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ERIC SMITH
Although cultural safety has arguably been the most successful attempt at
modifying implicit colonial ideals,*° its relative success and influence has not
come out of nowhere. There were many other ideology-modifying paradigms
before cultural safety, each of which gradually improved on its predecessors.*!
In this sense, cultural safety is part of a continuum of cultural effectiveness
paradigms (Figure 1), which will hopefully continue to grow in the future.
Understanding this continuum and the foci within it help demonstrate why,
despite a lack of empirical tenability attributable to its vague nature, cultural
safety has been so popular over the last thirty years.
At the least effective end of the continuum sits cultural awareness. To be
culturally aware, healthcare providers are simply expected to recognize the
fact that Indigenous patients have “different” cultural circumstances through
which they live their lives. In this, there is no requirement for reframing
power imbalances or humble consideration of patient’s cultural knowledge
and its effect on health outcomes. This paradigm is the least onerous on
healthcare providers, allowing for significant colonial barriers to patients.
Cultural sensitivity and competency, which improve on cultural awareness,
include expectations of equitable inter-personal engagements with individuals
belonging to diverse value systems (much like the deliberative patient¬
provider model). Cultural sensitivity dwells more on being inoffensive, while
cultural competency focuses more on creating open discourse. However,
neither of these paradigms says anything about systemic equity. This is a
large reason why cultural safety is so appealing. It is the first paradigm of
its kind to acknowledge systemic health inequities and aim to understand
these inequities from the point of view of disadvantaged cultural groups
(i.e., Indigenous persons). In this, healthcare providers are encouraged to
understand Indigenous cultures not only in terms of lived experience, but
also as a way of viewing healthcare cultures and their shortcomings (i.e., as
systems of value). However, this does not mean that cultural safety is the best
we can do. Indeed, a great deal of its success is likely attributable to the small
steps advanced by each of its predecessors, each of which made the ideals of
cultural safety easier to accept. As Figure 1 illustrates, each paradigm is a step
towards creating truly effective (i.e., decolonized) healthcare for Indigenous
persons, but no paradigm is the final destination.
30 Harding, Cultural Safety: Nursing Ethics, 4-11.
3 Simon Brascoupé — Catherine Waters, Cultural Safety: Exploring the Applicability of the
Concept of Cultural Safety to Aboriginal Health and Community Wellness, Journal of
Aboriginal Health, Vol. 5, No. 6-8 (2009), 10.