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ERIC SMITH
Structural competency,? a potential "next step" on the cultural efficacy
continuumis a paradigm that is centred on reorienting the direction of cultural
understanding. Specifically, structural competency encourages healthcare
systems to view their lack of Indigenous cultural understanding as an internal
problem, rather than a lack of external knowledge. In this way, healthcare
systems come to understand cultures from the inside out rather than the outside
in. By starting with an understanding of medical culture (the inside), we come
to recognize the structural flaws and gaps to be filled by Indigenous cultures
(the outside). Cultural safety views this relationship the other way around (by
understanding Indigenous cultures, we add to the lexicon of knowledge in
medical culture). Iherefore, structural competency seems to allow for a more
respectful, humble, and effective engagement with Indigenous culture while
still striving to understand and better serve patients.
Canadian and American Indigenous healthcare should strive to promote
the values of paradigms like ethical space and/or structural competency.
Both of these paradigms are still in their infancy and, although theoretically
promising, have some practical problems of their own.% Most glaringly,
these paradigms still grapple with issues of an “us versus them” mentality in
their inside/outside framing. Despite these sorts of flaws that will inevitably
present themselves over time, these paradigms make vast improvements on
the shortcomings of cultural safety. By shifting our standards of culturally
effective healthcare towards these paradigms, whilst employing them in
ways that allow us to edit and adapt our ideologies of care, we will be able to
improve treatment of Indigenous people as people.
BIBLIOGRAPHY
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Beavis, Allana S.W. — Hoyjati, Ala — Kassam, Aly — CHOUDHURY, Daniel
— Fraser, Michelle - MASCHING Renee — Nixon, Stephanie, What All
Students in Healthcare Training Programs Should Learn to Increase Health
Equity: Perspectives on Postcolonialism and the Health of Aboriginal
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° Jonathan M. Metzl —- Helena Hansen, Structural Competency: Theorizing a New Medical
Engagement with Stigma and Inequality, Social Science & Medicine (1982), Vol. 103 (2014),
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Billy Bromage et al., Understanding Health Disparities through the Eyes of Community
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