Publication
International year of the family report (phase 1): an overview of academic attempts to define the family
Summary
1. Introduction
Family life has re-emerged not only as an area of growing academic interest, but also as both a fit symbol for political slogans and a subject of public interest. The political nature of the family is manifest in the inability of different interest groups to agree on what the institution is and/or what are the correct forms of family life.
Academic debate throughout the 1940s and 50s was dominated by structural functionalist views of the family. These works sought to understand the family in terms of the functions that the institution plays within industrial society. Inherent in the functionalist models were consensual views of interpersonal and family relationships. Later feminist works have questioned these assumptions and pointed out that family life often involves conflict and the exercise of power by men over women and adults over children (Oakley 1982; Brannen 1987; Finch 1989 & 1993). On the theoretical level, feminists suggest that patriarchal values are inculcated in families, but they also permeate and influence all levels of society: political, economic and ideological. They argue that historically the form of patriarchy has been variable - religious, medical, scientific - but the essence remains the same and lies in a concept of a social order premised upon a male, and particularly paternal authority.
2. Social policy and the family
Political interest in the family is often closely tied to debates about public expenditure in the fields of welfare, health and social security (Finch 1989). For Van Every (1991), the common lack of a clear definition of the family in areas of public debate serves to mask an ideological construction. She argues that at ideological and practical levels many social policies (ranging across social security, housing, health and community care), encourage the belief and aim to promote the view that the most desirable and natural family type consists of “a heterosexual, married couple and their own (genetic) children, conceived 'naturally' ” (Van Every 1991 p 63). Finch and Mason (1993) point out that many family oriented policies are premised upon the belief that within families there is a natural division of labour (based upon gender) wherein women provide care for dependent family members (1991). Close analysis of many social policies suggests that when hard and fast boundaries are created between the ‘responsibilities of the state’ and the ‘responsibilities of the family’, there is a tendency for the state to deny more than minimal responsibility.
Health care professionals view of the family
The limited academic literature relating to doctors, heath visitors and social workers suggests that during their daily practice all use a particular common-sense view of what is a correct family type. This is normally the heterosexual nuclear family, consisting of husband, wife and child(ren). Most commonly this model comes to the surface when issues of child care and protection are raised. However, rhetorically most health care professionals claim not to engage in moral judgements and appear unaware of the influences of their common-sense knowledge upon their daily activities.
3. The changing family in Scotland
In reality there are a multiplicity of family types in Scotland. The last twenty years have seen falling fertility rates, with women completing their families younger. In 1970 there were 88,569 births, in 1980 there were 69,355 births and in 1992 there were 66,145 births. Marriage rates have also been decreasing during the last 20 years: between 1971 and 1975 there were on average 41,605 marriages per year; between 1976 and 1980 the average was 37,801 per year; and between 1986 and 1990 the average number per year was 35,400. However in 1992 there were still 35,057 new marriages. Marriage remains popular. At the same time divorce rates have risen. Between 1971 and 1975 there were on average 6604 divorces and nullities per year; between 1981 and 1985 the average divorce rate per year was 11,942; in 1991 and 1992 there were 12,399 and 12,479 divorces respectively. Births to unmarried parents have risen from 7.7 per cent of all births in 1970, to 11.3 per cent in 1980 and 30.3 per cent in 1992. Lone parenthood has also been rising. In 1986 63,000 Scottish families were receiving lone parent benefit by 1991 this had risen to 87,000 families. Most lone parents are women who have become divorced. Over half of all lone parents are economically inactive (61%), probably reflecting the lack of affordable and adequate child care.
The role of the family in maintaining and creating health
Families play a crucial role in creating and maintaining individuals health. In the best situations families provide tremendous emotional and physical support. However, families do not exist and live within a social vacuum and the opportunities open to families are affected by the level of public resources (MacIntyre 1993) as well as their private financial and social resources. An adequate understanding of people’s health promoting and health damaging behaviours requires that their actions be located within the context of their daily lives. From an individual’s perspective a single activity may be both health promoting and health damaging (Graham 1987). Individuals do not always see health damaging behaviours (e.g. smoking, excessive alcohol consumption, high fat diets) as equally bad at all stages of the life cycle (Backett & Davison 1992). People’s perceptions of what health is and how it should be promoted are related to age, gender and culture.
Health promotion, health education and the family
At the level of ideology there is an important distinction to be drawn between health education and health promotion (Tones 1993). Health education tends to stress the medical model, professional assessments of health status and the responsibility of individuals and families to look after their own health. By contrast, health promotion favours community participation in assessments of health needs and a community development path to improving health. Environmental issues such as the effects of bad housing, low incomes, unemployment and available public resources are stressed and related to the opportunities open to individuals and/or families. Inherent in the health education model is the tendency to stress individual and or family responsibility. The inherent danger in targeting families whilst using the health education ideology lies in the fact that it is all too easy to fall into ‘victim blaming’ (MacIntyre 1993) and to de-politicise health issues. This is particularly the case with regard to families as opposed to individuals because the family is often seen as the archetypal private domain.
A review of health promotion/education policies and initiative oriented towards the family
The Scottish Office, Health Boards (including HEBS), Health Councils and major voluntary sector organisations, were contacted and their central policy statements and initiatives reviewed. The inventory at the end of the main report provides a comprehensive list of the organisations contacted, as well as details of the documents reviewed. The central finding was that very few health education/promotion initiatives focus specifically upon the family. However, as most people live within what might be broadly defined as a family unit all health promotion/health education policies and initiatives have implications for family life. Health Boards tend to categorise their health promotion/education initiatives as being either settings based or topic based. Interestingly, the family is never cited as worthy of settings based initiatives. This may well reflect their recognition of the multiplicity of family types in Scotland. When families and households are mentioned in policy statements it is most commonly in relation to ‘parenting’ and the spheres of ‘child development’ and ‘child safety’.
Recommendations for stage two of the HEBS International Year of the Family Project
It is recommended that health visitors, their senior managers (and if resources allow their front-line managers), and health visitors’ clients are targeted for the second stage of the IYF project. This is because health visitors appear to be the health care professionals who spend most time working directly with families. Good research practice recognises that front-line workers often make policy through the exercise of their discretion. Importantly, however this is always within their organisational context. This is why it is recommended that, if resources allow, senior and front-line managers should also be included in the study.
The review of family health promotion initiatives in Scotland suggests that there are variations between Regions. It would therefore be interesting to take at least two geographical locations. This will allow for comparative analysis and a more adequate understanding of the ways in which organisational and managerial contexts affect health visitors’ daily practices.
4. References
Backett K & Davison C (1992) Rational or reasonable? Perceptions of health at different stages of life. Health Education Journal vol 52/1 pp 55-59.
Brannen J & Wilson G (eds) (1987) Give and Take in Families. London Allen & Unwin
Finch J & Mason J (1993) Negotiating Family Responsibilities London Tavistock and Routledge
Finch J (1989) Family Obligations and Social Change. London Polity Press.
Graham H (1987) Women’s smoking and family health. Social Science and Medicine Vol 25 No1 pp 47-56.
MacIntyre S MacIver S & Soomans A (1993) Area, Class and Health: should we be focusing on places or people? Journal of Social Policy Vol 22, 2, pp 213-234.
Oakley A (1982) Subject Women. Glasgow, Fontana.
Tones K (1993) Changing theory and practice: trends in methods, strategies and settings in health education. Health Education Journal Vol 52/3 pp 125 139
Van Every J 1991 Who is ’the family’? The assumptions of British social policy Critical Social Policy pp 62-75.