FAMILY EFFECTS ON HEALTH

1. FAMILY EFFECTS ON HEALTH Atatürk University Medical Faculty 2010-2011 Semester I Class 1 Family Medicine Lectures Yrd. Doç. Dr. Memet IŞIK memetisik@yahoo.com

2. Objektives • At the end of this lecture, the participants will be able to; • Describe “family” and discuss new forms of families. • Discuss functions of the family • Discuss the importance of social support • Discuss the role of family on individual’s health. • Discuss the role of family in the prevention of diseases.

3. WHAT IS A “FAMILY”? • The smallest social unit in the community, based on marriage and blood ties, consisting of wife, husband, children and siblings. Pequengnant and Bray, 1997: Group of people who are biologically, emotionally and legally bound. • Major social institution found in all human societies • a group of individuals living under one roof and usually under one head • a group of persons of common ancestry • the basic unit in society traditionally consisting of two parents rearing their children

4. Family Image • 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.

5. Turkish Family Structure • 1997 USA: The proportion of children out of wedlock 32% Bird ST. Beyond Marital Status: Relationship Type and Duration And the Risk of Low Birth Weight. Family Planning Perspectives 2000 • 2003 TR: The proportion of children out of wedlock 0 % Turkish Population and Health Surveys 2003

6. Importance of Social Support • The relation between social relationships and health is as important as morbidity and mortality effects of many diseases. House ve ark. 1988 • We can categorize social supportas "structured" and "functional“.

7. Importance of Links Between Relatives • Social support is an important factor for mortality estimates. • Regardless of socioeconomic status, previous health status and health practices, dying of individuals who are alone is as twice as than individuals living within a family.

8. Importance of Spouse • Probability of dying of the surviving spouse within 6 month after dying of one of the couple is high. -Accidents, violence, alcohol, heart attack, lung cancer Martikainen P, Valkonen T. Mortality after the death of a spouse: rates and causes of death in a large Finnish cohort. Am J Public Health 1996;86(8):1087-1093. • Risk is higher in younger then older ones. • Compared to persons with living spouses, probability of dying of the remaining couple is 17% more in males, 6% in females. Martikainen P, Valkonen T. Mortality after death of spouse in relation to duration of bereavement in Finland. J Epidemiol Community Health 1996;50(3):264-268.

9. Preventive Medicine and Family • Family is the first application area of preventive medicine World Health Organization. Statistical Indices of Family Health No. 589:17, 1976. • A healthy lifestyle is learned, applied and will be replaced in family.

10. Health Problems In Our Age

11. Chronic Illness and Family • Cigarette • Obesity • Immobility • Hypertension

12. Family Members Interact • Family members have similar risk factors • Are fed from the same kitchen • Harmful habits in the family will be copied In the case of smoking parents or siblings, smoke are more likely Salt, calories, cholesterol, fat consumption ... Gegenetic also have effect

13. Chronic Illness and Family • Families affect the course of chronic illnesses. • Individuals with chronic illness affects the family • Family meetings can be helpful Psychiatric disorders The presence of chronic patients Bedridden patients Incompatibility

14. Family may be supportive or fetter • Sometimes families can be supportive can remind to take drug whole family out for a walk ... • Sometimes the opposite might be make fun of exercising family members make fun of of the individuals who sports .

15. New Forms of the “Family” • Cohabiting couples (with or without children) • Single parent family (because of teen pregnancy, divorce or abandonment) • “Blended” family: a social unit consisting of two previously married parents and the children of their former marriages • Homosexual couples e.g. Netherlands has legalised homosexual marriages

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

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

18. The Family is Changing Changing roles (role = “expected behavior” 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)

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

20. Stressed Working Mothers Examples: • Female nurses 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

21. Effects of Family on Health 1) Effects on Illness Behaviour: Stoic? self-medicate? seek alternative medicine? Effects on medical adherence: the extent to which a person's behavior coincides with medical or health advice e.g. religion & health (faith healing)

22. 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)

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

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

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

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

27. 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)

28. 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

29. 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

30. 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 3) Stigmatizing diseases such as HIV/AIDS e.g. hostility from neighbours, abandonment by own family

31. THANK YOU