Connection between health and culture examined

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The quest to find out if there can or should be a global strategy to resolve modern, medical ethical dilemmas brought scientists, health care providers, sociologists and other interested parties to a four-day conference hosted by the Canadian Bioethics Society in Edmonton at the end of October. Prof. Madeleine Dion Stout, a member of Kehewin First Nation northeast of Edmonton, who teaches at Carleton University, was a keynote speaker.

"Expanding the boundaries of ethics" was the theme bringing experts from around the world to discuss controversial issues from mental health service delivery to euthanasia and commercialization of body parts. Protecting everybody's rights while incorporating leading edge biotechnology into the practice of medicine underpinned the presentations.

Vicki Smye, a PhD student at the University of British Columbia's School of Nursing, addressed a mental health topic that is still new in Canadian mainstream medical circles, yet it directly bears on the delivery of health services to Aboriginal people.

Her presentation, "Justice, Culture and Aboriginal Health," addressed the concept of "cultural safety," which is said to exist when health care providers deliver services in accord with people's social and physical environment, cultural values and history. Smye said New Zealand/Aotearoa is where cultural safety was first written about in the early1990s, in a nursing education environment.

Where it goes beyond a mere cultural awareness exercise is in the intensity and time practitioners put into self-examination, into examining the issues at the political level, and in practical terms supporting the health of minorities through a delivery system the client defines as acceptable.

Smye, who says she has 30 year's experience in the mental health arena, is non-Aboriginal. She said at the outset she was "not speaking from a First Nations, Métis or Inuit perspective, but rather from a point of inquiry."

She favors "a theory of justice" that supports Aboriginal people's right to determine their own health care needs and practices. "Aboriginal people," Smye said, "should feel their Indigenous worth is reflected in health care provision. Improved [mental] health status for Aboriginal peoples is dependent on social policies which reflect the moral and political values of their particular societal cultures."

Nevertheless, Dr. Cora Voyageur, a sociologist who attended the presentation, said, "I thought the issues were dealt with very superficially. I don't think you can deal with education, justice and health in 25 minutes and if we're going to talk about Aboriginal issues I think we need to have Aboriginal people speaking about them, or at least there be an attempt to have Aboriginal people speaking about them."

Voyageur, a member of Athabasca Chipewyan First Nation who works at the University of Calgary, says she knows Aboriginal medical doctors and academics who would be qualified to speak to the topic.

"She [Smye] was very nice. What she had to say was very good and whatnot, but I don't think she should have been the only person dealing with that particular issue. . . . The work that she's doing is very good and very needed, but at the same time organizers need to know that there are Aboriginal people out there and they don't have to bring people in from the U.S., because we have our own experts."

Smye talked about critical differences in the way health is defined by Aboriginal and mainstream cultures.

"Mental health programs and services designed in keeping with dominant culture (biomedical) views of mental health and illness," Smye said, "ignore the unique cultural identities and histories of Aboriginal peoples, putting them at risk of not having their health care needs recognized and met." She cited sources that say "wellness" from the Aboriginal point of view can be contingent upon people's connections with family and with the land.

She also compared New Zealand's Maori people's experiences sine colonial contact with those of Canada's Aboriginal people. She gave numerous examples of how both groups have been marginalized and subordinated by the dominant society and how, until recently, their holistic world-view has been denigrated.

As in Canada, early colonizers ignored and belittled the belief systems of New Zealand's Indigenous people and set up a health care system that reflected the colonizers' values exclusively. But now health care providers are moving away from the idea that health is merely the absence of disease. The past few years, the Nursing Council of New Zealand has required nursing schools to incorporate the obligations imposed by the country's founding and only treaty, the Treaty of Waitangi, when designing curricula.

The accommodation of Aboriginal beliefs into health service delivery in New Zealand more completely than in Canada may reflect important differences between the two countries, Smye pointed out. Significantly, Maoris comprise 20 per cent of the population of New Zealand compared to Canada's four per cent, and they don't live on reserves. More of them are urbanized and they have more national political representation in a unitary government. They have one treaty, contrasted with numerous, treaties administered by our federal system of government. Maoris also have one Aboriginal language and culture; whereas in Canada, there are "at least 11" Aboriginal language groups and several distinct Aboriginal cultures, Smye said.

These factors may explain why, since 1991, New Zealand's nursing council has insisted 20 per cent of the national nursing examination be targeted to cultural safety. Beyond that, nursing candidates have to demonstrate ethical, legal and cultural "safety" in addition to standard academic knowledge and clinical skills. In other words, student nurses must show they understand how their own values and beliefs about racism, perceptions of class differences, and healing and wellness may determine the outcome for th person seeking health services. They are also taught that the health care service the Maori receive is not as good as New Zealanders of European extraction get and the inequities must be dealt with.

Smye concludes that cultural safety is dependent upon ethical policy making. She makes it clear cultural safety will only occur in this country when Canadians re-examine their attitudes and adhere to the principles of respect outlined in laws such as our Multiculturalism Act.