Understanding Gender Based Violence within national and international contexts

GG NANadia Aghtaie and Geetanjali Gangoli from the Centre for Gender and Violence Research in the School for Policy Studies introduce their new book

The endemic, universal and multifaceted nature of gender based violence is what drives the work of the Centre for Gender and Violence Research (CGVR), at the School for Policy Studies, University of Bristol. Through our recent book (Aghtaie, N. and Gangoli, G. eds (2014) Understanding Gender Based Violence. National and international contexts. Routledge), we aim not only to contribute to scholarly debates on gender and violence,  but also to showcase some of the pioneering and original research conducted by members of the CGVR.  All the chapters in this book have contributions from current and former members of staff or post graduate research students attached to the CGVR.

While the Centre was formally created in 2009, members of the Centre have a long history of researching gender based violence at a local, national and international level, and feeding this into policy and practice. The CGVR grew organically from the Violence Against Women Research Group (2003) that emerged from the Domestic Violence Research Group (1990).All the members of the CGVR identify as feminist, and have a personal passion to end GBV, and our research has always originated from this desire.018

The CGVR works on all forms of GBV and interventions challenging it, and explores how violence, gender and power operate within intimate partner, interpersonal and structural violence, for example in the context of domestic abuse, prostitution and trafficking for sexual exploitation of women and girls, rape and sexual violence, domestic violence and disabled women and gender based violence for BME communities, young people’s experiences of intimate partner violence, online and offline,  same sex domestic violence and abuse, and international and comparative research on gender based violence, in a variety of contexts.

Based on the varied research conducted by members of the CGVR, the book aims to highlight the continuing, pervasive and varied nature of gender based violence in a range of countries and contexts, such as the UK, India, Iran, Rwanda and China. The chapters in the book focus on the importance of context and structure both nationally and internally The book both builds on, and expands on existing research, theories and methodologies on the issue; as well as, enters into some under researched geographical areas; and issues, such as children’s and young people’s experiences and attitudes to gender based violence and disability and domestic violence.

The book gives a taste of the many projects, studies, international reach and contributions to theories and practice of the CGVR. The Centre is now one of the largest research centre on gender based violence in Europe. Ultimately we believe and hope that the work done by the Centre does and will contribute to a more egalitarian society, where women, men and children, are free of the pressures to ‘do gender’ and are free of violence and abuse. This is, in our view, the core of feminist research.

The book will be launched on the 3rd December 2014 at the Common Room, 8 Priory Road, Bristol.  All welcome – book here!

 

Nudge and the state

alexmarsh

Professor Alex Marsh, Head of the School for Policy Studies

Last week I took part in an enjoyable discussion on nudge policy as part of Thinking Futures, the annual festival of social sciences. Through a slightly mysterious process I ended up speaking in favour of nudge-type policies, while Fiona Spotswood from UWE made the case against relying on behaviour change initiatives. Fiona made a robust case. I have to say mine was a little less than compelling, in part because in reality I have quite a lot of sympathy with the critics. I find debating from a position you don’t entirely agree with more successful on some days and some topics than on others. This was not one of the better days.

Nonetheless, I find the topic of nudge, and behaviour change policy more broadly, fascinating because it raises so many issues.

Thaler and Sunstein’s Nudge was published in 2008 and has subsequently generated a vast critical response. Such a response is not uncommon. But what is rarer is that it has got everyone worked up. There is barely a discipline across the social sciences and humanities that hasn’t had something to say on the matter. Thaler is an economist and Sunstein a lawyer, but the critical response has gone beyond those fields to include philosophers, sociologists, political scientists, geographers, management, marketing, public health and public policy scholars. We have also seen cognitive and behavioural scientists offering views on the issue.

The critical response has addressed nudge from a wide variety of angles. Much of literature addresses the ethics of nudge. Is it ethical for governments to seek to exploit known systematic biases in human cognition in order to assist individuals in meeting ends they would desire, if they had stopped to think about it? A whole host of questions follow: how are those ends identified and by whom? Does this constitute manipulation? Is it acceptable or unacceptable for governments to manipulate in the ‘public interest’? Is it coercion? Is this the thin end of a wedge that leads to authoritarianism or even fascism (which is part of the critical response primarily among more libertarian-inclined lawyers/economists in the US)?

Is a failure on the part of government to nudge simply allowing other (private sector) economic actors a free hand to nudge individuals in all directions, without any countervailing action to mitigate the worst effects of private nudges? Perhaps the simplest way to make that point is to consider the nudge argument that if you place healthy food more prominently near the checkout in a cafeteria, rather than the confectionary that is usually there, then it increases the likelihood that people will eat healthily. Critics object to government manipulating choices in this way. But the prior question is why is the confectionary there in the first place? It is, of course, because the manufacturers of sweets know that we are prone to temptation and impulse purchases while standing in line. They are manipulating a systematic bias in our decision-making.

Of course, the alternative response to this problem is to seek to do something about the way private actors manipulate choice in the first place, rather than surreptitiously nudging in the opposite direction. But that would require a braver government than any we have seen in recent years.

A second strand of the argument focuses on the evidence base underpinning policy proposals. How well attested are these behavioural effects? One simple criticism of the literature is that much of the original experimental data comes from studies of the decision making practices of US undergraduates. To what extent do these conclusions generalise? Behavioural economics tends to assume that generalisation is unproblematic, but that is hardly a sound starting point for policy. Under the UK Coalition government the policy debate about behaviour change has been one area where considerable prominence has been placed on the role of evidence and on policy pilots. But it is an area in which one type of evidence – that drawn from randomised controlled trials – is seen as pretty much the start and finish of the conversation.

A third strand of argument is about the efficacy of nudge. Even if we accept that there is robust evidence of systematic biases in cognition (such as the tendency to weight current consumption more heavily than future costs when making decisions) what can be done with this information? Most importantly, is it a substitute or complement to other forms of government action? Can nudge be used instead of more paternalistic regulation, for example? This is a point that governments have been rather vague on. Nudge, when it arrived on the scene, was viewed as being able to stand in for more interventionist approaches. But this position has subsequently been modified in the face of criticism. It may be possible to improve social outcomes in modest ways using nudge techniques, but it is hopelessly underpowered for addressing some of the major challenges facing society.

Finally, there is the fact that “nudge” is rather elusive. By that I mean that it doesn’t refer to a very clearly defined set of actions. Or rather it has been applied to a wide range of actions and interventions that don’t really accord very well with the original definition of a nudge offered by Thaler and Sunstein – a definition which has, itself, been heavily criticised. The Government’s Behavioural Insights Team was colloquially referred to as the “nudge unit” but it drew much more broadly on insights from social psychology and behavioural science than simply focusing on nudges of the Thaler and Sunstein variety. There are now quite a number of other approaches to behaviour change circulating. Some of them have similarly catchy labels (think, steer, budge, shove). Some of them start from very different premises to nudge itself. Some have had an impact on policy in particular fields – with much of the running being made by the debate in public health. Some of them have yet to make much of an impact on policymaking in practice. The academic discussion is a riot of theoretical innovation, with various frameworks and heuristics being proposed. Some are engaged in the hard graft of evaluation and synthesis, with the aim of being clearer regarding what works, when and how.

An outstanding question is whether as the accounts of behaviour change become more complex and nuanced they start to lose their purchase on policy – which typically wants simple messages leading to clear prescriptions. But that is simply another case of the perennial tension between research and policy.

This post was originally published on Alex’s Archives.

Multimorbidity guidelines falling short: National Institute for Health and Care Excellence (NICE)

Pauline Heslop, Norah Fry Research Centre

The National Institute for Health and Care Excellence (NICE) has recently been consulting on the scope of proposed guidelines on multimorbidity. Multimorbidity is, in summary, the co-occurrence of two or more chronic medical conditions in one person. Yet the proposed scope of the guidelines will not, in their current form, offer guidance on multimorbidity in people with learning disabilities. So is this a problem that needs attention? Yes.

The recent Confidential Inquiry into premature deaths of people with learning disabilities (CIPOLD) and other national and international studies suggest that people with learning disabilities have a greater number of health problems than others, and a greater variety of healthcare concerns than those of the same age and gender in the general population. This would suggest that particular attention must be paid to this population in any NICE Guidelines. Indeed, recommendation 3 of the CIPOLD report was that NICE Guidelines should take into account multimorbidity in relation to people with learning disabilities.

Despite this, the draft scope specifies that clinical issues that will not be covered include:‘Identification and management of specific morbidities associated with learning disabilities’. No justification for this exclusion is given, and this sentence alone raises four issues:

1)    What does ‘associated with’ mean in practice, and what would be the threshold for a disorder to be ‘associated with’ learning disabilities?

2)    Some people with the same condition (e.g. autism, cerebral palsy) may or may not have learning disabilities. As it stands, the NICE Guidelines would include people with autism and associated multimorbidity who do not have learning disabilities, but would exclude people with autism and associated multi-morbidity who do have learning disabilities. Clearly, this would be a nonsense.

3)    No other groups with protected characteristics under the Equality Act 2010 are excluded.

4)    No other groups of people with conditions that themselves have associated comorbidities are excluded.

In addition, people with learning disabilities (and people with dementia) are excluded from the guidelines in relation to ‘the management and organisation of care’ in relation to multimorbidity. Again, no rationale for this is given and no other potentially vulnerable groups have been excluded.

Although these exclusions are of serious concern, there is a second issue that suggests discrimination against disabled people, with the proposed use of Quality-Adjusted Life Years (QALYs) as the preferred unit of effectiveness. QALY is a measure of the value of health attributes in a single index number. The basic idea underlying the QALY is that a year of life lived in perfect health is worth 1 and that a year of life lived in a state of less than this perfect health is worth less than 1. QALYs are usually incorporated with medical costs to develop a cost-effectiveness analysis of any treatment or intervention. My concern is that on the QALY scale, the quality of life of those with illness or disability is ranked below that of someone without a disability or illness, suggesting that QALY gives a lower value to preserving the lives of people with a permanent disability or illness than to preserving the lives of those who are healthy and not disabled, and favours those with treatable conditions and those with greater potentials for health – in terms of functioning or longevity. Indeed the European Guidelines for Cost-Effectiveness Assessments of Health Technologies, which conducted the largest experimental survey ever undertaken in Europe to test the validation of QALY assumptions, concluded that the use of QALY indicators should be abandoned for healthcare decision-making.

In all, the draft scope for guidelines on multimorbidity by NICE has a long way to go in relation to equality for people with learning disabilities. To me it appears to be arbitrary, discriminatory and contrary to the requirements of the Equality Act 2010.

As supporters of people with learning disabilities we are raising our concerns about this. What will you do?

This is an edited version of a blog sent to the new Learning Disability Association England.

This blog was originally posted on the PolicyBristol blog. 

Revisiting the ‘English Question’ Post the Scottish Independence Referendum

sarah ayres

Sarah Ayres, Centre for Urban and Public Policy Research

Despite growing recognition across the major political parties that the territorial system of government in England is in need of change, there remains no clear and shared imagery on how England should be governed within a devolved UK. Recent changes to the political and economic landscape of the UK, especially those arising from the economic crisis and the Scottish referendum result, have made it more vital than ever before to address the English Question in a cohesive manner. Enhanced devolution in England’s territories is a potential solution to the English Question. I make three central claims about what needs to happen if devolution in England is to work. My views are based on my own research that has examined English governance over the past decade (see –http://www.bristol.ac.uk/sps/people/sarah-a-ayres/overview.html).

First, past attempts to address the English Question through enhanced decentralisation in England have been piecemeal, reactionary and have, therefore, proved unsustainable. The Prime Minister’s announcement, shortly after the referendum result, of constitutional reform at breakneck speed is risky and underplays the complexities of sub-national English governance.

Second, UK government remains highly centralised despite past and present government rhetoric around decentralisation, local discretion and enhanced fiscal autonomy. Any constitutional settlement must address highly differentiated preferences for devolution and decentralisation across Westminster and Whitehall departments as well as deep-rooted cultures that promote centralism.

Third, any moves to address the English Question must deal with England in its entirety and not focus on favoured geographies or localities at the expense of less favoured areas.

The Need for a Comprehensive Response

The motives for enhanced devolution and/or decentralisation centre on three main areas (i) boosting economic productivity (ii) public service improvement and efficiency and (iii) pressures for enhanced democracy. These themes were also evident at the start of New Labour’s devolution project in 1997. The key motivations for decentralisation have therefore remained consistent – as too have the main barriers. These include Whitehall’s differentiated approach to decentralisation, highly variable local governance capacity, a lack of resources for local investment and a continued inability to join up policy in any meaningful way at a sub-national level. The assumption that these problems are easily solved or can be quickly overcome this side of a general election is flawed. The Government’s presumption of a quick fix post the referendum result raises fears that it has not fully understood the challenges of a post devolution UK. Recent evidence submitted to the McKay Commission (2013), for example, is a stark reminder of the political complexity of this issue.

Is Westminster and Whitehall Ready for Devolution in England?

The feasibility of enhanced devolution in England rests on political and ideological grounds and on the willingness of the Centre to accommodate a new constitutional settlement. But, how might this be enacted systematically across Westminster and Whitehall departments with different levels of support for decentralisation? One doubts that there has been a drastic change in the mood music across the civil service or amongst politicians since the Scottish referendum. This raises a question about whether the Government’s renewed commitment to devolution in England is any more feasible than past attempts to promote local autonomy and discretion under, for example, regionalism or localism. There is a danger that Westminster’s disposition for centralism will result in a settlement that creates the illusion of change without too much cost to its power and political priorities.

Plans for enhanced devolution are likely to lead to greater geographical variations in policy design, delivery and evaluation. However, Whitehall has struggled to deal with variation between, for example, eight English regions and more recently 39 unelected Local Enterprise Partnerships (LEPs). This issue is likely to be compounded by recent public spending cuts across Whitehall. A reduced administrative capacity at the Centre has led to the greater use of ‘ad hoc’ procedures and ‘softer’ processes for managing inter-governmental relations as opposed to formal arrangements. More fluid structures are viewed as more suited to deal the complexity of localism and the problems of managing the sub-national tier with diminished resources. An issue will be whether these structures and procedures are robust enough to support future plans for enhanced devolution.

A Fair Constitutional Settlement for All

The final point I make is that any planned response to the English Question will need to deal with England in its entirety. The Coalition government’s territorial focus in England on Cities and LEP areas has resulted in winners and losers due to different socio-economic conditions and variable collaborative capacities. Recent research indicates that many Whitehall civil servants referred to the ‘City Deal’ agreed with Manchester as the ‘aspirational model’ for greater sub-national control over public policy and finance. Nonetheless, the same officials also acknowledged that, for some, emulating this model would be a significant challenge and for others, impossible. Consequently, the variable capacity of emerging local governance arrangements has the potential to widen regional economic disparities further and lead to a greater sense of alienation from those areas that do not qualify for City Mayors, City Deals or Enterprise Zones. Heightened tensions between localities as a consequence of place based competition and more visible inequalities will do little to appease growing public demand for a fairer constitutional settlement.

Devolution in England must be fair to all citizens no matter where they live. However, plans, for example, to empower cities raise important questions about social justice and spatial equality. Any new constitutional settlement cannot ignore rural or less buoyant areas, for example. Devolved politics is producing variable social citizenship rights in different parts of the UK.  It will be essential to consider how policy divergence, variable economic benefits and differentiated inter-governmental relations will impact on localities and citizens.

Conclusion

In sum, attempts to address the English Question through enhanced political autonomy in England have been the consequence of a set of reforms that lack an underlying logic and which are littered with contradictions. The big constitutional question about the future of the England post devolution in London and the devolved territories has not been addressed and there is no consensus in government about what the final constitutional settlement should be. New Labour’s reform agenda stalled at the 2004 North East referendum and, in the absence of a constitutional master plan, the outcome has been a set of reactionary and incremental adjustments that lack strategic direction, buy-in and focus. Moving forward the challenge for government will be to develop a solution based on realism, pragmatism and sustainability and to avoid politically motivated and reactionary policy this side of the general election.

Sarah Ayres is Reader in Public Policy and Governance at the University of Bristol, UK, and is also Co-Editor of Policy & Politics

This was originally published on the Policy&Politics blog