How social determinants matter; education and income are markers of health. NAHO social determinants of health Access – hospitals, clinics, technology, healthcare practitioners being available within the community. Colonization – the legacy of poor health choices, and social dependency. Cultural continuity – the cultural foundation of traditional knowledge and cultural practices in the community to sustain healthy lifestyles. Globalization Migration – relocation of communities to make way for logging, mining or hydro-electric damming. Poverty – unemployment and poor quality of life. Self-determination – Aboriginal People taking control over their own decisions as individuals and communities. Territory – the loss of traditional territory and occupations on the land, including the capacity to sustain a community through agriculture, fishing and hunting. NAHO 2007 TO CONCLUDE: Social Determinants of Health: economic & social conditions that influence health Health Inequity: difference that is unnecessary, avoidable, unfair and unjust Health Disparity: difference in incidence
Historical Trauma: Recognize the impacts of colonization and historical trauma as significant impacts on the health of First Nations people Stereotype: Address the challenge of communication, by better understanding culture and cultural difference. Respect: First Nations culture and traditional knowledge as important to First Nations health and well-being. Trust: Overcome the challenge of trust, for many, authority figures are immediately mistrusted.
CULTURAL DESTRUCTIVENESS is characterized by attitudes, policies, structures, and practices within a system or organization that are destructive to a cultural group. Cultural incapacity is the lack of capacity of systems and organizations to respond effectively to the needs, interests and preferences of culturally and linguistically diverse groups. Characteristic include but are not limited to: institutional or systemic bias; practices that may result in discrimination in hiring and promotion; disproportionate allocation of resources that may benefit one cultural group over another; subtle messages that some cultural groups are neither valued nor welcomed; and lower expectations for some cultural, ethnic, or racial groups. CULTURAL BLINDNESS is an expressed philosophy of viewing and treating all people as the same. Characteristics of such systems and organizations may include: policies that and personnel who encourage assimilation; approaches in the delivery of services and supports that ignore cultural strengths; institutional attitudes that blame consumers - individuals or families - for their circumstances; little value placed on training and resource development that facilitate cultural and linguistic competence; workforce and contract personnel that lack diversity (race, ethnicity. language, gender, age etc.); and few structures and resources dedicated to acquiring cultural knowledge. CULTURAL PRE-COMPETENCE is a level of awareness within systems or organizations of their strengths and areas for growth to respond effectively to culturally and linguistically diverse populations. Characteristics include but are not limited to: the system or organization expressly values the delivery of high quality services and supports to culturally and linguistically diverse populations; commitment to human and civil rights; hiring practices that support a diverse workforce; the capacity to conduct asset and needs assessments within diverse communities; concerted efforts to improve service delivery usually for a specific racial, ethnic or cultural group; tendency for token representation on governing boards; and no clear plan for achieving organizational cultural competence. Source: National Center for Cultural Competence
A look beyond cultural sensitivity or cultural competence: Unlike the linked concepts of cultural sensitivity or cultural competence , which may contribute to a service recipient’s experiences, cultural safety is an outcome . [emphasis the author’s] Regardless of how culturally sensitive, attuned or informed we think we have been as a service provider, the concept of cultural safety asks: How safe did the service recipient experience a service encounter in terms of being respected and assisted in having their cultural location, values, and preferences taken into account in the service encounter? (Ball, 2007: 1)
Low utilization of available services Denial of suggestions that there is a problem Non-compliance’ with referrals or prescribed interventions Reticence in interactions with practitioners Anger Low self-worth Complaints about lack of ‘cultural appropriateness’ of tools and interventions
Cultural Safety Healing Its important to understand what the Aboriginal Healing Foundation projects define as safety and its connection with cultural competency. The centres identified building trust as the first step when working with survivors, workers and centres. Safety for the Aboriginal Healing Foundations projects mean Personal Safety and Cultural Safety. The first step in the healing process is to establish safety and trust with clients. Safety can restore power and control to survivors and foster responsibility for self and a feeling of belonging. This is because of the lack of trust in authority which stems back to colonization and residential schools. A major part of creating safe institutions is building trust, see the following elements of cultural safety identified by Healing Centres: Build trusting build foundation with clients to start intensive treatment Clients rights clearly stated; code of ethics, guiding principles, etc Safe therapeutic process: plan or road map for healing journey Create comfortable place and safe atmosphere Reinforce safety: assistance is available throughout their healing journey
Levels of Healing: Individual Family Community Healing is a developmental process aimed at achieving balance within oneself, within human relationships and between human beings and the natural and spiritual worlds.
Cultural safety which is an important first step in building trust can be taught. Trust is critical to development because of the mistrust and trauma caused by colonization. Taken from a policy perspective, whole organisations have become culturally safe through strategic planning and training. The literature also provides evidence that cultural competence and safety result in improved health outcomes. A culturally safe delivery system can strengthen the capacity of the communities to resist the stressors that could push them from risk to crisis.
Protocols – respect for cultural forms of engagement Personal knowledge – understanding one’s own cultural identity and sharing information about oneself to create a sense of equity and trust. Process – engaging in mutual learning, checking on cultural safety of service recipient Positive purpose – ensuring the process yields the right outcome for the service recipient according to that recipient’s values, preferences and lifestyle. Partnerships – promoting collaborative practice. Ball, 2007
Cultural Competence Cultural competence requires that organizations: Set of values and principles, and demonstrate behaviours, attitudes, policies, and structures to work cross-culturally. Capacity to (1) value diversity, (2) conduct self-assessment, (3) manage the dynamics of difference, (4) acquire and institutionalize cultural knowledge, and (5) adapt to diversity and the cultural contexts of communities they serve. Incorporate the above in all aspects of policy-making, administration, practice and service delivery, systematically involve consumers, families and communities. Cultural competence is a developmental process that evolves over an extended period. Both individuals and organizations are at various levels of awareness, knowledge and skills along the cultural competence continuum. Source: The National Center for Cultural Competence (NCCC)
Cultural Competency and Safety
Simon Brascoupé Senior Adviser, Aboriginal Relations and Initiatives Unit
National Aboriginal Health Organization
Read online: “ Cultural Safety: Exploring the Applicability of the Concept of Cultural Safety to Aboriginal Health and Community Wellness” http://www.naho.ca/jah/english/jah05_02/V5_I2_Cultural_01.pdf
There has been growing interest in the delivery of culturally competent care and training.
Cultural competency is the delivery of respectful and responsive services that meet needs of patients as a strategy to reduce disparities, provide quality care and improve health outcomes.
Cultural competent training is on a continuum; from cultural awareness, to cross-cultural to cultural competency.
Cultural competence organizations have a set of values and principles, and demonstrate behaviours, attitudes, policies, and structures that enable them to work effectively and efficiently cross-culturally.
The benefits of culturally competent organizations are improved: workforce retention, patient satisfaction and compliance and communications.
A recent study on the growing number of cultural competent health organizations concluded that "cultural competence seems to be evolving from a marginal to a mainstream health care policy issue and as a potential strategy to improve quality and address disparities."
Have a defined set of values and principles, and demonstrate behaviors, attitudes, policies, and structures that enable them to work effective cross-culturally.
Have the capacity to (1) value diversity, (2) conduct self-assessment, (3) manage the dynamics of difference, (4) acquire and institutionalize cultural knowledge, and (5) adapt to diversity and the cultural contexts of communities they serve.
Incorporate the above in all aspects of policy-making, administration, practice and service delivery, systematically involve consumers, families and communities.
In the past twenty-five years in Canada, a wide variety of experiences, programs and activities have been part of what may be described as the "Aboriginal healing movement". These have included:
Participation in traditional healing and cultural activities;
Healing is possible for individuals and communities. Both appear to go through distinct stages of a healing journey.
The healing journey is a long-term process, probably involving several decades.
Healing cannot be confined to issues such as addictions, abuse or violence.
Healing interventions and programs have most impact when they take place within the context of a wider community development plan.
Community healing requires personal, cultural, economic, political, and social development initiatives woven together into a coherent, long-term, coordinated strategy.
Such a coherent strategy requires integrated program development, funding delivery and on-going evaluation.
Healing is directly connected to nation building. At some point, there needs to be a merger of program efforts between community healing activities and movements towards self-government and community development.