Eliminating indigenous and ethnic health inequities requires addressing the determinants of health inequities which includes institutionalised racism, and ensuring a health care system that delivers appropriate and equitable care. There is growing recognition of the importance of cultural competency and cultural safety at both individual health practitioner and organisational levels to achieve equitable health care. Some jurisdictions have included cultural competency in health professional licensing legislation, health professional accreditation standards, and pre-service and in-service training programmes. However, there are mixed definitions and understandings of cultural competency and cultural safety, and how best to achieve them. A literature review of 59 international articles on the definitions of cultural competency and cultural safety was undertaken. Findings were contextualised to the cultural competency legislation, statements and initiatives present within Aotearoa New Zealand, a national Symposium on Cultural Competence and Māori Health, convened by the Medical Council of New Zealand and Te Ohu Rata o Aotearoa – Māori Medical Practitioners Association (Te ORA) and consultation with Māori medical practitioners via Te ORA. Health practitioners, healthcare organisations and health systems need to be engaged in working towards cultural safety and critical consciousness. To do this, they must be prepared to critique the ‘taken for granted’ power structures and be prepared to challenge their own culture and cultural systems rather than prioritise becoming ‘competent’ in the cultures of others. The objective of cultural safety activities also needs to be clearly linked to achieving health equity. Healthcare organisations and authorities need to be held accountable for providing culturally safe care, as defined by patients and their communities, and as measured through progress towards achieving health equity. A move to cultural safety rather than cultural competency is recommended. We propose a definition for cultural safety that we believe to be more fit for purpose in achieving health equity, and clarify the essential principles and practical steps to operationalise this approach in healthcare organisations and workforce development. The unintended consequences of a narrow or limited understanding of cultural competency are discussed, along with recommendations for how a broader conceptualisation of these terms is important.

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Why cultural safety rather than cultural competency is required to achieve health equity: a literature review and recommended definition

The 2019 Report seeks to inform policy and decision-makers, inside and outside the water community, how improvements in water resources management and access to water supply and sanitation services are essential to overcoming poverty and addressing various other social and economic inequities. In an increasingly globalized world, the impacts of water-related decisions cross borders and affect everyone. Extreme events, environmental degradation, population growth, rapid urbanization, unsustainable and inequitable consumption patterns, conflicts and social unrest, and unprecedented migratory flows are among the interconnected pressures faced by humanity, often hitting those in vulnerable situations the hardest through their impacts on water. Addressing the inequalities faced by disadvantaged groups requires tailored solutions that take account of the day-to-day realities of people and communities in vulnerable situations. Properly designed and adequately implemented policies, efficient and appropriate use of financial resources, as well as evidence-based knowledge on water resources and water-related issues are also vital to eliminating inequalities in access to safe drinking water and sanitation. Titled ‘Leaving No One Behind ’, the report reinforces the commitments made by the UN member states in adopting the 2030 Agenda for Sustainable Development and in recognizing the human rights to safe drinking water and sanitation, both of which are essential for eradicating poverty and for building prosperous, peaceful societies.

The United Nations World Water Development Report 2019: Leaving No One Behind

This scientometric review of genome-wide association studies (GWAS) from 2005 to 2018 (3639 studies; 3508 traits) reveals extraordinary increases in sample sizes, rates of discovery and traits studied. A longitudinal examination shows fluctuating ancestral diversity, still predominantly European Ancestry (88% in 2017) with 72% of discoveries from participants recruited from three countries (US, UK, Iceland). US agencies, primarily NIH, fund 85% and women are less often senior authors. We generate a unique GWAS H-Index and reveal a tight social network of prominent authors and frequently used data sets. We conclude with 10 evidence-based policy recommendations for scientists, research bodies, funders, and editors.

/pdf/a-scientometric-review-of-genome-wide-association-studies-569i58qye4.pdf

A scientometric review of genome-wide association studies

Drawing on various national statements on the ethical conduct of research, the codes of ethics of professional associations and international agencies, and ethical guidelines in social research met...

https://www.tandfonline.com/doi/pdf/10.1080/14615517.2013.850307

Principles for ethical research involving humans: Ethical professional practice in impact assessment Part I

Research in the area of sustainable tourism continues to grow, however a lack of understanding regarding necessary action inhibits progress. McCloskey’s (2015) critique regarding the failure of the...

A critical framework for interrogating the United Nations Sustainable Development Goals 2030 Agenda in tourism

As previously discussed, Reyhner and Eder (1989) have divided the history of American Indian educational policy, and indeed Indian policy generally, into six distinct periods or eras, culminating in our current state of Self-Determination. While this seems to be an accurate assessment of the present day, the authors would like to suggest that recent global developments have created considerable impetus for change in Indian Country. The authors believe that Indigenous populations may well be on the cusp of a new day in Indian policy in America, if proper consideration is given to this global imperative.

F. E. Knowles

Papers

The United Nations Declaration on the Rights of Indigenous Peoples

A Critical Pedagogy for Native American Education Policy