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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 ---, Life Expectancy, Aboriginal Statistics at a Glance, Statistics Canada, 2015, https://www150.statcan.gc.ca/n1/pub/89-645-x/2010001/life-expectancyesperance-vie-eng.htm (accessed 12 April 2020). 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 Peoples in Canada, BMC Medical Education, Vol. 15 (2015), 155. ° Jonathan M. Metzl —- Helena Hansen, Structural Competency: Theorizing a New Medical Engagement with Stigma and Inequality, Social Science & Medicine (1982), Vol. 103 (2014), 126-133, https://doi.org/10.1016/j.socscimed.2013.06.032 (accessed 5 December 2020). Billy Bromage et al., Understanding Health Disparities through the Eyes of Community Members: A Structural Competency Education Intervention, Academic Psychiatry, Vol. 43, No. 2 (2019), 244-247. 66 + 262 +
