Since its original formulation and application in the health sector in Aotearoa New Zealand in the 1980s, Cultural Safety has been subject to wide reinterpretation. Its entry into institutional life more broadly has seen it turned it into a concept that allows it to be appropriated by the very powers that dominate the culture wars. Critique of Israel’s genocide in Palestine and gestures of solidarity with the Palestinian people have been repressed or censored using Cultural Safety as justification. I argue that the use of this term must not be dislocated from Indigenous critiques of settler colonialism.
I am a nurse academic who migrated to Australia from Aotearoa New Zealand and who was introduced to kawa whakaruruhau or Cultural Safety by Māori nurses and Dr Irihapeti Ramsden (Ngāi Tahu/ Rangitane) in her seminal doctoral thesis. The concept developed in the 1980s and 1990s as an Indigenous-led anti-colonial critique of nursing’s Anglo-European knowledge base. It represented a bicultural, liberatory framework based on Te Tiriti o Waitangi and the notion of negotiated partnership between Māori as Tangata Whenua (people of the land) and settlers, tauiwi (non-Māori) or Tangata Tiriti (people of the Treaty). For Indigenous Māori who had been dispossessed by colonialism, it was a pathway for recognition by the liberal democratic settler colonial state and its institutions, including the healthcare system, which had not only failed but harmed Māori. Cultural Safety challenged the victim-blaming tenor of liberal discourses, which attributed health disparities between Indigenous and non-Indigenous communities to people’s individual “choices”. Instead, it invited non-Indigenous nurses who dominated health services to acknowledge and recognise the mana (dignity), sovereignty (tino rangatiratanga), and hau ora (well-being) of Māori users of healthcare. It reversed the gaze away from the “other”, inviting non-Indigenous nurses to look at themselves and the culture of healthcare they both created and inhabited. This reflection would ideally underpin a careful institutional and personal analysis of how healthcare interactions were inflected by historical and broader social inequalities.
Cultural Safety represented a paradigm shift from models emphasising the acquisition of cultural knowledge about “others” to a reflexive process of understanding oneself and the health system as having a culture that imposes values and beliefs upon recipients of healthcare, and interrogating power relations as a way of addressing structural inequities. It demanded that nurses and midwives understand themselves as culture bearers and representatives of the values, assumptions, and limitations of the Western biomedical episodic care model. In turn, the clinician could see the patient or consumer as not only a partner in care, but an expert who could determine whether care was culturally safe.
In 1991, the Nursing Council of New Zealand incorporated Cultural Safety into nursing curricula, and guidelines were developed for education providers in 1992 for including it into nursing and midwifery preregistration courses. Between 1992 and 1996, Cultural Safety was contested in the public sphere, with dominant media discourses seeing Pākehā as disadvantaged victims of political correctness. New guidelines concerning Cultural Safety in nursing and midwifery education were developed partly in response to this debate, and published by the Nursing Council in 1996. Later, the 2002 set of guidelines separated the teaching of Cultural Safety from the Treaty of Waitangi and Māori health, broadening Cultural Safety to “apply to any person or group of people who may differ from the nurse/midwife because of socioeconomic status, age, gender, sexual orientation, ethnic origin, migrant/refugee status, religious belief or disability”. These changes appropriated an Indigenous-led bicultural framework in order to develop a more inclusive cross-cultural framework. However, this gesture of apparent inclusion also represented a deflection and deferral of Indigenous sovereignty claims in favour of a politics of recognition for racialised populations, conflating racialisation and colonisation in a pattern repeated in other white settler states.
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In Australia, Cultural Safety was introduced into the Nursing and Midwifery Codes of Conduct in 2018, thirty-nine years after its first appearance in Aotearoa. This introduction was also met with a media-fuelled controversy. The Australian Nursing and Midwifery Accreditation Council (ANMAC) mandated Cultural Safety into accredited Bachelor of Nursing and Midwifery programs in 2019, and the term is included in the Australian Codes of Conduct for Nurses and Midwives. Cultural Safety has also become a significant term in the arts and other sectors.
As I was neither a white settler nor Indigenous Māori, and felt ambivalently positioned as a settler of colour in discourses of “biculturalism”, kawa whakaruruhau represented to me a pathway for just care, for righting the wrongs of health inequities, and for ensuring that I had an ethical relationship to the whenua (land) that my family had migrated to. I enthusiastically embraced Cultural Safety — despite what I now understand to be inevitable issues in non-Indigenous enthusiasm for supporting Indigenous political action — seeing it as a mechanism for addressing my own complicity in colonial processes of dispossession, a way of taking responsibility and finding accountability.
In my youthful enthusiasm, I believed that Cultural Safety could be, as Irihapeti Ramsden described it, a korowai: a cloak that could also shelter negatively racialised others and those at the sharp end of the health system, by galvanising healthcare workers to create change. I even wrote — optimistically — that Cultural Safety could enable wellness for all. However, I now support arguments that the broadening of Cultural Safety from being an Indigenous-led critical intervention in health have “watered it down” so it is no longer fit for purpose — a view supported by Chelsea Watego et al (see also this dissertation by Jennifer Roberts).
Cultural Safety’s incorporation outside of health contexts has effectively coopted it. Instead of operating as a critique from those who have experienced colonisation or genocide, or been structurally marginalised, as well as a mechanism for creating safe environments for Indigenous and negatively racialised communities by addressing racism and power relations, Cultural Safety has been put in service of dominant groups or institutions, and now acts as a shield from critique or to silence debate, limit dissent and enforce ideological assimilation.
Overland has published several articles showing how Cultural Safety has been used to justify censorship on Palestine. In “The ruse of safety”, Andrew Brooks and Astrid Lorange describe how a gesture of solidarity with the Palestinian struggle was conflated with antisemitism rather than a critique of an ideology. In “A culture of repression”, Brooks and Lana Tatour outline how critiques of Israel and pro-Palestinian activities are seen as causing psychosocial harm or unsafety whilst obscuring the material harms of invasion and occupation.
Last month, when Palestinian-Australian author and Macquarie University academic Dr Randa Abdel-Fattah was disinvited from speaking at the Adelaide Writers’ Week, the festival Board’s statement claimed that her politics and past statements would have made that it would “not ne culturally sensitive” for her to appear, and that furthermore this would precent the festival from achieving its goal of “promoting social cohesion”.
The wellspring of support for Abdel-Fattah has been encouraging. Historian and community researcher Natasha Joyce has carefully laid out how cultural institutions subtly silence and exclude writers, in the guise of concern or responsibility, to censor and “reshape[s] what other writers feel able to say, and what audiences are permitted to hear”. Executive director for the Alliance for Journalists’ Freedom Peter Greste argues for freedom of speech and “grey zones” or spaces where different people can coexist, and where writers, journalists, poets and artists can debate and argue. In her resignation as Director, Dr Louise Adler points to Australia becoming a “less free nation” (and the beginning of worse to come) and argues that the intensity of Zionist lobbying in the arts has become a predictable opposition to programming that seeks to draw attention to the war on Gaza. Kim Goodwin, a Lecturer in Arts Management and Human Resources at The University of Melbourne, points out that a board’s role in arts organisation is governance not management, and that increasingly arts boards are stepping outside their remits by “weighing up artistic purpose against perceived organisational risk”.
Denis Muller, a Senior Research Fellow at The University of Melbourne, has suggested that the “cultural sensitivity” cited by the Festival Board “is based on a dangerously broad and vague criterion for suppressing free speech”, a point echoed by David Brophy for this magazine. Brophy’s critique focuses on the deployment of the phrase “ambient antisemitism”, developed by the UK’s Institute for Jewish Policy (IJP), as justification for such acts of censorship. In the case of the Adelaide festival, there was no direct claim of antisemitism, but the mere potential for discomfort was proposed as adequate grounds for excluding Abdel-Fattah. But surely, as academic and member of the Jewish Council of Australia Dr Liz Strakosch points out, experiencing “political discomfort” is part and parcel of living in a democracy.
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The case of Randa Abdel-Fattah is a prime example of the use of Cultural Safety by dominant groups as a tool to wrestle control of the debate on what constitutes harm away from marginal groups, and redefine the limits of public discourse. Dominant groups are dominant because they claim to speak for all, and subordinate and erase non-dominant views to fit their narrative. Therefore, when figures like the South Australian Premier adopt the rhetoric of marginalisation, reverse racism and Cultural Safety, they are bringing all the force of dominant narratives and state and corporate power, and fusing it with a politics of victimhood and grievance that reinforces the rubric concerning who is the victim of harm and for whom we might grieve.
Cultural Safety developed as an oppositional discourse adopting a standpoint epistemology: it takes as a starting point the notion that knowledge is shaped by our social location and that people from marginalised groups have specific knowledge of social systems from their experience that is not available to people from dominant groups, for whom such systems are constructed. When a subject from a dominant group claims a need for Cultural Safety, even on behalf of another, they are also working against the idea that marginalised groups have specific knowledge that allows them to identify what is culturally safe. It is a discourse that erases and appropriates the affective space of marginality.
What is the discourse of Cultural Safety doing in a neoliberal context in this millennium? It seems anyone can claim to feel culturally unsafe, including people who are adjacent to dominant groups. A language that developed from identity-based social movements seeking justice is being usurped in service of a dominant ethnonationalist agenda, sidelining actual experiences of colonisation, racism and discrimination that animated these movements. In the process, its use has transformed from an important intervention in health and later cultural spaces to a tool of dominant groups who now most often deploy it as a form of gaslighting.
Ambient antisemitism, working on the model of white fragility, turns into a threat the smallest gesture of inclusion of a dissenting marginal voice reminding the public of an active genocide.
Cultural Safety requires that dominant groups consider the impact of power relations and dominant culture on First Nations and racialised communities and find ways to address these power asymmetries toward justice. Creating “safety” for dominant groups through silence, non-participation, non-resistance, and withholding critique is not the responsibility of marginalised groups trying to survive in the wake of colonialism, genocide and racism.
Abdel-Fattah is correct when she argues that Zionists who demand Cultural Safety for themselves are making an inappropriate request in anti-colonial spaces. We need strength rather than fragility to fiercely interrogate why we might feel anxiety, discomfort, uncertainty, guilt, anger, and defensiveness in our own complicity. Now more than ever, we need all the brave people who are asking questions, protesting, divesting and boycotting. Instead, those who interrogate and challenge systems and structures that reproduce colonial violence are instead themselves identified as a threat to so-called “cohesiveness”.
If we are to truly activate the historical potential of Cultural Safety as a form of collective action in response to coloniality and oppression, we can be inspired by the Melbourne rallies in support of Palestine. These weekly gatherings supporting the political project of anticolonial liberation hold a core commitment to tackling both antisemitism and the work to free Palestine. We can support Indigenous led movements for sovereignty and truth-telling.
I came to Cultural Safety because of its deep-seated grounding in the value of reflexive critique. Whose values and interests are being upheld and maintained when critique from an Indigenous group is repressed? What arrangements and violences are being supported and reproduced when we must we comport and contort ourselves to avoid being punished for critique? What role does Cultural Safety play as a critique of settler colonialism today? How are we to have a vibrant society with collective spaces for solidarity and robust discussion — the kind we associate with the arts — in the face of repression and growing fascism? What does it mean to acknowledge Country and therefore the settler-colonial foundations of Australia, which continue to structure contemporary life, but also not speak of the denial of First Nations sovereignty and Palestinian freedom? How do we create spaces of solidarity in thinking spaces rather than repression? How do we develop muscles for going beyond hurt feelings to being willing to hear about the suffering of Palestinians and work to create the world we need right now?
As Jamal Hakim, chief executive of the Australian Arab Institute for Culture and Ideas, has said of the decision to disinvite Dr Abdel-Fattah: “It tells Palestinians that their testimony alone is too dangerous to be heard, that their grief is an unacceptable disturbance in public life”. Surely the time for having these discussions is more urgent now than it has ever been. As so many historical movements and ideas are coerced into supporting genocide, it will be a tragedy if Cultural Safety suffers the same fate.
My thanks to colleagues in Aotearoa, Micaela Sahhar, Jordy Silverstein and Danny Butt for their thoughtful and generous feedback on this piece.
Image: Te Wao Nui child health service, Wellington, Aotearoa New Zealand (Wikimedia Commons)
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