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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 patientprovider 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.
