HEALTH AND FAMILY HEALTH AND FAMILY DYNAMICSDYNAMICS

Kai-Lit Phua, PhD FLMIKai-Lit Phua, PhD FLMI

Associate ProfessorAssociate Professor

School of Medicine & Health School of Medicine & Health SciencesSciences

Monash University MalaysiaMonash University Malaysia

Biographical DetailsBiographical Details Kai-Lit Phua received his BA (cum laude) in Public Kai-Lit Phua received his BA (cum laude) in Public

Health & Population Studies from the University of Health & Population Studies from the University of Rochester and his PhD in Sociology (Medical Rochester and his PhD in Sociology (Medical Sociology) from Johns Hopkins University. He also Sociology) from Johns Hopkins University. He also holds professional qualifications from the holds professional qualifications from the insurance industry.insurance industry.

Prior to joining academia, he worked as a research Prior to joining academia, he worked as a research statistician for the Maryland Department of Health statistician for the Maryland Department of Health and Mental Hygiene and for the Managed Care and Mental Hygiene and for the Managed Care Department of a leading insurance company in Department of a leading insurance company in Singapore. Singapore.

He was awarded an Asian Public Intellectual Senior He was awarded an Asian Public Intellectual Senior Fellowship by the Nippon Foundation in 2003. Fellowship by the Nippon Foundation in 2003.

Highly RecommendedHighly Recommended

““The Lost Children of Rockdale County”The Lost Children of Rockdale County”

http://www.pbs.org/wgbh/pages/frontline/shows/georgia/etc/script.htmlfrontline/shows/georgia/etc/script.html

http://www.pbs.org/wgbh/pages/frontline/shows/georgia/isolatedfrontline/shows/georgia/isolated

WHAT IS A “FAMILY”?WHAT IS A “FAMILY”?

Major social institution found in all human Major social institution found in all human societiessocieties

Usual image: working father + housewife Usual image: working father + housewife mother + dependent childrenmother + dependent children

Reality: This is becoming less and less Reality: This is becoming less and less common as more & more mothers work common as more & more mothers work outside the home. Also because of rising outside the home. Also because of rising divorce rates. divorce rates.

New Forms of the “Family”New Forms of the “Family”

Cohabiting couples (with or without Cohabiting couples (with or without children)children)

Single parent family (because of teen Single parent family (because of teen pregnancy, divorce or abandonment)pregnancy, divorce or abandonment)

““Blended” familyBlended” family Homosexual couples e.g. Homosexual couples e.g.

Netherlands has legalised Netherlands has legalised homosexual marriageshomosexual marriages

Functions of the FamilyFunctions of the Family

Functions:Functions:

Companionship (“marry for love”)Companionship (“marry for love”) Sex and reproductionSex and reproduction Socialisation of childrenSocialisation of children Social support (especially during Social support (especially during

crises)crises) Economic cooperationEconomic cooperation

Family StructureFamily Structure

Nuclear family: Father, mother and Nuclear family: Father, mother and kidskids

Extended family: The above plus Extended family: The above plus grandparentsgrandparents

““Family life cycle” – structure of an Family life cycle” – structure of an individual family changes over timeindividual family changes over time

The Family is ChangingThe Family is Changing

Changing roles (role = “expected behaviour” Changing roles (role = “expected behaviour” that goes with a social position) that goes with a social position)

People marry later, have fewer kids, and People marry later, have fewer kids, and also have them lateralso have them later

More divorcesMore divorces

Single parent families (these are more likely Single parent families (these are more likely to be poor)to be poor)

The Family is ChangingThe Family is Changing

More working mothers and “latchkey More working mothers and “latchkey kids”kids”

Children may be unsupervised and Children may be unsupervised and feel neglected and unlovedfeel neglected and unloved

Working mothers are stressed Working mothers are stressed (“Supermom Syndrome” and “Double (“Supermom Syndrome” and “Double Burden of Women”)Burden of Women”)

Stressed Working MothersStressed Working Mothers

Examples:Examples: Female nurses with childrenFemale nurses with children Female doctors with childrenFemale doctors with children

Role conflict: Being a good doctor to Role conflict: Being a good doctor to one’s patients versus being a good one’s patients versus being a good mother to one’s kidsmother to one’s kids

Effects of Family on HealthEffects of Family on Health

1) Effects on Illness Behaviour:1) Effects on Illness Behaviour:

Stoic? self-medicate? seek Stoic? self-medicate? seek alternative medicine? Effects on alternative medicine? Effects on medical adherencemedical adherence

e.g. religion & health (faith healing, e.g. religion & health (faith healing, Jehovah’s Witness)Jehovah’s Witness)

Effects of Family on HealthEffects of Family on Health

2) Effects on patients with long term 2) Effects on patients with long term illness:illness:

Quality of care provided by family Quality of care provided by family members (female relatives as care members (female relatives as care providers for kids, husbands, in-laws providers for kids, husbands, in-laws and elderly parents)and elderly parents)

Effects of Family on HealthEffects of Family on Health

3) Family and social networks promote 3) Family and social networks promote health:health:

Socially isolated have poorer mental Socially isolated have poorer mental health; recover slower from sicknesshealth; recover slower from sickness

The Dysfunctional FamilyThe Dysfunctional Family

““Troubled family that has a negative Troubled family that has a negative effect on the physical or effect on the physical or psychological well-being of its psychological well-being of its individual family members”individual family members”

Effects of Family on HealthEffects of Family on Health

4) Dysfunctional families and poor parenting:4) Dysfunctional families and poor parenting:

Child abuse – neglect, physical abuse, Child abuse – neglect, physical abuse, verbal abuse, sexual abuseverbal abuse, sexual abuse

OverindulgenceOverindulgence Domestic violenceDomestic violence Alcoholism and substance-abuse in the Alcoholism and substance-abuse in the

familyfamily Gambling problemsGambling problems

NOTE !!NOTE !!

Families with divorced parents are NOT Families with divorced parents are NOT NECESSARILY dysfunctional families !NECESSARILY dysfunctional families !

Effects of Family on HealthEffects of Family on Health

5) Learning of health-related behaviour5) Learning of health-related behaviour

e.g. quality of diet and health e.g. quality of diet and health (including obesity), smoking and (including obesity), smoking and passive smoking, alcohol (religion & passive smoking, alcohol (religion & alcohol consumption), risk-taking alcohol consumption), risk-taking behaviour, values and behaviour behaviour, values and behaviour (including sexual behaviour) (including sexual behaviour)

Effects of Family on HealthEffects of Family on Health

6) Family changes can affect health6) Family changes can affect health

““Stressful life events” such as marital Stressful life events” such as marital breakdown and divorce, death of breakdown and divorce, death of spouse etc. increase risk of sickness spouse etc. increase risk of sickness for other family membersfor other family members

Large families: can affect health of Large families: can affect health of kids in a negative manner kids in a negative manner

Effect of Sickness on the Effect of Sickness on the FamilyFamily

1) Effect of chronic disease or death1) Effect of chronic disease or death

Role changes: if the wife gets sick or Role changes: if the wife gets sick or dies, the husband has to adjust (or dies, the husband has to adjust (or vice-versa)vice-versa)

Economic pressures: family member Economic pressures: family member stops work to care for the sick, patient stops work to care for the sick, patient is unable to work, medical bills is unable to work, medical bills become highbecome high

Effect of Sickness on the Effect of Sickness on the FamilyFamily

2) Stress from taking care of sick family 2) Stress from taking care of sick family membermember

e.g. Alzheimer’s disease, serious e.g. Alzheimer’s disease, serious mental illness, relative who is bed-mental illness, relative who is bed-ridden or incontinentridden or incontinent

3) Stigmatizing diseases such as 3) Stigmatizing diseases such as HIV/AIDSHIV/AIDS

e.g. hostility from neighbours, e.g. hostility from neighbours, abandonment by own familyabandonment by own family

THE ENDTHE END

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