L1 familly structure function comprehensive care

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lecture 1: family structure

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  • In the last fifteen years, 1991-2005, the Malaysian economy experienced credible growth. The economic fundamentals were strong. The structure of the economy mirrored that of a developed nation. Substantial achievements in infrastructure development, which placed Malaysia at par with developed economies. Significant progress was made in poverty eradication. More needs to be done to inculcate the required mindset in line with a developed nation status. In the next fifteen years, 2006-2020, Malaysia must build upon the strengths that were developed over the years. The introduction of the universal principles of Islam Hadhari, which will serve as a model for development.
  • In the last fifteen years, 1991-2005, the Malaysian economy experienced credible growth. The economic fundamentals were strong. The structure of the economy mirrored that of a developed nation. Substantial achievements in infrastructure development, which placed Malaysia at par with developed economies. Significant progress was made in poverty eradication. More needs to be done to inculcate the required mindset in line with a developed nation status. In the next fifteen years, 2006-2020, Malaysia must build upon the strengths that were developed over the years. The introduction of the universal principles of Islam Hadhari, which will serve as a model for development.
  • In the last fifteen years, 1991-2005, the Malaysian economy experienced credible growth. The economic fundamentals were strong. The structure of the economy mirrored that of a developed nation. Substantial achievements in infrastructure development, which placed Malaysia at par with developed economies. Significant progress was made in poverty eradication. More needs to be done to inculcate the required mindset in line with a developed nation status. In the next fifteen years, 2006-2020, Malaysia must build upon the strengths that were developed over the years. The introduction of the universal principles of Islam Hadhari, which will serve as a model for development.
  • In the last fifteen years, 1991-2005, the Malaysian economy experienced credible growth. The economic fundamentals were strong. The structure of the economy mirrored that of a developed nation. Substantial achievements in infrastructure development, which placed Malaysia at par with developed economies. Significant progress was made in poverty eradication. More needs to be done to inculcate the required mindset in line with a developed nation status. In the next fifteen years, 2006-2020, Malaysia must build upon the strengths that were developed over the years. The introduction of the universal principles of Islam Hadhari, which will serve as a model for development.
  • In the last fifteen years, 1991-2005, the Malaysian economy experienced credible growth. The economic fundamentals were strong. The structure of the economy mirrored that of a developed nation. Substantial achievements in infrastructure development, which placed Malaysia at par with developed economies. Significant progress was made in poverty eradication. More needs to be done to inculcate the required mindset in line with a developed nation status. In the next fifteen years, 2006-2020, Malaysia must build upon the strengths that were developed over the years. The introduction of the universal principles of Islam Hadhari, which will serve as a model for development.
  • FOCUS OF FEDERAL GOVERNMENT DEVELOPMENT PROGRAMME Soft infrastructure (examples are shown in the link chart) Human capital ~ education and training Poverty reduction Rural development Revitalise the agriculture sector Restructuring of society Enhance capacity of S&T and R&D Curb crime and drug abuse Address infrastructure problems : water supply public transportation flash flood quality electric supply Scheduling of project expenditure to take into consideration election year 2008/09
  • In the last fifteen years, 1991-2005, the Malaysian economy experienced credible growth. The economic fundamentals were strong. The structure of the economy mirrored that of a developed nation. Substantial achievements in infrastructure development, which placed Malaysia at par with developed economies. Significant progress was made in poverty eradication. More needs to be done to inculcate the required mindset in line with a developed nation status. In the next fifteen years, 2006-2020, Malaysia must build upon the strengths that were developed over the years. The introduction of the universal principles of Islam Hadhari, which will serve as a model for development.
  • L1 familly structure function comprehensive care

    1. 1. L1: Social Determinants of Family Health Dr Rahmah Mohd Amin Family Health Unit Department of Community Health Medical Faculty, UKM 16th June 2006
    2. 2. Family- Defined• Is a social institution, found in all societies• An important basic unit in a society• It unites people in cooperative groups to oversee the bearing and raising of children.• Family ties = kinship. This is a social bond based on blood, marriage or adoption.• Normally based on a legally sanctioned relationship involving economic cooperation as well as sexual activity and childbearing.
    3. 3. Family-Defined• A single person cannot be a family• Family members are dynamic – can increase in number, interact, communicate, teach, love etc• Perception as to what is a family differs by attitude, values, beliefs
    4. 4. Family structure• Various structure depend on – Number of members – Who the family members are – Perception in terms of power – Living arrangement – Where they live
    5. 5. Fig 1: Family ‘Core’ Family as a unit Nucleus Extended Modified extended Single parent
    6. 6. Family: based on living arrangement Nuclear family  Extended family• A social unit • A social unit composed of one or including parents, two adults and children and other children. kin.• Also called conjugal • Also called family = based on consanguine family marriage
    7. 7. Family: based on living arrangement Single parent  Modified extended family• Either father or mother alone raising • Core family, the child because of grandparents, uncle divorce/separation/ or aunties death
    8. 8. Family: based on marriage pattern• Monogamy – Marriage joining two partners• Polygamy – Marriage joining three or more people. – Has two form i.e Polygyny (many women) and Polyandry (many men). – E.g of Polyandry is in Tibet• Most of the world societies have, at some time, permitted more than one marital pattern.• Most actual marriage has been monogamous.
    9. 9. Family: based on marriage pattern• Endogamy – Marriage between people of the same social category. Same age, village, race, religion• Exogamy – Marriage between people of different social categories In India for e.g a person suppose to marry people from same caste (endogamy but from a different village (exogamy). Endogamy because people of similar position pass along their standing to children. Exogamy to encourage cultural diffusion and build alliance.
    10. 10. Family: based on where they live• Matrilocality • Neolocality Married couples live Lives apart from with or near the both sets of wife’s family. parents. More in industrial society.• Patrilocality Married couples live • Ambilocality with or near the Alternately living as husband’s family. matrilocal and patrilocal
    11. 11. Family in terms of powerMalay adat is divided into two• Matriarcal law (Adat Pepatih)• Patriarchal law (Adat Temenggung) Compared with Adat Pepatih, the social institution of Adat Temenggung is more patrilineal in character. Its inheritence rules are in accordance with what is stated in the Quran, and the practice of Adat Temenggung is more prominent and acceptable in Malay society. Adat Pepatih is practiced only in the state of Negeri Sembilan. In adat Pepatih, inheritence is towards females.
    12. 12. Family in terms of power• Father has the power in a family, Patrilineal, patriarchal• Aborigines – follow “batin” –• Sheikh of a tribe-• powerful and influential person in their community
    13. 13. Other arrangements…• Families of affinity – unmarried but committed partners.• Cohabitation – heterosexual or homosexual• Accepting them as family unit excluding them from health care or other benefits.• “Elton John & David Farnish”• Doubting the impact of rearing children in homosexual partners / cohabitation among heterosexual partner
    14. 14. Family and Health Impact• Care giving• Responsibility – gender, or chronology• Health seeking behaviours – older members, Sheikh, husband• Consent, decision making
    15. 15. Functions of family• Family performs many task• Family is the backbone of a society to care for its members1) Biological2) Socialization3) Regulation of sexual activities4) Social placement5) Emotional / psychological security6) Economic / material security7) Physical security8) Education
    16. 16. • Biological function • Safety and love – Sexual function and – Protection and love. Over needs or under protection. Over compensate with material. Moderation is always the best.• Physical function – Safety, survival. Place • Reproductive to stay, eat, sleep. – Children are needed. Without them a family is considered as ‘not• Socialization complete’. Wealth, family – Personality developed name. son or daughter. Test tube babies, in family. Attitude, surrogate mothers. idea, values. Parents as role model
    17. 17. • Economy • Giving status – Working for salary to – Give legal status, support family. respect.. Out of Knowledge and skills in wedlock child. home economics. • Education• Psychological / pleasure – Illiteracy is a major – Interact with spouse and barrier for those children. Positive home seeking improvement condition. in health status and – Feel happy to be at quality of life home. Spacious. Flats – Functional literacy with two rooms. Privacy. – (Life skill & specific Loitering. knowledge). Not just primary education
    18. 18. The Family• Has greatest impact on socialization• Plays a major role in family/societal building and stability• Advocates and maintains the health of family members and society.
    19. 19. Poor Anna…On a cold winter day in 1938, a social workerwalked quickly to the door of a ruralPennsylvania farmhouse. Investigating acase of possible child abuse, the socialworker soon discovered a five-year-old girlhidden in a second-floor storage room. Thechild whose name was Anna, was wedgedinto an old chair with her arms tied above herhead so that she couldn’t move. She waswearing filthy clothes, and her arms and legswere as thin as matchsticks.
    20. 20. Anna’s condition could be described as tragic. Shewas born in 1932 to an unmarried and mentallyimpaired woman of twenty-six who lived with herstrict father. Enraged by his daughter’s “illegitimate”motherhood, the grandfather did not even want thechild in his house. For the first six months of her life,Anna was shuttled among various welfare agencies.But when her mother was no longer able to pay forher care, Anna returned to the hostile home of hergrandfather. To lessen the grandfather’s anger,Anna’s mother put the child in the storage room,giving her just enough milk to keep her alive. Thereshe stayed – day after day, month after month, withalmost no human contact – for five long years.
    21. 21. How a sociologist described Anna when he saw her at a county home…• I was appalled by the emaciated girl, who could not laugh, speak or even smile. Anna was completely unresponsive, as if alone in an empty world.Taken from Macionis, J.J. (2000) Society the Basic, Prentice-Hall International: New Jersey.
    22. 22. Social interaction: the key to socialization and humanity • Anna was deprived of social contact. • Although physically alive, Anna hardly seemed human • Without social experience, a child is incapable of thought, emotion or meaningful action – more an object than a person. • Unlike other species whose behavior is biologically set, human need social experience to learn their culture and to survive. • Social experience is also the basis of personality (a person’s fairly consistent patterns of acting, thinking and feeling. • Without social experience, as Anna’s case shows, personality does not emerged at all.
    23. 23. Responses to “Annas” in different societies• Anna in Pennslyvania USA in 1932• Anna in Pennslyvania USA in 2008?• Anna in Malaysia?• Anna in Hadramout?• Anna in Sanaa?
    24. 24. Other Examples of dysfunctional families• Example I- Economic deprivation and poverty• Example II- Divorce and single parenthood• Example III- Illegitimate• Example IV- “Neo” families- single sex• Example V- Violence and abuse• Example VI-
    25. 25. Family HealthFrom MCH to Family Health
    26. 26. Fig 1: Family Life Cycle Family as a unit Elderly MarriageMen Maternal Adulthood Perinatal/Women infancy Gender sensitivity Children Program Adolescent/ Youth Toddlers Schoolers Pre-schoolers
    27. 27. What is Health?
    28. 28. Health• The preamble to the Constitution of the WHO (adopted in 1946) stated that; “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”• 50 years later this definition was updated with the addition of two words; “Health is a dynamic state of complete physical, mental, spiritual and social well-being and not merely the absence of disease or infirmity”
    29. 29. The broadening of the original definitionof health to include dynamicdemonstrates the flexibility of the conceptof health and the manner in which it isprone to change under various humanand environment influences.The addition of the word spiritualindicates the influence of values andbeliefs derived from the diversity ofcultural norms and practices.
    30. 30. Family health and environment Physical SocialEnvironment environment-geography, Family -SES, workplace, Culture, Beliefs,study place Religion, Values Mental Environment -emotion, psychology
    31. 31. Family and treatmentComprehensive care
    32. 32. Health Services• Maternal and child health• Family health
    33. 33. SERVICE DEVELOPMENT 1950s National Rural Health Services Maternal Maternal & Child Child Health Dental services services Out-patient services
    34. 34. SERIAL VITAL STATISTICS M ALAYSIA 45 40 35 Per 1000 LB 30 25 20 15 10 5 0 1970 1980 1990 2000 2004 IMR 39.4 23.8 13.1 6.8 5.6 CBR 32.4 30.6 27.9 22.6 21.3 PMR 31.2 23.5 13.2 6.6 * 10.2 NMR 21.4 14.2 8.5 3.9 4.9* CDR 6.7 5.3 4.6 4.5 4.5 MMR 1.4 0.6 0.2 0.3 * 0.5* - Year 2002 Source: Ministry of Health Malaysia
    35. 35. 1995SERVICE DEVELOPMENT ONWARDS FAMILY Primary Health Nutrition DEVELOPMENT Care Branch DIVISION Branch Family Health Maternal & Branch Elderly Perinatal Unit Health Child Health Mental Unit Health Women’s Rehabilitation Adolescent Health Health Unit
    36. 36. Social determinants of family health
    37. 37. Culture Fig 2: Social determinants of Family Health Race, Social class, Age, Gender Lifestyle Health Bio-genetic andnon-health related social Socio- policies Economic Family status Nutrition Health Outcome Accessibility to HCS Non- modifiable Occupational factors Modifiable Environment factors
    38. 38. Determinants of health: an e.g from the UK• In relation to the determinants of health, the National Health Service (NHS) of the United Kingdom stated that; “The worst health problems in our country will not be tackled without dealing with their fundamental causes. This means tackling disadvantage in all its forms – poverty, lack of educational attainment, unemployment, discrimination and social exclusion” (DOH, 2000: 106)
    39. 39. Determinants of health…Several policy documents in the UK such as TheBlack Report (1980); The Health Divide (1987) &The Acheson Inquiry (1998) highlighted theapparent class gradient between health andillness, and point to the link between deprivationand health status.Socio-economic factors associated withvariations in health and illness include incomeand employment and housing condition.
    40. 40. Determinants of health… Poverty and ill health go hand in hand. Unemployed people tend to have worse health than people who are employed.e.g ethnic minorities, older people, older ethnic minorities
    41. 41. Even historically…• The Greeks, Romans and Victorians had more or less identified such associations and their impact on health, and had sought to address the causes of health inequalities; “…the Ancient Greeks recognized the links between location, environment, nutrition and the health of the community. The Romans too were aware of these factors, and sought to improve public health through large scale engineering works such as water supply systems and sewers. Centuries later, the Victorians established a legislative and administrative framework which led to improvements in health through better housing, sanitation and a cleaner environment” (Baggott, 1998: 270)
    42. 42. Culture Fig 2: Social determinants of Family Health Race, Social class, Age, Gender Lifestyle Bio-geneticHealth-related Family socialpolicies Socio- Health Economic Outcome status Nutrition Accessibility to HCS Non- modifiable Environment factors Modifiable Occupational factors
    43. 43. Health related social policy
    44. 44. Health related social policies…(Malaysia context)• New Economic Policy (1971)• Vision 2020 (1991)• National Mission
    45. 45. The National Mission (2006 – 2020) The five key thrusts : 1. Moving the economy up the value chain; 2. Raising the capacity for knowledge and innovation, and nurturing “first class mentality”; 3. Addressing persistent socio-economic inequalities constructively and productively; 4. Improving the standards and sustainability of the quality of life; and 5. Strengthening the country’s institutional and implementation capacity The Ninth Malaysia Plan (2006-2010) ~ the first step in the National Mission
    46. 46. Enhancing Human Capital . . .  Policies and New Emphasis :  Develop holistic human capitalNurturing ‘First Class Mentality’Thrust 2 : Raising The Capacity  Strengthen national schools to become theFor Knowledge & Innovation, & school of choice  Enhance the quality of institutions of higher education to be at par with renowned universities  Increase the supply of highly skilled human resource, particularly at diploma and advanced diploma levels  Accelerate lifelong learning for individuals to add value to themselves  Promoting self-employment and fostering entrepreneurship  Increase participation of persons with disabilities to engage in productive economic activities and to be self-reliant
    47. 47. Advancing Women in Development . . .  Policies and New Emphasis :  Special window in existing financialNurturing ‘First Class Mentality’ programmes to enable women to obtain loansThrust 2 : Raising The CapacityFor Knowledge & Innovation, &  Home office concept  Programme for poor women in urban areas Special emphasis on single mothers through formulation of strategic action plan  Inkubator Kemahiran Ibu Tunggal (I-KIT) programme, a skills training programmes for single mothers  Program Anak Angkat, financial assistance for the education of children of single mothers  Measures to meet the 30 per cent quota for women in decision-making positions in public sector
    48. 48. Empowering Youth for the Future . . .  Policies and New Emphasis :  Enhancing their role in societyNurturing ‘First Class Mentality’Thrust 2 : Raising The CapacityFor Knowledge & Innovation, &  Formulation of National Youth Act  Empowering youth to foster national unity & nation building  Developing youths with good leadership qualities & entrepreneurial skills  Creating wholesome individuals with spiritual and high moral values • Focused programmes for youths in the 15 – 24 age group • Establishment of National Youth Research Institute within existing facility • Skills training and enterpreneurial development • Enhancing training programmes to promote self- employment
    49. 49. Fostering Family & Community Development . . .  Policies and New Emphasis :  Building resilient families and creating a moreNurturing ‘First Class Mentality’Thrust 2 : Raising The CapacityFor Knowledge & Innovation, & caring society  Enhancing community participation  Increasing the role of civil society and NGOs through partnerships and joint programmes  Foster national unity and closer integration  Strengthening family unit  Formulation of National Family Policy  Strengthen family support mechanism to facilitate child welfare, protection, development and participation  Capacity building of personnel and upgrading of facilities  Early Childhood Care and Development Policy  People with Disabilities Act
    50. 50. Focus Of Federal Government Development  Soft infrastructure Programme . . .The 9th Malaysia Plan, 2006-10  Human capital ~ education and training  Poverty reduction  Rural development  Revitalise the agriculture sector  Restructuring of society  Enhance capacity of S&T and R&D  Curb crime and drug abuse  Address infrastructure problems : - water supply - public transportation - flash flood - quality electric supply  Scheduling of project expenditure to take into consideration election year 2008/09
    51. 51. Pg 1-Highlights THE 9 CHALLENGES :1. The establishment of a united Malaysian nation made up of one Bangsa Malaysia;2. The creation of a psychologically liberated, secure and developed Malaysian society;3. The fostering and development of a mature democratic society;4. The development of a moral and ethical society;5. The creation of a mature, liberal and tolerant society.6. The transformation to a scientific and progressive society;7. The realization of a fully caring society;8. The development of an economically just society, in which there is a fair and equitable distribution of wealth; and9. The establishment of a prosperous society with an economy that is fully competitive, dynamic, robust and resilient. Pg 14 Next 15
    52. 52. TOWARDS VISION 2020 Challenges V2020Highlights . . . The First Fifteen Years, 1991-2005  The Malaysian economy experienced credible growth with strong fundamentals.  Structure of the economy approaching that of a developed nation  Substantial achievements in infrastructure development at par with developed economies  Significant progress in poverty eradication and improvements in the quality of life  More needs to be done to develop technology, especially indigenous technology and competitive entrepreneurs as well as inculcate the required mindset The Next Fifteen Years, 2006- 2020  Build upon the strengths that were developed  Internalizing of the universal principles of Islam Hadhari  Launching of new initiatives to enhance human capital
    53. 53. Malaysia’s Health Vision Malaysia is to be a nation of healthy 96 individuals, families19 and communities Health system Emphasis • Equitable • Quality • Affordable • Innovation • Efficient • Health promotion • Technologically appropriate • Respect for human dignity • Environmentally adaptable Promotion • Consumer friendly • Individual responsibility • Community participation towards an enhanced quality of life
    54. 54. National Policy of older people – its objectives• 1) to enhance the respect and self-worth of the elderly in their family, society and nation• 2)to improve the potential of older people so that they continue to be active and productive in national development and create opportunity to assist them to live independently• 3) to encourage the creation and availability of specific facilities to ensure the care and protection of older people to enhance their well-being
    55. 55. Culture…• From the definition of health by WHO, health is as much a social as a biological issue.• Cultural patterns define health – ideas about health are a form of social control that encourages conformity to cultural norms• Cultural standards of health change over time• Health relates to a society’s technology• Social inequality affects health
    56. 56. Age and gender…• Death is now rare among young people.• But young people do fall victim of accidents, AIDS• Life expectancy is much higher in most countries• Across life course, women have better health compared to men• Women live longer than men• Men because of aggressiveness and individualistic are more prone to accidents, violence
    57. 57. Even lifestyle…• Research also point to the influence of lifestyle factors at the level of individual. Lifestyle factors are identified in policy documents. In this context, the Saving Our Lives white paper (DOH, 1999: 1.4) stated; “…the four main killers – the illnesses which together with accidents, play the greatest part in causing preventable deaths and ill-health: cancer, coronary heart disease and mental health. Together they account for more than 75 percent of all people who die before the age of 75 years.”
    58. 58. Social class and race…• Infant Mortality is twice as high for disadvantage children in the US compared to those from privilege family.• Studies have shown that those from higher social class think that their health is excellent compared to the lower social class.• African Americans are two and one half times as likely as whites to be poor, which helps explain why they are more likely to die in infancy and to suffer ill health and effects of violence as adults
    59. 59. Culture Fig 2: Social determinants of Family Health Race, Social class, Age, Gender Lifestyle Bio-geneticHealth-related Family socialpolicies Socio- Health Economic Outcome status Nutrition Accessibility to HCS Non- modifiable Environment factors Modifiable Occupational factors
    60. 60. Conclusion• Health of family are multi-factorial.• Understanding of family concept and development• Comprehensive care

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