The Forgotten Habit That Lowers Dementia, Depression & Aging | Daisy Fancourt

Dr. Rangan Chatterjee 0:00 Why is it that you think the arts and our engagement with the arts should be considered the fifth pillar of health?

Daisy Fancourt 0:10 Over the last few decades, we've had this absolute explosion of scientific studies looking at how the arts influence our mind, brain, body, and behavior. And now we're seeing from that research that arts can have really tangible, meaningful effects on us, often with similar effect sizes that we see from other behaviors like physical activity or sleep. So I think it's really important that we're actually acknowledging that and talking about it because it's another thing that we can all be doing in our lives that could be having real impact.

Dr. Rangan Chatterjee 0:37 Yeah, it's interesting. When I was reading your book, The Art Cure, the amount of studies in there for different diseases, different aspects of our health, our wellbeing, our psychology, it is absolutely incredible how much research there actually is that I would argue most people simply don't know about.

Daisy Fancourt 0:58 It's been this bizarrely well-kept secret, and I think part of it is that, you know, it's a natural process that you have to get evidence that builds up gradually over time that then gradually starts to reach public awareness. A lot of it gets published in quite obscure medical journals initially. But I also think that there is a sort of challenge in the way that we view arts in society. We often think of them as this sort of fluffy luxury thing that shouldn't really be a priority. It's the nice to have rather than the essential, and I think that has obscured some of our thinking actually about how we engage in the arts.

Dr. Rangan Chatterjee 1:27 There are so many studies I could choose to, to jump off onto. One that comes to mind is towards the end of the book in the chapter on longevity, you talk about hypertension-

Daisy Fancourt 1:40 Mm-hmm

Dr. Rangan Chatterjee 1:40 ... high blood pressure, and in that chapter you talk about research where listening to music-

Daisy Fancourt 1:47 Yeah

Dr. Rangan Chatterjee 1:47 ... can lower our blood pressure to an amount comparable or even superior to certain drugs that we have. That's incredible, right?

Daisy Fancourt 1:57 It is. It's really exciting. There have now been direct trials that have said, what if we tell people the advice we normally tell them, so lifestyle changes and medication, or what if we do that and we tell them to listen to music every day? And actually we find that the music group have improvements above and beyond the other group. In other words, adding music into our lifestyle or our medication for hypertension leads to extra reductions of about 9 to 10 kind of points in systolic blood pressure, which is an amazing change. And partly this is really down to the relaxing effects that music has on us. It's such a potent way of calming ourselves down, and that's something that is so important in hypertension.

Dr. Rangan Chatterjee 2:32 Have any studies looked at music in isolation, so without the lifestyle advice, without the pharmaceutical intervention? If you have high blood pressure, what does listening to music alone do? Have we seen any evidence about that?

Daisy Fancourt 2:47 Yes, we have d- done that, and actually, when we look at the general population, people who are more regularly engaged in the arts have lower levels of blood pressure. They have lower heart rates. They also have better cholesterol, lower glucose levels, and this is even when we've taken account of things like whether they're doing exercise or what their diet is alongside this. This is what we're seeing a- additively from them being involved in the arts, too.

Dr. Rangan Chatterjee 3:08 Yeah. If I think about high blood pressure, and I think about how I was taught about it, one of the things I don't feel was emphasized enough to me as a medical student was the idea that high blood pressure is a natural consequence of chronic stress.

Daisy Fancourt 3:25 Mm-hmm.

Dr. Rangan Chatterjee 3:25 So it's part of the stress response.

Daisy Fancourt 3:27 Mm-hmm.

Dr. Rangan Chatterjee 3:28 And so in a society where we are chronically stressed, and a few years ago, the World Health Organization, as you know, called stress the health epidemic of the 21st century, it stands to reason that any activity that can help us lower stress could potentially also lower our blood pressure. Is it just music when we talk about the arts that can do that, or are there other types of engaging with the arts that can also do that?

Daisy Fancourt 3:57 It's not just music. It's other art forms as well. So we see this when people are involved with dance, with crafts, with regularly reading, with going to cultural venues. What we particularly see is if you've got these regular, the regular time you're putting aside and doing this, this is when we start to see these reductions in people's blood pressure and heart rate. And what we typically see is if you do it for sort of half an hour or an hour, you can already see short-term changes in that time span. But then if you're then doing that regularly, like every week, for example, that's when you start to see these additive benefits, like the benefits accumulating from it, and that's because you get relaxation responses from all different kinds of arts experiences.

Dr. Rangan Chatterjee 4:35 Yeah. Your research has also shown a connection between the arts and mortality.

Daisy Fancourt 4:42 Mm.

Dr. Rangan Chatterjee 4:42 You write about it as this, uh, I think it was a balmy summer's evening-

Daisy Fancourt 4:46 [laughs]

Dr. Rangan Chatterjee 4:46 ... that you were crunching some numbers and something quite surprising came up, didn't it?

Daisy Fancourt 4:51 Yes. I'm an epidemiologist by training, so I look a lot at very large cohort studies that track thousands, tens of thousands of people over years and decades of their lives, and it's a perfect opportunity to see how our day-to-day behaviors link in with these long-term outcomes, including the length of our lives. And it's not just my study now. There have been over a dozen that have shown-

Dr. Rangan Chatterjee 5:11 Mm

Daisy Fancourt 5:11 ... that people who are regularly engaged in arts and culture have longer lifespans. And I think initially we thought, well, is this actually anything to do with arts and culture, or is it just that people are wealthier or they're, they've got other lifestyle behaviors-

Dr. Rangan Chatterjee 5:23 Mm

Daisy Fancourt 5:23 ... that, that are healthier? But actually now we've used so many different methods, testing all of these other explanations, and yes, they explain a bit of the association, but we still see this very strong and clear link that the more regularly people are engaged in the arts, independent of those factors, the longer their lifespan.

Dr. Rangan Chatterjee 5:40 Yeah. I think you quote in the book that there is a 31% lower risk of dying for people who are engaged in the arts compared to those who are not.

Daisy Fancourt 5:51 Yeah. It's a complex statistic, this, because obviously it's, it's to do with what your own risk of dying is year on year.

Dr. Rangan Chatterjee 5:55 Yeah.

Daisy Fancourt 5:55 So we've particularly looked at people who are older, where, you know, you- you're, that's a, a more likely outcome compared to younger people, and we've been able to sort of quantify, well, what happens in terms of each year your risk of dying and, and is that lower if you're more regularly engaged, and we do see this marked reduction in people who are engaged in the arts. And I think it can sound a little bit science fiction-y, but actually we're starting to understand a lot more about the biological processes that explain this.And one of the things that I think is most exciting, which is the really cutting-edge research literally coming out right now, is seeing that arts engagement relates to biological processes of aging. So it's actually helping to slow some of these processes, and we're seeing this across our brains and also our bodies. So for example, some of my colleagues recently published a paper looking at people's brains, and they've got a way of quantifying your brain age.

Dr. Rangan Chatterjee 6:44 Mm.

Daisy Fancourt 6:44 So in other words, they can tell if your brain is older or younger than your chronological age. And they found that people who are regularly engaged in the arts, as amateurs or professionals, actually have younger brain ages, decelerated brain aging. And we've done a similar thing as well looking at physiological, biological aging clocks that tell us a lot more about, uh, the way our bodies are aging, and we're seeing a similar pattern, that people are aging biologically slower when they're very regularly engaged in the arts.

Dr. Rangan Chatterjee 7:10 It's interesting. Longevity is one of the hottest or certainly one of the most popular topics in health-

Daisy Fancourt 7:17 Mm-hmm

Dr. Rangan Chatterjee 7:17 ... over the past few years. And there are many prominent longevity influencers, let's call them, who are talking about all kinds of things that we can do to slow the aging process down-

Daisy Fancourt 7:30 Mm-hmm

Dr. Rangan Chatterjee 7:30 ... and make sure that we're increasing not necessarily our lifespan, but certainly our health span. But again, the conversation typically revolves around food, exercise, sleep. And again, there is a huge evidence base behind those three, you know, pillars of health, as it were, but going back to the start of this conversation about arts being the fifth pillar or, as you say in the book, the forgotten pillar, I cannot remember the last time I heard a prominent longevity conversation where they actually spoke about the benefits of engaging with the arts.

Daisy Fancourt 8:09 No. It's, it's interesting, though, because if you look back even sort of 40, 50 years ago, there are discussions in the 1980s in papers where people were really debating how good physical activity really was for your health, and that feels such a funny thing to say now 'cause we're now so used to it, hearing it. We know the evidence base is so strong. But my point here is that it takes time for a behavior to be fully recognized and appreciated. And we've had these sort of tipping points for other health behaviors, like physical activity, where the evidence base grows to this point that suddenly there's a big shift in public awareness and recognition of it. We've seen a similar thing in the last couple of decades with sleep. We've seen gradual shifts in our understanding of diet, and I think it's the same now for arts. It's not had that real shift, but I really think that that moment, that tipping point, is definitely coming now. And I think in a few years you will be hearing people talking about this a lot more.

Dr. Rangan Chatterjee 8:59 One of the things I have been talking about for a few years is the importance of doing something that you love.

Daisy Fancourt 9:06 Mm.

Dr. Rangan Chatterjee 9:07 And I saw some research a few years ago showing that people who regularly do things that they love are more resilient to stress.

Daisy Fancourt 9:18 Mm-hmm.

Dr. Rangan Chatterjee 9:18 And at the same time, people who are chronically stressed and overworked can sometimes find it harder to experience pleasure in those day-to-day things that they used to enjoy. And so one of my, in inverted commas, prescriptions has been, you know, can you do something you love each day for five to 10 minutes? And when I was reading some of the case studies, and there's many stories in The Art Cure, I started to wonder how much of this or is a component of this to do with the fact that generally we tend to enjoy engaging with the arts.

Daisy Fancourt 9:55 That is a really important part of it. We know that when we engage in arts, whether that's reading, listening to music, making art, going to cultural events, it activates pleasure and reward centers in the brain, and it particularly activates a reward system called the dopaminergic mesolimbic system, which leads to the release of the neurotransmitter dopamine. And with dopamine, one of the things we know is that we don't just get dopamine kind of hits in, at the moment of pleasure and things, but also in anticipation-

Dr. Rangan Chatterjee 10:20 Yeah

Daisy Fancourt 10:20 ... of that pleasure. And one of the things about the arts is that it's, it's a tempor- it's often a temporal experience that's all about building tension and resolution. Like think about a book that you're reading.

Dr. Rangan Chatterjee 10:30 Mm.

Daisy Fancourt 10:30 As you're reading that story, you're going through tension, wondering what characters are going to do, anticipating big moments. The same with songs. And it's that continued anticipation and then resolution that gives us these dopamine hits, sort of double dopamine hits, for both of those different points, and that's why the arts are particularly powerful at increasing our levels of happiness.

Dr. Rangan Chatterjee 10:52 What's one of the most surprising bits of research you've come across in your many years-

Daisy Fancourt 10:57 [laughs]

Dr. Rangan Chatterjee 10:58 ... of studying this area?

Daisy Fancourt 11:00 One of the most surprising is the stuff we're literally working on right now, which, which comes back to something we mentioned a few minutes ago to do with longevity, in that we have been looking at what are called epigenetic clocks, and these are a way of measuring, um, another way of measuring our biological age.

Dr. Rangan Chatterjee 11:14 Mm.

Daisy Fancourt 11:14 And essentially our DNA is fixed from the point of conception, but we choose which parts of our DNA we read out.

Dr. Rangan Chatterjee 11:21 Yeah.

Daisy Fancourt 11:21 Um, so a little bit like a recipe book. If you've got a recipe book, it, it's the same recipes once it goes to print, but you decide which ones you're going to cook. And sometimes you might pick the healthier ones or, or the less healthy ones. And there's a particular process that happens as we get older, which is, uh, called DNA methylation, which is when a chemical tag can get attached to our DNA, meaning that we don't read that bit out, so a bit like pages in that recipe book getting stuck together.

Dr. Rangan Chatterjee 11:44 So, so it's almost hidden.

Daisy Fancourt 11:45 Yeah, exactly. Um, so it's sort of not accessible for us to then, to then use that bit of DNA.

Dr. Rangan Chatterjee 11:51 And that's a bad thing?

Daisy Fancourt 11:52 Not necessarily. It can be a good and a bad thing. It depends which parts-

Dr. Rangan Chatterjee 11:55 Mm

Daisy Fancourt 11:55 ... of the DNA are getting that tag on them, which pages are being stuck together. But there are particular patterns of these pages, um, that they're sort of indicative of us aging. So we can look at people's patterns of these, this DNA methylation, and therefore tell what their DNA age is, their epigenetic age is. And we already know that those other lifestyle behaviors that we've been mentioning, like physical activity, are associated with decelerated epigenetic aging, like younger-

Dr. Rangan Chatterjee 12:22 Mm

Daisy Fancourt 12:22 ... epigenetic age. But we've recently found that it's the same for arts engagement. People who've got the most frequent and diverse patterns of arts engagement have younger epigenetic age, decelerated epigenetic aging, actually with a really similar effect size to what we see from physical activity. And this is hugely exciting because it's showing that arts engagement isn't just a surface thing that affects our feelings on the outside, but it's affecting the fundamental building blocks of our health.

Dr. Rangan Chatterjee 12:49 I think that is so profound. It reminds me of a study you quoted. I think people had to listen to either classical musicOr what you call relaxing non-creative activities.

Daisy Fancourt 13:01 Mm-hmm.

Dr. Rangan Chatterjee 13:01 And that included chatting, reading magazines, taking a walk. Now, the relaxing non-creative activities do sound really enjoyable-

Daisy Fancourt 13:11 Mm-hmm

Dr. Rangan Chatterjee 13:12 ... and pleasurable, and as though they would reduce stress. But I think the study you quoted showed that the group who listened to classical music basically repressed genes involved with the destruction of neurons and increased the expression of genes involved with creating new neurons and enhancing the function of synapses. That's incredible, right?

Daisy Fancourt 13:37 It is. It's really exciting. But yes, you're right that we're actually seeing these fundamental processes that actually then have cascading effects across other neurological and biological, um, systems in the body. And it's actually really interesting as well because we've had so many studies actually for quite a long time showing the benefits of music for cognition. For example, that as people get older, if they're regularly engaged, like playing instruments for example, that they have better what we call cognitive reserve, better resilience of the brain against cognitive decline. They have better cognition lasting for longer. They even have a reduced risk of dementia. And so it's really interesting seeing these biological findings that are helping to explain and give that biological plausibility to these, to these results that we've actually had coming out of randomized trials and from epidemiological like big cohort evidence for the last couple of decades.

Dr. Rangan Chatterjee 14:28 C- can I ask you, Daisy? Again, J- just on that point I just raised, 'cause for me this is a really key point. People often tune into this podcast because they, they want vitality and energy-

Daisy Fancourt 14:42 Mm-hmm

Dr. Rangan Chatterjee 14:42 ... and they want to slow their rate of aging. They wanna be as well as they can for as long as they can, and so they're always looking for, "What is it I could bring into my life?" And those relaxing non-creative activities like chatting with a friend, uh, going for a walk, these are things that we'll often talk about on this show-

Daisy Fancourt 15:03 Mm-hmm

Dr. Rangan Chatterjee 15:03 ... and suggest that people think about introducing. And of course, I know you're not saying, "Don't do them," right?

Daisy Fancourt 15:08 [laughs] No.

Dr. Rangan Chatterjee 15:09 But it is interesting to me that listening to classical music, at least in that study, seemed to have an enhanced benefit certainly on the things that were measured.

Daisy Fancourt 15:22 Yes.

Dr. Rangan Chatterjee 15:22 And so how can we apply the findings of that study in our lives?

Daisy Fancourt 15:27 So what we're saying is think about the arts as a vehicle that actually often gives you a lot of the things we know are good for you, like social interaction-

Dr. Rangan Chatterjee 15:34 Mm

Daisy Fancourt 15:34 ... getting out and about, cognitive stimulation, but it's also giving you these extra ingredients like multisensory stimulation, uh, imagination, uh, and, uh, also, you know, making you think about new ideas or challenging you with new viewpoints. So actually, if we're meeting up with friends, for example, instead of just meeting up and going for a drink or chatting, meet up and go to a, a live music event, or go and look at an exhibition that's on-

Dr. Rangan Chatterjee 15:58 Mm

Daisy Fancourt 15:58 ... or go to a show. 'Cause that gives you those social benefits, but adding in that kind of creative engagement as well, which we know has these additive benefits. Same with exercise. A lot of studies now have compared aerobic exercise with dance-based aerobic exercise, and actually found that the dance-based has, again, uh, benefits above and beyond just the aerobic exercise itself because it's giving you the exercise, but also with the mental health benefits you get from the music and also the sort of creativity and imagination cognitive challenge that you get from following, uh, following the moves that you might be learning as well.

Dr. Rangan Chatterjee 16:32 Yeah. It's incredible. It brings up something else for me. It reminds me of some of the conversations I've had with Dr. Tommy Wood. He's super well qualified. He's one of the doctors I respect the most, and routinely Tommy will talk about the benefits of dancing.

Daisy Fancourt 16:48 Mm-hmm.

Dr. Rangan Chatterjee 16:49 Right? So he's talking a lot about this idea that as you get older, one of the things the brain needs more than anything is stimulus.

Daisy Fancourt 16:56 Yes.

Dr. Rangan Chatterjee 16:56 Right? The stimulus for something new. And he has shared research with me on multiple occasions of why dancing is so good.

Daisy Fancourt 17:06 Mm-hmm.

Dr. Rangan Chatterjee 17:06 Right? And yes, there is a, uh, there's a, there's a physical component, okay? Depending on what dance you're doing. Of c- I think any dance has got-

Daisy Fancourt 17:13 [laughs]

Dr. Rangan Chatterjee 17:13 ... a physical components. There is often a social component if you're doing it with someone else-

Daisy Fancourt 17:19 Mm-hmm

Dr. Rangan Chatterjee 17:20 ... or in a group, but then there's also a coordination component-

Daisy Fancourt 17:24 Yes

Dr. Rangan Chatterjee 17:24 ... alongside music, right? So he sort of made the case that it's this triple input that is potentially cr- creating so many of those brain and cognitive benefits that help reduce the risk of dementia and all those kind of things. And when I read you writing about the benefits of dance and just then talking about the benefits of dance, it feels like there's quite a big crossover there, right?

Daisy Fancourt 17:46 It's a sort of way of supercharging some of the behaviors we already know about. And actually, there was this big craze a few years ago for brain training apps that were all about, you know, playing-

Dr. Rangan Chatterjee 17:55 Yeah

Daisy Fancourt 17:55 ... a particular game. But actually, when the big studies came out on them, they didn't really have the big impact that people had been hoping because they realized that these apps are often sort of focusing on one particular cognitive process, and training one process doesn't mean you're training all of the brain. But actually, things like arts, dance, music, they involve so many different brain regions. It effectively becomes a kind of whole brain workout, so it's a really good way of challenging yourself cognitively in a really sophisticated way.

Dr. Rangan Chatterjee 18:23 Are you a dancer yourself?

Daisy Fancourt 18:25 I, I am not a [laughs] -- not, not a competent dancer, but someone who very much enjoys it when it's at weddings, for example.

Dr. Rangan Chatterjee 18:31 Yeah, well, w- literally this morning I was reading that section on dance and I said to my wife, I said to her, "You know what?" 'Cause I also, probably like you, I might dance at a wedding. I might dance when no one's in the kitchen if I've got the music-

Daisy Fancourt 18:46 Yeah

Dr. Rangan Chatterjee 18:46 ... blaring and there's no o- there's no one at home. But reading that section in your book really made me think, "Wow, there really are additional benefits to dancing." And, and I guess a lot of people feel time-poor, and I said to Vid, I said, "You know what? I, I'm really starting to, to..."... get the impression that we should take up and learn some form of dancing together because I kind of feel it would be good for our relationship, we'd spend time together, we'd be learning a new skill together, and we'd get all of these cognitive and, you know, coordination-type benefits that you also get. Now, whether we do it or not, uh, time will tell, but you certainly make a very compelling case for it.

Daisy Fancourt 19:26 And actually, studies show that if people do dance regularly, they actually have improved balance as they get older. It affects things like your bone mineral density. You know, it is a strength-based activity as well. It's also linked in with decreased falls, um, particularly because it's about that coordination, that balance, that sense of your body in space. So you're really having to focus on that, which is something that's so important neurologically for your brain and maintaining its functioning.

Dr. Rangan Chatterjee 19:50 One thing I really appreciate about your work, Daisy, is that you, you're very careful in the book not to oversell things.

Daisy Fancourt 19:56 Mm-hmm.

Dr. Rangan Chatterjee 19:56 You, you, you explain where things you feel have been oversold, and you say, "Well, this is what we know so far. This is-

Daisy Fancourt 20:01 Mm-hmm

Dr. Rangan Chatterjee 20:01 ... what we don't know." Do you know from any research, are there specific types of dancing that are better than others when it comes to, you know, health and wellbeing benefits?

Daisy Fancourt 20:13 To be honest, I've not yet seen anything that's saying that one particular dance form is better than another. And actually, if you think about dance forms, they've probably got like a kind of 95% shared DNA across all of them- [laughs]

Dr. Rangan Chatterjee 20:23 Yeah

Daisy Fancourt 20:23 ... in terms of what they're doing. So I doubt that any difference would be that meaningful. But I'd say it's probably more important to pick something that you comfortably feel that you could get into. Like, personally, I really like ceilidh dancing because they're telling you what to do, and it's sort of partly about the skipping fun as well. You haven't got to worry that you don't exactly know how you're supposed to be moving. There's beautiful shapes that get created by the groups. So things like that that might have a caller or something where it's a class where they're really gonna help you to learn those steps can, can be a great way of sort of entry into dance.

Dr. Rangan Chatterjee 20:53 Yeah. You mentioned ceilidh dancing then. I've not really thought about ceilidh dancing since my time at Edinburgh. I went to uni at Edinburgh. I, I worked there for two years. So I, I lived in Edinburgh for eight years, and there was a lot of ceilidh dancing. Through a historical lens, it's quite interesting that, you know, different communities of people, whether it be in Scotland or Africa or South America or India, dance has been a part of cultures-

Daisy Fancourt 21:21 Mm-hmm

Dr. Rangan Chatterjee 21:21 ... for a long time, hasn't it?

Daisy Fancourt 21:23 It has.

Dr. Rangan Chatterjee 21:23 So they must have known something. Maybe they didn't have modern science to say, "Well, it's doing this." They must have sort of intuitively felt that there were some incredible benefits from, from doing it or, or maybe they just enjoyed it.

Daisy Fancourt 21:35 Well, something that's quite interesting is if we look back across history, a lot of the times, a lot of the early evidence we have of the arts emerging has actually been in the context of health or healing practices. I mean, some of, some... And this is still slightly contentious, but some of the early anthropological and evolutionary, um, psychology theories about the origins of singing suggest that it evolved as a way of groups bonding together before language developed.

Dr. Rangan Chatterjee 21:58 Mm.

Daisy Fancourt 21:59 Um, actually, when we find things like cave paintings or the early carving stone figurines, they often are, are from things that we, we believe were used in, like, fertility rituals, for example. So I think it is actually quite likely that there is this role that the arts were developing to support processes that are good for our health. And there's something called the icebreaker effect, which is a phenomenon that shows that if we sing or dance with people, we actually bond with them faster than if we chat to them or exercise with them. So there does certainly seem to be something around that bonding process, that bringing together of people. And you mentioned earlier that we all used to sing, dance, tell stories just as part of everyday life. It's something that arose in every society around the world. But we really have lapsed now into this funny sort of state of artistic passivity where we don't actually tend to engage in the arts regularly. In fact, we did a study last year. We looked at representative sample of adults in the US and said, "How many minutes yesterday did you spend actively doing the arts?" Only 5% of people said they did any arts yesterday, and that was compared to 57% of people in high-income countries who say they will have eaten vegetables yesterday, and 40% who say they've exercised. So arts engagement is way, way down our list of priorities in our lifestyle. But really, I think we're making a mistake with that.

Dr. Rangan Chatterjee 23:18 It makes me think about how we used to as humans eat mostly whole food, minimally processed food until relatively recently, where ultra-processed foods have come into the food supply.

Daisy Fancourt 23:33 Mm-hmm.

Dr. Rangan Chatterjee 23:33 And if I think about that through the lens of art, I wonder if we've got to a situation where there's almost like there is junk food, junk art. So maybe we would engage at the end of our days with song and dance and bonding, whereas maybe n- now we've got our smartphones.

Daisy Fancourt 23:54 Yeah.

Dr. Rangan Chatterjee 23:54 So we're watching someone sing online. You know, we're, we're commenting on a post of some, of an artist we like with a live performance, so we think we're engaging. Do you know what I mean?

Daisy Fancourt 24:05 Yeah.

Dr. Rangan Chatterjee 24:05 It almost feels like there's a, there's a, there's, like, junk food and, and perhaps junk arts maybe.

Daisy Fancourt 24:11 [laughs] There definitely is, is a state now where even if we do arts, we tend to be doing it in the background. So lots of us listen to music, but we'll often put music on, like plug in, and then zone out and do something else. It's like we won't actually just sit and listen to and enjoy the music as the primary focus. And you're right that actually a screen-based arts engagement is growing. And actually, in Art Cure, I'm probably quite rude, but I call screen-based arts engagement the ultra-processed food of the art worlds. [laughs] Because although we do see benefits from, like, watching dramas on TV or going to the cinema, like, there are still definitely benefits from those activities. But they tend to be a bit more muted when we look at studies that directly compare screen-based arts to actually engaging in real life ourselves. So there's something around perhaps the slightly more passive engagement or the screen itself or the lack of other people in that engagement that means it doesn't have as great a benefit for our health. So I think there is a real need for us to sort of question, like, what behaviors did it, what behaviors are displacing the time that we, we used to spend on arts effectively.

Dr. Rangan Chatterjee 25:14 Yeah. I, I definitely wanna talk about more benefits, like on lung health and wound healing and the immune system and reduction in pain and all kinds of things-

Daisy Fancourt 25:23 [laughs]

Dr. Rangan Chatterjee 25:23 ... right? But I think it'll be worth just pausing for a moment to define what you mean when you say engaging with the arts.

Daisy Fancourt 25:35 Mm-hmm.

Dr. Rangan Chatterjee 25:35 You just mentioned there an example. You know, music is art, right? Most-- I think if you ask most people, you know, does music qualify as engagement with the arts? I think, I think many people would probably say yes.

Daisy Fancourt 25:43 Yeah.

Dr. Rangan Chatterjee 25:44 But you're saying that that background music listening whilst you're doing something else perhaps doesn't have the same benefits. So help us understand what are the kinds of arts that we should be thinking about engaging with in order to get all of these incredible benefits?

Daisy Fancourt 26:03 So arts engagement is typically defined as sort of a creative practice that's engaged in primarily for the emotional involvement or for the beauty or ideas that are in part of it. Now, that normally means activities that involve that multisensory stimulation, creativity, imagination, aesthetics. So we often think of things like performing arts, visual arts, literary arts like reading books, crafts or going to exhibitions, galleries, gigs, uh, concerts, the cinema. Um, but I also argue in the book that I think we need to consider some other activities that actually share those common ingredients, but we don't always think of intuitively. So things like culinary arts, like baking and decorating a cake. That's got all of those same creative processes, imagining the recipe, how you want it to look, the tactile involvement. Horticultural arts, so like growing and arranging flowers, has got that same focus on sensory stimulation and, and beauty and form.

Dr. Rangan Chatterjee 26:59 Mm.

Daisy Fancourt 26:59 And things like circus arts as well. I talk in the book about things like magic tricks that again share all those ingredients, but we sometimes forget that they're activities that we could be doing as well.

Dr. Rangan Chatterjee 27:09 It feels like there's an active component in terms of our relationship with, with those activities compared to a passive one. Like, we can passively consume arts, can't we? We can, as you say, listen to music. We can sit on the sofa and watch a drama.

Daisy Fancourt 27:31 Mm-hmm.

Dr. Rangan Chatterjee 27:34 I guess you're watching a drama, in some way you're actively engaging 'cause you, you're having to follow the story and imagine that you-

Daisy Fancourt 27:41 Mm-hmm

Dr. Rangan Chatterjee 27:41 ... the character or what might you do in that situation. But, but is part of the distinction passive versus active?

Daisy Fancourt 27:46 Yeah. I tend to prefer the term receptive because you're not completely passive, are you? If you are, if you are responding to characters, you're thinking things through. But again, if we think about this in terms of sort of ingredients, then if you are receptively engaging, yeah, you're kind of receiving things, but you're not having to do as much. You're not having to use your hands or, or to use your body. You're not having to come up with the ideas yourself, like have that process of imagination and invention yourself. So we, we see that for some outcomes, like for example, for mental health actually, both receptively and actively engaging, both actually have very, very similar benefits for things like reductions in symptoms of depression. But there are other outcomes where we find that participating is particularly key, particularly for a lot of cognitive outcomes, and particularly for more kind of physiological outcomes when we're thinking about some of the longevity-based things as well. But I think the most important thing is giving it attention if you're actually doing it. There are still benefits to having music on in the background as a kind of background stress relief whilst you're doing other tasks, but it's just important that we make sure we do give arts active attention within each day as well.

Dr. Rangan Chatterjee 28:51 If we're going to get the benefits of the arts, do they need to be something that we enjoy?

Daisy Fancourt 28:58 I think that's always better. It doesn't mean, though, that it has to be something that has got positive emotions attached to it, and there's a clear distinction here. 'Cause studies have shown that if you force people to listen to music that they hate, they actually don't get the benefits, for example, for mood-

Dr. Rangan Chatterjee 29:11 Mm

Daisy Fancourt 29:11 ... for dopamine. So there's no point forcing yourself to do something that you're not actually finding pleasurable. But it doesn't mean you always have to, for example, listen to happy music or read happy books in order for it to benefit your mood. One of the really fascinating things that's come out of research is that even, like, reading sad stories or watching-

Dr. Rangan Chatterjee 29:29 Mm

Daisy Fancourt 29:29 ... horror films, um, or listening to angry music, all of those things actually also have benefits for mental health. And part-- this is really because in real life, if we had events that gave us those negative emotions, it would negatively affect us. But when it's art, we know it's art, which means that our brain processes it a bit differently.

Dr. Rangan Chatterjee 29:47 Mm.

Daisy Fancourt 29:47 We have a bit more of an aesthetic distance between us and what we're consuming or watching. So it means that we often experience positive emotions alongside the negative ones. So it can be beneficial to sort of cathartically experience those negative emotions and to feel that sense of, like, resonance listening to a sad song, and you feel like the songwriter really got how you were feeling in the moment. But because your brain knows it's not real, it sort of contemplates that emotion, but without having to panic or s- actually think about how it would respond in the real world.

Dr. Rangan Chatterjee 30:16 Hey guys, just taking a quick break to ask you a small favor. On this show, I'm always looking to improve things, make sure I'm booking the most interesting guests, having conversations about the right topics, and building relationships with the most aligned sponsors. But in order to do this, my team and I need to know a little bit more about you. So we have created a super short survey that I would dearly love you to fill out. It will only take you two minutes to do so, and I would really, really appreciate it. All you have to do is click the QR code on screen or go to drchatterjee.com/survey. That's drchatterjee.com/survey. It reminds me of the conversation I had with Daniel Levitin a few months ago. Daniel's a neuroscientist, musician, a record producer, and I'm pretty sure in that conversation we spoke about-You know, when, when people are feeling sad, they perhaps don't wanna listen to a happy song.

Daisy Fancourt 31:23 Mm-hmm.

Dr. Rangan Chatterjee 31:23 You wanna... You know, if you're going through a breakup, listening to a breakup song is one of the most beautiful things that an individual can do because it's, you know, it... I guess it's connecting you to wider humanity.

Daisy Fancourt 31:36 Mm-hmm.

Dr. Rangan Chatterjee 31:36 It connects you to, "Oh, I'm not alone-

Daisy Fancourt 31:39 Exactly

Dr. Rangan Chatterjee 31:39 ... feeling this way. Somebody else has literally articulated how I'm feeling in their lyrics," right? So there, there's something about that, isn't there? And, and also, I know, you know, some of the things you write about in the book are how engagement with the arts build our sense of identity. I wonder how much of that is also coming from, as you just said, you know, there... You know, we're in make-believe world in the arts, right? So it's not real, so we can imagine what it might be like to feel angry, to feel upset.

Daisy Fancourt 32:12 Mm-hmm.

Dr. Rangan Chatterjee 32:12 Um, you know, y- maybe it's a way that we can experience the full range of human emotions in our mind without actually having to do it in real life.

Daisy Fancourt 32:21 Without having to face the consequences, and that's actually really good for our brains 'cause our brains are prediction machines. They're constantly having to navigate an unpredictable world around us. And actually, what's been coming out of neuroscientific research recently on the arts is showing that when we engage with the arts, we're essentially feeding our brain with lots of different emotions and scenarios, which help it to hone its abilities to regulate our emotions or to plan how we might respond if it were the real world, and that is what's called our predictive coding abilities of our brain.

Dr. Rangan Chatterjee 32:53 Mm.

Daisy Fancourt 32:53 And this actually helps us then to be more resilient and better able to adapt and tackle those challenges when they really do come along for us in real life.

Dr. Rangan Chatterjee 33:01 There's research, isn't there, about dementia and music-

Daisy Fancourt 33:05 Mm-hmm

Dr. Rangan Chatterjee 33:05 ... which I wanna talk about. Before we do that, one thing that's just come to mind is, for whatever reason, at the moment, I'm loving listening to '90s music.

Daisy Fancourt 33:18 [laughs]

Dr. Rangan Chatterjee 33:20 And in my head, it's because it takes me back to a really influential time in my life-

Daisy Fancourt 33:26 Mm-hmm

Dr. Rangan Chatterjee 33:26 ... when I saw possibility and the future and, you know, I was imagining what I could become or whatever it might be. As someone who's studied the arts and music for many years, is there anything to that at all?

Daisy Fancourt 33:40 There is. I mean, it suggests that that's music where you've got particularly strong dopamine tags, and actually, we often find that that is people for, uh, music for people in their adolescence because that's when all of our emotions are pretty highly charged. Um, but I think it's also a really good reminder about why we often get strong emotions from music or from arts because it does give us those memories that are associated, which often can be really lovely, but I guess it also kind of gives me a caveat to some of the things we've just been talking about because actually, if an arts experience triggers memories or thoughts about a really negative experience in your life, then actually that's one of the times when it doesn't come with positive emotional benefits. And equally, we were talking about, like, horror mu- horror films, for example. Some people, including me, really hate horror films. I actually genuinely find them scary, and I find that I'm not getting positive emotions, and that's because we're forgetting that it's art. So this is a really important caveat that if you are engaging in art forms that might be giving you more negative or challenging emotions or scenarios, you have to be able to remember it is art, and you also have to make sure that you're kind of competent enough in your own emotions to be able to manage-

Dr. Rangan Chatterjee 34:44 Yeah

Daisy Fancourt 34:44 ... those when they come along. So sometimes if people are feeling vulnerable, then actually listening to really sad songs is something that can actually be a little bit triggering. So there's, there's a balance to be struck here.

Dr. Rangan Chatterjee 34:54 It's such a subjective experience, isn't it, e- engaging with the arts-

Daisy Fancourt 34:59 Mm-hmm

Dr. Rangan Chatterjee 34:59 ... because you were just sharing about if it'd take you back to a negative time, and I totally get that, and it made me think of a playlist that I recently put together for Apple, and one of the tracks I put on it was from an album that I listened to pretty much on repeat in my car on CD after my dad died in 2013.

Daisy Fancourt 35:20 Mm-hmm.

Dr. Rangan Chatterjee 35:21 And it was a song by Matt Schwartzman called The Way, and whenever I hear it now, I actually don't feel sad. It, it really connects me to a really important part of my life, and it's kind of interesting, isn't it? You know, that it, that it is such a subjective thing. So to, to someone else, they may not want to hear a track that they listened to in the aftermath of a parent's death.

Daisy Fancourt 35:46 Mm-hmm.

Dr. Rangan Chatterjee 35:47 But for me, it actually connects me to that moment in time.

Daisy Fancourt 35:50 And I think this is actually what's so wonderful about the arts when we're thinking about lifestyle advice 'cause, you know, often if people are being told to, like, take pills and things, it's quite an, a sort of in- inhumane thing to do. But actually, with the arts, part of the way they affect us is the kind of raw ingredients that they give us, and we know there are certain things like the tempo of a song that affects our arousal levels in a pretty universal way, but the other part of it is about the perception-

Dr. Rangan Chatterjee 36:13 Mm

Daisy Fancourt 36:13 ... of that art form, which is about our own personality, memories, experiences. So that does mean that two people can have quite different experiences even to the same art form. I'm sure we've all been in the cinema with a friend. One of us loved the film, one of us hated it. But it also means that this is some of the most joyous lifestyle advice that you can have because it allows you to have that personal connection and that sense of personality in how you're going to, how you're going to engage in the arts.

Dr. Rangan Chatterjee 36:39 It feels that this is such an important message for the current age in which we live.

Daisy Fancourt 36:46 Mm-hmm.

Dr. Rangan Chatterjee 36:46 There's so much instability, unhappiness, stress, burnout, frustration about the future or, or, or uncertainty about the future.

Daisy Fancourt 37:01 Mm-hmm.

Dr. Rangan Chatterjee 37:02 I guess out of all the things we could think about introducing into our lives, it feels that at the very least, engagement with the arts is gonna give us a shot of joy and vitality. And, you know, what are you asking us to do? You're saying, you know-Obviously you don't have to enjoy it, but you're, you're basically saying go and do enjoyable things-

Daisy Fancourt 37:24 [laughs]

Dr. Rangan Chatterjee 37:24 ... that get you to imagine the possibility and feel different emotions. That's quite a nice thing to hear from a scientist, isn't it?

Daisy Fancourt 37:32 It's a nice feelgood message. But actually we tend to be much better about thinking about what our physical needs are compared to our psychological needs. And within psychology we understand that we as humans have got a whole set of core psychological needs in our lives if we're really going to feel happy and flourishing. And some of this is about us having a sense of control in our lives, something that's increasingly hard in the world around us. But a lot of studies show that engaging in arts gives you that sense of control, sometimes just in the activity and the craft that you're doing, but actually that gradually starts to sort of seep out into affecting your how in control you are feeling more generally. Arts also help to give us a sense of meaning, of purpose in our lives, which are very difficult things to achieve, but things that are fundamental if we really want to have high levels of wellbeing.

Dr. Rangan Chatterjee 38:19 I remember a story from your book, Daisy. I think it was a palliative care ward in Chelsea and Westminster Hospital.

Daisy Fancourt 38:27 Yes.

Dr. Rangan Chatterjee 38:28 And from recollection, please correct me if I- I haven't quite got this right, but from recollection, there was a gentleman on that ward and people came in, or, or someone came in and was playing-

Daisy Fancourt 38:40 Mm-hmm

Dr. Rangan Chatterjee 38:40 ... acoustic guitar and singing, and I think he said that it helped give him a sense of meaning.

Daisy Fancourt 38:48 Yes. This is something, I worked in the NHS for a number of years, and I kept seeing this time and time again that, you know, there were people who were in hospital for conditions where, you know, medicine was helping parts of the condition, but there were, there were broader aspects of the psychological and social experience they were having where there wasn't a medical treatment that was supporting those.

Dr. Rangan Chatterjee 39:04 Mm.

Daisy Fancourt 39:04 And actually bringing the arts into that hospital was a really pertinent, powerful way of supporting people holistically. And I think there's no better example of this when we're thinking about end of life care, palliative care, and we're also thinking about b- uh, bereavement and grieving. If we look all around the world, arts are something that we instinctively turn to in those phenomenally difficult moments. People use songs and poems and photographs and, and, and crafts and memory books as a way of remembering people. They're things we instinctively turn to, but actually we don't really acknowledge this enough. We don't con- consider how we should be valuing the arts more within end of life care. And I remember times in the hospital when it was, you know, people's final hours, and they were asking to have music there with them, and they were having their relatives singing along, and times like that were incredibly, incredibly powerful example of, of how much the arts can do for us.

Dr. Rangan Chatterjee 39:54 Yeah. I went to see my mum last night, and I told her that I was talking to you today about this topic, and she said, "Oh, you know, what, what were you gonna talk about?" I said, "Well, Mum, you know, Daisy's written this cool book, and she's talking about the benefits of the arts on our health and wellbeing," and, you know, Mum's 85, not in fantastic health anymore unfortunately, and you know, I, I think I said something to her about the benefits of music. And she said, "Yeah, of course."

Daisy Fancourt 40:22 [laughs]

Dr. Rangan Chatterjee 40:23 She said, "Whenever I've felt down in my life or low or stressed, I'll just sing and play songs and sing or, or listen to music." And you know, Mum hasn't done any of the scientific research on this, but it was quite interesting to me that she just knew straight away. She wasn't even surprised when I told her. She goes, "Yeah, of course."

Daisy Fancourt 40:43 It is an age-old wisdom. I don't think people are surprised by the idea of this. I think people are often surprised by the depth and rigor of the science.

Dr. Rangan Chatterjee 40:49 Exactly.

Daisy Fancourt 40:50 But even though it is wisdom, like I was saying earlier, we all engage so little on average. We know the wisdom, but for some reason we're not putting it into practice. We're not prioritizing it in our lives.

Dr. Rangan Chatterjee 40:59 Yeah. One of the things that I reflected on as I was reading your book was children and bringing up children and how important the arts is. I'm super lucky because the school my children are at have just the most incredible and inspiring head of music-

Daisy Fancourt 41:20 Mm-hmm

Dr. Rangan Chatterjee 41:20 ... who, you know, I was at their spring concert recently where both my kids were performing, and there was other kids from the school performing, and orchestras and choirs and street drumming and all sorts of things. But the, the head of music had such passion for each-

Daisy Fancourt 41:37 Mm

Dr. Rangan Chatterjee 41:37 ... and every track and all the children who were engaging, and it's such an inclusive school about trying to get people to engage in the arts in whatever way they want to. I don't think I really realized how fantastic that is for my kids and, and, and other kids at that school until I read your book. I was like, "Oh, this isn't just an enjoyable thing to do. It, it is that, and-

Daisy Fancourt 42:04 Mm

Dr. Rangan Chatterjee 42:04 ... there are all of these other benefits." Clearly, not every school has that kind of relationship with the arts and music.

Daisy Fancourt 42:13 Mm-hmm.

Dr. Rangan Chatterjee 42:14 And you are a mother, I think, of two children.

Daisy Fancourt 42:17 Yeah.

Dr. Rangan Chatterjee 42:18 What do you think your research is going to do, or how do you think that's going to influence the way you parent as your children get older?

Daisy Fancourt 42:29 Well, I think there are two things here. One is about what we do as parents, but also one is about what we need schools to do, because actually we've got ourselves in a bit of a mess at the moment. We've really deprioritized arts within schools, taken them off curricula. We've had massive decreases in the number of students that now get to engage in the arts at school and take arts subjects. We've now got whole schools that have absolutely no arts in them, and this is really problematic because arts are so beneficial for children's development-

Dr. Rangan Chatterjee 42:53 Mm

Daisy Fancourt 42:53 ... in terms of cognitive development, particularly in terms of mental health, identity formation, self-esteem, and also nurturing these core skills like creativity, curiosity, compassion, like some of the skills that we want young people to have the most as they're heading out into the world. But we're not making it equally available, and the challenge then is it means that it really rests on them whether children have got opportunities to do-

Dr. Rangan Chatterjee 43:16 Mm

Daisy Fancourt 43:16 ... the arts outside school, and there's a huge social gradient in that. So some families are lucky enough that they might have the time or the resources to be able to do arts outside schools. Others don't. So I do think we have an issue here, 'cause if children don't engage in the arts as children, they're also way less likely to engage as adults, and therefore that's huge groups of people who'll be missing out on the health and wellbeing benefits across their whole lives.

Dr. Rangan Chatterjee 43:39 One thing you challenge right at the start of the book is the idea that some people will say, "The arts are not for me, Daisy."

Daisy Fancourt 43:47 [laughs]

Dr. Rangan Chatterjee 43:47 "I'm not creative. I'm not artistic." What do you say to those people?

Daisy Fancourt 43:52 We are literally born artistic. Babies are responding in utero to music when they hear it. If you sing to a newborn baby a song and then a song with an altered, like, a wrong note in it, they can even spot the difference within a few weeks of being born. So e- everybody has the innate creative potential here, but it comes down to opportunities and access. So yeah, if you're someone that has had no exposure to the arts across your early years, your education, then it's not surprising that you might not feel creative or artistic. But I talk in the book about actually lots of people who've entered the arts as an adult, often through things like being referred to it by a doctor, so they- they're not choosing, they've kind of been recommended it, and in the process gone from thinking that they weren't artistic, it wasn't for them, to realizing how much they love it. And this, I think, is so powerful in showing that if people can give things a go and sort of have that try, people are often surprised a- a- actually that the response they have when, when they actually enjoy it much more than they thought.

Dr. Rangan Chatterjee 44:48 That's what happened to Russell, isn't it?

Daisy Fancourt 44:50 It is. It is, very much.

Dr. Rangan Chatterjee 44:51 Can you tell us a little bit about Russell?

Daisy Fancourt 44:52 Yeah. Russell is someone I met nearly 10 years ago when we both went onto BBC Breakfast to talk about this scheme that was rolling arts on prescription out within the UK. And Russell was a construction worker from Gloucester, um, and one day on the way to work he had a stroke, and it caused severe neurological damage, and he had to relearn how to walk again, how to talk again. Um, in the process, like, he lost his job, his relationship fell apart, and he said that he was just in bed all the time with chronic pain. It caused so many issues for him, so he said he got on more and more and more medication trying to deal with things, couldn't sleep, and eventually his doctor said, like, "Enough. We need to try something new." So he prescribed an arts class for Russell, and Russell said he was just so not artistic, it really wasn't him. But he, he said he's not even sure why he agreed to go along. But in that first class, he said there was just something about it that kind of piqued his curiosity.

Dr. Rangan Chatterjee 45:45 Mm.

Daisy Fancourt 45:45 And as he started going back, he started actually drawing and painting and realizing how much he loved it. And, uh, sort of fast-forward, he actually found that he was feeling happier, his pain was lower, his sleep was better. He and his doctor actually started to reverse the pills that he was on. It gave him this whole new lease of life, and actually now 10 years later, Russell, um... In fact, longer than that now, but Russell is now actually an artist, and he does his own painting. He's had exhibitions from Gloucester Cathedral to the Tower of London. He also leads his own art workshops in the community for other people like him, sort of saying to them, "You haven't got to be an artist. You can do this." And he said he's not even on any medication anymore.

Dr. Rangan Chatterjee 46:23 I think he also says that art saved his life.

Daisy Fancourt 46:25 Yeah. I said... I was trying to ask him to sort of quantify how big this effect was, and yeah, he said it saved his life. And I, I've met so many people over the years who use those same words, like, whether it's been art that's actually brought them back from the brink of taking their own life or art that's given them a whole new lease of life in the way that they're n- they're able to engage with and enjoy things day to day.

Dr. Rangan Chatterjee 46:46 Before we get onto practical tips-

Daisy Fancourt 46:49 Mm-hmm

Dr. Rangan Chatterjee 46:49 ... in terms of how people can think about introducing the arts into their lives-

Daisy Fancourt 46:54 Mm-hmm

Dr. Rangan Chatterjee 46:55 ... I just wanna close the loop on dementia.

Daisy Fancourt 46:59 Yeah.

Dr. Rangan Chatterjee 46:59 We, we mentioned that a couple of times, and I know just from talking to a lot of my audience, a lot of people do fear getting dementia.

Daisy Fancourt 47:09 Mm-hmm.

Dr. Rangan Chatterjee 47:10 They, they, they've seen it in family members. And one of the most striking things I heard you say was that if patients with dementia are played songs from their youth at bathing times-

Daisy Fancourt 47:25 Mm-hmm

Dr. Rangan Chatterjee 47:25 ... and at mealtimes, it can reduce emotional agitation. Now, that, I think, has so many practical applications. I've spoken to a lot of carers, and a lot of them will say that those are the times-

Daisy Fancourt 47:43 Mm-hmm

Dr. Rangan Chatterjee 47:43 ... where there's a lot of tension. There's, you know, y- you know, someone doesn't wanna be bathed, but for hygiene, they need to be bathed.

Daisy Fancourt 47:52 Mm-hmm.

Dr. Rangan Chatterjee 47:52 And it seems as though the arts may have a particular role here, right?

Daisy Fancourt 47:56 They do. This is actually a really important area to think about 'cause again, it's one where it can be quite hard. We haven't really got medical solutions for, for some of the, the challenges psychologically and socially that people with dementia experience. And one of the things is that when people have dementia, it can be much harder to rationalize things that are going on, like the noise of a bin lid clanging, for example, is something that causes a lot of distress-

Dr. Rangan Chatterjee 48:18 Mm

Daisy Fancourt 48:18 ... on hospital wards for people who have dementia. Things like bathing and mealtimes, if you've forgotten what that is, it's quite an overwhelming thing to be plunged into water or handed a plate of colorful food and, and implements and you, you don't remember how to use them.

Dr. Rangan Chatterjee 48:30 Mm-hmm.

Daisy Fancourt 48:31 So playing calming music is a really effective way of just relaxing people, activating that relaxation response so that they're calmer in those moments. And also, um, playing something that's familiar can help to buffer out those background noises that might be upsetting people. When I worked at Chelsea and Westminster Hospital, we also did a lot about wayfinding. Like, if someone with dementia needs to go to the loo, they might have forgotten the way there. And actually, if everything is white, if it's white corridors, white walls, white doors, white loo seat, it can be almost impossible to distinguish where they're going. That's one of the things that's affected in dementia. So things like colored pathways on the floor, being able to use artwork so patients remember which bed is theirs-

Dr. Rangan Chatterjee 49:10 Mm-hmm

Daisy Fancourt 49:11 ... changing the color of surfaces, these kinds of interior art-based things are really powerful. But there's also a reason why music is particularly helpful in dementia.And this is because the region of the brain that's involved in long-term musical memory is one of the last to be affected by Alzheimer's disease.

Dr. Rangan Chatterjee 49:29 Wow.

Daisy Fancourt 49:29 So many people will say that, you know, that their relative might have forgotten who they are, but then they'll remember a song, and they'll sing along. Um, and this is because of this particular region in the brain being preserved very late in Alzheimer's. So playing music to people, particularly music that's got a lot of dopamine attached, that pleasure hormone we've been speaking about, is really, is really effective. And, and particularly dopamine is good because dopamine is not only involved in pleasure, it's also involved in long-term memory consolidation, which is why it's often the music from people's adolescence where they've got those very strong dopamine tags-

Dr. Rangan Chatterjee 50:01 Mm

Daisy Fancourt 50:01 ... music from people's childhood or from really positive emotions in their experiences in their lives that they're most likely to remember even in the late stages of dementia.

Dr. Rangan Chatterjee 50:11 So someone who's listening to this who may have a family member-

Daisy Fancourt 50:14 Mm-hmm

Dr. Rangan Chatterjee 50:14 ... who is perhaps struggling with dementia-

Daisy Fancourt 50:16 Yeah

Dr. Rangan Chatterjee 50:17 ... one immediate take-home might be they could start playing for that individual music from their youth.

Daisy Fancourt 50:25 Yeah. Find a playlist of the music you know this person used to love listening to. And watch them closely, uh, make sure it's not causing distress, but it can be a really lovely thing to do. Also, think about calm background music at the times they normally get agitated. Think about the environments they're in and how you're using color in them so that you're trying-

Dr. Rangan Chatterjee 50:41 Mm

Daisy Fancourt 50:41 ... to make sure they can have easy navigation, and it's calming environments around them as well.

Dr. Rangan Chatterjee 50:46 Wow. And I think you did touch on it earlier in the conversation, but just to cover it again here whilst we're talking about dementia and brain health, you have found research, haven't you, showing that regularly engaging with the arts preserves our cognition for longer and delays the onset of dementia. Is that right?

Daisy Fancourt 51:07 That's what we're seeing. We're seeing that people who are regularly engaged in the arts have better preservation of cognition for longer and a reduced risk of developing dementia, and this is through what's called cognitive reserve, so building the resilience of the brain against cognitive decline. So it basically means that even if your brain is starting to accumulate the kind of physical signs of dementia, then you're able to compensate for longer. You're, you're sort of able to cover it and, and manage cognitively for longer before it actually starts to affect your life, and we're seeing this with delayed brain aging through arts experiences too like I mentioned earlier.

Dr. Rangan Chatterjee 51:40 Yeah. For people who've heard enough of the benefits to go, "Yeah, she's convinced me. I would like to engage with the arts more," there's a really nice section at the end of the book where you, y- I think it's called How to Fix Things.

Daisy Fancourt 51:53 Mm-hmm.

Dr. Rangan Chatterjee 51:53 Right? So can you walk us through some of the practical things that we can think about if we want to introduce the arts into our life?

Daisy Fancourt 52:02 So I think a great way of thinking about it is a bit like how we think about our diets. So we all know the concept of, like, have your five a day for your fruit and veg or whatever. Well, think about what your equivalent can be for the arts to make sure you get some kind of artistic engagement every day. Even if it's just 10, 15, 20 minutes, that's a really great way to start. Also, think about variety, just like we used to say an apple a day keeps the doctor away, but now we focus on, like, variety of plants in our diet. It's similar with arts experiences, so if you're someone that loves reading, well, that's great, but also think about how could I bring in another art form that might bring some different kind of ingredients. So, like, might be dance that would bring in the physical, or that might be, like, making music, sort of so really focusing on that cognitive challenge of it as well. I also say, like, don't think that you have to be a great chef, like, and list- like, to cook good food. You've not got to be really brilliant at art. You've not even got to think that you're an artistic or creative person 'cause for our health, it genuinely is the taking part which brings so many of those benefits.

Dr. Rangan Chatterjee 53:02 You mentioned reading a book there. Does reading a book count as engaging with the arts?

Daisy Fancourt 53:08 That very much is an art form. Yes, that is one of the arts activities you can be doing, but it's... that's why I say it brings certain benefits. It brings, like, narrative storylines that will be challenging your brain to think differently about the world. It brings emotional experiences that can be helping to, uh, give you that sense of emotion-

Dr. Rangan Chatterjee 53:24 Mm

Daisy Fancourt 53:24 ... regulation. It's a relaxing activity. But obviously you're not generating, you're not physically doing things as well, so it's just good to have balance with other arts activities too.

Dr. Rangan Chatterjee 53:33 Is going to the theater similar to going to the cinema?

Daisy Fancourt 53:38 This comes back to that ultra-processed food metaphor that I used for-

Dr. Rangan Chatterjee 53:41 Okay

Daisy Fancourt 53:41 ... thinking about screen-based arts activities. So yeah, going to the theater and going to the cinema both have benefits for our mental health, for example, when we look at them in studies. But actually for, like, cognitive outcomes, we see much stronger effects for going to watch live arts events like concerts or gigs or going to the theater or going to exhibitions than we do from the more screen-based engagement like watching dramas on television or going to the cinema. So it's important to sort of think, yeah, engage in the cinema and things if you're enjoying that emotionally, but try and mix it up by also bringing in arts experiences that, that might be more cognitively or physically beneficial.

Dr. Rangan Chatterjee 54:17 Have we seen a decline in our engagement with the arts since COVID? And the reason I ask for that is I think o- one thing I've seen a lot is that COVID broke certain patterns, social patterns, hobby patterns that we all had.

Daisy Fancourt 54:38 Mm.

Dr. Rangan Chatterjee 54:39 People who, for example, used to go to a once-a-week yoga class in their local town center realized in COVID that they could do it on YouTube or online. And of course, there can be loads of benefits of doing that for people-

Daisy Fancourt 54:54 Yeah

Dr. Rangan Chatterjee 54:54 ... especially if they live remotely, and they don't have time, whatever. So I'm not criticizing that. But it's not the same thing as doing a yoga class, as an example, with other people in your community. Have we seen a similar thing with arts where people used to go out to the theater and to concerts and, you know, museums, whatever it might be? COVID put a stop to that, and has there, in your view, been almost a collective inertia that has set in which-We really need to urgently start to rebalance

Daisy Fancourt 55:32 There are definitely things where we've seen a change that hasn't fully rebounded. Like, if you look at footfall going through museums, for example, then actually that is still down in many places compared to before COVID. But I think it's not always just our fault. There are also really challenging societal circumstances, like lots of arts venues have closed, lots of libraries have closed. Cost of living crisis, you know, there can be much higher now costs to actually go to some of these things. So that it sort of makes it partly about us thinking, "How can I get more active?" But also partly about us thinking, "How can we talk about this more, and how can we maybe change awareness politically about the funding that goes in to enable us to engage?"

Dr. Rangan Chatterjee 56:07 Yeah. One of the bits I enjoyed the most, because I'm very passionate about this, towards the end of the book, is how difficult it is now for artists to make a living.

Daisy Fancourt 56:19 Mm-hmm.

Dr. Rangan Chatterjee 56:20 And you wrote a little section on Spotify and, you know, how little artists make when their tracks are streamed, and how the whole commercial model of music has changed. That, that, that is going to have an impact, isn't it? Because w- yeah, we can engage ourselves, read a book or, you know, whatever it is we enjoy doing. But also if, as a culture, we're going to get the best out of art, we need artists.

Daisy Fancourt 56:51 We do.

Dr. Rangan Chatterjee 56:51 We need musicians. We need actors. We need people to be able to devote themselves to these things and perform for us and create music for us. But if people are literally getting pennies for doing that, actually, yeah, we can want to engage, but societally, we're gonna have less things to engage with, right?

Daisy Fancourt 57:14 Yeah. If we want to have arts in society, we need artists to be leading those groups, to be, to be putting art out there for us. And I've got so many friends who are artists who are just experiencing such-

Dr. Rangan Chatterjee 57:24 Yeah

Daisy Fancourt 57:24 ... challenging working conditions. It's sort of like if you want to be an artist now, you've, you've got to do it for the passion rather than being able to make full livings out of it, for many people. And this is really problematic. It's about how little we value the arts within society. And I don't think it's any coincidence that we see that professional artists in general have higher levels of wellbeing than the general population, but also higher levels of stress and anxiety and depression. Because the circumstances they're put in to try and craft careers out of this is just so difficult now.

Dr. Rangan Chatterjee 57:55 As I was reading your book, I was thinking about Keith Richards from the Rolling Stones, and the reason I was thinking about him was there are lots of musicians that I see, certainly in the sort of music I'm interested in, who seem to still be performing in their 70s, touring, playing long show... Bruce Springsteen still does three-hour, three-hour sets, right? And he's, you know, he's not a spring chicken anymore. It's interesting to me. Yes, they're engaging with something, but these guys are constantly writing new music. They're trying to still stay relevant, you know, tell stories in their music that speak to the culture today, just as it did when they were in their 20s.

Daisy Fancourt 58:39 Mm-hmm.

Dr. Rangan Chatterjee 58:40 What's your take on that, you know? Am I barking up the wrong tree, or could there be something to it?

Daisy Fancourt 58:45 [laughs] I mean, there are always random lucky combinations of genes.

Dr. Rangan Chatterjee 58:49 Of course.

Daisy Fancourt 58:49 So I think that's something that's important to caveat up front. But there, there is something to the saying of use it or lose it. And actually, one of the things that we see from the arts is that they're so powerful at giving us a sense of purpose. And a sense of purpose-

Dr. Rangan Chatterjee 59:02 Hmm

Daisy Fancourt 59:02 ... is one of the big drivers of a health- a longer health span, so, like, staying healthier for longer, as well as a longer lifespan. So I think it's probably not a coincidence that we see that people who've got that real passion for the art that they're doing, that that really does drive them and help them to have that continued purpose, that continued activity that supports their health.

Dr. Rangan Chatterjee 59:21 Yeah. Going back to the similarities I see between reading this and some of what Tommy Wood, uh, writes about. You know, Tommy talks a lot about how damaging retirement can be for our brains.

Daisy Fancourt 59:34 Mm-hmm. Yes.

Dr. Rangan Chatterjee 59:35 And if we think about that through the lens of what I just said about musicians, of course, if you just forget the arts and forget all those benefits and put them to the side for, for a minute, even the fact that people are not retiring, they're still engaging in their passion, they're writing, they're performing. They- they've got a reason to get up and get out there and do something.

Daisy Fancourt 59:59 Mm-hmm.

Dr. Rangan Chatterjee 59:59 And engage in communities and, you know, it's not just done in isolation. It's done with other people in a live venue. That in and of itself is going to be beneficial, isn't it?

Daisy Fancourt 1:00:09 It is. And a lot of the work that I've done has been looking at older adults. And we found that as people retire, as they sort of head into later 50s, into 60s, we see that people who are more regularly engaged in the arts have a reduced risk of developing depression over the following decade or so, a reduced risk of becoming frail, of developing age-related disability, of developing problems like chronic pain. We really do see this link with a, a longer health span as they get older.

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Daisy Fancourt 1:02:23 [laughs]

Dr. Rangan Chatterjee 1:02:24 ... and one was plan your meals out. What do those two things mean?

Daisy Fancourt 1:02:29 The chicken soup is about the fact that when we're ill, we often know there are things that make us feel better. For some people that's like a homemade chicken soup or... But I think it's often when we're ill that we f- don't think as creatively about what's gonna help us. We often go in a kind of protective survival mode. Um, so it's sort of easy to sort of lie on the sofa and just binge-watch Netflix. So my point is, think in advance. Like, what are the books that you really love reading, like the comfort reads that you could return to when you feel ill? What's the music that really relaxes that you could put on and listen to? Um, are there crafts or things that, you know, you could even just spend a few minutes doing-

Dr. Rangan Chatterjee 1:03:03 Mm

Daisy Fancourt 1:03:03 ... that actually could both support your mood as well as your relaxation? And this is really important because it sort of brings us onto the issue of inflammation, which is one of the areas that we've got really exciting evidence, um, coming up on about the impact the arts have. Not only do the arts relax us in terms of stress response-

Dr. Rangan Chatterjee 1:03:20 Mm

Daisy Fancourt 1:03:20 ... but they also affect levels of inflammation in our immune system, which means that if we engage, we actually have reductions in inflammatory markers, things like cytokines, which are these chemical messengers in our immune system. Um, and this-- And over time we see that people who are more regularly engaged in the arts have lower inflammatory profiles. And inflammation is not only linked in with our physical health, but also with our mental health.

Dr. Rangan Chatterjee 1:03:44 Mm.

Daisy Fancourt 1:03:44 So it's really important when we're ill, like when we're in that kind of inflammatory state, that actually doing things that will improve our mood can actually help with that recovery as well.

Dr. Rangan Chatterjee 1:03:52 One of my favorite studies that you wrote about was the drumming study, right?

Daisy Fancourt 1:03:57 Mm-hmm.

Dr. Rangan Chatterjee 1:03:57 When you studied people who were drumming for six weeks, and you showed that four inflammatory cytokines went down.

Daisy Fancourt 1:04:07 Mm-hmm.

Dr. Rangan Chatterjee 1:04:09 I mean, basically, this is kind of the point we're trying to sort of highlight in this conversation, Daisy. We might think drumming's good, you know. It's a fun activity. You enjoy drums, you play. But, but it, but it's, it's so much more than that. It's changing the inflammatory milieu inside your body. That's really exciting. Can we say that that's exclusive to drumming?

Daisy Fancourt 1:04:34 [laughs]

Dr. Rangan Chatterjee 1:04:35 Or do we think other forms of arts or even musical instrument playing would do similar things?

Daisy Fancourt 1:04:42 We've seen this from a range of art forms now, from dancing, from singing, from making visual art as well. So it's certainly not just a drumming effect. But it's really relevant 'cause a lot of people live with chronic inflammation, which puts you at a higher risk of type 2 diabetes, of cardiovascular events, as well as depression. And we've actually looked, um, really broadly now, if people are regularly engaged in the arts, do they have different inflammatory profiles? We've just completed a study where we looked at over 200 different proteins in people's bloods, and we found that people who've got more regular arts engagements actually have patterns of protein abundance that show they've actually got lower levels of inflammation. They've actually got a dialing down of inflammatory pathways in their bodies. And so we see this bo- We sort of see short-term effects, like lower little dips in inflammation from just half an hour or an hour of engaging. But we see this adding up more and more over the weeks and months, so that overall people who've got those higher patterns of engagement, lower levels of inflammation.

Dr. Rangan Chatterjee 1:05:39 There was a study on wound healing, and in particular expressive writing-

Daisy Fancourt 1:05:44 Mm

Dr. Rangan Chatterjee 1:05:45 ... which I found really interesting. Because, because initially when I, when I thought about what, what, what does it mean to engage with the arts, I didn't necessarily think of expressive writing.

Daisy Fancourt 1:05:56 Mm-hmm.

Dr. Rangan Chatterjee 1:05:57 And then I thought, well, why not? You know, journaling and, um, writing out your emotions and trying to process them. Well, we know that's really beneficial. Does that count as engaging with the arts?

Daisy Fancourt 1:06:11 Mm-hmm.

Dr. Rangan Chatterjee 1:06:11 And then also could you talk about that study if you can recall? I know there's like hundreds of studies in the book, so you may not have them all to hand. But there was-- it was pretty powerful to see that expressive writing could speed up wound healing.

Daisy Fancourt 1:06:23 This was a really cool study where they were looking at if people could do writing where they're, yeah, they're getting their emotions and things out there. Would it actually affect inflam- inflammation levels, and would it help with things like wound healing? For this particular study, they gave people a punch biopsy, so they deliberately gave them a small wound, and then they measured it every day. And they found that the group that did expressive writing had significantly faster healing of that wound and changes in their inflammatory levels. And actually this feeds into a sort of much bigger literature that shows that if we, if we're doing this regular arts engagement, we can actually see it affecting these quite physical aspects of our, of our illness, of our recovery.

Dr. Rangan Chatterjee 1:06:59 Yeah. So would you say expressive writing could count as arts?

Daisy Fancourt 1:07:05 Definitely. It's creative writing. That's one of, one of the core art forms-

Dr. Rangan Chatterjee 1:07:08 Right

Daisy Fancourt 1:07:09 ... out there.

Dr. Rangan Chatterjee 1:07:09 Is that different from journaling about your own life?

Daisy Fancourt 1:07:11 Uh, well, interestingly in this study, they actually had a control group which was having to write about how they were planning their time, I believe it was.

Dr. Rangan Chatterjee 1:07:19 Yeah, it was.

Daisy Fancourt 1:07:19 So quite boring writing. Um, and they didn't see the faster, um, wound healing in that group. So this was very much something that was happening from that creative, that expressive process.

Dr. Rangan Chatterjee 1:07:28 Listening and/or making music can enhance our immune system, can't it?

Daisy Fancourt 1:07:34 It can. We've run studies where we've looked at these cytokines, these chemical messengers, and shown that if people are making music for sort of an hour or so, they actually have a short-term boost in their immune activity, kind of activation of the cytokine network. And then over time, we do tend to see that this rebalancing towards lower inflammatory profiles that we've just been talking about. So it's really nice to see that's another whole biological system that's influenced by arts engagements.

Dr. Rangan Chatterjee 1:07:58 Yeah. When we think about music and we can engage in music actively or passively, I guess active might be us playing something or we're listening intensively and-

Daisy Fancourt 1:08:10 Mm-hmm

Dr. Rangan Chatterjee 1:08:10 ... you know, my wife and I, for example, we engage with music in very different ways. Like, if we're listening to music, she's more drawn to lyrics than I am.

Daisy Fancourt 1:08:19 Mm-hmm.

Dr. Rangan Chatterjee 1:08:19 Like, I'll hear the different layers. I'll, I'll hear what the bass is doing-

Daisy Fancourt 1:08:24 Mm-hmm

Dr. Rangan Chatterjee 1:08:24 ... what the guitar's... I'm like, "Oh my God, did you, did you hear what the bass player just did?"

Daisy Fancourt 1:08:28 Yes.

Dr. Rangan Chatterjee 1:08:28 And of course, as we're saying, it is a subjective experience. But you also, you, you write about Brian Eno and what I think is called ambient music.

Daisy Fancourt 1:08:38 Mm-hmm.

Dr. Rangan Chatterjee 1:08:39 Can you explain what ambient music is, and then how that fits with this whole idea that to get the benefits or to get most of the benefits from art, perhaps we wanna be more active when we engage with it than passive?

Daisy Fancourt 1:08:56 So-

Dr. Rangan Chatterjee 1:08:56 Does that make sense?

Daisy Fancourt 1:08:57 No, it does make sense. I'm sure everyone's had that situation where you're like, you're in an elevator, you're in a lift, and there's that really annoying kind of tinny background music that's supposed to make you feel calmer.

Dr. Rangan Chatterjee 1:09:07 Yeah.

Daisy Fancourt 1:09:07 But basically you end up feeling more and more wound up by it until you can't stand it anymore. So that lift music was music that was created particularly trying to combine the elements that we know are most relaxing for us. But in the process, it's so bland and it's so predictable that actually we don't have that tension resolution thing that I was speaking about in terms of dopamine response earlier. So actually we don't find it something that triggers dopamine. We don't find it something that's particularly enjoyable. So what Brian Eno came up with was a different concept where he said, "We don't want things to be too predictable, but what if we take those relaxing elements, so like the slow beat, like the, the, the, the nice tones, sort of consonant tones, um, relaxing instruments, but we actually put them on tape loops so they'll play in random combinations. So you can't predict-

Dr. Rangan Chatterjee 1:09:51 Hmm

Daisy Fancourt 1:09:52 ... what's coming, but it's inherently got the relaxing ingredients." And that was the genre of ambient music. And personally, I find it so much more enjoyable listening to that than listening to elevator lift music. But Brian Eno, um, I met when I worked at Chelsea and Westminster Hospital because we had this big problem around anxiety in surgical settings. Like quite understandably, people were coming in for surgeries. They were put in kind of toilet sized cubicle booths and told to wait for hours until their operation. They got more and more anxious, and that then meant they were often having to have anti-anxiety medication to calm them. It was taking more sedatives, it was taking more pain relief after, and creating a kind of spiral of medication that-

Dr. Rangan Chatterjee 1:10:30 Hmm

Daisy Fancourt 1:10:30 ... wasn't necessary. So what we did with Brian is we said, "Well, could we use his ambient music in the hospital setting?" And we combined it with these incredible digital artworks that he'd created that again, had this randomness. They kind of gradually changed over time, but in a way you couldn't predict. And we found that the patients who went into these booths, um, uh, with this artwork and music actually had this incredible relaxation response. And so many studies now have shown that if people are more relaxed through music, then they actually need fewer sedatives. They need fewer opioids afterwards. And in fact, studies that have directly compared giving people anti-anxiety medication or music before surgery show that you get a greater relaxation response from music compared to the drugs.

Dr. Rangan Chatterjee 1:11:13 I mean, this has implications individually for that patient, but also the potential for massive cost saving in the health service is absolutely there, isn't it?

Daisy Fancourt 1:11:25 Absolutely. Same for vets as well. Dogs respond the same way. [laughs]

Dr. Rangan Chatterjee 1:11:28 Really?

Daisy Fancourt 1:11:29 Yeah. [laughs]

Dr. Rangan Chatterjee 1:11:30 Wow.

Daisy Fancourt 1:11:30 Um, but this, this is really important 'cause I think we're actually being less safe, less ethical by not offering arts in these settings compared to offering them.

Dr. Rangan Chatterjee 1:11:41 It's kind of interesting, isn't it, that there is all this research there. We've already spoken about the, the high blood pressure studies, but I think you, you sort of wrote about this, you know, i- in your book this, this idea that when was the last time your doctor prescribed listening to music? It's very clear from your research and the data that actually it should be one of the many tools we have in our toolbox.

Daisy Fancourt 1:12:10 Mm-hmm.

Dr. Rangan Chatterjee 1:12:10 You know?

Daisy Fancourt 1:12:11 Well, already this concept of being able to prescribe arts is out there. I mean, depression is a really good example of this because with depression, many people with mild and moderate depression, antidepressants don't really help them.

Dr. Rangan Chatterjee 1:12:21 Yeah.

Daisy Fancourt 1:12:22 And there can be side effects as well. There have now been so many studies that have said, "Well, what if people did 6 or 10 weeks of weekly arts classes?" And they've actually found that the reduction in symptoms is actually very similar to what you get from either psychological therapies or from medication without the side effects and without the waiting lists. And actually, if it's offered alongside, we've actually found that it can augment the benefits. So studies that have shown people who've been offered medication or psychological therapies or that plus arts therapies have actually found that there's even greater benefits. In fact, nearly twice the improvement in symptoms within three months if people have both together. And I just got back from Greece last week where we've been running this incredible four-year program saying, "Well, what if we actually fully integrated arts on prescription as part of psychiatric care?" So we were working with, in the end, 1,000 adults in Greece who had diagnosed severe mental illnesses, and they were referred to 12 weeks of arts on prescription. They could choose-

Dr. Rangan Chatterjee 1:13:19 Wow

Daisy Fancourt 1:13:19 ... whether they went to book clubs, theaters, galleries, like they made arts in classes. And we found there were 30% reductions in anxiety and depression within those 12 weeks to the point that Greece has actually now announced a new law last week making arts on prescription formally part of all psychiatric care in the country. And we've already got similar things in the UK. We've got arts on prescription as part of social prescribing within GP practices. So your GP can make a referral to these activities. But I just don't think we're giving it enough recognition or prominence or letting people know they could be talking to their doctor about this.

Dr. Rangan Chatterjee 1:13:51 Yeah.It's also very important in terms of the outcome. You know, if we whole bodily, you know, believe in something and talk about it and say, "Look, this is gonna be really, really helpful," that's very different from saying, "There's a nine-month waiting list for talk therapy, so in the meantime we'll get you some art therapy." Do you know what I mean?

Daisy Fancourt 1:14:12 Yeah.

Dr. Rangan Chatterjee 1:14:12 It's, it's the same thing, but, but the message we give to the patient is very different. You're waiting for the big, for the, for the main thing.

Daisy Fancourt 1:14:18 This is the-

Dr. Rangan Chatterjee 1:14:18 Whilst you're waiting-

Daisy Fancourt 1:14:19 ... consolation prize

Dr. Rangan Chatterjee 1:14:19 ... do a bit of art on the side. You know, even that needs to potentially change.

Daisy Fancourt 1:14:23 I think people need to know these effect sizes that are coming through from trials. They need to have the choice, so they can be told, "These are all the options available, and you get to have a say in which one you think is going to suit you. And if that one doesn't work, you can be trying the other options."

Dr. Rangan Chatterjee 1:14:36 One of the things I think listeners to this podcast will be particularly interested in, Daisy, is your work stating that people who engage with the arts are more likely to engage with other health-promoting behaviors.

Daisy Fancourt 1:14:54 Mm.

Dr. Rangan Chatterjee 1:14:54 Tell us a little bit about that.

Daisy Fancourt 1:14:55 This is super interesting. So this is something that we're consistently seeing now in studies, is that engaging in arts means you're then more likely to do more exercise or to eat more healthily or to, uh, stop smoking, and partly this is something which is spillover effect. You know, if you do one health-promoting behavior, you are more likely to sort of catalyze a virtuous cycle of other health-promoting behaviors. But it's also because when we engage in the arts, it helps with a lot of psychological processes. It builds our sense of self-control. So a lot of randomized trials say you have higher levels of self-control if you've taken part in several weeks of arts activities, and that can help with inhibiting behaviors you might not want to do. And it also helps things like self-esteem. Self-esteem is a major driver of our behaviors, and one of the big things that's supported through engaging in the arts. So essentially, we're sort of giving ourselves some psychological toolboxes that support positive behavior change through arts engagements.

Dr. Rangan Chatterjee 1:15:49 I wonder how much of that could be increasingly relevant or even more relevant in what we would call socially deprived communities. Because of course, cost and access to things can be a huge issue-

Daisy Fancourt 1:16:03 Mm

Dr. Rangan Chatterjee 1:16:03 ... in those communities. But lots of art forms are not that expensive, right? So yes, going to the theater, for example, that there is a cost associated with that. Um, reading a book, singing, listening to music, these things are perhaps a little bit more accessible. And I guess if we're saying that engaging with the arts changes how we feel about ourselves, um, increases our empathy, increases our self-control, in some ways it could be quite a low-cost intervention that could have some quite profound effects, even in deprived populations.

Daisy Fancourt 1:16:48 Actually, even more so. Some of the studies that we've done have shown that people who come from more deprived areas geographically actually benefit from arts engagement even more, like disproportionately more-

Dr. Rangan Chatterjee 1:16:58 Mm

Daisy Fancourt 1:16:58 ... than people who are engaging who already live in more affluent areas. Similarly, people who are already experiencing mental health challenges, they often have even greater improvements in mental health through arts engagement compared to someone who doesn't really feel like they're struggling particularly. So actually, I think it's at a point we need to try and improve the equity of access even more, because actually those people who aren't engaging are probably the ones who could stand to benefit the most.

Dr. Rangan Chatterjee 1:17:24 You also write about some of the benefits that people in prison have had from engaging with the arts. I think there was one, uh, what, something called the, the Shakespeare Behind Bars that I heard you, you, you talk about. Can you, can you explain what sort of things the arts have been shown to do for people who are in prison?

Daisy Fancourt 1:17:43 These are incredible programs that are trying to integrate arts within criminal justice systems, recognizing that actually engaging in arts, doing things like drama, gives people a chance to build their sense of confidence, their new identity. Actually, when we're doing things that are particularly acting based or, or, or involving stories, we're also helping to build our imagination. Actually, higher levels of creativity and imagination help people to navigate complex life choices.

Dr. Rangan Chatterjee 1:18:08 Mm-hmm.

Daisy Fancourt 1:18:08 It helps them to have more creative solutions to problems. There's actually amazing research showing that these sort of narrative art forms that particularly will challenge us and give us new perspectives, we're more likely to take that information in if we're-

Dr. Rangan Chatterjee 1:18:21 Mm

Daisy Fancourt 1:18:21 ... experiencing it through a story compared to if someone's having a conversation with us or giving us a leaflet to read.

Dr. Rangan Chatterjee 1:18:27 On the subject of stories, your book is full of real-life stories of people who've improved their lives through engaging with the arts. As well as those stories, though, you shared a very personal story of your own-

Daisy Fancourt 1:18:42 Mm

Dr. Rangan Chatterjee 1:18:42 ... about what happened when your daughter Daphne was born, and how the arts had a pretty big effect.

Daisy Fancourt 1:18:49 Mm-hmm.

Dr. Rangan Chatterjee 1:18:49 Um, I wonder if you'd be open to sharing that.

Daisy Fancourt 1:18:51 Yes. And I wanna say that all the stories in this book are real people with their real names, which actually is quite unusual to have people who are happy to be identified in that way. But they were such incredible stories, I really wanted it to be authentic things that people are reading. But obviously there is a vulnerability in sharing stories, so it only felt fair to, to offer up one of my own. And yeah, my younger daughter, Daphne, unfortunately was premature, and when she was five days old she contracted meningitis, and we had an absolutely horrific time in intensive care with her. And I remember feeling so powerless. There was nothing I could do. I wasn't even allowed to touch her. Um, but I remembered these studies that I'd read about 10 years previously that had been about the impact that singing to premature babies has on them in intensive care. Um, there were sto- stories that showed that babies had reductions in their stress response, they had reductions in their heart rate, their blood pressure, even improvements in their oxygen saturation. And so I sang. It was Christmastime, so I sang Christmas carols to Daphne for hour after hour, and I could see on the monitors those improvements. I could see that there were these slight increases in her oxygen levels, that there were these reductions in her stress, stress response. And for me, it was the most profound arts experience I had, because there was nothing else that I could have done that I had at my disposal in that time, but it was something that I could see was benefiting her, and also undoubtedly had huge benefits for me in terms of coping in that time too.

Dr. Rangan Chatterjee 1:20:10 Wow. Thank you for sharing that. I think there's been quite a lot of research now, hasn't there, in terms of the benefit of music in neonatal-

Daisy Fancourt 1:20:19 Hmm

Dr. Rangan Chatterjee 1:20:19 ... intensive care units?

Daisy Fancourt 1:20:20 Absolutely. And some of this is a little bit like the dementia things we were talking about, where there are lots of really weird, high-pitched, scary noises in intensive care. And if you're thinking about premature babies, they should still be in the womb. They should still have-

Dr. Rangan Chatterjee 1:20:32 Mm

Daisy Fancourt 1:20:32 ... those low, deep, sonorous noises instead. So buffering those out with calming music is something that we can do, which is very simple. But also there's something about that human interaction. Babies can tell if it's their own mother singing to them. They can even tell if it's their mother singing live compared to in a recording.

Dr. Rangan Chatterjee 1:20:50 Wow.

Daisy Fancourt 1:20:50 So having that voice, which is the most dominant sound they'd have had in the womb, but having that intensive, in intensive care is something that seems really important, not only to babies in the moment in terms of their physiological response, but actually we're starting to learn that it could be having cognitive benefits for them in the months and years that follow.

Dr. Rangan Chatterjee 1:21:08 Wow. It's absolutely incredible. Honestly, Daisy, I had no idea there was that much research on the benefits of the arts until I read your book. I think you did a fantastic job. We've not even scratched the surface today-

Daisy Fancourt 1:21:22 [laughs]

Dr. Rangan Chatterjee 1:21:22 ... in terms of things that you have written about. I mean, in the book, there's all kinds of things. The benefits of engaging with the arts include increasing happiness and its associated neurotransmitters, fulfilling our fundamental human needs, giving us peak moments of joy and euphoria, building our wellbeing and resilience, preventing and managing symptoms of depression and anxiety, helping us regulate our emotions, broadening the ways we think and act, supporting our cognitive development, enhancing learning, enhancing neuroplasticity, and the list goes on. It's utterly incredible. If there was anything else doing this, if there was a pill that could do all those things, we would be hearing about it. But thanks to your book, now we're learning about the benefits of the arts and what the arts can do for all these areas. So first of all, thank you for writing it. Thank you for giving the arts the PR job that you are giving them. Um, to, to finish off, Daisy, if there's someone listening who has realized throughout this conversation that the arts just doesn't feature in their life, maybe they weren't exposed to it, maybe they feel that they're too busy for it, or it's something they associate with being a kid and not an adult, what would you say to them?

Daisy Fancourt 1:22:43 Give it a go and start small and manageable. I made a swap last year, which has been one of the biggest, like bene- like biggest beneficial behaviors I could have done, which is that we hear a lot about active commutes to work. I can't active commute. I live too far away. So I've gone for creative commute. So now instead of scrolling the news on my phone and stressing myself on, out on the way to and from work, I read a book every day on the way to work on the train, and on the way home, I listen to music to calm myself down, and it has made such a difference bookending my workday in that way. And I think that small shifts, swaps in our lives like that are very simple to do, but you could be surprised at how quickly you feel the benefits and how quickly you want to try even more things.

Dr. Rangan Chatterjee 1:23:24 Yeah, I love that, a creative commute. What a lovely thought to finish this conversation on. The book is called Art Cure: The Science of How the Arts Transform Our Health. Thank you so much for coming on the show.

Daisy Fancourt 1:23:35 Thank you.

Dr. Rangan Chatterjee 1:23:36 If you enjoyed that conversation, then I think you are really going to enjoy this one that I picked out especially.

Speaker 1:23:43 If you actually went to the happiness gym several times a week, you will actually have a happier life, right? And the happiness gym is very straightforward. It's a set of skills, hmm, that you need to practice