Cultural Safety in Healthcare: Evidence Shows It Saves Lives Amid New Zealand Regulatory Overhaul
Key Insights
New Zealand's Health Minister has moved to increase political control over medical registration authorities, replacing Medical Council leadership and reducing Māori representation on the Nursing Council.
The government's proposed Health Practitioners Competence Assurance Amendment Bill would expand ministerial powers to interfere with the work of medical regulators.
Evidence from New Zealand demonstrates culturally safe practices dramatically reduced sudden unexpected infant deaths among Māori from 7.4 to 3 per 1,000 between 2008 and 2015.
New Zealand's Health Minister Simeon Brown has introduced legislation that would significantly expand ministerial powers over medical registration authorities, while simultaneously replacing the leadership of the Medical Council over its attention to cultural safety in medical practice. The Health Practitioners Competence Assurance Amendment Bill, introduced under urgency, aims to "align health workforce regulation with patient needs […] and government priorities," marking what critics describe as an unprecedented level of political interference in the regulation of medical training and practice.
The minister has also altered the composition of the Nursing Council, significantly reducing the number of nurses and Māori representatives on the board. While the health minister is legally able to make all appointments to these registration authorities under current law, the convention for nurses and doctors has been that a proportion of the council is appointed from top candidates in an election by members. Brown is the first to make significant changes to both councils on grounds of government policy.
Following the minister's appointment of a new chair, the Medical Council discontinued work on revising its existing statements on cultural safety, cultural competence and Hauora Māori services.
The origins and requirements of cultural safety
The concept of cultural safety is recognised worldwide as an innovation by New Zealand nursing academic Irihapeti Ramsden, with the New Zealand Nursing Council serving as a leader in implementing culturally safe practice. Under current law, both the nursing and medical councils are required to set standards of cultural competence, including those to "enable effective and respectful interaction with Māori."
Cultural safety is also an essential component of medical training. The Australian Medical Council accredits New Zealand's medical schools, and one of the expected graduate outcomes is that students demonstrate culturally competent practice to deliver "safe, accessible and responsive healthcare free of racism and discrimination." Medical students in New Zealand cannot graduate without meeting this requirement. The principle is further embedded in postgraduate training through the Council of Medical Colleges program, which ensures cultural safety is included in teaching, continuing professional development and curriculum development.
Evidence of impact: sudden unexpected deaths in infants (search)
During the 1980s, New Zealand recorded some of the highest rates of sudden unexpected deaths in infants (search) (SUDI) globally. A landmark research and prevention program between 1986 and 1992 prompted nationwide campaigns addressing four identified risk factors: infants sleeping prone, maternal smoking, lack of breastfeeding, and infants sharing a bed with another person. For non-Māori, rates dropped from almost four babies per 1,000 to 1.6.
However, for Māori families, rates remained stubbornly high at 7.4 to 6.9 per 1,000. In 2008, a Māori team developed a culturally competent response that included education campaigns and the provision of portable infant sleeping pods, often woven from flax using traditional techniques. By 2015, Māori rates had dropped to three babies per 1,000.
The success hinged on understanding that bed-sharing was a common practice for Māori families. Rather than advising mothers not to share the bed with their babies—an approach that had proven ineffective—the culturally adapted intervention introduced small pods allowing infants to sleep safely on the parents' bed. This represents a clear case of lives saved through culturally safe care.
Persistent disparities in diabetes (search) and bariatric surgery
Diabetes (search) affects Māori and Pacific people disproportionately, and research on long-term conditions describes how treatment guidelines developed for the dominant culture remain ineffective in addressing high and rising rates of diabetes among these populations. When new diabetes drugs were released, New Zealand's drug-funding agency Pharmac (search) included a provision for Māori and Pasifika to have prioritised access, but the government reversed that policy.
Bariatric surgery provides another stark example. A recent study examining rates of public hospital bariatric surgery in Counties Manukau—where Pacific people make up 23% of the population, Māori 15%, and Europeans 24%—found that Pacific people have twice the rate of obesity (search) compared with Europeans. Yet of all bariatric procedures performed, 46% were for Europeans, 27% for Māori, and only 17% for Pacific people. After adjusting for age, gender, body mass index, other health conditions and deprivation, Māori and Pacific people were 47% and 70% less likely, respectively, to proceed to having bariatric surgery.
The government has removed ethnicity as a relevant factor to target funding, stating that public services should be "based on the needs of all New Zealanders." However, these examples highlight that ethnicity is an independent predictor of need, and that political involvement in the regulation of medical training and practice risks undermining public trust. Interfering with regulators' attempts to redress ethnic disparities in health outcomes by requiring medical staff to be trained in cultural competence, the evidence suggests, flies in the face of the data.