Academic journal article
By Montgomery, Bette; Rider, Mary Ellen
Journal of Family and Consumer Sciences , Vol. 93, No. 1
Scholarship and Practice
To sustain a key societal system, such as health care, individuals and families need to assume a citizen participation role with regard to services. Although Family and Consumer Sciences (FCS) education has traditionally incorporated health-related topics, emphasis has not been placed on public policy issues or multiple systems. The authors use ecological systems theory as a foundation for integrating health care and its public policy issues into FCS classrooms. It offers FCS teachers and educators alternative FCS educational perspectives on the consumer behavior changes and needs in health care systems and policies.
Individuals and families need to understand and assume an active role in the environments or systems in which they live. Family and consumer sciences supports ". . an integrative approach to the relationships among individuals, families and communities and the environments in which they function" (American Home Economics Association, 1993, p. A-5). In Family and Consumer Sciences (FCS) education, however, we have not necessarily facilitated understanding of the relationships in health care policy issues. FCS education has focused primarily on preventive health measures but has not addressed the broader issues related to interacting with health care systems. Yet, Healthy People 2010 (U.S. Department of Health and Human Services, 2000) has identified access to care issues through community education as key to achieving its goal of "increasing years of healthy life and eliminating health disparities."
An understanding of health care systems including policy is important to individual and family well being (McGregor and Goldsmith, 1998; Rider and Riportella-Muller, 1999). Knowledge of health care systems from an ecological perspective is needed, given the rapidly occurring changes. Individuals and families, as well as professionals, need to assume active roles, including one of a citizen participation role in health care, which may be different from what they have experienced or how they have been educated (Richards, Brown, and Kettler, 1999). This paper presents a rationale for more fully integrating health care public policy concepts into FCS education from an ecological systems perspective.
Within an ecological systems perspective, the environments in which people live are intricately linked with one another. These systems are described from four levels: (1) the microsystem, encompassing the settings of an individual's everyday life; (2) the mesosystem, including the family; (3) the exosystem, representing social structures such as the world of work; and (4) the broadest system, the macrosytem, integrating the overarching institutional patterns of the culture including economic, social, and political systems (Bronfenbrenner, 1977; Egan and Cowan, 1979). Reciprocal interaction can occur within and among the levels. Health care and related public policy issues can be more fully examined from a systems approach within FCS.
To address issues related to health care, skills and knowledge are required with which to interact within and among systems. At the microsystem level, individuals and families must have, for example, an understanding of personal health and family health history. Communication and leadership skills and basic knowledge of governing systems and health care systems are needed at the mesosystem level (interactions between and among microsystems). To develop an understanding at the exosystem level requires critical questioning skills and identification of credible resources from alternative systems (medical research, popular press, and Internet). Macrosystem level decisions should recognize the integration of all systems (micro-, meso-, and exosystems). At this level, assuming an advocacy role, analyzing privacy standards, understanding health insurance policies, determining health care needs and assets of a community, writing an effective letter to a local legislator, or following a successful complaint resolution process requires an integrative understanding of all the systems. …