Five years ago I edited a book called 'What dancer's do that other health worker's don't'. It was a response to the 'Windsor Seminars' of which I was a part. Kick started by the then Chief Medical Officer Sir Kenneth Calman, and hosted by the Nuffield Trust, they were an inquiry into how the arts might be more involved in health. I came away fired up on a number of issues and invited four other dancers to join me - first in a day of debate, then in writing a chapter for a book addressing the title question head on. We intended to define the territory for our particular kind of dance and health work.
When we had finished we were pleased with the outcome, but ruefully said to each other, 'Not sure if any of us really identified what dancers do that other health workers won't!' As I sit down to write about dance and health again several years on, I'm not sure that we, or the profession, has got substantially further in addressing this fundamental question. This time though, I don't feel merely rueful. I feel an urgency and a considerable discomfort. The climate around us has changed, government is asking us straight forwardly what we can contribute, and I'm unconvinced that we are well placed to reply - hence the discomfort.
And we haven't got long to sort ourselves out. The window of opportunity will shut in our faces if we don't leap through pretty damned quickly. So let's get sorted... We need to be able to do that most basic of things, to properly articulate what it is that we do and differentiate the many different kinds of contribution that dancers can make to population health.
The current agenda
There are two clear drivers to the government agenda. Firstly, active lifestyles produce all-round healthier people - and dancing is one way to get people active. Secondly, obesity is an urgent problem - and dancing is one way to help people to lose weight. Interest is high because not only can dancing encourage people to take up a more active pursuit, but, because it's usually darned good fun, it encourages them to keep at it as well.
We are dealing with a simple equation here. Dance = Activity = Better Health. And it is apparent that at this simple level there is no need to generate further evidence to prove the equation. 'The case is proven' was the clear message at the recent Dance and Health event called by Department for Culture, Media and Sport at Laban. The men from the ministry were clear that the evidence exists. 'Just get on with it'. Well, at one level it's great to hear this, but we should be measured on several counts. Firstly, it remains hard to work in many health settings without providing sound evidence on which to base the practice. The more embedded or specialist the contribution we seek to make, the harder it is. I suspect that the case is only proven where our contribution offers indirect, rather than direct, health benefits. But our potential contribution is so much greater than the Dance = Activity = Better Health equation.
Secondly, although there are many dancers who do want to work in partnership with health, there are many who do not. Those developing the art form do not necessarily want to spend time being 'dancing social workers', a phrase of exasperation that I suspect we will hear increasingly often if the pressure to get involved in health work continues to be addressed to the profession as a whole, rather than the section of it with the desire.
But muddles about what we offer and what we should be asked to do will continue until we, the profession, define the territory with the same kind of precision that health workers do. Dancers can impact on the determinants of health in many more ways than simply getting people active, but if we fail to articulate this clearly, address some of the training and compliance issues that are involved, and identify the different strands of our work, people outside our profession will continue to respond to us in the only way possible - roping us all in to get people active.
Many kinds of dance work
There are as many kinds of dancer as there are kinds of health worker, but in the popular imagination there is only one. I travel by train a great deal and, rattling along on the 7.47 from Peterborough (or wherever), buoyed by the camaraderie created by the most recent excuses for delays (I've had fire, cows and swans on the line recently), I often find myself trying to describe my job. It's a struggle. "I'm a dancer' just doesn't do it. It's always followed by the inevitable, 'Ballet"? inquiry, and then a terrible skirmish with some strangulated sentences about 'Not performance' and 'with nurses and physios and teachers' and then a ghastly disappointment sets in. No costume? No lights? No performance!? Just something incomprehensible and odd in a sideward then. Hmmm...
When I ask my fellow travellers about their occupation no-one says, 'I'm a health worker' In fact they probably don't even say 'nurse', or 'physio', or 'doctor'. They are able to give a really clear insight by saying 'paediatric nurse', or 'special care physio' or some such. (When a leaflet dropped through my door recently, for some inexplicable reason, inviting me to make use of my local 'Radical Midwife' I nearly burst with jealousy. Not only a precise profession in that inscription, but an attitude to that professional practice summed up in just two words. I toyed briefly with the idea of re-training for the sheer pleasure of being able to share in that simplicity.)
The point is this. Health professionals are able to differentiate their particular skills, and their particular contribution, very closely. We are not. And more importantly, behind their titles lie detailed and precise descriptions of the core skills and core competencies that each type of health worker has. When new practice develops, each specialism enters discussions to decide how the core skills and competencies need to be re-defined, or extended. They arrive at a new clarity as a professional group. We dancers have no such detailed documentation and no such forum for on going, shared, professional debates. It is as if we are all 'General Practitioners'. (And GPs with no shared understanding at that.) But we have our GPs and our specialists. How can the public, or the government for that matter, know what we truly offer, or know what they can expect from us, unless we tell them?
And yes, I know that many dancers resist definition and codification with every fibre of their being. I know that for some this is totally at odds with the nature of being an artist and making an artist's response. But I for one, as a dancer wanting to work with other people's agendas, am sick of the lack of clarity that my 'profession' continues to have, because it gets in the way of developing new collaborations, new ways of working and new partnerships. I believe that we can articulate the spectrum of 'dance' in such a way that allows us to differentiate ourselves from one another - giving some dancers the detail and regulation that is crucial to certain areas of work, whilst leaving others free to articulate their place on the spectrum in a different way - an artist's way.
Knowing our core competencies is a vital starting point and yet it's not a requirement for any of us. 'Teaching creative dance', or 'leading movement activities with frail elderly people' just isn't enough. We work with the body but we don't know what skills and understanding we should have beyond the art form itself. We have not created a unified structure across our profession that requires any rigour in these matters. Now, with some urgency, we need to create a structure within which to account for the different contributions that dancers make to this society. Working in health is just one, but perhaps the one that requires us to sharpen up most quickly.
Will it be hard to negotiate this with each other? Oh yes. But I once worked with a young boy who battled daily with the challenges of severe autism who might teach us a thing or two here. Sometimes he resisted the exhausting work he had come to do moaning 'Hard! Too hard!' His grandmother - the glorious woman who brought him for these one-to-one sessions - would say gently, but firmly, 'That's right Harry. It's hard. But you can do hard things'. She knew that he must, to have the chance of opening out. And he got on with it.
Defining the territory
Let's begin with an understanding of complexity of the health sector that some of us hope to contribute to, before we adding our own complexities. Dancers can, and do, work across the spectrum already, and do so in a range of different ways.
- Managing Illness: ironically perhaps, the first thing people think of under the term 'health'. Work that supports people who are actually ill and seeking to get better
- Care: all kinds of activities designed to support people who are getting better, or who need extra help to manage an on-going condition
- Health Education: offering insights and information to enable people to make choices about how they live
- Community Development: initiatives designed to build the environments and social networks that are the basis of good health; to reduce and eliminate the poverty that feeds poor health
- New ways to live: work that guides people to new ways of viewing themselves and their health.
We meet this already complex arena with many complexities of our own. Dance is not one practice, but many very different ones. Just as Sport ranges from fly-fishing to football, dance ranges from performance art to majorettes. ('We can do hard things...') Identifying all these under one umbrella does not mean we have to be the same as each other. It means we have to identify our different core values, core competencies, training routes and on-going regulations in such a way as our contribution in different contexts becomes clear. And identify the same duty of care issues that we must all address regardless of our different styles and processes.
This feels like difficult territory. I am in no doubt that feelings run high and resistance is strong. I've backed off for many years, but I'm not of a mind to any more. Deep breath ...sweaty palms ... dive in. (I can do hard things...) As we engage with this process there can be many starting points. Here's one I've been toying with of late. I don't expect I'm alone in pondering some version of this.
One
Can we create one overall inclusive identity for all dance activities, with one voice to speak for the whole - one that truly represents and gives equal worth to all the different facets, so that there is no value difference between performance and process oriented activities,' technical' dance and 'people' dancing. Can we create one spectacular identity that celebrates a wide range of roles for dancers in this society - from artist to collaborator in social agendas, to leisure time activity facilitator; an identity that places professionals and volunteers along a single spectrum? Can we give someone the trust required to speak for us all? Can we place the different training routes alongside one another, cross-referenced and, in some ways, entwined?
Two
Then, can we identify and articulate the different core purposes that different dancers have. Perhaps Art Form, Leisure and Recreation, Social Agenda, and Therapy, Personal and Spiritual Development. The titles are clumsy; I will have missed essential headings. But the principle remains. I am grappling with the need to re-define the sector by desired outcome, or focus, rather than the mish-mash of ways we do it at present. The funding-led development of our profession over several years, with individuals and companies forced to tick ever more boxes to qualify for funding, (performance, education, outreach, health, etc etc) has led to a kind of dance soup with everything mingling together, no clear separate identity.
Three
Each us will then need to further define our practice within these clear strands. For most of us, our core competencies lie within one strand, unless we truly are GPs. (And we can't all be GPs if we want a profession with breadth and depth.) Our professional specialisms need to be articulated, either by the way we work, or the people we work with. This is where Art Form and Leisure and Rec. categories can divide into the different styles, processes and age groups in focus; Social Agenda can divide into education, health, community development, diversity, cultural development etc as well as different processes and age groups. And Dance Therapy can retain its clear identity as a profession that has done much of this clarifying work already, alongside other approaches that swim around in the soup with the rest of us.
In the health profession, Special Interest Groups have grown around these separate areas of practice. I long, for instance, for a Frail Older People Special Interest group in my own profession - a place to debate and share practice across many approaches to the same sector, to develop networks of dancers who work in different ways (from performance to body work), but towards similar outcomes; a place to define and articulate the core competencies necessary to achieve these outcomes safely. I long for many other special interest groups as well...
We will have to be canny to avoid creating a nightmare web of structures that only serve to enmesh us. But there are plenty of examples of good practice and people who have trodden the path before from whom to seek advice. If we manage this the clarity about core competencies will not only serve to strengthen our professional identity and support an articulation of our potential role to partners, it will also clarify training issues, Continuing Professional Development and research design.
Next steps
The structure I have suggested may be far from what's needed when we all talk together. There's certainly plenty of debate to be had. But what we do need is a will to clarify and articulate what we do afresh; a collective desire to shift something, and shift it quickly. At present, it is the funding bodies that are doing it by proxy - Creativity Hubs and Forums for this, that and the other springing up left, right and centre. (Dizzy? You will be). We, the practitioners, must take the initiative, articulate our practices and identify our partners. Perhaps this can start amongst those of us who are interested in working with the health sector. Could we set up Special Interest Group with the express aim of debating and articulating our contribution?
Hard work? Yep - but we can do hard things.
Penny Greenland is Director of JABADAO - National Centre for Movement, Learning and Health - and a partner in Pathway of the Biscuit Training and Consultancy Team, created to breathe life into 'duty of care' issues.
Contact JABADAO on 0113 236 3311 or email info@jabadao.org for more information.
References:
What dancers do that other health workers don't... Miranda Tufnell, Penny Greenland, Sandy Crichton,. Katy Dymoke, Richard Coaten. A JABADAO publication 2000 ISBN 1-903819 - 02 - 4