Title

Family leave policy in the United States: Social determinants of family life course health

Location

Merritt Room

Start Time

3-10-2015 2:30 PM

End Time

3-10-2015 4:00 PM

Session Type

Theoretical Paper

Abstract

Background: This theoretical paper uses results from a recent study of the occupation of breastfeeding to create a practical scenario illustrating how lack of access to paid family medical leave in the United States contributes to disparities in family health and exclusion from participation in early family occupations such as breastfeeding (1). The Life Course Health Development (LCHD) framework a theoretical framework examining contexts of health disparities (2), is introduced as a relevant and useful lens for examining social determinants of family health and occupation. In the United States, the lack of paid family leave from employment is a social policy barrier that deprives families from health producing early family occupations. Factors such as lower levels of education and income, associated with risk of not breastfeeding, are also associated with having employment that does not afford family leave or other flexible work characteristics (3). These factors interact to create a nested environment of early adversity for families, who in addition to being deprived of participation in the health producing occupation of breastfeeding, also experience parent-infant separation and exclusion from other early family occupations. Complex social determinants interact to create early adversity for families leading to a trajectory of decreased occupational potential and poor family health across the life course (4). Thinking about occupation often underemphasizes the influence of social determinants, such as alienating social policies, on occupation across the life course. Recognizing and understanding how social determinants create barriers to occupational participation and performance will help inform occupational science and client-centered occupational therapy practice (5).

Aim/Objectives: The aim of this paper is to critically examine gaps in thinking about social determinants of occupation and demonstrate how the complex interplay between social determinants, including social policy, may lead to injustices in occupational participation and performance.

Methods: A practical scenario illustrating social determinants of breastfeeding was constructed using results from bivariate and multivariate analysis of contextual factors associated with extended, exclusive breastfeeding. Factors from the Infant Feeding and Practices Study II (IFPS II), a study described elsewhere, were mapped to the most appropriate LCHD context and used to create a scenario depicting the nested environment of disparity in family health and occupation resulting from lack of access to family medical leave.

Results: The LCHD framework is a useful lens for examining social determinants of occupation and identifying how lack of access to family leave creates a situation of exclusion from breastfeeding and occupational injustice.

Conclusion and Significance: Expanding thinking about social determinants of early family occupation to include understanding of how social policy may alienate or exclude families from occupations such as breastfeeding may enhance therapist-client interactions and outcomes of the occupational therapy process, and address gaps in current thinking that may contribute to occupational injustices.

Keywords: family occupation, social policy, occupational injustice

References

  1. Pitonyak, J. S., Mroz, T. M., & Fogelberg, D. (2015). Expanding client-centred thinking to include social determinants: a practical scenario based on the occupation of breastfeeding. Scandinavian Journal of Occupational Therapy, e-publication ahead of print.
  2. Halfon, N. & Hochstein, M. (2002). Life course health development: An integrated framework for developing health, policy, and research. The Milbank Quarterly, 80(3), 433-479.
  3. Johnston, M. & Esposito, N. (2007). Barriers and facilitators for breastfeeding among working women in the United States. JOGNN, 36, (1), 9-20.
  4. Wicks, A. (2005). Understanding occupational potential. Journal of Occupational Science, 12(3), 130-139.
  5. Townsend, E. & Wilcock, A. (2004). Occupational justice and client-centred practice: A dialogue in progress. Canadian Journal of Occupational Therapy, 71, 75–87.

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Oct 3rd, 2:30 PM Oct 3rd, 4:00 PM

Family leave policy in the United States: Social determinants of family life course health

Merritt Room

Background: This theoretical paper uses results from a recent study of the occupation of breastfeeding to create a practical scenario illustrating how lack of access to paid family medical leave in the United States contributes to disparities in family health and exclusion from participation in early family occupations such as breastfeeding (1). The Life Course Health Development (LCHD) framework a theoretical framework examining contexts of health disparities (2), is introduced as a relevant and useful lens for examining social determinants of family health and occupation. In the United States, the lack of paid family leave from employment is a social policy barrier that deprives families from health producing early family occupations. Factors such as lower levels of education and income, associated with risk of not breastfeeding, are also associated with having employment that does not afford family leave or other flexible work characteristics (3). These factors interact to create a nested environment of early adversity for families, who in addition to being deprived of participation in the health producing occupation of breastfeeding, also experience parent-infant separation and exclusion from other early family occupations. Complex social determinants interact to create early adversity for families leading to a trajectory of decreased occupational potential and poor family health across the life course (4). Thinking about occupation often underemphasizes the influence of social determinants, such as alienating social policies, on occupation across the life course. Recognizing and understanding how social determinants create barriers to occupational participation and performance will help inform occupational science and client-centered occupational therapy practice (5).

Aim/Objectives: The aim of this paper is to critically examine gaps in thinking about social determinants of occupation and demonstrate how the complex interplay between social determinants, including social policy, may lead to injustices in occupational participation and performance.

Methods: A practical scenario illustrating social determinants of breastfeeding was constructed using results from bivariate and multivariate analysis of contextual factors associated with extended, exclusive breastfeeding. Factors from the Infant Feeding and Practices Study II (IFPS II), a study described elsewhere, were mapped to the most appropriate LCHD context and used to create a scenario depicting the nested environment of disparity in family health and occupation resulting from lack of access to family medical leave.

Results: The LCHD framework is a useful lens for examining social determinants of occupation and identifying how lack of access to family leave creates a situation of exclusion from breastfeeding and occupational injustice.

Conclusion and Significance: Expanding thinking about social determinants of early family occupation to include understanding of how social policy may alienate or exclude families from occupations such as breastfeeding may enhance therapist-client interactions and outcomes of the occupational therapy process, and address gaps in current thinking that may contribute to occupational injustices.

Keywords: family occupation, social policy, occupational injustice