Curtis Elana, Loring Belinda, Jones Rhys, Tipene-Leach David, Walker Curtis, Paine Sarah-Jane, Reid Papaarangi
Faculty of Medical and Health Sciences, Te Kupenga Hauora Māori, University of Auckland, Auckland, New Zealand.
Te Kura I Awarua Rangahau Māori Research Centre, Eastern Institute of Technology, Hawke's Bay, New Zealand.
Int J Equity Health. 2025 May 9;24(1):130. doi: 10.1186/s12939-025-02478-3.
Eliminating Indigenous and ethnic health inequities requires culturally-competent and culturally-safe health workforces and systems. Health professional training institutions and regulatory bodies are increasingly including cultural competency and cultural safety in health professional accreditation standards, and pre-service and in-service training programmes. However, there are mixed definitions and understandings of cultural competency and cultural safety, and how best to achieve them. In 2019, we published a review of international understandings of these terms, and proposed an Indigenous-led definition for cultural safety that we believed to be more fit for purpose in achieving health equity. We also clarified essential principles and practical steps to operationalise this approach in healthcare organisations and workforce development. The aim of this paper is to share our expert reflections upon the experience over the six years since 2019, of implementing this definition in an Aotearoa New Zealand (NZ) context. Recent work undertaken with health regulatory bodies in NZ to refine the understandings of cultural competency, cultural safety and Indigenous health has extended our positioning on these important concepts. A practical example of how these related but distinct concepts apply to Indigenous health is presented.
消除原住民和少数族裔的健康不平等现象，需要具备文化能力且文化安全的卫生人力和卫生系统。卫生专业培训机构和监管机构越来越多地将文化能力和文化安全纳入卫生专业认证标准以及职前和在职培训计划。然而，对于文化能力和文化安全以及如何最好地实现它们，存在着不同的定义和理解。2019年，我们发表了一篇关于对这些术语的国际理解的综述，并提出了一个由原住民主导的文化安全定义，我们认为这个定义更适合实现健康公平的目标。我们还阐明了在医疗组织和劳动力发展中实施这一方法的基本原则和实际步骤。本文的目的是分享我们自2019年以来在新西兰实施这一定义的六年经验中的专家思考。最近与新西兰卫生监管机构开展的工作，以完善对文化能力、文化安全和原住民健康的理解，扩展了我们对这些重要概念的定位。本文还给出了一个实际例子，说明这些相关但不同的概念如何应用于原住民健康。
