Critical Cultural Perspectives and Health Care Involving Aboriginal Peoples

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Critical Cultural Perspectives and Health Care
Involving Aboriginal Peoples

• Annette J. Browne, PhD, RN
• Associate Professor
• New Investigator, Canadian Institutes of Health
  Research
• Michael Smith Foundation for Health Research
  Scholar
• School of Nursing, University of British Columbia
• Vancouver, Canada

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Objectives

• Examine commonly-held assumptions about culture
  in health care
• Explore how conventional thinking about culture
  has the potential to become problematic in health
  care
• a. Distinguish cultural sensitivity from cultural
  safety

• Examine the relevance of critical cultural
  approaches in relation to health care involving
  Aboriginal peoples.

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Culture is a Very Complex Concept!

• Anthropologist Margaret Lock (1993)
• culture is one of the two or three most
  complicated words in the English language.
• Our ideas about culture are so strongly
  influenced by recent historical events, todays
  political climate, and expanding patterns of
  globalization.

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Conventional Notions of Culture in Health Care

• Founded on values of multculturalism, cultural
  defined in terms of

• Beliefs, values, behaviors, customs, and
  lifestyles
• Fixed sets of characteristics that belong to
  particular groups
• Often presented as lists of cultural traits
• Tends to be based on fairly narrow definitions of
  culture

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Examples from Research Health Care Providers
Understandings about Culture

• Health care providers ideas
• I find with Native people, just the way their
  culture is, I think you get a lot more social
  things that you need to deal with.
• It is in their culture to have a lot of
  violence, stabbing, alcohol abuse more than what
  you see in other cultures.

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Culturalism An Important Concept to Grasp

• Is a process of equating culture with social
  problems or health issues
• Is closely linked to ideas about difference,
  Othering, stigma, discrimination and racism

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Additional Examples from Research Perceptions
about Culture

• Health care providers
• She the woman didnt take care of any of her
  own responsibilities. She didnt look after her
  own child. Now, I know that is a cultural thing.
  
• Quite often in this culture, they drink a lot

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Culturalism.diverts our attention

• Problematic because
• Our attention is diverted away from the wider
  social, historical and economic contexts that
  shape peoples lives
• Enables us to overlook the burden of history

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Othering. .also an important concept

• Is the process of defining ones self in relation
  to a differentiated Other, thus dividing the
  world into an us and them.
• People who are considered different are
  constructed as being even more different from
  us than they really are
• (Varcoe McCormick, 2007)

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Cultural Safety An Alternate to Cultural
Sensitivity

• Developed in New Zealand by nurse leaders, in
  collaboration with Maori people, to address Maori
  health concerns related to
• Persistent health disparities
• Power imbalances in the delivery of health care
• Inequities in access to health care
• Discriminatory attitudes and practices embedded
  in health care

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Cultural Safety Moves beyond cultural
sensitivity Toward shifting the attitudes and
practices in nursing and health care that
contribute to inequities

• 20 of New Zealands Nursing Registration Exam
• is on Cultural Safety

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Cultural Safety Founded on a Critical Cultural
Perspectives

• Has an explicit social justice agenda
• Founded on a critical and politicized
  understanding of culture

• Critical Definition of Culture
• Culture is understood to be located within a
  constantly shifting network of meanings enmeshed
  within historical, social, economic and political
  relationships and processes.
• Cannot be reduced to a set of characteristics
• Is not a politically neutral concept

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Cultural Safety versus Cultural Risk

• Cultural Risk
• Situations that arise when people from a
  particular group believe they are demeaned,
  diminished or disempowered by the actions and the
  delivery systems of people from another culture
• (Wood and Schwass, 1993)

• Cultural Safety
• Requires us to shift our gaze onto the culture
  of health care, and how practices, policies and
  research approaches can themselves perpetuate
  marginalizing conditions and inequities
• (Browne, Smye Varcoe, 2005)

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Case Example HIV Rates Among Aboriginal Women
in Canada

• Aboriginal women represent 45.1 of all positive
  HIV test reports among Aboriginal people compared
  to 19.5 for non-Aboriginal women
  (McKay-McNabb,2006).

• Cultural safety asks
• What social, economic and historical conditions
  led to this degree of vulnerability?
• How do assumptions about Aboriginal women shape
  their ability to access care?
• How do policies impact womens capacity to access
  resources for health?
• What is it about the culture of health care that
  creates marginalizing conditions for Aboriginal
  women affected by HIV/AIDS?

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Colonizing Messages in (Current) Neo-Colonial
Times

• Excerpt from Canadian Newspaper (2002)
• Its called a culture of entitlement and a whole
  lot of Canadas aboriginals have it real bad.
  Those who suffer from this energy sapping
  affliction almost always grow lethargic and
  passive. People around them come to resent them,
  a situation that fosters an unhealthy
  societyEven the label First Nations speaks of
  entitlement, as though all others are second in
  lineThe truth is, however, impolitic it may be
  to say it, pandering to Native Indians has become
  a virtual industry in this county.

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Impact on Patients

• Without necessarily intending it as such
• Social problems become reframed as cultural
  issues
• Cultural differences are presented as factual
  information

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Pragmatic Applications Applying Cultural Safety
as a Conceptual Framework in Health Care

• Raises ethical and moral concerns
• What is our responsibility in disrupting
  inequities that sustain the status quo?
• How might we be reinforcing norms of practice
  that may be alienating to indigenous people (and
  others)?
• How can we challenge and counter assumptions
  about cultural Others?

• How can we work to raise critical consciousness
  in our own local practice areas?
• How do current policies cause people to feel
  demeaned, diminished, or disrespected as they
  seek health care?

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If all are like me, then all are my relations
(Little Bear, 2000, p. 68)