the NAHS, the National Strategic Framework for Aboriginal and Torres Strait Islander Health (2003). These agreements influence the way that Music Health services are delivered in Australia.

References
Anderson, I. 2004, The framework agreements: Intergovernmental agreements and Aboriginal and Torres Strait Islander health, in Honour among nations? Treaties and agreements with Indigenous people, eds M. Langton, M. Tehan, L. Palmer and K. Shain, Melbourne University Press, Melbourne, pp. 254-272.
 

MUSIC HEALTH PROMOTION - INDIVIDUALS AND COMMUNITIES

The flow-on effect of the "Health for All" principle is that individuals can be active in taking responsibility for the self-management of their own health and well-being, and they can assist those around them at the community level. Music, health professionals, and other people can support this process by providing community music, education, and therapy programs. Music can also be used in health education to promote well-being.


MUSIC AND WELL-BEING
There is growing evidence from case studies and other research that active participation in music is beneficial to people's health and well-being.

Dr Steve Dillon has accumulated some evidence about the associations between music and well-being. He sent the following links: Save to Disc (Documenting Innovation in Sound Communities), the Sweet Freedom website, and a U-Tube video about  My Life, My Voice with Down's Syndrome Queensland - as examples of the work he is doing. Steve has recently authored a book entitled Music, meaning and transformation: Meaningful music making for life. The book is aimed at current and pre-service music teachers, but it has wider application to community music, therapy and other related fields.

PERFORMANCE HEALTH OF MUSICIANS
The Australian Society for Performing Arts Healthcare (ASPAH) was formed in November 2006. Its members come from a variety of backgrounds, from healthcare professionals, to performing artists, to educators and researchers, all of whom share a passion and common belief. 

• Accessible high quality holistic health care for all performing artists
• Education for health workers, teachers, performers and students to improve health and well-being
• Research across disciplines relevant to this field
• A culture of lifelong preventative health care and safety practices
• Multidisciplinary discourse among health professionals, educators and performing artists
• Increased community awareness of performing arts health care