Cultural Safety and Equity

Practising in Aotearoa New Zealand requires a continuing commitment to culturally safe patient-centred care, and a focus on improving health outcomes for Māori as tangata whenua.

Cultural Safety and Equity (CSE) encompasses a range of possible learning and review activities, including those in the related areas of cultural competence, hauora Māori and Te Tiriti o Waitangi. Doing work in any of these areas can be claimed under the CSE category.

Cultural safety

Cultural safety refers to the ability to be self-critical of the impact your own culture has on your interactions and your approach to providing healthcare. It involves doing work to find what assumptions or biases you might hold, how this may impact the service you provide, and taking steps to address or accommodate for these attitudes. Cultural safety is distinct from cultural competence.

Culturally competent medical practitioners are committed to ongoing development to accommodate for the cultural preferences of patients, whānau and communities, have knowledge of cultural protocols, beliefs, and language, and use this to facilitate engagement. They have the communication skills and confidence to ask about cultural expectations and traditional practices, including the correct pronunciation of names.

Hauora Māori

Hauora Māori medical practitioners have knowledge of the historical and contemporary Māori health situation, use Māori health models within clinical practice, engage appropriately with Māori patients, whānau and communities, are familiar with te reo me ngā tikanga Māori, and the diversity of Māori. Health is holistically viewed and considered a property of the collective rather than the individual.

These definitions can be found in the Cultural Safety Training Plan for Vocational Medicine in Aotearoa.

"A huge part of my cultural safety journey has been listening to my patients and hearing their stories. Learning more about te ao Māori from my patients improves everything about the doctor-patient relationship: the relationship is better, the consult is easier and the outcomes are better." Dr Phillipa Sleigh, Hutt Union Community Health Services, Pomare.

Equity

The Manatū Hauora | Ministry of Health’s definition of equity is "In Aotearoa New Zealand, people have differences in health that are not only avoidable but unfair and unjust. Equity recognises different people with different levels of advantage require different approaches and resources to get equitable health outcomes."

Any learning into the health concerns that a particular demographic (eg age, sex, race, ethnicity, location, sexuality, religion, and disability) may disproportionately face, the health determinants that contribute to worse health outcomes, understanding the current political, social and economic factors that may exacerbate the disparities in health outcomes, and what steps can help achieve health equity, can therefore be claimed under CSE.

Any activities completed under the other 3 categories can, and should, incorporate elements of CSE consideration.

Cultural Safety and Equity resources

Cultural competency courses

  • Five interactive modules accessed through RNZCGP Dashboard that focus on foundational language and tikanga principles of Te Ao Māori:
    • An Introduction to Aotearoa - place names and mihimihi: This module will provide you with the skills to pronounce place names correctly in Aotearoa and connect to the land by constructing your personal mihimihi. (Audio required). Duration: 20 minutes
    • Hui: This module will provide you with the knowledge on how to run a hui following tikanga Māori principles. (Audio required). Duration: 10 minutes
    • Kia Māori: This module will provide you with the skills necessary to understand the connection between Māori language and culture, beliefs, and values and tips on how to gain confidence to engage and uphold and the importance of respecting Māori culture. (Audio required). Duration: 15 minutes
    • Kia Tika: This module will provide you with the skills necessary to have an in-depth understanding of the history of the Māori language, recognise te reo Māori sounds and confidently pronounce common language used throughout Aotearoa. (Audio required). Duration: 20 minutes
    • Kia Rere: This module will guide you through the steps of setting up your digital tools to engage authentically and correctly with te reo Māori through your digital communications. (Audio required). Duration: 20 minutes
  • Mauri Ora Associates: Introductory 10 hour online courses – Foundations in Cultural Competency; and Foundations Course on Healthcare and Te Tiriti
  • eCALD: in-person and online courses for both caring for culturally and linguistically diverse (CALD) patients from Asian, Middle Eastern and African backgrounds, as well as for working in culturally diverse workplaces.
  • Le Va: Engaging Pasifika cultural competency training programme through in-person 1-day workshops around Aotearoa.
  • A selection of te Reo Māori courses (with a variety of online and in-person options):
  • Tikanga Māori courses: 

Cultural Competency – Resources

Cultural Safety – Courses

Cultural Safety – Resources

  • Harvard Implicit Association Test: Online free Implicit Association Test from a list of possible topics (eg weight, skin colour, age; US-based).
  • Why cultural safety rather than cultural competency is required to achieve health equity: a literature review and recommended definition: Article
  • Ideas on culturally safe consultations - A discussion on communicating to improve medicine access equity | He Ako Hiringa: Webinar recording and linked resources.
  • The Cultural Safety Training Plan for Vocational Medicine in Aotearoa has been developed by Te ORA and the Council of Medical Colleges. This plan defines and contextualises cultural safety, provides a conceptual framework for optimal health for Māori in Aotearoa, describes cultural safety proficiencies, outlines a teaching and assessment rubric and self-assessment tool, and provides guidance on the implementation of the training plan.
    • It introduces the cultural safety practice self-assessment tool, and states “Cultural safety is not something that can be ’achieved’: it is a lifelong journey of continual reflection and development.” On page 21 it provides a continuum which among other things, can be used by practitioners to self-assess “with respect to each of the enabling proficiencies in the training plan. This requires self-reflection on existing practice, and identifying areas for change and progression.”
    • On pp.22-23 it provides a table of Suggested teaching methods and assessment tasks/CPD activities as guidance for medical college programmes, but which can also be a useful framework for practitioners when deciding on their approach to the Cultural Safety and Equity category.
  • Cultural Safety Toolkit: A set of interactive digital tools designed to support practitioners reflect on their cultural safety as part of their Continuing Professional Development. This resource helps foster inclusive, respectful and culturally safe environments. The toolkit includes:
    • Self-Reflection Interactive Tool
    • Reflective Cycle Interactive Tool
    • Transformative Action Interactive Tool
    Alongside these, the Cultural Safety Resource Index provides options for further training and development in cultural safety.

Hauora Māori – Courses

Hauora Māori – Resources

Equity – Resources