Culture Diversity and Healthcare Delivery in Australia

Introduction

Ethnic minorities make up a significant part of many countries’ populations. Specifically, aboriginal populations, though severely diminished, have maintained steady population numbers and their existence and needs is an important factor to consider in every aspect of national development. In some cases, like the US and Australia, the population of minorities has been rising for the last couple of years necessitating the need for cultural awareness in the health sector.

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The general health life of many Australians has improved over time. However, some scholars argue that in some cases, minorities especially aboriginal people account for a disproportionate share of national mortality and morbidity rates. Diversity in the Australian population places a challenge of effective healthcare management of people of different ethnicities, cultures and languages.

Thomson (2005, p. 4) says that given the differences emanating from the above backgrounds, it is imperative that the health profession ensures delivery of culturally and linguistically competent healthcare in order to reduce racial and ethnic disparities that may exist in the healthcare sector while improving the overall healthcare fortunes of the country. In order to improve overall delivery of healthcare it is extremely important for professionals to ensure a thorough understanding of the importance of equity, culture, diversity and cultural competency (Trentham et al., 2007, p. 53).

This paper will present a report with different sections detailing elements and principles of cultural competency, the policy and guidelines that apply in the Australian context as well as internationally, pre-requisites of safe practice and recommendations on how to ensure provision of culturally appropriate health services

Elements and principles of cultural competency

In healthcare, cultural competence involves provision of health services to a diverse group of people with different backgrounds, including beliefs and values in order to meet their social, cultural and linguistic needs. While cultural competence is a diverse area of study some elements and principles of are very basic to cultural competence. They include cultural awareness, cultural security, cultural respect and cultural safety.

Cultural awareness

This is the consciousness and sensitivity that a practitioner has towards a client’s cultures and beliefs. This is an important issue in delivery of healthcare within the context of cultural competence (Trentham et al., 2007, p. 49). Cultural awareness helps practitioners effectively manage cultural biases and stereotypes that could be stemming from their own cultural experiences.

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Cultural security

Though controversial in Australia, cultural security is basically the commitment by healthcare professionals not to compromise the legitimate cultural rights, values and expectations of different backgrounds especially aboriginal people (Goode et al., 2002, p. 13). Cultural security aims at recognizing, appreciating and responding to the impact of cultural diversity in the provision of healthcare services to people of different backgrounds.

Cultural respect

This particular element includes recognition, protection and ensuring the continuation of cultures especially of minority aboriginal people. For cultural respect to be achieved there is need for increased knowledge and awareness to help shape skilled practice and behaviours and also to help in the development of strong relationships among healthcare stakeholders for the achievement of equity outcomes (Brach & Fraser 2000, p. 191).

Cultural safety

Cultural safety entails care that is given to people of different cultures by a health practitioner who is culturally aware of his/her own culture and knows the impact it has on his/her profession.

Policy and guidelines

Purnell says that organizations are quickly adopting exceptional policies and guidelines in the delivery of services that take into account cultural competence (2002, p. 195). To achieve cultural competence in health systems, organizations globally have moved to include policies that emphasise techniques in interpretation services, recruitment and retention, training, use of community health workers, administrative as well as organizational accommodations. Dana et al support the above assertion by saying that many global organizations have in progress training and practice adaptations for multicultural societies (2008, p. 49).

Administrative and organizational accommodations

Health systems have put in place mechanisms that make it easier for minority patients to access health services in a culturally competent environment. These mechanisms include favourable location of clinics, hours of operation and availability of written material.

Training

Organizations have implemented cultural competence training programs for staff aimed at increasing cultural awareness. These programs are aimed at increasing cultural competence skills among health workers in order to improve staff behaviours as well as patient-staff interactions.

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Interpretation services

Other organizations in the health system have in place on-site professional interpreters as well as ad hoc interpreters to help in the facilitation of communication between staff and patients of different linguistic backgrounds.

Recruitment and retention

This policy guideline aims at attracting, recruiting and retaining professionals from minority and aboriginal backgrounds to ensure cultural diversity aims are achieved in health systems. According to Papps (2005, p. 24), this has been possible through initiatives such as creation of minority residency programs, minority mentorship programs and contracting with minority health providers in different countries besides Australia. This particular policy has been stressed by the international organization for immigration to ensure access of better healthcare by minority immigrants and effectively indigenous populations (Bischoff, 2006, p. 117).

Community health workers

Organizations have also sought to increase cultural competence especially among aboriginal populations through use minority community health workers (Anderson et al., 2003, p. 69). This involves deployment of members of a particular minority community to interact with community members in order to overcome mistrust while increasing clinician-patient communication. Singer & Viens say that historically, there has been acute lack of cultural competence among healthcare providers towards Aboriginal North Americans (2008, p. 386). However, organizations are increasingly implementing culturally competent policies to ensure community health workers are well-trained in handling minority groups (Singer & Viens, 2008, p. 386).

It is important to note that while the above policy guidelines and initiatives largely apply to Australia, they are also drawn from different minority and aboriginal communities especially in the United States.

Safe and Equitable Health Practice

As emphasised throughout the report, safe and equitable provision of health services is the main aim of cultural competence. This concept is especially important in societies like the US, Canada and Australia where indigenous communities are present. Cultural competence initiatives have helped increase provision of health services to communities in Australia, Canada’s Nova Scotia and among the Maori population in New Zealand. Cultural competence promotes safe and equitable health practice through the ways explored below.

Reduction of disparities in health services

Nashet al. says that cultural competence has been proven to help in the reduction of disparities in health services promotion especially through detection of culture specific diseases (2006, p. 300). Through community outreach programs and implementation of culture-friendly practices, cultural competence is slowly levelling access to health services by indigenous communities.

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Addresses inequalities in the access to primary care

According to Belfrage (2007, p. 542), cultural barrier have in some cases hindered proper access to health services by indigenous people and other minority groups. Cultural competence has sought to increase access to primary care by minority groups through programs that enhance cultural awareness among health workers effectively making the health system receptive and friendly.

Characteristics of a culturally competent healthcare system

Achieving a culturally competent healthcare system is a difficult undertaking that needs careful planning, commitment and availability of resources (Betancourt et al., 2002, p. 67). It must at least have the following:

  • A culturally competent healthcare system accords healthcare services to patients from diverse backgrounds, beliefs and values. Sometimes, it may include tailoring the services according to a patient’s cultural, social and linguistic needs.
  • It must have in place a requirement that professionals understand the cultural backgrounds of the communities they serve for better delivery of services.
  • Some scholars assert that a culturally competent system must put in place strategies aimed at addressing cultural barriers that affect access to healthcare by minority communities.

Recommendations

  • There is need to incorporate cultural competence initiatives into the law so that they apply across the board in the healthcare sector.
  • Organizations should put in place programs that help the advancement of minority leadership in healthcare so as to increase understanding of minority cultures in the healthcare workplace
  • There should be more healthcare initiatives that avail culturally competent healthcare indicators of minority and indigenous communities
  • There is need for more cross-cultural training of healthcare professionals at all levels with the aim of improving cultural competence and delivery of healthcare services to indigenous population groups.

Conclusion

Culture is the sum total of all beliefs, values and traditions that a particular group of people share. It includes both material and non material aspects. While on one hand it acts as the common bond among people, differences in cultures can also be a source of division among human beings in all aspects. It is therefore prudent that all healthcare stakeholders pursue cultural competence in order to ensure access to quality health services by these people.

References

Anderson, L. M., Scrimshaw, S. C., Fullilove, M. T., Fielding, J. E., Normant, J., & Task Force on Community Preventive Services. (2003). Culturally competent healthcare systems: a systematic review. American Journal of Preventative Medicine, 24(3S), 68-79.

Belfrage, M. (2007). Why ‘culturally safe’ health care? Medical Journal of Australia, 186(10),537-538.

Betancourt, J. R., Green, A. R., & Carillo, J. E. (2002). Cultural competence in health care: emerging frameworks and practical approaches. New York: The Commonwealth Fund.

Bischoff, A. (2006). Caring for migrant and minority patients in European hospitals: a review of effective interventions. Stockholm: SFM.

Brach, C., & Fraser, I. (2000). Can cultural competency reduce racial and ethnic health disparities?: a review and conceptual model. Medical Care Research and Review, 57(1), 181-217.

Dana, R. et al. (2008). Cultural Competency Training in a Global Society. New York: Springer.

Goode, T. W., Jones, W., & Mason, J. (2002). A guide to planning and implementing cultural competence organizational self-assessment. Washington, DC: National Center for Cultural Competence, Georgetown University Development Center.

Nash, R., Meiklejohn, B., & Sacre, S. (2006). The Yapunyah project: embedding Aboriginal and Torres Strait Islander perspectives in the nursing curriculum. Contemporary Nurse, 22(2), 296-316.

Papps, E. (2005). Cultural safety: daring to be different: Cultural safety in Aotearoa New Zealand. Auckland, NZ: Pearson Education.

Purnell, L. (2002). The Purnell model for cultural competence. Journal of Transcultural Nursing, 13, 193-196.

Thomson, N. (2005). Cultural respect and related concepts: a brief summary of the literature. Australian Indigenous Health Bulletin, 5(4), 1-11.

Trentham, B., Cockburn, L., Cameron, D., & Iwama, M. (2007). Diversity and inclusion within an occupational therapy curriculum. Australian Occupational Therapy Journal, 51, S49-S57.

Singer, P. & Viens, A. (2008). The Cambridge Textbook of Bioethics. Cambridge: Cambridge University Press.

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