Québec’s Minister Responsible for Relations with the First Nations and the Inuit, Ian Lafrenière, recently introduced , which aims to “establish the cultural safety approach within the health and social services network.”
is for health and social service networks in Québec to adopt a cultural safety approach towards Indigenous people, taking into account cultural and historical realities.
In November 2020, in the aftermath of the at the Centre hospitalier de Lanaudière in Joliette, the Québec government introduced for all employees of the province’s ministry of health and social services.
The goal of this training was to quickly sensitize health-care personnel to Indigenous cultures in order to improve the care provided for First Nations and Inuit Peoples in the Québec health and social services system.
It also aims to deconstruct myths and prejudices regarding Indigenous Peoples, to foster effective intercultural communication and to .
However, since the training program was launched, Indigenous leaders and health professionals have said it and .
Legislating individuals and systems to shift behaviours and attitudes is useless without well-developed cultural safety programs developed and delivered by Indigenous Peoples.
Cultural safety
In April, we attended a round table on cultural safety organized by the Québe Network Environment for Indigenous Health Research on cultural safety alongside Indigenous scholars, patient partners and other community members in Montréal. Participants at the round table arrived to the same conclusions and supported concerns that the content of the mandatory training is .
In addition, important results and calls to actions from the , the , and the are not mentioned during the training. Glaringly absent are also any references to the concept of cultural safety, cultural humility, systemic racism and — which “aims to guarantee to all Indigenous people the right of equitable access, without any discrimination, to all social and health services.”
In this article, we assert that Québec’s training falls short of its objectives because it is based on three flawed assumptions about the problem at hand.
1. Racism is an individual problem.
The focus on mandatory training as a solution to a systemic issue misrepresents the problem of racism as an individual problem of bias, attitudes and knowledge. Discrimination by health-care professionals should not be viewed only as individual acts, but as part of broader patterns of institutional and systemic racism.
and in this field assert that racism in health care needs to be understood in the context of past and current colonialism.
It is a fact that colonial policies of assimilation were based on a of Indigenous Peoples. These policies have imprinted racist structures and stereotypes across institutions.
For instance, when analyzing the case of Echaquan, her mistreatment took place in an environment that lacked culturally appropriate resources, was characterized by inequitable practices and tolerated racist attitudes and comments.
Understanding the problem of racial discrimination in health care means we must frankly and openly discuss contemporary colonialist and racist realities. To address systemic racism and its influence on health, we need to go beyond individual racial bias and address . Systemic racism needs systemic solutions, not individual ones.
2. Racism, bias and stereotypes can be addressed through cultural sensitivity training.
The educational strategies that underlie the awareness training are insufficient to countering racism and fostering cultural safety. This is because the training program is based on a cultural sensitivity approach. However, numerous studies suggest this kind of training may of the concerned groups.
Cultural sensitivity tends to focus on having knowledge of a patient’s culture and reducing their experience of the health-care system to a matter of overcoming .
Research shows that cultural safety is a better way to foster change. It compels us to examine the . Cultural safety promotes an approach to foster change that moves away from simply learning about a culture. Instead, it aims to help staff and how these manifest in their interactions with Indigenous patients.
Scholars propose a conception of cultural safety as a systemic approach to health-care transformation, one that goes beyond individual training but engages organizations and society as a whole towards the principles of cultural safety, equity, social justice and decolonization. As such, comprehensive Indigenous cultural safety training programs should explicitly integrate notions of power, privilege, colonialism and racism.
3. Cultural safety can’t be developed without involving the concerned groups.
The lack of meaningful involvement by Indigenous stakeholders is a critical weakness of the awareness training. However, cultural safety and self-determination of Indigenous Peoples in relation to their health services, and as such, promotes their empowerment.
The current awareness training does not significantly involve Indigenous stakeholders. . This is contrary to the very concept of cultural safety. It also contradicts all the declarations, established by Indigenous groups in the last decades, which are based on the rallying cry “nothing about us without us.”
Cultural safety should be guided by the people it concerns. They are the only ones with the lived experience to share on the topic of safety and on the .
This approach to health-care transformation recognizes Indigenous expertise in designing solutions relevant to their needs. is aligned with and rely on values such as respect, equity and reciprocity.
In addition to failing to address the problems Indigenous people face, the training risks further marginalization and continued discrimination, as well as increased distrust of government and institutions among Indigenous populations.
For these reasons, this training should be immediately discontinued. To create a more equal health-care system, Indigenous people, organizations and health-care professionals — Indigenous or not — must have space to develop solutions based on cultural knowledge, lived experiences and their collective expertise.
The authors of this piece would like to acknowledge the significant contributions made to the article by the members of the Indigenous patient partner circles of the Unité de Soutien SSA Québec.
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Read the original article in The Conversation: