Written by April Shaw, Senior Staff Attorney, Network for Public Health Law – Northern Region Office
People that work in public health work to promote healthy individuals and communities. Only recently have people began to understand that racial equity is needed to build healthy communities. One definition of equity is “the quality of being fair and impartial.” Racial equity then can mean removing unfair and biased practices that have made people of color worse-off compared to White people. For example, cultural healing practices valued by Indigenous and other non-mainstream cultures are often seen as inferior to traditional White Western ideas on healing. The result is that diverse cultural healing practices are not available to people seeking them when they get health care services. So, the quality of healthcare services offered is not fair and impartial towards many people of color. Racial equity calls for more than just fairness and impartiality. It also calls honoring different cultural practices, like cultural healing, and treating those practices as valuable.
Cultural healing has received too little attention in conversations about how to achieve racial justice and health equity. There is not one definition of cultural healing. But the term has been used to mean the need to include historically rooted cultural healing practices of non-Western and underrepresented cultures within traditional mainstream Western institutions (such as in hospitals, clinics, education, and research). To be clear, cultural healing is not about simply adding cultural practices in. Healing practices in the U.S. are culturally biased towards mainstream cultural practices. These cultural biases are often only seen by people who do not share the same beliefs, which tend to be underrepresented communities of color. Part of the harm that this creates is that the under-valuing and exclusion of different cultural views and practices is often invisible to those working in health care settings and others.
What does cultural healing look like in practice? A hospital in Helena decided to allow smudging ceremonies and created space for traditional healing practices of Native American and other communities. Cultural healing includes offering foods that meet a community (and individuals’) dietary, spiritual, and other needs. One newspaper used pictures of typical hospital meals offered around the world to show how culture shapes what food hospitals provide to patients: from chicken pot pie and a cookie (United States), eggs with salsa and a side of chopped papaya (Mexico), to soba noodles and green tea (Japan). Cultural healing can also include developing culturally safe non-narcotic pain management programs in a community clinic. What these examples show is that culture is in the food we eat, the spaces where we heal, the medicines or herbs we ingest, and in so many other practices.
“What these examples show is that culture is in the food we eat, the spaces where we heal, the medicines or herbs we ingest, and in so many other practices.”
Cultural healing can help communities of color heal from historical trauma. Dr. Maria Yellow Horse Brave Heart defined historical trauma as “cumulative emotional and psychological wounding over the lifespan and across generations, emanating from massive group trauma” that contributes to poor mental and physical health. For example, historical trauma points to holocausts, genocides, forced relocation of Native Americans, and slavery, and how these traumas are passed on from generation to generation and create negative health impacts. Dr. Joseph P. Gone has argued that understanding historical trauma and drawing on Indigenous knowledge and traditions will better promote mental health in American Indian communities. These is just one example of how cultural healing can contribute to healthier communities.
To truly adopt cultural healing practices across society, we will need to pass laws that require culturally inclusive practices in healthcare and other settings. Currently, the law is not supportive of cultural healing. A simple word search of the term “cultural healing” in a database of U.S. laws showed that the term “cultural healing” is barely mentioned in all U.S. laws or even scholarly writings about the law. This tells us that protection of cultural healing is not recognized as important by people who pass laws or who write about legal reforms. In fact, because it is so rarely mentioned, it shows that idea of cultural healing is not on most people’s radars.
When it comes to protecting culture, the law has been too focused on requiring “cultural competency” training, which generally calls for becoming knowledgeable about the culture of a patient or whoever is being helped. Cultural competency training requirements are also usually infrequent, meaning the people being trained spend very little time on becoming “culturally competent.” Some scholars have criticized the idea of “cultural competency” as treating people’s cultures as if it’s something that you can learn on exam (like how to measure blood pressure). They argue this encourages providers to use racial stereotypes and view patients who are part of similar cultural groups as if they are all the same. These scholars have called for switching from cultural competency to a cultural safety model.
Cultural safety does a better job at helping to bring about changes that will make cultural healing the norm not the exception. This is because cultural safety asks healthcare providers and facilities to understand how their biases (which includes cultural biases) affect the care and health of patients (instead of just studying the culture of the patient) and gives patients the final say on when cultural safety has been achieved. For example, the state of Washington passed a law including cultural safety in its health equity continuing education training requirements. That law defines cultural safety to include that health care professionals and organizations examine how their biases and stereotypes impact care and provide “culturally safe care, as defined by the patient and their communities.” Making diverse cultural healing practices available to patients, will be a big part of cultural safety for many communities of color.
Cultural safety turns the “cultural” lens not just on the patient but on providers and health care organizations. It shines a light on cultural biases that lead to the exclusion of Indigenous and other cultural healing practices that are not mainstream. All of us have a culture. Making space for cultural healing is not about building culture into healing practices, it is a call to be more inclusive about what cultural healing practices are offered. It’s time to examine the role of culture more deeply to uncover which practices are ignored because they are not culturally familiar. The concept of cultural healing is old and is performed in every society. To promote health equity, we must use law and policy to create a culture of healing that is inclusive, honors diversity, and that creates spaces that heal the whole person.
This post was written by April Shaw, Senior Staff Attorney, Network for Public Health Law – Northern Region Office. Special thanks to the Eastside Health & Well-Being Collaborative, which provided space for shared learnings and discussions on what constitutes cultural healing that shaped and informed many of the examples provided in this piece.
The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this document do not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state.
Support for the Network is provided by the Robert Wood Johnson Foundation (RWJF). The views expressed in this post do not represent the views of (and should not be attributed to) RWJF.
Cultural healing has received too little attention in conversations about how to achieve racial justice and health equity.
To truly adopt cultural healing practices across society, we will need to pass laws that require culturally inclusive practices in healthcare and other settings.
Cultural safety turns the “cultural” lens not just on the patient but on providers and health care organizations. It shines a light on cultural biases that lead to the exclusion of Indigenous and other cultural healing practices that are not mainstream.
