HUMAN RIGHTS COMMISSION | A FAIR GO FOR A L L ? The Medical Council of New Zealand acknowledges that “a culturally competent approach should also recognise that addressing inequalities in health care means addressing barriers between different communities and health-care systems.”116 Thus cultural competence initiatives can also be used to address systemic barriers to health equality. Factors for success 1. Cultural competency initiatives were set up to address unequal outcomes between ethnic groups in the health system. 2. Cultural competency depends on a relational model The Medical Council further outlined a commitment to that places both the health professional and patient in addressing structural discrimination and systemic barriers a wider socio-political context, and makes explicit the in its 2006 Statement on Cultural Competence by stating power relations between them. that health practitioners must have “a willingness to appropriately challenge the cultural bias of individual colleagues or systemic bias within health care services where this will have a negative impact on patients.” The Ministry of Health recognises that “cultural competence of the workforce is vital to ensure equity in access to appropriate and high quality care.” It has implemented a variety of initiatives to embed cultural 3. Cultural safety is a New Zealand-developed model that is sensitive to New Zealand’s particular population and values. 4. Cultural competence measures are backed by legislation which supports ongoing visibility and government regulation. 5. The introduction of cultural competence measures competence practices, including a recent report that encourages organisational leadership and ownership in develops support for Pacific Cultural Competencies in evaluating results and providing incentives. health, local District Health Board community health programmes and a soon-to-be released online cultural competency tool for health providers. The Health Practitioners Competence Assurance Act 2003 supports ongoing visibility and government regulation of cultural Sustainability One challenge outlined by the Ministry is that cultural competencies within health systems often lack rigorous evaluation. Thus it is still unclear which approaches are competence measures. most effective in improving health outcomes. Increased Despite these government measures, it is important achieving meaningful and sustainable outcomes in cultural for health care organisations to provide leadership in competence. Improved integration and evaluation of evaluating, properly resourcing and providing incentives cultural competence practices can lead to better outcomes for continued adherence to cultural competency initiatives. through improved communication between doctors A 2011 study of health equity in New Zealand outlined and patients, in terms of treatment acceptability and the importance of organisational leadership in challenging adherence to treatment plans.118 Measurements of doctor “habitual and inequitable” practices, both of health performance in delivery of services to Mäori, Pacific and practitioners and health systems. The study stated: “it is ethnic patients are critical to addressing the effectiveness an organisational responsibility to set frameworks that can of cultural competence initiatives and thus in addressing guide development, implementation and monitoring of unconscious manifestations of structural discrimination. cultural competency in the workforce.” Many in the health sector stress that all government agencies need to work together collaboratively at the structural level to make an impact on health inequalities: “Increasing cultural competency is a shared responsibility, requiring partnerships across a wide range of sectors − including health, social services, education, justice and research − using systematic and sustainable approaches.”117 research and evaluation are therefore recommended for 25