To tackle health inequalities, clinicians must reflect on power imbalances and their biases and values
Narrow definitions of ‘cultural competency’ in New Zealand’s medical services are undermining efforts to reduce health inequalities for Māori and Pacific Island communities, according to a leading academic.
Elana Curtis, a public health lecturer at the University of Auckland, says the concept has been oversimplified and has led to cultural stereotyping and marginalisation.
“Cultural competency, under its varied definitions, focuses on the culture of the ‘exotic, other patient’,” she writes in an editorial for Newsroom, an independent NZ news website.
“The often-narrow definition of cultural competency by health organisations actually undermines work to reduce health inequities. This is because organisations have tended to cast cultural competency as an individual rather than organisational process. It is for individual staff to gain cultural knowledge.”
Curtis, who has Ngāti Rongomai and Ngāti Pikiao heritage, is a leading researcher on Māori health, medical education and social inequities in treating heart disease in NZ.
In her editorial, she argues that it is time to replace the confused and narrow concept of cultural competency with “a clear and shared definition of cultural safety”.
“As a concept, cultural competency has existed since the 1980s, and has had a raft of interpretations across different countries…The range of terminology will be familiar: cultural awareness, cultural sensitivity, cultural respect,” Curtis says.
“The origins of cultural safety are entirely different. Cultural safety was first proposed in New Zealand by Dr Irihapeti Ramsden and Māori nurses in the 1990s.”
She says the Nursing Council of NZ made cultural safety a formal part of nursing and midwifery education, defining it as “a focus for the delivery of quality care” and patients’ rights.
“This concept rejects the notion that health providers should focus on learning cultural customs of ethnic groups,” Curtis writes.
“Instead, cultural safety seeks to achieve better care through becoming actively conscious of difference, decolonisation and power relationships by putting in place a reflective practice where the patient decides whether their clinical encounter is safe.”
She says that it “will be no surprise that cultural safety as a formal practice will be confronting” for NZ health professionals and institutions.
“However, in the face of continuing, persistent health inequities for Māori, it is a transformation that urgently needs to happen.”