Sing to Health - the public health argument

“Group singing might be taken - both literally and figuratively - as a potent form of ‘healthy public’, creating an ‘ideal’ community, which participants can subsequently mobilise as a positive resource for everyday life" (Camlin et al. 2020)

Many systems at play in our capitalist world promote increased isolation couched as “independence”, “consumer choice” or “convenience”. This individualism is reflected in our health care sector based on a one-to-one interaction between a clinician and patient. “Personalised care” is being championed as the gateway to better health by the NHS in the UK - treating patients as consumers and health as a matter of personal choice - and responsibility. Similarly, the wellness movement treats our health and wellbeing as a result of our personal discipline - our step counts, our keto diets or minutes spent on the headspace app. Under a capitalist framework, healthcare is treated as a commodity rather than a right, which fosters an individualistic approach to public health.

The 80% Gap - medical care only accounts for approximately 10% to 20% of health outcomes.

However, in his landmark Shattuck Lecture, Dr. Steven Schroeder (2007) revealed this startling statistic - that social determinants of health - where and how we are born, grow, live, learn and work have an 80% impact on health whereas medical care only accounts for 10-20%. This builds on the foundational work of McGinnis and Foege (1993), who argued that we must look past the "clinical" causes of death to the "actual" causes, such as the socio-economic pressures that drive chronic stress and poor nutrition. When we approach public health through a purely individualistic lens, we effectively ignore the 80% of factors that act as the true pathogens of modern society (Woolf, 2019).

The Biological Case for Group Intervention

If 80% of our health is social, then our 'prescriptions' must be social too. This is where Social Prescribing steps in. By connecting individuals to collective resources like group singing initiatives, the healthcare system finally begins to address the social isolation and environmental 'pathogens' that a traditional medicine simply cannot reach. This means viewing the community as a single biological unit.

A primary example of this is the research into group singing. Professor Daisy Fancourt (UCL/WHO) has demonstrated that collective singing provides a multi-modal intervention that medicine cannot replicate in isolation. Her studies (2016) found that just one hour of group singing produces measurable biological changes:

• Endocrine Regulation: A significant reduction in cortisol (stress) and an increase in oxytocin (social bonding).

• Immune Function: An increase in cytokines, the proteins responsible for signaling the immune system to fight inflammation.

• Preventative Resilience: Fancourt's longitudinal data shows that regular cultural engagement reduces the risk of developing depression in older age by 48%.

Group Singing as a "Healthy Public"

Dr. Dave Camlin builds on this by framing group singing as a Complex Adaptive System (Camlin et al. 2020). He argues that musicking is a form of "social ecology" that fosters reciprocity and democratic equality, values that stand in opposition to capitalist competition. In this view, a choir is not just a leisure activity, it is a "Healthy Public" where health is co-produced through social resonance and collective action. In his 2020 study, Group singing as a resource for the development of a healthy public, Camlin et al (2020) explored how collective singing creates an "ideal" community, confirming a "social bonding effect" that remains stable regardless of environmental factors and allowing participants to "rehearse and perform" healthy relationships.

Healthy communities create healthy individuals

Individualism in healthcare is biologically and economically inefficient. It attempts to solve systemic problems with private, clinical solutions. By shifting our focus toward collective resources such as the community-driven models supported by the NHS and the biological interventions identified by Fancourt and Camlin we move toward a model of "Mutual Recovery" (Crawford et al. 2015).

To improve the health of the individual, we must first improve the health of the collective. Public health is not a private commodity - it is a shared social asset, which should be funded accordingly.

References

Camlin, D. A., Daffern, H., & Zeserson, K. (2020). "Group singing as a resource for the development of a healthy public: a study of adult group singing." Humanities and Social Sciences Communications, 7(1), 1–15. https://doi.org/10.1057/s41599-020-00549-0

Crawford, P., Brown, B., Baker, B., Tischler, V. & Abrams, B. (2015) Health Humanities. Palgrave: London.

Fancourt, D., et al. (2016). Singing modulates mood, stress, cortisol, cytokine and neuropeptide activity. ecancermedicalscience.

McGinnis, J. M., & Foege, W. H. (1993). Actual causes of death in the United States. JAMA, 270(18), 2207–2212. https://doi.org/10.1001/jama.1993.03510180077038

Schroeder, S. A. (2007). We can do better — improving the health of the American people. New England Journal of Medicine, 357(12), 1221–1228. https://doi.org/10.1056/NEJMsa073350

WHO (2019). What is the evidence on the role of the arts in improving health and well-being?

Woolf, S. H. (2019). Necessary But Not Sufficient: Why Health Care Alone Cannot Improve Population Health. Annals of Family Medicine.