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ERIC SMITH
designing a paradigm that would blanket and seek to modify only the implicit
oppressive influences of healthcare. As such, the cultural safety paradigm was
designed to reframe, rather than rebuild, healthcare provision in a manner
more holistically receptive to Indigenous culture.
To accomplish this reframing, the cultural safety paradigm encourages
values of holistic, humble, and responsive care for Indigenous persons.
These three values are quite vague and can refer to a number of different
behaviours in an infinite number of circumstances. This is by design. Given
the innumerable ways in which oppression can manifest and the equally
innumerable permutations of values that patients and providers may hold,
a paradigm that can reframe all possible idiosyncrasies must be vague enough
to apply in all of these possible cases. Moreover, in an attempt to fight fire with
fire, the cultural safety paradigm is designed to instil implicitly understood
ideals through vague manners of encompassing influence, much in the same
way colonial ideals instil their oppressive ideals.
That being said, there are specific aspects to these three values. In terms of
holistic care, the paradigm encourages healthcare providers to understand the
health of their patients in a more inclusive sense. That is, taking into account
the emotional, spiritual, and physical health of individuals as well as the socio¬
historical roots of illness in the populations to which they belong. In terms of
humility and responsiveness, cultural safety encourages healthcare providers
to view culture as a system of values, carrying normative weight. That is, being
humble enough to appreciate that cultural influences are not distant factors of
life outside of the biomedical sphere, but are very much a part of both patient
and provider behaviour. Moreover, this humility deals with acknowledging
that patients are more knowledgeable than providers of the influences of
their culture on their health, whilst providers are responsible for responding
promptly and appropriately to this knowledge. The combined effect of holistic,
humble, and responsive care opens the door for understanding patients on
a cultural level, which helps to decolonize healthcare methodologies” and
reduce the risk of implicit colonial bias in patient-provider interactions.”
If done correctly, this cultural understanding increases positive cared-based
relationships, which builds rapport and patterns of beneficence between
healthcare systems and Indigenous communities.
Since the relationships and interactions between patients and providers
are the ultimate gatekeepers of colonial influence (without them, there would
be no manifested oppression or space for reframing), it is worth further
clarifying the type of “positive relationships” that cultural safety aims to
26 Smith, Decolonizing Methodologies, 8-24.
27 J. R. Betancourt — A. W. Maina, The Institute of Medicine Report Unequal Treatment:
Implications for Academic Health Centers, Mount Sinai Journal of Medicine, Vol. 71, No. 5
(2004), 314-321. PMID: 15543432.