Introduction

When discussing Cultural Safety, ‘cultural competency’ or similar ‘cultural…’ terms are often (and incorrectly) used interchangeably. Whilst there may be some similarities and overlaps, Cultural Safety advocates for an approach that steps beyond understanding ‘the other’. Cultural Safety is grounded in the concept of power and how understanding and challenging power dynamics can lead to more equitable power sharing between individuals, groups and organisations. It requires critical self-reflective practices that go beyond both the consideration of an individual’s personal or professional culture/s (connected to cultural awareness) and practices that legitimise the cultures of others (connected to cultural sensitivity). Encompassing these principles, Cultural Safety goes a step further in encouraging individuals to reflect on and challenge the dimensions of power in their personal, professional, and organisational cultures to promote greater power sharing (Cox et al., 2021).

This chapter will provide a perspective on large, complex, and often compounding systemic issues about power and how it manifests. It is a broad overview of key concepts that provide a starting point to develop, strengthen, and challenge your understanding of Cultural Safety. This will be anchored with reflective questions to build your critical self-reflection skills as well as additional readings to support you in strengthening your understanding of these topics and their alignment with the principles and practices of Cultural Safety.

Power

Why talk about power?

Power remains one of the most contested concepts in social and political theory (Avelino, 2021) and understanding ‘what power is’ is essential for culturally safe practice. Grounded in different theories, including critical and feminist theory, Cultural Safety conceptualises that power can be used to redistribute and redress inequities, which themselves derive from systemic imbalances in power. Cultural Safety hence focuses on how people work together to identify and address power imbalances and power structures that lead to forms of discrimination, including (but not limited to) racism and sexism (Cox & Best, 2022). By centralising considerations of power, we are better able to ‘…challenge and subvert’ power structures and ‘unmask their principles of operation, whose effectiveness is increased by their being hidden from view…’ (Luke, 2005, p. 63). Therefore, understanding power and power differentials at all levels, including personal, professional, organisational, and societal, is essential to Cultural Safety (Curtis et al., 2019).

What is power? 

How does power work?

Whilst power can be conceptualised in many ways, it is often categorised. For example, political, social, and economic power are common classifications devised by considering the application of power to various societal structures (Cox et al., 2021).

A misconception of power is that it is a commodity that can be traded or handed over from person to person, group to group, society to society.  Rather, power can be understood in terms of class and conditions. For example, in society, there are certain groups of people who influence the distribution of wealth. This form of stratification highlights how those in positions of power might influence profit (or the economy) which has a flow-on effect on all essential human needs like housing, work, and health (Cox et al., 2021).

Instead, power is:

• Exercised – with an individual or group being able to act or express themselves. The degree to which power can be exercised is often determined by how social structures are developed and maintained, which may limit or enhance a person’s ability to exercise power;
• Everywhere – ordinary and dispersed at every interface between people and across systems;
• Fluid – how power is exercised can differ across time and context, it is not static;
• Relational – it exists at all levels of interaction. This includes personal levels, such as between individuals or within families. It can also exist in the relationships that groups of people have within society; at professional levels, such as workplaces; and within and across societal structures, such as governments, organisations, and countries.

Who has power?

Foucault (2003) states that ‘everyone has power’. However, current structures often see power exercised in ways that lead to and entrench imbalances between people and groups within society. This dynamic often disenfranchises people and groups who do not follow, understand, or are positioned outside the power structures that reinforce the dominant culture’s rules or norms, impacting their ability to exercise power (Cox et al., 2021).  For example, those with a university education benefit from the power that a degree affords a person in society. There are  jobs that are unattainable without these qualifications.

Expressing power

Power can be expressed in different ways. Harris et al. (2020) outlines a useful classification for conceptualising expressions of power, it includes:

• Power over: Power built on force, coercion, domination, and control, sometimes motivated through fear. A common example given by Dahl (1957) is when a person (Person A) has power over another person (Person B), and the person with power (Person A) makes another person (Person B) do something they would otherwise not want to do;
• Power with: A shared power that grows out of collaboration and relationships built on respect, mutual support, empowerment and collaborative decision making;
• Power to:  Power is built on every person’s potential to make a difference, to create something new, or to achieve goals;
• Power within: This reflects that we all have power. Power derived from an individual or group’s sense of their capacity and self-worth. It allows people to recognise their ‘power to’ and ‘power with’ and believe they can make a difference.

Returning to the dictionary definition of power previously used to ‘exercise control over other individuals or groups’ (Cambridge Dictionary, 2023), this is a clear example of a definition that positions power as something expressed over someone. This expression of power can lead to forms of discrimination, violence, and persecution. Conversely, other areas of literature such as feminist definitions that discuss power distribution start to tap into the other expressions of power: with, to, and within.

Reflecting on power

What is sovereignty?

Like power, there are many definitions of sovereignty, some of which are contested. Sovereignty is related to power, as it looks at an individual or a group of people’s ability and authority to have power (e.g., govern). Sovereignty can be possessed by an individual or group of people but is often primarily related to occupying a particular position within a state or collective. Moreton-Robinson (2007, p. 33) captures the international definition of sovereignty as ‘the supreme authority in an independent political society’. Often, when considering sovereignty (Moreton-Robinson, 2007), people think it is:

• Absolute: Existing independently, being universal and not relative to anything;
• Monopolistic: Is complete control over something, and something that cannot be shared;
• Irrecoverable: Cannot be regained, recovered, or addressed.

However, sovereignty is not absolute, for example a sovereign state cannot just do whatever it likes, as there are mechanisms such as constitutions and laws that create parameters for sovereignty.  Sovereignty therefore is not beyond the law but rather interconnected with it. The ongoing acts of many groups, such as First Nation’s peoples’ worldwide, continue to demonstrate sovereignty amidst political, social and economic oppression (Moreton-Robinson, 2007).

In international law, sovereignty is a principle that has ‘internal’ and ‘external (and political)’ aspects (Parry & Grant, 2009, p. 563). Internal aspects of sovereignty consider the person/people who hold the supreme authority within a state and how power is shared within the state. External (political) sovereignty considers the organisation of a state and how it governs and control its own affairs, as well as the potential weakness of a structure, for example if the state can hold power against other countries (Parry & Grant, 2009, p. 563). When reflecting on these concepts of sovereignty, it is also essential to consider how sovereignty exists within the non-human world, such as within ecosystems, at the planetary level, or in the development of technological innovations. From an ecosystem perspective, sovereignty can be understood as the self-regulating mechanism that maintains balance and diversity. These systems within nature operate without human intervention, demonstrating ecological sovereignty.

First nations sovereignty

‘If Indigenous sovereignty does not exist, why does it constantly need to be refused?’ (Moreton-Robinson, 2007, p. 3)

All Indigenous peoples and groups worldwide will have their own way of defining sovereignty. Indigenous sovereignty came before Western theories, such as social contract theory models by Hobbes, Locke, Hume, and Rosseau (Moreton-Robinson, 2007, p.2). Indigenous sovereignty and rights have often not been written by Indigenous people (Moreton-Robinson, 2007); yet, Indigenous sovereignty remains grounded in resistance to settler-colonial contexts (Cox & Best, 2022; Clavé-Mercier, 2022).

First Nations Sovereignty in Australia and Aotearoa (New Zealand)

Indigenous sovereignty cannot be assumed to be similar (homogenised). First Nations people of Australia and Aotearoa (New Zealand) have unique histories and contexts for how sovereignty is articulated and demonstrated within settler-colonial contexts (Clavé-Mercier, 2022; Cox & Best, 2022). Tino rangatiratanga in te reo Māori (Māori language) is similar to sovereignty or ‘total control’, recognised as exercised by chiefs (rangatira) over all their lands and taonga (everything that is of significance) in Te Tiriti o Waitangi Article 2 ^[1] (Waitangi Tribunal, n.d.). In Sovereign Subjects, Moreton-Robinson’s (2007) writing on Indigenous sovereignty from an Indigenous perspective is, in itself, an act of sovereignty. Moreton-Robinson (2007, p. 2) considers sovereignty from an Indigenous Australian (First Nations peoples of Australia) feminist perspective to be:

• Embodied: Carried in the body;
• Ontological: Ways of being;
• Epistemological: Ways of knowing;
• Relational: Including complex relations such as those between ancestral beings, humans, and land.

Compared to other forms of sovereignty, Moreton-Robinson (2007) states that Indigenous sovereignty does not seek to dominate over non-Indigenous peoples. For example, as described by Mutu (2010), Māori signatories to Te Tiriti o Waitangi likely understood tino rangatiratanga as enduring despite the British Crown securing kāwanatanga (governance) in Article 1; kāwanatanga was viewed as pertaining to the Queen’s control over her subjects, namely Pākehā (European) migrants and their descendants.

Indigenous peoples’ sovereignty continues to be heavily contested and denied with questions such as, ‘What does embodiment look like?’, ‘How does this align with the dominant (Western) perspectives and politics?’ and ‘How does it align with various Indigenous perspectives and politics?’ Yet this contestation and refusal to acknowledge Indigenous sovereignty often persists without regard for or consideration of how the concept itself is being defined (Moreton-Robinson, 2007).

Power and domination

Like the Western definition of power above, the Cambridge Dictionary (2023) defines domination as ‘power or control over people or things’. In both definitions, the word over infers a particular expression of power built on force, coercion or control. This inference leads to cultures (personal and professional) that tend to create a ‘dominant’ way of thinking, acting, or characteristics of people. In many cases, individuals or groups who subscribe to these normalised ways of thinking, acting or being, become a dominant group and are afforded power over certain people or things within that context.

Theorists such as Foucault (1991; 1998, 2003) see power as an ever-present instrument often used to enforce domination. Knowledge is often a form of power that reproduces inequality and inequity through different forms of control (MacMillian, 2010).

Impacts of power and domination: privilege

It is essential to understand how different individuals and groups may respond to power and how it is expressed. Within society, these different aspects of power influence the structures that can lead to privilege and disadvantage, including oppression for specific groups.

What is privilege?

Privilege is not separate from power but interconnected with it. It relates to the benefits and advantages that often come in a range of social, economic, or political forms held by the group in power (or the majority) in a society (Garcia, 2015). These are often invisible and unearned and are not just linked to skin colour; they can relate to other cultural aspects that make up a person, such as age, gender, sex, and sexuality (MacIntosh, 2003).

Privilege is an interesting concept to reflect on, consider, teach and learn. In general conversation, the word itself can elicit a range of different responses. Like racism and other forms of discrimination, everyone comes with a different understanding and experience of what privilege is and can often be viewed as ‘subjective’. Ironically, the invisibility of privilege contributes to these different reasons, understandings and experiences.

We ask you to consider your experience of going to the grocery store. What is your experience of a grocery store? For many of these authors at this current point in time, the grocery store feels like an ‘everyday experience’ borderline a chore rather than a privilege. However, to some, these privileges have not always been afforded, and grocery stores haven’t always felt like ‘everyday experiences’.  For some, grocery stores have not been affordable, others the environment isn’t accessible with bright lights and too many sounds that lead to overstimulation. For others, they have been surveilled due to their appearance, often related to their perceived ethnicity, and others have not had the physical means to get to the store, let alone navigate it with physical impairments. It is the unseen aspects of privilege that makes them even harder to acknowledge.

Consider access to grocery stores. In some rural and remote areas, there is not a grocery store. To get groceries, some people need to travel significant distances which requires reliable transport and the financial ability to cover the costs. Some rural and remote areas may have a convenience store, that has groceries air lifted in, once a week, if weather permits. Whereas, urban areas have access to many grocery stores, with fresh produce regularly available. When considering privilege, from the perspective of accessibility to the grocery store, who is privileged? To some extent, does everyone have a level of privilege that there is an option, if all circumstances align, they can go to a grocery store for food? Or are the people who are subsistent farmers, who are not dependent on a grocery store privileged? These simple examples showcase how privilege can be relative, and often unseen as we cannot always see or understand what is happening for others.

Privilege is not…

There are many misconceptions about privilege. However, it is essential to be clear on what privilege is not:

• Privilege is not a one-off event: Privilege is a result of how societies and cultures are built that afford certain privileges and advantages to an individual or group. Privilege derives from the ongoing historical dominance in a society that positions some as dominant over others (MacIntosh, 2003);
• Privilege is not just individual; it is structural: There is a common assumption that privileges that could be afforded to specific individuals and groups have been deserved, earned, or chosen. This assumption is often reduced to socio-economic status and how much a person can afford. Instead, privilege is structural. It is a result of how societies and cultures are built that afford certain privileges and advantages to an individual or group (Cox et al., 2021);
• Privilege is not equal for all people: Due to the structural nature of power, which results in privilege and disadvantage, not all people in the dominant group will experience equal or similar advantages, nor disadvantages. However, privilege creates a form of currency, and if you are part of the dominant group, you have a greater chance of receiving benefits. Alternatively, you may be part of the dominant group and not be aware that you have benefits, as they may feel like ‘a given’ (Garcia, 2015). An analogy to privilege is fish in water. Water to a fish is given. It is part of its environment and cannot be seen, as it is part of its existing survival structure (Morrison, 1993). It is often not until the fish is removed from the water that it realises how connected it has been to the water to survive. Like water, privilege   can have benefits and advantages that a person may not see or ever have considered because they may not perceive it to impact on their day-to-day life or they may not have experienced oppressive structures of society;
• Privilege is not binary: Some people often consider privilege a binary construct: you either ‘have it’ or ‘do not have it’. In reality, it is far more complex and challenging to determine privilege sometimes, as the benefits and advantages in society may not be clear. It can be things a person may not have had to think about (Garcia, 2015). Celebrations that are acknowledged with public holidays are a less recognised privilege that people from the dominant culture enjoy for example;
• Privilege is not able to negate adversity: You can still experience other forms of adversity, even if you have not experienced adversity through societal oppression or disadvantage. Likewise, even if you have experienced adversity through oppression and disadvantages, you may also have been afforded privileges.

Impacts of power and domination: intersectionality

What is intersectionality?

Professor Kimberlé Crenshaw first coined the term intersectionality in 1989 (Crenshaw, 1991). Intersectionality can be defined as the complex, cumulative way in which the effects of multiple forms of discrimination (such as racism, sexism, and classism) combine, overlap, or intersect, especially in the experiences of marginalised individuals or groups (Crenshaw, 1991). Similarly, privileges can combine, overlap or intersect, especially for groups with power or those within the dominant cultural group (Crenshaw, 1991).

Compounding disadvantage and the systems that maintain this disadvantage can lead to oppression.   For example, the colonial structures within Aotearoa (New Zealand) and Australia, have led to social, political and economic injustice for First Nation’s peoples creating a gap between Indigenous and non-Indigenous peoples, particularly in relation to health.

Why understand intersectionality?

The models discussed by Crenshaw (1989) capture the complexity around discrimination and its compounding nature. It is vital to look beyond standalone social and cultural categories as superior or inferior, leading to forms of privilege and disadvantage. Instead, intersectionality invites us to examine how these social and cultural categories intersect (Guittar & Guittar, 2015). This intersection of many parts of culture (age, race, ethnicity, class, gender, ability, etc.) can lead to certain advantages (power and privilege) or disadvantages (discrimination and oppression) for a person or group. It can also mean that many parts that make up a person or group can increase the advantages or disadvantages that person or group may experience (Shannon et al., 2022).

For example, dominant power structures such as education institutions and health care systems produce and reproduce privilege, disadvantage and marginalisation through a dominant system of values and beliefs; where Western values and beliefs are constructed as the ‘true’ values, and alternative values and beliefs constructed as ‘the other’ (Cox & Best, 2022).   For example, the idea of autonomy (or choice) in health care is often viewed from an individual perspective – what does the person want for their own health? This dominant value often ignores historical ideas of autonomy that valued paternalism over individual choice (e.g. the doctor makes the decision for the patient), and other legitimate ways of decision making (e.g. communitarian approaches).

Given the various facets of individuals that are governed by social structures, norms and discourses, it is often the case that people are not entirely privileged or oppressed, but experience privilege in some respects, and disadvantage in others. It is also the case that intersecting identities will likely compound privilege or disadvantage. For example, an Indigenous person who identifies as non-binary and disabled is excluded from fully participating in a society that is designed for able-bodied and heterosexual white people.

How does power (re)produce privilege, disadvantage and oppression?

Without understanding power and privilege, people usually do not understand their social position and inherent unearned privileges. This often leads to further disadvantage and marginalising groups already oppressed by the dominant society, by reinforcing what the ‘norms’ are that further exclude certain groups of people. The coin model (Figure 4.1) is a framework for understanding how social systems that lead to forms of discrimination, such as sexism, racism, and ableism, interact with each other to produce complex patterns of privileges and oppression of some groups (Nixon, 2019). The coin symbolises the systems of inequality. It represents discrimination and inequality as unjust social structures that give people unearned privileges and disadvantages (Nixon, 2019). The top side of the coin represents privilege. This includes people who receive advantages from social structures and unfair or unearned benefits due to their ways of being valued by others, whether because of their racial, cultural or other privileges. The bottom side of the coin represents oppression. This includes people who are made up of the most disadvantaged and vulnerable groups in society, such as specific high-risk groups, communities  with identified needs, and lower socioeconomic groups (Nixon, 2019).

Unlike intersectionality, Nixon’s (2019) coin analogy specifically states,

“A single coin does not represent all privilege or all oppression. Rather, each coin represents a specific system of inequality (e.g., sexism, racism, ableism). Each person typically occupies the position on the top of some coins and the bottom of other coins at the same time.”

However, each coin that represents each social structure highlights internal asymmetries which may benefit some, but not others (Nixon, 2019).

Impacts of power and domination: oppression

Oppression is an ongoing process ‘in which people are governed unfairly and cruelly and prevented from having opportunities and freedom (Cambridge Dictionary, 2023). A non-exhaustive list of ways oppression manifests, and may overlap, includes:

• Exclusion: Unjustly excluded from social groups based on particular membership conditions (Richardson, 2023). This exclusion leads to forms of discrimination against individuals or groups of people, such as racism, sexism and ableism (Crenshaw, 1991; Nixon, 2019).  For example, many buildings (both public and private) are designed in certain ways which actively exclude some body types;
• Exploitation: Unfairly using someone or something to their advantage. Overt examples of exploitation include systems of oppression worldwide, particularly in the treatment of Indigenous lands and peoples (Moreton-Robinson, 2004).  More covert ways of exploitation include cultural (in)appropriation;
• Surveillance: Foucault defines surveillance as the ‘watching, counting and categorising of people’ (as cited in Gutting, 1984). However, a contemporary definition by Cambridge Dictionary (2023) states that surveillance is ‘the act of watching a person or place, especially a person believed to be involved with criminal activity or a place where criminals gather’. The contemporary definition extends this seemingly innocent – abacus approach to monitoring a person to showcase that surveillance is directly related to criminality.  These acts of surveillance can be both overt and covert;
• Sanctioned violence: Violent acts against people supported by the law (Moreton-Robinson, 2004). Sanctioned violence is not limited to physical acts of violence towards an individual. It can be systemic towards a group of people. A key example of this would be the disproportionate incarceration rates, and over-representation of Aboriginal, Torres Strait Islander (Watego et al., 2021) and Māori people in the justice system (Ministry of Justice, n.d.);
• Silencing: Denying individuals or groups the ability to speak freely or undermining the validity of their claims. There are substantial attempts to silence critical race theories and other forms of ways of knowing, being and doing that threaten to address forms of oppression within society. This silencing occurs through how the media reports or does not report on certain topics particularly pertaining to people of colour;
• Erasure: Ignoring or attempting to remove histories (Richardson, 2023). For example, in Aotearoa, silencing Te Tiriti was an attempt to erase Māori history from the national narrative (Seuffert, 1998). This process ignores the sovereign power of Indigenous peoples, as acknowledged in the United Nations Declaration of Rights of Indigenous Peoples (UNDRIP, 2007).

Overlapping acts of oppression lead to significant and intergenerational impacts on oppressed individuals and groups and are ultimately a determinant of their overall health.

Power and resistance

Resistance or opposition to the dominant norms within society has been demonstrated throughout history in many different examples, including that of Indigenous peoples worldwide (Watego et al. 2021). Challenging the status quo including dominant norms, cultures and groups can be extremely difficult, and may be mounted at two different levels:

• Micro resistance: individual level;
• Macro resistance: political level.

Many acts of resistance can be considered on both a micro (individual) level and a macro (political) level. For example, the landmark case in Australia where Ophthalmologist Associate Professor Kris Rallah-Baker, a Yuggera, Warangoo and Wiradjuri man, brought forward claims of culturally unsafe, insulting and offensive treatment towards him by another practitioner to the Australian Health Practitioner Registry Association (Australian Health Practitioner Registry Association, 2023). This demonstrates micro resistance, as he spoke up against discriminatory behaviour which has often been considered a norm. It also demonstrates macro resistance, as this has become a landmark case which has impacted legislation for practitioners in Australia leading to structural change. Another example is Irihāpeti Ramsden, Māori nurse and scholar, who first introduced Cultural Safety. Her thesis was an individual act of resistance speaking out against the dominant norms within nursing and health care (Ramsden, 2002), that has led to systemic change beyond nursing to address power and power structures (Cox et al.,2021).

Resistance to the dominant group

Resistance to the dominant group, and challenging dominant norms has been showcased throughout history. Knowledge is a source of power. Knowledge, such as Indigenous Knowledges surrounding relationality and positionality have resist dominant power relations, and the dominance enacted over groups of people. This knowledge about resisting dominant powers has been advanced through many different avenues. Resistance often comes from individuals and groups outside the dominant group who experience inequality and inequity through social, political, and economic structures and rally against these.

Resistance by the dominant group

For the dominant group, the idea of resistance to the status quo can play out in two different ways:

• Resistance to change: Some dominant groups are resistant to addressing forms of inequality, disadvantage, and oppression. They are resistant to change, with attempts to maintain the norm;
• Resistance in order to create change: To address forms of inequality, disadvantage, and oppression the dominant group can resist the dominant cultures and/or groups they have been part of. Creating change, in line with the principles of Cultural Safety requires critical self-reflection on individual and systemic levels. It requires knowledge of one’s social positioning and privileges, which can allow for transformative thinking and behaviours by those with membership in the dominant social identity (Cox et al., 2021). It requires the dominant group to involve themselves in truth-telling, learning, and acknowledging how their ways of knowing, being and doing produce and reproduce unearned privileges.

Therefore, knowledge, as power, has the potential to be both transformative and an instrument that reproduces inequality.

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