Introduction

For more than forty years, the Performing Arts Medicine Association (PAMA) has been the primary international platform for advancing health-related knowledge in the performing arts. In July 2025, this trajectory expanded with the First Global Summit on Occupational Health in Music, held at the Johns Hopkins Bloomberg Center in Washington, D.C. The Summit brought together leaders from music, medicine, public health, engineering, psychology, and education to address persistent, preventable music-specific occupational health risks and to advance a more unified, systems-oriented approach to research, education, clinical care, and policy.

Historical Context and Rationale

Although musicians’ health has received sustained clinical and research attention, responses to music-related health concerns remain fragmented across disciplines and institutions. Musicians continue to face high rates of preventable musculoskeletal disorders, noise-induced hearing loss, vocal injuries, and mental health issues, many of which develop during training and are reinforced by prevailing teaching norms and institutional cultures in higher music education. Despite decades of evidence, many musicians, and critically, those responsible for their education and training, still lack the knowledge, competencies, and professional preparation needed to recognize, prevent, and manage these risks. This is not simply an educational gap; it reflects a systemic failure to define health as a core competency in music training and professional practice. As a result, health remains peripheral to the very systems that shape how music is taught, practiced, and performed. The Summit responded to a growing recognition that isolated wellness efforts and individual interventions are insufficient. Instead, music must be recognized as an occupation with music-specific occupational health risks that require the same preventive, educational, and policy measures as other occupational sectors.

This effort builds on earlier initiatives that sought to address musicians’ health through prevention-oriented educational frameworks, most notably the Health Promotion in Schools of Music (HPSM) project, which emerged from a 2004 national conference and emphasized the roles of institutions, faculty, and cultural norms in shaping health outcomes and influencing musicians’ behavior. While these early efforts established the importance of health promotion in higher music education, they also revealed the need for a more comprehensive framework that integrates individual, organizational, and developmental determinants of health. The present Summit advances this trajectory by introducing the Total Musician HealthTM (TMH) model and explicitly situating music within an occupational health context, thereby extending prior work toward a more unified, systems-oriented approach now described as Occupational Health in Music.

Relationship to the Performing Arts Medicine Association

The Summit was deliberately organized as a pre-conference event for the annual international symposium of the Performing Arts Medicine Association (PAMA). This arrangement underscores both the Summit’s intellectual origins and its forward-looking agenda.

For decades, PAMA has been the leading international professional hub for clinicians, researchers, educators, and advocates working at the intersection of the performing arts and health. While PAMA has been instrumental in advancing clinical care and research, the decision to host the Summit immediately before its annual conference reflects a deliberate effort to broaden the field beyond its historically dominant clinical orientation. This effort builds on earlier initiatives, including the Health Promotion in Schools of Music (HPSM) project, which advanced a prevention-oriented, education-centered framework for addressing music-related health risks.

The Washington, D.C., meeting extended two prior pre-conference PAMA convenings organized by the leaders of the Oxford Handbook of Musicians’ Health Advocacy, one in New York and another in London, which initiated cross-disciplinary dialogue, clarified emerging conceptual priorities, and established an international network of collaborators. Together, these efforts laid the groundwork for the 2025 Summit to engage more directly with systemic challenges that have remained underdeveloped in the field, including prevention as a primary strategy, the responsibilities of faculty and institutional leadership, recognition of the workforce within occupational health systems, and alignment with policy and accreditation structures. In this way, the Summit both complements and expands upon PAMA’s longstanding contributions, positioning Occupational Health in Music as a broader, systems-oriented framework.

Summit Design and Scope

The one-day summit brought together more than 125 invited experts from six continents, representing a wide range of fields, including music performance and education, performing arts medicine, audiology, occupational health, rehabilitation sciences, psychology, engineering, public health, and health policy. The program was organized around themes to address both diagnosing the problem and exploring coordinated action.

Core themes included music as an occupation with specific, preventable health risks; faculty and leadership responsibilities within music schools; clinical outcomes and competencies related to musicians’ healthcare; pathways to establishing professional legitimacy in performing arts medicine; and transdisciplinary collaboration and policy engagement. A key feature of the Summit was integrating occupational health principles directly into discussions of music pedagogy and institutional practices, rather than treating health as a secondary concern.

While performing arts medicine encompasses multiple disciplines, including dance, the Summit intentionally focused on music as a distinct occupational domain. This decision reflects the need to more precisely define music-specific exposures, risks, and institutional practices, which have historically been addressed in fragmented, discipline-specific ways. Establishing conceptual clarity within music is a necessary step toward broader integration across performing arts disciplines. The frameworks and recommendations emerging from the Summit, including the TMH model, are conceptually extensible and may inform future efforts to address occupational health in dance and other performing arts contexts.

Institutional Support and Venue

The Summit received competitive funding from the Johns Hopkins Nexus Awards, a university-wide program that promotes interdisciplinary convening and research across divisions. This funding enabled the deliberate integration of expertise from music, medicine, public health, engineering, nursing, and policy and encouraged participation by international scholars and clinicians.

The gathering took place at the Johns Hopkins Bloomberg Center in Washington, D.C. The selection of this venue highlighted the Summit’s emphasis on policy relevance and global leadership and enabled conversations on workforce recognition, prevention strategies, and institutional accountability within existing occupational health systems.

Conceptual Frameworks and Consensus Efforts

Central to the Summit was the introduction and discussion of the Total Musician HealthTM (TMH) model, a conceptual framework designed to integrate previously fragmented approaches to musicians’ health. The model brings together three complementary domains: (1) a biopsychosocial perspective that addresses the physical, psychological, and social determinants of health; (2) occupational health principles, including alignment with the National Institute for Occupational Safety and Health (NIOSH) Total Worker Health® approach, which emphasizes organizational structures, environmental exposures, and institutional responsibility; and (3) a developmental perspective that recognizes that music-specific health risks emerge, accumulate, and interact across the lifespan of training and professional practice.

Within this developmental framework, TMH explicitly acknowledges that occupational health in music is shaped not only in higher education and professional performance settings, but also in earlier educational environments and clinical contexts. This includes the role of music education systems, where teachers are responsible for managing risk in school-based settings and introducing developmentally appropriate knowledge and behaviors related to health, as well as the role of music therapy, where therapeutic use of music must be balanced with awareness of potential occupational exposures and cumulative health effects. In this way, TMH extends beyond traditional disciplinary boundaries to encompass the full continuum and breadth of music participation, from early learning through professional practice.

What distinguishes the TMH model is its explicit positioning of music as an occupation rather than solely as an artistic or educational activity. Within this framework, health outcomes are understood to arise from interactions among individual behaviors, pedagogical practices, institutional environments, and broader cultural norms. This perspective shifts the field away from reactive, treatment-oriented approaches to prevention, systems-level accountability, and upstream intervention, particularly across the interconnected domains of education, clinical care, and performance.

The TMH model further emphasizes alignment across education, clinical care, research, and policy, offering a unifying structure to coordinate disparate efforts in performing arts medicine. In this sense, TMH serves not only as a conceptual model but also as an organizing framework for redefining expectations and responsibilities of professionals engaged in music teaching, therapy, and performance. In doing so, it provides a foundation for defining competencies, guiding research priorities, and informing institutional and accreditation standards.

A defining feature of the Summit was the use of international, consensus-based working groups to advance coordinated thinking across disciplines and regions. These working groups translated conceptual priorities into coordinated action, bringing together experts in music, healthcare, public health, and education to address key priority areas. Central to these discussions was the recognition that meaningful, sustained improvements in musicians’ health depend on the unique and essential roles of music professionals, whose daily practices shape training environments and occupational exposures across the lifespan.

In particular, the Summit emphasized the responsibilities of studio faculty, conductors and ensemble directors, music education faculty, music therapists, and music school leaders, whose decisions and professional practices directly influence how music is taught, practiced, and experienced in educational, clinical, and community settings.

Accordingly, working group discussions were organized to address not only clinical and research priorities, but also the competencies, expectations, and accountabilities associated with these roles:

  • Core competencies across professional roles, encompassing healthcare providers, music faculty, music educators, and music therapists, with emphasis on the knowledge and skills required to recognize, prevent, and manage music-specific occupational health risks

  • Training pathways and professional development, including:

    • preparation of studio faculty and conductors to integrate health principles into pedagogy, rehearsal design, and performance practices

    • preparation of music education faculty and school-based educators to manage risk in K–12 settings and to teach developmentally appropriate occupational health knowledge and behaviors

    • preparation of music therapists to recognize and manage music-related exposures in therapeutic settings while balancing clinical goals with occupational health considerations

  • Institutional accountability and leadership responsibility, particularly the role of administrators and school leaders in establishing policies, allocating resources, and shaping cultures that support health, safety, and prevention across educational and clinical environments.

  • Patient-centered clinical outcomes, including the identification of meaningful health indicators specific to musicians and their translation into educational, therapeutic, and performance contexts

  • Research priorities and measurement frameworks, including approaches to exposure assessment, prevention strategies, and longitudinal outcomes linked to educational, therapeutic, and institutional practices.

Through this structure, the working groups advanced a shift from viewing health as an individual responsibility to recognizing it as a shared professional obligation embedded within the roles, practices, and leadership structures of music training and care systems. Implicit in this shift is the need to define health-related knowledge and competencies as core expectations of professional practice across all domains of music, with implications for role-specific standards, ethical responsibilities, and the preparation of future educators, clinicians, and leaders.

This orientation aligns with broader accreditation and policy frameworks in higher education, suggesting that health and safety considerations should be articulated as essential components of curricular design, instructional practice, and institutional responsibility, rather than treated as ancillary or elective concerns. In this way, the Summit extends existing efforts in performing arts medicine by advancing a more explicit linkage between occupational health principles and the formal structures that govern professional training in music. Failure to articulate these expectations risks perpetuating the very conditions that contribute to preventable health outcomes in musicians. These additions underscore that occupational health in music is not confined to professional performance settings but is initiated, shaped, and reinforced across educational and therapeutic contexts.

These groups operated through structured dialogue and consensus-building, contributing to a growing international effort to define standards of practice and align research, education, and clinical care. Their outputs inform ongoing collaborative initiatives, including the development of the Oxford Handbook of Musicians’ Health Advocacy, and mark an important step toward establishing Occupational Health in Music as a coordinated, global field. The sequence of convenings among members of these groups reflects a process of convergence, through which shared concepts, priorities, and collaborative structures were progressively refined across international contexts.

Policy and Federal Engagement

A key moment of the Summit was the keynote address by Dr. John Howard, Director of the National Institute for Occupational Safety and Health, which highlighted musicians as an important yet often overlooked occupational sector. The address emphasized the importance of exposure assessment, prevention, and institutional accountability in music education and performance settings.

Integration with Scholarship and Education

The Summit was directly connected to the forthcoming Oxford Handbook of Musicians’ Health Advocacy, which is driven by a convergence-based approach to advancing knowledge and practice across disciplines, incorporating expertise of over 100 authors across approximately 40 chapters. Together, the Handbook and the Summit function as mutually complementary initiatives, linking scholarship with coordinated international dialogue and consensus-building.

This integration reflects a broader shift toward transdisciplinary collaboration, in which research, education, and clinical practice are aligned within a shared conceptual framework. By situating musicians’ health within an occupational context and emphasizing prevention, accountability, and systems-level design, these efforts contribute to the maturation of Occupational Health in Music as a coherent and actionable field.

Additional details about the Summit, including access to all video-recorded sessions and related materials, are available on the Occupational Health in Music website (https://occupationalhealthinmusic.org). These materials will be regularly updated to support ongoing research and collaboration.

Acknowledgment of Support

The organizers gratefully thank the Performing Arts Medicine Association for supporting the First Global Summit on Occupational Health in Music and for its ongoing leadership in advancing the health and well-being of performing artists worldwide.

Conclusion

The First Global Summit on Occupational Health in Music marks a significant step in the evolution of musicians’ health, shifting from a collection of specialized clinical and research efforts to a more unified, systems-oriented framework. By explicitly defining music as an occupational domain and introducing the Total Musician HealthTM model, the Summit advances a prevention-focused perspective that emphasizes institutional responsibility, interdisciplinary collaboration, and alignment across education, clinical care, research, and policy. In this context, the Summit’s emphasis on prevention, institutional responsibility, and systems-level alignment builds on the foundational work of the Health Promotion in Schools of Music (HPSM) initiative, extending it into a more comprehensive occupational health framework.

As this work progresses, the development of Occupational Health in Music will depend on continued international collaboration, refinement of conceptual frameworks, and integration into educational and professional standards. While the present effort focused specifically on music, its principles may inform broader applications across all performing arts disciplines.

The Journal of Performing Arts Medicine serves as an important platform for documenting and advancing this emerging field. Through ongoing scholarship and dialogue, it can support the transition toward a more coherent, evidence-based approach to health in music and, ultimately, contribute to improved outcomes for musicians worldwide.

Defining music as an occupational domain is not merely a conceptual shift; it is a necessary step toward meaningful, sustainable improvements in musicians’ health.