The concept of Kawa whakaruruhau Cultural Safety has travelled across time and space since I was introduced to it as a nurse. I wrote about my own journey with the concept and how it is now becoming misused in an Overland article earlier this year:
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 Jennifer Roberts excellent dissertation).
Despite my reservations about where the concept is headed, I’m happy the third edition of Cultural Safety in Aotearoa New Zealand has been published. The chapters mark a time when Cultural Safety could be seen as a widespread liberatory framework or call to action, in support of First Nations voices, rights and aspirations. To give you a taster, excerpts and references from the two chapters I have authored are below.
Ethics (Chapter Seven, pages 105-119)
The climate catastrophe and COVID-19 pandemic have exposed racism as a global public health emergency and determinant of health (De Souza, 2021). The long shadow of colonialism, structural violence and over-policing (Smith & Foth, 2021) in settler colonies like Aotearoa New Zealand have accompanied a moral imperative to transform hegemonic and colonial Pākeha institutions. For Māori, this has meant reassertion of self-determination and decolonisation, and for cultural minorities a focus on racial justice. This urgent institutional transformation requires the re-examination of healthcare and its professional and ethical frameworks. Two criticisms of ethics have been articulated in this contemporary context; the first is that hegemonic frameworks centre whiteness and reinscribe it (Anderson, 2021), and the second is that the frameworks fail to dismantle racism and maintain it through silence around racial justice (Mayes et al., 2021). This chapter outlines dominant frameworks in bioethics and recommends that ethical frameworks must both be deconstructed and supplemented if practitioners are to practice in culturally safe ways. I build on the challenge extended by Smith & Foth (2021) and invite readers to expand their ethical reasoning to include tools and theories informed by cultural safety and Indigenous sovereignties.
References
Anderson, W. (2021). The whiteness of bioethics. Journal of Bioethical Inquiry 18, 93–97. https://doi.org/10.1007/s11673-020-10075-y
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Mayes, C. (2020). White medicine, white ethics: On the historical formation of racism in Australian healthcare. Australian Journal of French Studies 44(3), 287–302. https://doi.org/10.1080/14443058.2020.1796754
Mayes, C. (2021). Race, reproduction, and biopolitics: A review essay. Journal of Bioethical Inquiry 18, 99–107. https://doi.org/10.1007/s11673-020-10071-2
Mayes, C., Paradies, Y., and Elias, A. (2021). Institutional racism, whiteness, and the role of critical bioethics. Journal of Bioethical Inquiry 18, 9–12. https://doi.org/10.1007/s11673-021-101035
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Ngo, H. (2021). The habits of racism: A phenomenology of racism and racialized embodiment. Lanham.
Nursing Council of New Zealand / Te Kaunihera Tapuhi o Aotearoa. (2012). Code of conduct for nurses. http://www.nursingcouncil.org.nz/Nurses/Code-of-Conduct
Nursing Council of New Zealand / Te Kaunihera Tapuhi o Aotearoa. (2025). Standards of competence for registered nurses.
Ornelas, I. J. (2008). Cultural competency at the community level: A strategy for reducing racial and ethnic disparities. Cambridge Quarterly of Healthcare Ethics 17(2), 185–194. https://doi.org/10.1017/S0963180108080213121
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Migration (Chapter Eight, pages 122- 135)
Dedication: This chapter is dedicated to the 51 Shuhada (martyrs) of the Christchurch terror attack, New Zealand, in March 2019.
“At the age of 7, my family immigrates from Zimbabwe to Aotearoa. I pass through Customs but my culture is made to stay behind. In the classroom, I am afraid my tongue will beat back to its African rhythm, be concussed by fear, have amnesia turn all its memories to dust.
Yesterday I was African, today I am lost. Maybe I was blinded by the neon sign of opportunity, failed to read the fine print that read: ‘assimilate or go back where you came from’. […] To be a child of the diaspora is to battle two tongues and be forced to trade one for another so much so that my articulation of the English language now tastes like the un-birthing of my country.”
Takunda Muzondiwa, “Race Unity Speech” (2019)
What does it mean to move to a country, by force or willingly, and then have to navigate a new system, a hundred new systems that make up your new life? Or what might it mean to be born in Aotearoa New Zealand or for your family to have been here for multiple generations and yet to be made to feel forever that you do not belong? Do systems have a place in promoting wellbeing and belonging? What might it mean to work in health care or social services with people and communities that are culturally different from your own? This chapter invites you to go beyond thinking about skills and competencies for working with difference or about models of diversity and to instead zoom out and think about how bigger social and political contexts impact on care. How does the media, your family, politicians and others shape how you treat others? The concept of cultural safety invites practitioners to engage in critical and reflective processes to understand these contexts and histories. It is more likely that if we do so, we might transform the unequal societal power relations that impact on the life chances and health outcomes of others.
This chapter outlines how whakawhanaungatanga (making connections) might be more useful as a concept for working with others than terms like diversity and inclusion. Indigenous concepts such as cultural safety are discussed as a way of working with diasporic communities, and the chapter reviews histories of diasporic communities that highlight the unequal social relations that have been produced through policy. Health practitioners’ relative power and privilege will be considered along with the invitation to zoom out to think about big histories and zoom in on how you think about people who might have a religion or culture that is different from one’s own.
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