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SAFELY EMBRACING CULTURE: THE ADEQUACY OF
THE CULTURAL SAFETY PARADIGM IN CANADIAN
AND AMERICAN INDIGENOUS HEALTHCARE
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ERIC SMITH!
ABSTRACT
The Canadian and American healthcare systems have long histories of
providing inequitable and ineffective care for Indigenous persons. This ineffec¬
tiveness is largely attributable to the confluence of socio-political inequities
and a lack of understanding of Indigenous culture amongst healthcare
providers. In an attempt to rectify this lack of understanding, a group of
Maori nurses developed the cultural safety paradigm. Building off of the
failures of its predecessors, this paradigm encourages healthcare providers
to understand health holistically and socio-historically, in and through
systems of value (i.e., cultures). The conceptual promise of the paradigm has
led to its adoption into Canadian and American healthcare, but has been
appropriated in a way that perpetuates the very problems it aims to rectify.
Although cultural safety is a step towards more equitable healthcare, a new
precedent of cultural understanding is needed for truly effective care for
Indigenous persons.
INTRODUCTION
The Canadian and American healthcare systems have long histories of
providing inequitable and ineffective care for Indigenous persons.’ Although
Canadian healthcare has long been touted for its “universal care” and American
healthcare has similarly been recognized for its innovativeness, the umbrellas of
universality and innovation have rarely covered the Indigenous groups of North
America. Since first contact, both Canadian and American settlers have justified
this lack of coverage using the language of the “Indian problem”, an erroneous
! University of Alberta.
? Piotr Wilk - Alana Maltby - Joel Phillips, Unmet Healthcare Needs among Indigenous Peoples
in Canada: Findings from the 2006 and 2012 Aboriginal Peoples Surveys, Journal of Public
Health, Vol. 26, No. 4 (2018), 481-483. Based on indigenous identity, gender, age, geographic
region and urban/rural area. Additionally, frequency distributions were produced for reasons
for UHN and types of care needed. Standard errors and confidence intervals were calculated
and took into account bootstrap weights. Results: In 2006, 11.65% (CI: 11.04, 12.26)
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