24 H U M A N R I G H T S COMMISSION | A FAIR GO FOR ALL? Responses to structural discrimination in the health system Case study 1: The concept of cultural safety is closely related to cultural Cultural Competency and Cultural Safety Initiatives competence, but was developed from within New Zealand as a uniquely New Zealand concept. Cultural safety was Many in the health sector have identified the importance since been adopted by other health professions. Cultural of cultural competence and cultural safety in the delivery safety, according to University of Otago researcher Marion of health and disability services to Mäori, Pacific and Asian Gray, is about positive attitudinal change toward those communities. Cultural competency programmes provide who are culturally different from us and becoming aware one avenue to address structural discrimination and ethnic of power relationships between health professionals and inequalities in health. clients. A key concept in cultural safety is that “a nurse or While there are multiple and evolving definitions of cultural competence, one comparatively simple definition that the Ministry of Health uses is: “the capacity of first developed in the nursing field in the 1990s and has midwife who can understand his or her own culture and the theory of power relations can be culturally safe in any context.”113 a health system to improve health and wellbeing by Cultural safety is intended to contribute to ameliorating integrating cultural practices and concepts into health the disparities with existing health care delivery for Mäori service delivery.” 111 Cultural competency also requires by beginning to address and change health practitioner acknowledgement of one’s own culture in order to attitudes, including racism. Although developed as an understand the culture of patients and clients, thereby indigenous approach to health inequalities for Mäori, providing more effective and culturally-appropriate health culturally safe frameworks have also developed for Pacific services. The significance of cultural competence has and Asian communities.114 Cultural safety also places grown since the introduction of the Health Practitioners emphasis on the bicultural relationship between Mäori Competence Assurance Act (HPCAA) of 2003, which and Päkehä in New Zealand and the obligations that come outlines cultural competence requirements for doctors and under the Treaty of Waitangi. health practitioners. As described in the previous section, recent studies on The Medical Council of New Zealand has adopted the health outcomes provide consistent evidence that some following definition of cultural competence: doctors treat patients differently based on ethnicity. Many Cultural competence requires an awareness of cultural diversity and the ability to function effectively, and respectfully, when working with and treating people of different cultural backgrounds. Cultural competence means a doctor has the attitudes, skills and knowledge needed to achieve this. A culturally competent doctor will acknowledge: • that New Zealand has a culturally diverse population • that a doctor’s culture and belief systems influence his or her interactions with patients and accepts this may impact on the doctor-patient relationship • that a positive patient outcome is achieved when a doctor and patient have mutual respect and understanding.112 health professionals may be unaware of biased attitudes and unaware that these attitudes can be translated into practice. These studies illustrate the manifestation of structural discrimination through the often unconscious and unspoken bias of health practitioners. Research has indicated that health disparities for Mäori, Pacific and Asian peoples are strongly linked to the behaviour of their health care providers.115 Cultural competency initiatives and cultural safety frameworks can be used to address these embedded health disparities. Health outcomes for Mäori, Pacific and Asian people can be improved when health professionals are supported to develop greater cultural competence and awareness of their own attitudes towards people who are culturally different from themselves.