The First Australians whom this project honours – the Gumbaynggirr, Dunghutti, Birpai and Nganyaywana Nations – have the right to a healthcare system that enhances, respects and values their cultural voices.
This proposition is complex to implement, as shown throughout the Framework report, which is the outcome of the first stage of the Aboriginal Cultural Safety and Security Framework project – sponsored in 2016 by the Mid North Coast Aboriginal Health Authority and funded by the Mid North Coast Local Health District.
When reading through each chapter of the Framework, it becomes apparent that the cultural voices of Aboriginal peoples can influence every point and pathway of mainstream healthcare governance so that equitable health outcomes are achieved.
A Co-designed Framework
The project partners – Durri Aboriginal Medical Service, Galambila Aboriginal Medical Service, the Mid North Coast Local Health District, the North Coast Primary Health Network and Werin Aboriginal Medical Service (these five organisations comprise the Mid North Coast Aboriginal Health Authority), as well as the National Centre for Cultural Competence (academic organisation at the University of Sydney) and Committix Pty Ltd (a private research company) – committed to this project with the intent that Aboriginal peoples can influence the many healthcare governance pathways in and through which mainstream healthcare organisational contexts can become more culturally safe and secure.
Four Barriers to Aboriginal Cultural Voice
There are some clear thematic signals tying the chapters together. The first is that Australia’s First Peoples are routinely excluded from healthcare governance decisions that affect them, and that this is a cultural norm in Australia. The second is that power is a core concern for activists but is completely ignored in healthcare governance. The third is that complexity is glossed over where ‘culture’ is used as a ‘variable’ rather than accepted as a deeply ingrained and sophisticated pattern of behaviour. The fourth is that the human cultural perspectives of Aboriginal peoples – their cultural voices – are systematically excluded from the construct of Australian healthcare governance. Overcoming these barriers is the objective of the Framework.
The objective of the Aboriginal Cultural Safety & Security Framework is to enable culturally safe and secure mainstream healthcare governance and thus improve the health outcomes of Aboriginal people.
What is cultural safety & security?
Addressing that objective needs to include a clear and unambiguous meaning of Aboriginal cultural safety and security. The phrase ‘cultural safety and security’ signals the origin in healthcare governance where the human cultures of Aboriginal peoples are routinely included in every decision-making point and pathway of healthcare organisations. The concept of ‘cultural safety’ means that Aboriginal cultures are safe in an environment that is designed to prevent harm to the physical, social, cultural and emotional wellbeing of individuals, families and whole communities. When all healthcare organisations are culturally safe, then the healthcare system is culturally secure. ‘Cultural security’ means that all an Aboriginal person needs to think about is getting healthier in whatever healthcare organisation setting they visit, wherever it is located.
A culturally secure healthcare system is trusted to be a culturally safe system because every healthcare organisation has demonstrated, through time and tide, that cultural safety is taken for granted by everyone, everywhere and every time.
Definition of Culturally Safe & Secure Healthcare Governance
Demonstrating trust will be difficult given the complexity of healthcare governance. This definition is a guide: cultural safety and security for mainstream healthcare governance is the brokerage of moral obligations into every point in an organisation, so that protocols for cultural safety operate in every service pathway to create and sustain culturally secure environments for Australia’s First Peoples. The primary intent underlying that definition is to bring cultural voice – the human cultural perspectives of Aboriginal peoples – into Australian healthcare governance. Bringing in cultural voice means engaging in many ways on many governance levels outlined in the implementation and evaluation methodology.
This Aboriginal cultural safety and security framework provides a governance map for mainstream health organisations on the journey towards Closing the Gap in Aboriginal health outcomes.