Table Of ContentCulture, Diversity and Health
in Australia
Australia is increasingly recognised as a multicultural and diverse society. Nationally, all accrediting bod-
ies for allied health, nursing, midwifery and medical professions require tertiary educated students to be
culturally safe with regards to cultural and social diversity. This text, drawing on experts from a range of
disciplines, including public health, nursing and sociology, shows how the theory and practice of cultural
safety can inform effective health care practices with all kinds of diverse populations.
Part 1 explores key themes and concepts, including social determinants of health and cultural models
of health and health care. There is a particular focus on how different models of health, including the bio-
medical and Indigenous perspectives, intersect in Australia today. Part 2 looks at culturally safe health care
practice focusing on principles and practice as well as policy and advocacy. The authors consider the prac-
tices that can be most effective, including meaningful communication skills and cultural responsiveness.
Part 3 examines the practice issues in working with diverse populations, including Indigenous Australians,
Culturally and Linguistically Diverse Australians, Australians with disabilities, Australians of diverse sexual
orientation and gender identity, and ageing Australians. Part 4 combines all learnings from Parts 1–3 into
practical learning activities, assessments and feedback for learners engaging with this textbook.
Culture, Diversity and Health in Australia is a sensitive, richly nuanced and comprehensive guide to effective
health practice in Australia today and is a key reference text for either undergraduate or postgraduate students
studying health care. It will also be of interest to professional health care practitioners and policy administrators.
Tinashe Dune is a multi-award-winning Senior Lecturer in the areas of health sociology and public
health and is also a clinical psychology registrar. At Western Sydney University Dr Dune teaches in the
Interprofessional Health Science program. Her research and teaching focuses on marginalised popula-
tions. This includes the experiences of culturally and linguistically diverse people, those living with dis-
ability, ageing populations, LGBTIQ-identifying people and Indigenous populations. Dr Dune utilises
mixed-methods approaches and interdisciplinary perspectives, which support multidimensional under-
standings of the lived experience, health outcomes and empowered ways to improve wellbeing.
Kim McLeod is Senior Lecturer in the School of Social Sciences at the University of Tasmania. Kim
is known for her expertise in philosophically informed and arts-based health research. Much of Kim’s
work explores the social change that contributes to health equity and population-level wellbeing. Kim’s
approach to understanding health as ongoing processes of change is presented in her single authored
book, Wellbeing Machine: How Health Emerges from the Assemblages of Everyday Life. Kim brings a multidis-
ciplinary approach to her research practice. She commonly collaborates with researchers from the Health
Sciences, Humanities and Social Sciences on health-related research projects. Kim’s teaching expertise is
introducing health profession students to cultural safety and the social context of health. She leads col-
laborative research projects to explore best teaching practice in this area.
Robyn Williams has nursing and education qualifications and has over 37 years of experience of work-
ing with Indigenous peoples, primarily in the Northern Territory but also all over Australia. Her fields of
expertise include cultural safety, effective communication, curriculum development and program imple-
mentation, evaluation of community-based programs, and qualitative research in Indigenous and rural and
remote health issues and culturally safe practitioners.
Culture, Diversity and Health in
Australia
Towards Culturally Safe Health Care
Edited by
Tinashe Dune, Kim McLeod and
Robyn Williams
First published 2021
by Routledge
2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN
and by Routledge
605 Third Avenue, New York, NY 10158
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2021 selection and editorial matter, Tinashe Dune, Kim McLeod and Robyn Williams
individual chapters, the contributors
The right of Tinashe Dune, Kim McLeod and Robyn Williams to be identified as the
authors of the editorial material, and of the authors for their individual chapters, has been
asserted in accordance with sections 77 and 78 of the Copyright, Designs and Patents Act
1988.
All rights reserved. No part of this book may be reprinted or reproduced or utilised in any
form or by any electronic, mechanical, or other means, now known or hereafter invented,
including photocopying and recording, or in any information storage or retrieval system,
without permission in writing from the publishers.
Trademark notice: Product or corporate names may be trademarks or registered trademarks,
and are used only for identification and explanation without intent to infringe.
British Library Cataloguing-in-Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging-in-Publication Data
A catalog record has been requested for this book
ISBN: 978-0-367-68676-5 (hbk)
ISBN: 978-1-760-52738-9 (pbk)
ISBN: 978-1-003-13855-6 (ebk)
Typeset in Bembo
by SPi Global, India
I dedicate this book to my children, Naya, Yarran and Burnum Lawson—so the
world will be ready for you.
Love
Tinashe
I dedicate this book to my partner Joanne, and Biscuit, our Golden Retriever. Your
companionship sustains me every day. This book is also for all the students who
are embarking on a journey in relation to culturally safe health care. Thank you
for the contribution you will make towards more equitable health for us all.
All the best
Kim
I dedicate this book to my partner Mick for your years of patience with my wind-
mill tilting, and my two adult sons Stephen and Joseph—you give me hope for
a future that has caring, compassionate and critical thinkers. I also dedicate this
book to the students past, present, and future that have, do and will embrace the
challenge of negotiating culturally safe practice.
Robyn
Contents
List of figures xiii
List of tables xiv
List of boxes xv
List of contributors xix
Acknowledgements xxvi
List of abbreviations xxviii
PART I
Understanding culture, diversity and health 1
1 An introduction to culture, diversity and health in Australia 3
TINASHE DUNE, KIM McLEOD AND ROBYN WILLIAMS
Diversity in Australia 4
An introduction to social determinants of health 5
What are social constructions, and why do they matter? 6
Health and intersecting identities: Intersectionality 8
Cultural safety, diversity and the health care system 9
Culture, diversity and health in Australia: Towards cultural safety 11
Conclusion 13
References 13
2 The social and cultural determinants of health 15
REBECCA E. OLSON, ALLYSON MUTCH, LISA FITZGERALD AND SOPHIE HICKEY
Introduction 17
Conceptualising the social determinants of health 18
Cultural determinants of health 20
Understanding culture 20
Explaining the cultural determinants of health: An “invisible” concept 22
History of the social determinants of health 23
Explaining health inequalities 24
The social determinants of health—Critical perspectives 27
Conclusion 31
References 31
viii Contents
3 Cultural models of health and health care 36
ALEXANDER WORKMAN, SYEDA ZAKIA HOSSAIN, PRANEE LIAMPUTTONG,
ANGELICA OJINNAKA AND ELIAS MPOFU
Introduction 37
What is health? 39
The biomedical model of health and wellbeing 39
Ethnocentrism, Eurocentrism and health 41
The biopsychosocial model of health and wellbeing 42
Primary health care models and cultural safety 43
Non-Western models of health and wellbeing 47
Conclusion 48
References 49
PART II
Culturally safe health care practice 53
4 Principles of cultural safety 55
ROBYN WILLIAMS, TINASHE DUNE AND KIM McLEOD
Introduction 56
Principles of cultural safety 56
Why cultural safety? 57
Understanding cultural safety in health care 58
Access to health care 60
Effects of power and authority on health care 60
Whiteness, White privilege, White fragility 62
White privilege 64
White fragility 65
Reverse racism? 66
Reactions to the launch of the codes 67
Conclusion 68
Notes 69
References 69
5 Policy and advocacy in culturally diverse health care 73
KEERA LACCOS-BARRETT AND ANGELA BROWN
Introduction 74
Health policy in Australian health care 74
Social determinants of health and policy 75
Policy and standards in Australian health care 76
Health national standards 77
Cultural safety and policy considerations 79
Critiques in policies 80
Policy and cultural safety for health professionals 81
Policies, enablers and limitations towards culturally safe care 83
Contents ix
Institutional discrimination 84
The role of health professionals in health advocacy 86
Scenario 1 87
Scenario 2 88
Conclusion 89
References 89
6 Culturally safe health care practice 92
KIM McLEOD, ROBYN WILLIAMS AND TINASHE DUNE
Introduction 93
Culturally safe practice addresses the impact of health professionals’
cultural realities, attitudes and behaviours on others 95
Culturally safe practice recognises the importance of health care that is driven
by the individual, family and community 98
Culturally safe practice acknowledges the factors that impact individual
and community health 101
Culturally safe practice is regardful of culture 103
Conclusion 106
Action plan for enacting cultural safety in professional health practice 106
References 108
PART III
Working with diverse populations 113
7 Aboriginal and Torres Strait Islander Australians 115
LIESA CLAGUE, JANELLE TREES AND ROB ATKINSON
Aboriginal and Torres Strait Islander peoples 117
The East Coast of Australia: First arrival of the British (including convicts
from Ireland, Wales, Scotland and England) in the Sydney Basin 119
What do we know about Aboriginal peoples from the Sydney Basin before
the penal colony was established and invasion of land, resources, culture
and society of Aboriginal peoples? 120
Impacts of invasion and the establishment of a penal colony in Australia:
Breakdown of societies 122
Government policies 124
Aboriginal and Torres Strait Islander peoples and their health 127
Aboriginal Community Controlled Health Organisations (ACCHOs) and
Aboriginal Medical Services (AMS): A wholistic model of primary health care 128
The importance of understanding health 128
Culture is an important determinant of health 129
Changes happening for health professional bodies such as Ahpra 131
Disparities in health 133
Scenario: Torres Strait 133
Scenario summary 137
Learn more about this topic 138
Conclusion 138
References 140
