We all know we need to do much more for Indigenous health. What we don’t always know is how best to go about doing more to reduce and ideally eliminate Indigenous health inequities. One of the common pitfalls that health professionals and healthcare organizations make when it comes to Indigenous health is to believe that the answer lies in learning more about Indigenous culture, customs and practices. We argue that this positioning is flawed and potentially harmful. A focus away fromcultural competencyand onto文化安全is necessary if we are to realize Indigenous health potential.
So, what is the difference between cultural ‘competency’ and ‘safety’? Our recent literature审查examined 59 international articles on the definitions of cultural competency and cultural safety over time. Early definitions of cultural competency focused on the acquisition of knowledge about the ‘exotic’ cultural other. Contextualized to transcultural interactions between the assumed ‘White’ physician and culturally different patient, early proponents of cultural competency encouraged health professionals to maintain their expert status as they appropriated knowledge, skills and attitudes about Indigenous patients and their culture.
The assumptions inherent in a cultural competency approach is that there is a level of ‘competency’ that can be acquired (like a tick box), that Indigenous peoples can be homogenized into a collective ‘they’ and that a lack of knowledge about Indigenous people and their culture is the major cause of Indigenous health inequities. Cultural safety on the other hand, requires health professionals and their organizations to look at their own culture and to examine their own customs and practices that may be harmful to Indigenous peoples.
This positioning does not frame a lack of knowledge about Indigenous culture as the problem and is explicit in the need for health professionals and their organizations to regularly examine their own ‘culture’ in terms of biases, attitudes, assumptions, stereotypes, prejudices, structures and characteristics that may affect the quality of care provided to Indigenous peoples. This term, developed byDr Irihapeti Ramsden1980年代后期，新西兰Aotearoa的毛利护士明确承认临床相遇中固有的功率差异。文化安全需要将权力转移到卫生专业人员身上。是土著患者及其社区应该决定互动是否在文化上是安全的（是否）。
The literature base is now clear that cultural competency, whilst being necessary to some degree, is not sufficient to eliminate health inequities for Indigenous peoples. A movement towards“批评意识”is required. Health professionals must be prepared to critique the ‘taken for granted’ power structures and be prepared to challenge their own culture, biases, privilege and power rather than attempt to become ‘competent’ in the cultures of others.
文献也很清楚，不仅需要个人从业者，而且还需要在结构层面运营的医疗机构。进入卫生的社会决定因素的不平等是其在殖民历史中的基础，随后的权力不平衡始终受益于其他人。在不承认和解决差异权力，医疗互动以及更广泛的卫生系统和社会结构（包括决策和资源分配）中，无法实现健康平等。
在审查了国际文献之后，我们提出了对文化安全的定义，我们认为我们更适合于实现健康公平，并阐明了在医疗保健组织和劳动力发展中运作这种方法的基本原则和实际步骤。
我们了解到，致力于文化安全可能具有挑战性和面对。随它吧。我们绝不能接受土著健康不平等是正常或可以接受的，这将需要我们实现健康公平的方法的重大转变。
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