ONE SIZE FITS FEW - From Cultural Incompetence to Contextual Sensitivity in Health Policy Development in Australia and Canada

Abstract

Australia and Canada have long and similar histories of accepting immigrants from an increasingly diverse range of countries, leading to the multicultural societies we see today. Both countries also share a commitment to citizen engagement in government business which, when combined with policies of multiculturalism, seek to enrich government policy by the input of the many and varied experiences and voices. However, despite these best intentions, the engagement of citizens of culturally and linguistically diverse (CALD) backgrounds in government business remains a challenge, particularly because of a lack of attention to ‘culture’ in policy making processes. The concept of cultural competence is well known in the public sector. However, although mandatory Indigenous cultural competence training exists to varying degrees in both countries, there is no training for cultural competence relevant to other CALD citizens specifically. Similarly, although some jurisdictions offer support and guidance for citizen engagement, there is very little explicit guidance in either country when it comes to engaging with CALD background citizens. This research is a comparative, cross country, case study which focusses on the health-related public sector in Australia and Canada. Drawing on analysis of government policy and interviews with health policy officers, this thesis examines understandings and applications of cultural competence, multiculturalism and citizen engagement at the Federal and State or Territory and Provincial government levels. Using a critical multicultural perspective, I examine whether paying greater attention to cultural competence could lead to better deliberative health policy development in multicultural societies. A number of key findings arise from this research: 1. A critical multicultural perspective draws attention to systemic and individual assumptions which serve to stereotype CALD citizens and entrench exclusion and disadvantage. Application of a critical multicultural approach to health policy development supports questioning of institutional processes and procedures, as well as health policy officer assumptions and biases, for equitable health policy development. 2. Everyday understandings of culture as an unchanging catalogue of attributes which is somehow knowable are out of step with current anthropological thinking of culture as relational and meaning-centred and thus constantly changing. To suggest that a health policy maker could become competent in culture is therefore misleading. 3. The language of ‘cultural competence’ is unhelpful because it focusses on culture as ethnicity. It is timely to shift language to ‘contextual sensitivity’ for heightened awareness of citizens as individuals shaped by their histories, life experiences and current institutional structures. Awareness of the context surrounding CALD citizens removes the need to consider an individual as an ethnicity. 4. Resource constraints, multiple interests and competing priorities influence citizen engagement practices. Despite the presence of guidance and support in some jurisdictions, the current one-size-fits-all processes exclude CALD background citizens. A critical multicultural perspective applied to citizen engagement supports questioning of processes and procedures with a view to adoption of inclusive practices. Whilst health policy is the focus of this thesis, ultimately these findings are applicable to all levels of government from Federal to local, and to all public policy domains.