Threshold Concepts

THRESHOLD CONCEPTS FOR DEVELOPING INTERCULTURAL & INDIGENOUS HEALTH COMPETENCE draft

1. Ideas about health, illness and wellbeing are shaped by our cultural influences. What we regard as normal, correct or effective about health care can vary a lot between different cultures. Exclusively Western biomedical models of health care can limit quality and reduce safety for many cultures. Often more holistic models are appropriate, ones that recognise the important influence of spiritual, emotional and cultural dimensions. To be effective health care professionals, we need to balance respect for different cultural health perspectives, while maintaining high professional standards of quality and safety.

2. The current health and wellbeing of some cultural groups, particularly Aboriginal and Torres Strait Islander peoples, is profoundly disadvantaged by current and historical practices. This includes trauma and intergenerational transmission of trauma resulting from practices such as racism, invasion, colonialism, destruction of culture and population, repression of cultural identity, forced dislocation from country and community.

3. Access to health care is a universal human right. Institutional policies or practices that are more suited to dominant cultures can systematically make barriers for some people to access health care. Targeted policies and actions are needed to redress this disadvantage. Our responsibilities as health professionals includes upholding these human rights, by attending to community wellbeing and development, and social determinants of health- as well as immediate individual needs.

4. The attitudes, skills and knowledge needed for intercultural health care largely overlap with 'intracultural' care for the mainstream. Improving competence in intercultural health care will benefits for practitioners (in reducing stress) and cultural groups, not just specific ethnicities.

5. All cultural groups have similarities and differences with other cultures. There are always subgroups that, while sharing some values and practices with the larger group, also having distinctive differences that may be unique to that subgroup's identity. An important example is the diversity of Aboriginal and Torres Strait Islander peoples particularly in terms of culture, language and history.

Quick Quiz 2

1 Evidence-based health care is culture free, that is, the dominant Western scientific model applies universally across different cultures.

	True.
	False.

2 Ensuring quality and safety means correcting clients' 'irrational' cultural beliefs about their health.

	True.
	False.

3 Clients who complain about the effects of historical injustices to their cultural group should just look to the future and stop being so negative.

	True.
	False.

4 Developing awareness and respect for the Human Right to access good health care should be part of every health professional's training.

	True.
	False.

5 Australian citizens do not have to worry about the human right to access good health care, that is a third world problem.

	True.
	False.

6 Sometimes cultural and spiritual concerns can be just as important as physical symptoms in promoting intercultural health.

	True.
	False.

7 Becoming an interculturally competent health professional will also have benefits for clients in 'mainstream' Australian culture.

	True.
	False.

8 In-depth learning about the Indigenous Australian culture will help health professionals understand how to work with Indigenous people all over Australia.

	True.
	False.