Cultural safety and the health of adolescents

BMJ 2003; 327 doi: (Published 21 August 2003) Cite this as: BMJ 2003;327:457
  1. Nicola J Gray, lecturer in pharmacy practice (,
  2. Frances A Hughes, chief nursing adviser Ministry of Health,
  3. Jonathan D Klein, associate professor of paediatrics
  1. University of Nottingham
  2. New Zealand
  3. University of Rochester,NY

    Barriers to providing good health care for adolescents parallel those facing minority groups such as the Maori. Indigenous peoples often feel disenfranchised and dominated by a “foreign” culture. They feel pressure to assimilate into the majority culture, yet the dominant culture shows little respect for or comprehension of their lifestyle. Adolescents experience similar stresses, which manifest as health problems that are classically displayed among oppressed groups: mental health problems, lifestyle disorders (such as obesity), and self harm.

    In the late 1980s Maori nurses conceived the idea of “cultural safety” to improve nurses' delivery of health care. The study of its principles is now part of the registration requirement for nurses and midwives. Cultural safety requires healthcare providers to reflect on their own cultural background and the nature of power relations in the provision of services to a minority culture by a dominant culture, so that the providers can …

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