Culturally safe services improve Aboriginal and Torres Strait Islander peoples’ experiences of, and access to, health care. Embedding cultural safety in our health system will improve health outcomes and address widening gaps in health and wellbeing between Aboriginal and Torres Strait Islander peoples and non-Indigenous Australians.
The Commission defines ‘cultural safety’ in accordance with the Cultural Respect Framework 2016–2026 for Aboriginal and Torres Strait Islander Health.[i] Cultural safety identifies that health consumers are safest when health professionals have considered power relations, cultural differences and patients’ rights. Part of this process requires health professionals to examine their own realities, beliefs and attitudes.
The essential features of cultural safety are:
- Understanding your own culture and cultural bias
- Acknowledging difference, requiring that caregivers are actively mindful and respectful of difference(s)
- Being informed by the theory of power relations; any attempt to depoliticise cultural safety is to miss the point
- Appreciating the historical context of colonisation, the practices of racism at individual and institutional levels and their impact on First Nations peoples’ living and wellbeing, both in the present and past
- Its presence or absence is determined by the experience of the recipient of care and not defined by the caregiver.[ii]
Australian Health Practitioner Regulation Agency’s Aboriginal and Torres Strait Islander Health and Cultural Safety Strategy 2020–2025 focuses on achieving patient safety for Aboriginal and Torres Islander peoples in Australia’s health system and recognises the linked elements of clinical and cultural safety in patient safety.
When providing care to Aboriginal and Torres Strait Islander patients, the workforce should acknowledge and be respectful of the cultural factors and complex kinship relationships that exist in the local community. Currently, the Australian health system does not always meet the needs of Aboriginal and Torres Strait Islander peoples. Aboriginal and Torres Strait Islander peoples may experience:
- Language barriers in understanding health messages and difficulty in informing members of the workforce of their needs
- Financial difficulties in gaining access to treatments and funding the costs of treatment
- Perception of inferior treatment.
Embedding cultural safety is an ongoing process, and something that the workforce must be supported in doing, in partnership with Aboriginal and Torres Strait Islander peoples. Table 2 compares actions and practices that improve the delivery of culturally safe care versus actions and practices that lack cultural safety. If your healthcare service implements these practices, the likelihood of an individual feeling safe when accessing health care will improve.
Table 2: Practices and actions that improve the delivery of culturally safe care compared to those that lack cultural safety
| Practices and actions undertaken by the healthcare workforce that embed cultural safety |
Practices and actions that create a lack of cultural safety |
| Have an awareness of their own culture, cultural practices and assumptions |
Are unaware of their own culture, cultural practices and assumptions |
| Have an awareness of how their own cultural practices and assumptions may be different from those of other cultural groups |
Focus on understanding other cultures. This assumes that people can be understood by studying their culture. This approach can promote the ‘othering’ of consumers and ‘cultural voyeurism’. It can reinforce stereotypes by not exploring social, historical, economic, class and occupational diversity |
| Use personal reflection to become aware of stereotypes and act to counter stereotypes |
Are unaware of their own stereotypes |
| Have an awareness of how cultural diversity may impact relationships with consumers from other cultures |
Apply cultural group stereotypes to individuals |
| Include the world view and life experience of the person receiving care |
Focus on lifestyles without considering the world view and life experience of the person receiving care |
| Know that healthcare services may be unfamiliar to some people |
Assume that healthcare providers and the culture of healthcare services are the norm |
| Give the power of defining ‘health’ to the person receiving care |
Retain the power to define norms for the person receiving care |
| Are aware of power dynamics in relationships with people receiving care |
Are unaware of power dynamics in relationship with people receiving care |
| Accept that power imbalances can be negotiated/changed |
Retain power |
| Are aware of the strengths, resilience and resistance of Aboriginal and Torres Strait Islander peoples |
Unaware of the strength, resilience, and resistance of Aboriginal and Torres Strait Islander peoples |
| Consider identity as a resource that can support wellbeing and social connectedness during times of illness and stress |
May consider identity a burden or a problem related to poor health outcomes |
| Are aware of the importance of developing trust in the relationship |
May assume trust because of profession |
| Engage in a two-way dialogue where knowledge is shared |
Uses one-way dialogue |
| Understand how past events can impact the health of Aboriginal and Torres Strait Islander peoples |
Unaware of history of Aboriginal and Torres Strait Islander peoples and current impacts |
| Understand that culture shock may be present |
Unaware of potential for culture shock |
- Source: Adapted from Assessing the Aboriginal and Torres Strait Islander actions in national safety and quality standards: Pre-reading workshop readings and activity (ACSQHC, 2022, unpublished).
