From the Exposure Model to the Generative Brain: Art, Creativity, and the Case for Cultural Vitality as Health Infrastructure

A quarter-century of neuroaesthetics and cultural epidemiology has established that engagement with art is broadly and durably health-bearing, yet the finding sits awkwardly within the paradigm through which it is usually read: a tacit exposure model, in which art is beneficial input, the person is its recipient, and benefit is modelled on the dose received. Translated into practice as social prescribing, now expanding on an evidence base that the field’s own systematic reviews describe as weak, this model inherits the grammar of the receptor and the individual patient, and leaves an anomaly it cannot explain. The epidemiological signature of cultural engagement is that of a cultivated capacity distributed across a coupled system rather than of an administered agent; it survives adjustment for socioeconomic position, health status, health behaviours, and social connectedness, though not the residual confounding we treat as its most serious rival explanation. We advance the hypothesis that aesthetic reception and creative production are two directions of a single generative regime of brain function: neurally instantiated but neither neurally nor individually bounded, scaling from a transient individual state to dyadic and group-level creativity and to the enactive coupling of organism and environment. Cultural vitality thereby becomes a candidate infrastructural determinant of health, adjudicated by three stated criteria and tested through seven falsifiable predictions. Whether the reclassification holds is an empirical question, and one that neuroscience is morally compelled to help resolve before policy commitments harden.