1. HEALTH AND FAMILY DYNAMICS Kai-Lit Phua, PhD FLMI Associate Professor School of Medicine & Health Sciences Monash University Malaysia

2. Biographical Details Kai-Lit Phua received his BA (cum laude) in Public Health & Population Studies from the University of Rochester and his PhD in Sociology (Medical Sociology) from Johns Hopkins University. He also holds professional qualifications from the insurance industry. Kai-Lit Phua received his BA (cum laude) in Public Health & Population Studies from the University of Rochester and his PhD in Sociology (Medical Sociology) from Johns Hopkins University. He also holds professional qualifications from the insurance industry. Prior to joining academia, he worked as a research statistician for the Maryland Department of Health and Mental Hygiene and for the Managed Care Department of a leading insurance company in Singapore. Prior to joining academia, he worked as a research statistician for the Maryland Department of Health and Mental Hygiene and for the Managed Care Department of a leading insurance company in Singapore. He was awarded an Asian Public Intellectual Senior Fellowship by the Nippon Foundation in 2003. He was awarded an Asian Public Intellectual Senior Fellowship by the Nippon Foundation in 2003.

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4. WHAT IS A “FAMILY”? Major social institution found in all human societies Major social institution found in all human societies Usual image: working father + housewife mother + dependent children Usual image: working father + housewife mother + dependent children Reality: This is becoming less and less common as more & more mothers work outside the home. Also because of rising divorce rates. Reality: This is becoming less and less common as more & more mothers work outside the home. Also because of rising divorce rates.

5. New Forms of the “Family” Cohabiting couples (with or without children) Cohabiting couples (with or without children) Single parent family (because of teen pregnancy, divorce or abandonment) Single parent family (because of teen pregnancy, divorce or abandonment) “Blended” family “Blended” family Homosexual couples e.g. Netherlands has legalised homosexual marriages Homosexual couples e.g. Netherlands has legalised homosexual marriages

6. Functions of the Family Functions: Companionship (“marry for love”) Companionship (“marry for love”) Sex and reproduction Sex and reproduction Socialisation of children Socialisation of children Social support (especially during crises) Social support (especially during crises) Economic cooperation Economic cooperation

7. Family Structure Nuclear family: Father, mother and kids Nuclear family: Father, mother and kids Extended family: The above plus grandparents Extended family: The above plus grandparents “Family life cycle” – structure of an individual family changes over time “Family life cycle” – structure of an individual family changes over time

8. The Family is Changing Changing roles (role = “expected behaviour” that goes with a social position) People marry later, have fewer kids, and also have them later More divorces Single parent families (these are more likely to be poor)

9. The Family is Changing More working mothers and “latchkey kids” More working mothers and “latchkey kids” Children may be unsupervised and feel neglected and unloved Children may be unsupervised and feel neglected and unloved Working mothers are stressed (“Supermom Syndrome” and “Double Burden of Women”) Working mothers are stressed (“Supermom Syndrome” and “Double Burden of Women”)

10. Stressed Working Mothers Examples: Female nurses with children Female nurses with children Female doctors with children Female doctors with children Role conflict: Being a good doctor to one’s patients versus being a good mother to one’s kids

11. Effects of Family on Health 1) Effects on Illness Behaviour: Stoic? self-medicate? seek alternative medicine? Effects on medical adherence Stoic? self-medicate? seek alternative medicine? Effects on medical adherence e.g. religion & health (faith healing, Jehovah’s Witness)

12. Effects of Family on Health 2) Effects on patients with long term illness: Quality of care provided by family members (female relatives as care providers for kids, husbands, in-laws and elderly parents) Quality of care provided by family members (female relatives as care providers for kids, husbands, in-laws and elderly parents)

13. Effects of Family on Health 3) Family and social networks promote health: Socially isolated have poorer mental health; recover slower from sickness

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

15. Effects of Family on Health 4) Dysfunctional families and poor parenting: Child abuse – neglect, physical abuse, verbal abuse, sexual abuse Child abuse – neglect, physical abuse, verbal abuse, sexual abuse Overindulgence Overindulgence Domestic violence Domestic violence Alcoholism and substance-abuse in the family Alcoholism and substance-abuse in the family Gambling problems Gambling problems

16. NOTE !! Families with divorced parents are NOT NECESSARILY dysfunctional families !

17. Effects of Family on Health 5) Learning of health-related behaviour e.g. quality of diet and health (including obesity), smoking and passive smoking, alcohol (religion & alcohol consumption), risk-taking behaviour, values and behaviour (including sexual behaviour)

18. Effects of Family on Health 6) Family changes can affect health “Stressful life events” such as marital breakdown and divorce, death of spouse etc. increase risk of sickness for other family members Large families: can affect health of kids in a negative manner

19. Effect of Sickness on the Family 1) Effect of chronic disease or death Role changes: if the wife gets sick or dies, the husband has to adjust (or vice-versa) Economic pressures: family member stops work to care for the sick, patient is unable to work, medical bills become high

20. Effect of Sickness on the Family 2) Stress from taking care of sick family member e.g. Alzheimer’s disease, serious mental illness, relative who is bed-ridden or incontinent e.g. Alzheimer’s disease, serious mental illness, relative who is bed-ridden or incontinent 3) Stigmatizing diseases such as HIV/AIDS e.g. hostility from neighbours, abandonment by own family e.g. hostility from neighbours, abandonment by own family

21. THE END THANK YOU THANK YOU