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This paper examines cultural well-being as a critical but under-theorised dimension of contemporary health and care systems. Drawing on research conducted within the Finnish ArtsEqual project, it develops a model grounded in the capability approach of Amartya Sen and Martha Nussbaum to ask a central question: do people have genuine opportunities to participate in the arts within health and care contexts?

The paper argues that, while cultural participation is recognised as a fundamental human right—also constitutionally protected in Finland—formal rights alone do not guarantee meaningful or equitable access in practice. Instead, cultural well-being is conceptualised as a systemic process shaped by how resources within health, social, and cultural systems are transformed into real opportunities, or capabilities, and ultimately into functionings—such as creating, performing, interpreting, and engaging critically with the arts.

Focusing on the role of social and personal conversion factors, the paper demonstrates how participation is shaped by structural conditions, including institutional arrangements, accessibility, inclusivity, and exclusionary mechanisms within care environments, as well as by individual factors such as cultural capital, confidence, and motivation. It further highlights the role of agency and high-quality arts education in enabling meaningful participation and the development of cultural and social capacities relevant to health and wellbeing across the life course.

The analysis challenges instrumental views of arts in medicine that assume straightforward causal impacts on health outcomes, arguing instead for a contextual and relational understanding of participation that also recognises the intrinsic value of the arts. It concludes that more sustained collaboration between health and care systems and the cultural sector is needed to address inequalities in genuine access and meaningful participation. Recognising cultural needs as basic human needs is central to advancing cultural well-being and more holistic approaches to health, regardless of life situations.