Scotland’s shores were graced by some big names from across the Atlantic during the last fortnight: a group of world-renowned health care professionals from Alaska and a feminist sociologist from Penn State University.
Katherine Gottlieb the warm and energetic CEO from South Central Foundation and her team told a large and eager crowd at Dynamic Earth all about the Alaskan Native People’s Nuka System of Care. The event, organised by Survivor Scotland, a national organisation who ‘oversee the National Strategy for survivors of childhood abuse’ with senior figures from NHS presented the system as the next big thing which could help improve Scotland’s physical, mental, emotional and spiritual wellness – health to you and I.
Michael Johnson was also visiting Scotland c/o Scotland’s National Violence Against Women Research Network, Scottish Women’s Aid and West Lothian Council. A proud male feminist with a long career in the Shelter Movement in the U.S., Professor Johnson is a world expert on Intimate Partner Violence. Alaska and Pennsylvania, are separated not only by many hundreds of miles but , it seems, by their approach to dealing with gender-based violence in the family.
Nuka is a healthcare system created, managed and owned by Alaska Native people with direct funding from the U.S. Government since the 1970s. Nuka is an Alaskan Native word meaning large, living, strong structures. The Nuka system provided through the SCF is based on the development of strong, high quality human relationships intrinsic to the traditional culture of Alaskan Native People. The NHS in Fife were the first to show an interest in their approach in 2010 and since then there has been regular traffic across the Atlantic as senior Scottish health officials seek lessons for our health service from the worldwide success of Nuka and SCF.
Nuka is a philosophy rooted in Alaskan Native culture transposed to their primary care health service and , refreshingly, is not entirely thirled to a medical model of health. Their lexicon of ‘customer/owners’ and ‘family warriors’ grates a little on the Scottish ear but by all accounts the health benefits for the Alaskan Native people are substantial. The model works because ‘health professionals are not heroes but partners’, ‘patients are not passive and take responsibility for their own health’, ‘they are on a journey of wellness together’. However, this is not soft and fluffy North American psychobabble, this is a healthcare system which gets results, as a visit to their open access ‘data malls’ would apparently show. So far so good, until they started talking about the Family Wellness Warriors Initiative…
The aims of the Initiative are ambitious: to end domestic violence, child sexual abuse and child neglect in this generation. Margaret Hannah, Deputy Director of Public Health, NHS Fife, an enthusiast for FWWI feels this could also work in Scotland. Echoing their approach she suggests ‘addressing the underlying causes of these problems and breaking the cycle of inter-generational abuse and violence offers a way to make a step-change in Scotland’s health and end these problems within a generation’ (http://www.internationalfuturesforum.com/projects.php?pid=57). There are a number of concerns about this approach which derive from their definition of what they term ‘family violence’ and their analysis of causation which may surprise the Scottish VAW sector and could cause difficulties in translating to a Scottish context.
FWWI defines domestic violence, child sexual abuse and child neglect as ‘family violence’. Gottlieb stated that ‘30% of abused and neglected children will later abuse their own children’ and that having the opportunity of ‘telling their story creates a good chance that they will not go on to abuse’, that ‘the men told us we need to get the men involved and that the women’s movement would have got on better if they had’. To eradicate these forms of abuse what Alaskan society needed was ‘knights in shining armour’ and to ‘call out the warriors who were willing to die for their families’. Figures quoted by the Foundation suggest that the FWWI may take longer than a generation to achieve its aims. Alaska has the highest homicide rate for female victims of domestic violence in the U.S. and is in the top five states in the US with the highest incidence of rape – it has been at the top several times in the last 25 years; child sexual abuse is six times the national average.
Public and voluntary sector bodies in Scotland use an operational definition of Violence Against Women derived from the United Nations. The definition recognises that violence against women, including domestic abuse, rape and sexual assault and sexual abuse are human rights violations and are both a cause and consequence of women’s inequality worldwide The Scottish Government has taken an ecological perspective on such matters since the early days of devolution and accepts that these are gender-based forms of violence which require a broad strategic approach to their elimination. Tackling violence against women requires political, legal, social and cultural action alongside to support prevention strategies and service provision for those affected. Social policies and activities confined to focussing on individuals and families alone have long been considered inadequate and miss the point. Alaska’s ‘knights in shining armour’ are as likely to be the cause of the problem as the solution gender-wise.
According to Johnson, speaking to packed meeting rooms and lecture halls in Glasgow and West Lothian last week, there are three main types of intimate partner violence: ‘intimate terrorism‘ is mainly perpetrated by men who wish to control their partners and who are not averse to the use of physical and sexual violence. ‘Situational couple violence’ is where partners are equally prone to physical fighting to resolve conflict or disputes and can be exacerbated by poverty, substance misuse and other stressors. Men and women both engage in this but men are likely to resort to it more frequently and with more severe physical consequences for their partner. ‘Violent Resistance” is almost always carried out by women retaliating against violence used against them in the context of intimate terrorism. Many intimate terrorists hold traditional, patriarchal and frequently negative views of women and wish to ensure conformity in their partners and children. Few such characteristics are found where there is situational couple violence.
From the perspective of the current Scottish VAW research, policy and practice perspective it is difficult to see how interventions which avoid focussing on the central gendered power dynamic of intimate gender-based violence and on gender inequality can work. To implement the principles of FWWI in Scotland would effectively run counter to the carefully constructed approach to VAW which has been developed over the last 15 years.
‘Breaking the cycle of inter-generational abuse’, is another aim of the FWWI and its Scottish enthusiasts which goes against the global grain. Studies show that most children growing up in violent homes do not go on to be violent in their adult relationships or family life. Johnson’s research shows that growing up in a family where there is situational couple violence has little effect on boys’ or girls’ future potential for using violence in relationships. Any moderate effect that exists relates to intimate terrorism and applies only to boys.
The roots of domestic abuse and sexual assault are more strongly correlated to the wider functionality of violence in society and culture, to currently acceptable notions of masculinity and to inequality. Black and minority ethnic communities living in a majority context may experience more poverty and additional discrimination. Alaskan Native Peoples have faced centuries of discrimination and dislocation across the North American continent. Figures indicate a higher incidence of situational couple violence in these minority contexts. Interventions cannot be designed on the principle of ‘one size fits all’.
While FWWI may work within the culture of the Alaskan Native people, in Scotland the focus for VAW service interventions is the identification, assessment and management of risk, the promotion of physical and emotional safety and trauma recovery. Scotland’s challenge is to create a portfolio of interventions sensitive to the needs of people often living within a complex matrix of adversities and which are no longer rooted in the traditional heterosexual, white Scottish two parent family. Johnson’s typologies of intimate partner violence have provided a valuable addition to the evidence base at the heart of Scottish VAW services, criminal justice and law enforcement activities. Knowing who is doing what to whom, how recently, how frequently and how severely and dealing with perpetrators and victims separately are key principles gradually being adopted. Police Scotland, Procurator Fiscal Service, statutory services and the VAW voluntary sectors are now in the second decade of growing a more coordinated community-based approach to all forms of gender-based violence.
Scotland’s NHS could learn a great deal from the egalitarian principles behind the Nuka System of Care but perhaps we could be so bold as to introduce the Family Warriors and their Survivor Scotland outriders to the work of Professor Michael Johnson and his colleagues in Scotland. Eradication of domestic abuse and the rest of that accursed constellation of physical and sexual abuses might even then be possible within a generation if women warriors can participate equally.