Cultural competence and safety in Circumpolar countries: an analysis of discourses in healthcare

Abstract

Circumpolar Indigenous populations continue to experience dramatic health inequities when compared to their national counterparts. The objectives of this study are first, to explore the space given in the existing literature to the concepts of cultural safety and cultural competence, as it relates to Indigenous peoples in Circumpolar contexts; and second, to document where innovations have emerged. We conducted a review of the English, Danish, Norwegian, Russian and Swedish Circumpolar health literature focusing on Indigenous populations. We include research related to Alaska (USA); the Yukon, the Northwest Territories, Nunavik and Labrador (Canada); Greenland; Sápmi (northmost part of Sweden, Norway, and Finland); and arctic Russia. Our results show that the concepts of cultural safety and cultural competence (cultural humility in Nunavut) are widely discussed in the Canadian literature. In Alaska, the term relationship-centred care has emerged, and is defined broadly to encompass clinician-patient relationships and structural barriers to care. We found no evidence that similar concepts are used to inform service delivery in Greenland, Nordic countries and Russia. While we recognise that healthcare innovations are often localised, and that there is often a lapse before localised innovations find their way into the literature, we conclude that the general lack of attention to culturally safe care for Sámi and Greenlandic Inuit is somewhat surprising given Nordic countries’ concern for the welfare of their citizens. We see this as an important gap, and out of step with commitments made under United Nations Declarations on the Rights of Indigenous Peoples. We call for the integration of cultural safety (and its variants) as a lens to inform the development of health programs aiming to improve Indigenous in Circumpolar countries.

The results of pancreatic surgery in Inuit patients from Greenland 1999-2022

“…Patients from Greenland have the same access to specialised surgical treatment in Denmark as Danish patients [ 26 ]. Time from diagnosis and referral after MDT conference was not significantly different between the two groups of patients.…”

Experimental studies testing interventions to promote cultural safety, interculturality or antiracism in healthcare: protocol for a systematic review

“…55 73 74 Several literature reviews and at least ten additional PROS-PERO registrations address cultural safety. These reviews focus on describing culturally safe interventions for specific health issues, [9][10][11][12][13][14][15][16] how to improve healthcare practices (medicine, nursing, midwifery), [17][18][19][20][21][22][23] eHealth applications, 24 the presence of cultural safety in health research, 25 narrative descriptions of what cultural safety is [26][27][28][29][30][31][32] and the experiences of beneficiaries. 33 34 A limited literature on intercultural approaches to health emphasises communication issues.…”

“…Familiarity with cultural safety is growing in New Zealand, Australia, Canada and the USA. 28 In Latin America and Europe, interculturality is a more common and related concept. 59 69 Healthcare providers and governments have increasingly committed to integrating these principles into their services.…”

Reassembling cultural safety education for Korean medical students based on the actor-network theory: Situational analysis of discourses

“…How could CS be translated into Korean contexts for equity, diversity, and inclusion? While most CS programs have targeted Indigenous Peoples in countries with colonial histories (Lavoie et al, 2022;Mehus et al, 2019;Pimentel et al, 2021;Pitama et al, 2018), literature has rarely reported on programs in countries that had been occupied, such as Korea. Some studies have documented a small number of Asian students' re ections (Plaisime et al, 2023), but their main focus was white/Black-based racism, which does not apply to Korean contexts.…”