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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 sociohistorical 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.
