Forty-eight leaders in medical education, medical care and public health along with leaders who use the arts and creative arts therapies in health care, and heads of state and federal arts agencies met at the Inova Shar Cancer Institute in Fairfax, Virginia Thursday and Friday, Jan. 16 and 17.

They came together to identify and develop strategies for using the arts to address three priorities identified in a 2019 leadership summit; burnout among health care providers, public health disparities and research.

This gathering was assembled by the National Organization for Arts in Health, working in partnership with Inova Schar Cancer Institute and the Hamilton Garbulinska Foundation and opened by Dr. John Deeken, president of the Institute and medical director of Inova's Head and Neck Cancer Program. Fresh on the minds of many was the recent World Health Organization report on the value of the arts in keeping people healthy and assisting their recovery from illness, injury, and trauma. (Lake Placid News Dec. 12, 2019, "WHO Endorses the Arts ... for Health").

From left are Linda Jackson, director of Arts in Health, Metro Health, Cleveland; David Leventhal, founding director of Dance for PD at the Mark Morris Dance Company; and Dr Jennifer Jose Lo, medical director at the Boston Public Health Commission.(Provided photo Naj Wikoff)

Burnout in medical care, medical education and public health is at a crisis point and is impacting patient safety and quality of care. The National Academy of Medicine defines burnout as a syndrome characterized by high emotional exhaustion, high depersonalization, and a low sense of personal accomplishment. According to the 2019 Medscape National Burnout and Depression Report, the burnout rates for male physicians is 44% and over 50% for female physicians. Within some specialties, such as physical medicine and rehabilitation, the average is 52%. Emergency and family medicine rates are 48%, and public health is at 30% (representing the low end).

The most significant contributors to burnout are too many bureaucratic tasks, too many hours at work, increasing computerization of practice, and lack of respect from colleagues and staff, an outcome, in part, from increased siloing within the field. Another is that many physicians enter their profession already stressed out while in medical school; the burnout rates have been reported as high as 74% with the average at 50%. Long hours of studying, coupled with depersonalization during the education process, the stress of clerkships and awareness of their accumulating debt, contribute to medical student burnout.

According to a study conducted by the Pew Charitable Trust, the majority adults think public health priorities should be reducing cancer, and the environmental pollutants they feel cause it, along with the addressing growing opiate crisis and the negative effects of Juuling (vaping), especially on the young. While these are all major issues of critical importance, public health's overarching purpose is to address the social determinants of health - the dynamics that lead to health inequities and along with improved health outcomes.

A way of looking at it is to address immediate threats to public health while changing the root causes of those threats. The root causes are the economic and social conditions that influence individual and group differences in health status or, according to the World Health Organization, the circumstances in which people are born, grow, live, work and age.

An example of a social determinant is Lake Placid's housing crisis, which is leading to the death of longstanding family neighborhoods. Because fewer people who work for the town, school district, local shops and restaurants can afford to live in Lake Placid, they seek housing in Saranac Lake, Wilmington and beyond. The added time driving to work takes away from time to be with their families and participating in healthy activities. In addition, commuting expenses increases their cost of living and reduces the amount of funding they have for healthy foods, and so forth.

The stress of having a harder time making ends meet may result in such unhealthy behaviors as increased smoking and the consumption of alcohol. These behaviors can lead to increased medical expenses, increased chances of heart diseases, and premature death (the average is 41% of Essex County residents die prematurely).

On the research end of the Leadership Summit, the priority established by attendees was developing a research agenda as a means of directing and encouraging research that addresses medical health, medical education and public health priorities.

The team drilling into medical burnout agreed to build a database that will include examples of best practices for using the arts to build resiliency and address burnout among medical practitioners. Also, they will seek funding to create a series of small videos of clinicians sharing the importance of the arts as part of their well-being and clinical practice, and, to organize presentations at the National Academy of Medicine and other lead gatherings of medical and nursing providers and medical educators.

As an example, emergency physician Dr. Jay Kaplan, medical director for care transformation for LCMC Health System and past president of the College for Emergency Physicians, said, "When patients come to us, they come with their pain and anxiety. I have a choice to make when they do that. Do I connect and empathize with them, or do I keep them at a distance? My choice, for the most part, is to make that connection. When I make that connection, I'm going to pick up some of their pain and anxiety. Unless I do something, I will keep some of that in my body such as getting sick or burned out. The arts have been valuable in terms of helping me transform that energy into something that's positive and helps me stay healthy."

The public health team focused on two health disparities: isolation and race equity. Dr. Jennifer Jose Lo, medical director at the Boston Public Health Commission, facilitated a subgroup on race equity, and Jill Sonke, director of the Center for Arts in Medicine at the University of Florida, led the subgroup on isolation.

Dr. Lo said that her teams' goal is to identify and analyze how the arts can increase dialogue around race equity.

Initially, they will organize a national survey to determine the variety of ways that the arts programming is being used to address race equity along with the character of the programs; how they are being organized. The second part of their effort is to develop a marketing initiative to educate public health officials and others on how the arts can be utilized.

"We want to find out what are the barriers to using the arts to increase dialogue around race equity," said Dr. Lo. "We recognize we can't do this in-depth across the nation, so we agreed to identify a community/region that includes rural and urban to test out this strategy, one where we can have robust community engagement, where community members are part of the conversation. One of the things the arts can do is improve dialogue and communication. The public health group did not shy away from challenging topics, specifically race, race equity, and race relations, and community building around isolation and loneliness. Those are very difficult conversations. It was very exciting to work and build on that."

"This was a very active, integrated and informative session," said David Leventhal, founding director of Dance for PD at the Mark Morris Dance Group. "The attendees decided to focus and drill down on some very important issues. This was one of the most successful strategic planning meetings I've attended."

I came away with many insights that I hope to share with our arts, medical and public health leadership. The National Organization for Arts in Health will be publishing a report in about four months that will be available on its website.

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