Culturally Safe and Responsive Care Statement
Cultural safety represents a key philosophical shift from providing a service regardless of difference to care that takes account of peoples’ unique needs. Cultural safety is central to Aboriginal and Torres Strait Islander people and their relationships with the health system. Cultural safety describes a state, where people are enabled and feel they can access health care that suits their needs, are able to challenge personal or institutional racism (when they experience it), establish trust in services and expect effective, quality care.
It requires all people to undertake an ongoing process of self-reflection and cultural self-awareness and an acknowledgement of how these impact on interactions and service delivery. Critically, cultural safety does not necessarily require the study of any culture other than one’s own: it is essentially about being open-minded and flexible in attitudes towards others. Identifying what makes others different is simple – however, understanding our own culture and its influence on how we think, feel and behave is much more complex, and often goes unquestioned.
If Cultural Safety describes the state we are aiming to reach – safe, accessible, person-oriented and informed care – Cultural Responsiveness is the practice to enable it.
Cultural Determinants of Health
Culture is a foundation for Aboriginal and Torres Strait Islander health and well-being. Culture provides protection across the life course and has a direct influence on broader social determinant outcomes. Gains across these broader determinants, in turn, reinforce cultural connectedness, maintenance, resurgence, nation building and pride in cultural identity.
Accordingly, the Cultural Determinations of Health are factors such as connection to Country, family, kinship and community; knowledge and beliefs, cultural expression and continuity; language, self-determination, and leadership.
These cultural determinants are embedded in the National Aboriginal and Torres Strait Islander Health Plan 2021-2031 and were informed by the Mayi Kuwayu study on Aboriginal and Torres Strait Islander well-being and further work by the Lowitja Institute, Australia’s national institute for Aboriginal and Torres Strait Islander health research.
Social Determiants of Health
The National Aboriginal and Torres Strait Islander Health Plan 2021-2031 stresses that addressing the social determinants of health is key to achieving health equity for Aboriginal and Torres Strait Islander people.
This requires shared action across maternal health and early childhood development, community and family safety, education and youth, employment and income, racism, housing, environment and infrastructure, interactions with government systems and services, law and justice, poverty, welfare dependency, food security and access to nutritious food, and experiences with alcohol, tobacco and other drugs.
The social determinants of health account for 34% of the total health gap between Aboriginal and Torres Strait Islander and non-Indigenous health outcomes. The social determinants that account for the majority of the health gap are household income, employment and hours worked, and health risk factors, such as smoking and obesity. Of the social determinants, racism is one of the most impactful for Aboriginal and Torres Strait Islander people.
The National Aboriginal and Torres Strait Islander Health Plan 2021-2031 acknowledges that the history of policy making in Australia has largely excluded Aboriginal and Torres Strait Islander people in the laws and policy decisions that have impacted our own health and well-being. Health Policy has generally revolved around consultation process that have tended to be ignored that have resulted failed policy development and program designs.
Consultation alone does not enable or include any decision-making authority or control over outcomes. Self-determination requires more than participation in service delivery. In a participation model, Aboriginal and Torres Strait Islander people have not determined the nature of the service and the ways in which the service is provided. For there to be self-determination for Aboriginal and Torres Strait Islander peoples, we must be involved in the decision making in the implementation of this Health Plan.
Self-determination is part of the Aboriginal and Torres Strait Islander Nation (re)building process to strengthen collective identity and capacity for effective Aboriginal and Torres Strait Islander governance, and sustained self-determination for community and economic development.
- Submission – Cancer Australia – Public Consultation Lung Cancer Screening Enquiry February 2020
- Submission – Council of Attorneys-General Review of Age of Criminal Responsibility
- Submission – House of Representatives Standing Committee on Indigenous Affairs – Pathways and Participation Opportunities for Indigenous Australians in Employment and Business
- Submission – Royal Commission into violence abuse, neglect and exploitation of people with a disability