Family: a disease buster

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Family is a social unit. Living together brings about interactions, caring, and also provides additional purpose in our lives. Our personalities depend on mentoring and sharing of thoughts. Almost all religious institutions promote family life as virtuous, and a tool to bind societies. There are various connotations to the word “family”. It is a group, either of all living in a household, or of parents and children, and today of any two or more individuals living together. Traditional images of a family always include a mother and her child (or children). More members it has, more complex or complete it becomes.

Syphillis and Fertility

In early 1900s, Europe was a war theatre. Various crumbling monarchies were fighting it out. Industrial revolution in the preceding century, discovery of new lands, colonialism, and better transportation all led to multiple human migrations. Syphillis, a disease that had appeared about 500 years ago, was a huge health concern. Media propaganda portrayed it as a destroyer of “families”. In middle of all such events, French were also worried about their falling fertility levels. A 1916 French government created a commission for prophylaxis of venereal diseases, and incorporated it in ministry of Hygiene. Remember venereal or sexually transmitted diseases were a huge taboo.

More than a disease, societies considered syphillis as an issue related to virtues and upbringing. Social scientists proposed early marriage as a strategy to reduce syphilis. “If men married early, and had a family, it would reduce chances of contracting an infection.” We do not know if this strategy was indeed useful. It however had a potential to spread disease to younger women.

Syphillis was probably just a smoke-screen. Real motive was to produce more “French progeny”. Thus began a pro-natalist movement in 1920s, with a twin aim of a disease buster and a fertility enhancer. In the same year, French government banned contraception. In 1939 came a legislation “code de la famillie” that gave various economic and social concessions to women with more kids. Today more than 96% of all countries in the world offer such maternity, paternity, or child-care benefits. These social benefits were outcomes of a pro-natal movement.

After Second World War…

After the Second World War, our planet was a different place. We had discovered our first antibiotics, Syphillis became treatable and its prevalence declined. On one hand devastated Europe was on a path of economic rebuild, and on another most countries in Asia, and Africa were on brink of being freed from colonialism. After years of separation, many soldiers from Second World War were back with their families. In US this was one of the biggest factors for a fertility-surge, or a baby boom.

In contrast, many developing countries were facing resource crunch, and were overburdened by high populations. They embarked on a path of limiting family size. In 1950s, this was a revolutionary concept, as contraceptives were still banned in most of Europe. It was only in 1967 when political environment was conducive, that French assembly passed Neuwirth Law, to revoke a 40 year old ban. While on one hand more populous countries such as India, China, Bangladesh, and Indonesia were promoting smaller families. In contrast, countries in Europe and Australia struggled with a population decline.

HIV brings back a focus on families

In 1983 we discovered HIV, and in next few years, we had realised its epidemic proportions. Another sexually transmitted disease brought safe sexual practices to the forefront. Societies reemphasised restraint and discipline as virtues to be emphasised. It is no wonder, that in the same period between 1983-85, many countries called for family to be at the forefront of all development agendas. In 1989 United Nations proclaimed International Year of the family (IYF). UN expressed need for such initiative as

“The family constitutes the basic unit of society and therefore warrants special attention. Hence, the widest possible protection and assistance should be accorded to families so that they may fully assume their responsibilities within the community..”

A consensus could be built five years later and world observed IYF in 1994, and many countries displayed ideal representations of a family in their postage stamps. Since then, 15th May is observed as an international family day.

Healthcare for entire families

Many countries and organisations provide healthcare to entire families. These social security initiatives are an important incentive. In 1948, India created an Employee State Insurance act, and established a corporation (ESIC) in 1952. In 2012 ESIC completed its 50 years, and Indian Post issued a postage stamp to mark the occasion. Today, India has a nationwide state sponsored health insurance (Ayushman) which also provides a cashless cover for beneficiary families.

A postage stamp from Macau, shows families in a stamp celebrating its social services. These stamps (in a panel below) depict mother and child, a one-child family and an interaction with grand-parents as desirable family values.

Family Medicine

By later half of 20th century, advances in science added a layer of complexity to healthcare needs. Previously, a single physician could take care of diverse health needs in a family. This “family-doctor” could treat children, adults, elderly, and pregnant mothers alike. Most health needs were simple, and more advanced therapies were simply not available. As treatments became complex, healthcare became more specialised. Now there was a doctor for every organ. This made a cohesive healthcare for a family more and more difficult.

Some countries have a well established system of family-physicians. They can take care of basic health needs for all family members, and are also gatekeepers for a more specialised care. This has an advantage of minimising overall costs of care.

Changing definitions of a family

What does it mean to be a family. According to census based definitions, it is a group of individuals living in a household. However, some member may be living away for either education, occupation, or for logistic reasons. Traditional definitions include a phrase – “connected by marriage, birth, or adoption”. This definition allows extended families to be counted as one. Philatelic representations of a family have considered “a fundamental social group in society typically consisting of one or two parents and their children.” Many modern families may not fit this description.

Another modern definition is “Two or more people who share goals and values, and have long-term commitments to one another and commonly reside in the same dwelling”. This definition may be controversial in the eyes of law, but accommodates many modern relational affiliations.

Recently I came across above picture postcard. This was issued by Lithuanian Post in 2019. It shows a single parent family, with two children and a pet. It is indeed quite a change from traditional norms. Many households consider close-friends and pets as a family. Indeed, despite not bonded by blood or marriage, they can share values, goals or commitments.

Togetherness promotes desirable health-behaviour better

Physical activity is an important tool to control chronic diseases such as hypertension, diabetes and obesity. Various studies have shown that when families engage in health promotion together, it has a better uptake. In 2019 Singapore issued a set of Postage stamps to depict “Morning Singapore”. Three stamps in this five stamp set show family outings, parents leaving kids in school, or togetherness in physical activity.

Families can keep diseases away. This was applied for conditions such as Syphillis or HIV, but it also holds true for chronic diseases, and mental health. They also make health financing more meaningful. Families are indeed effective disease busters