Cultural safety

Focus is shifting from cultural competence to cultural safety.

General practitioner and professor Māori and indigenous research, David Tipene-Leach, says the difference between cultural competence and cultural safety is that with competence, we often end up ‘othering’ the other person.

‘We go out and learn about someone else’s culture, their way of doing things – so that theoretically we can better understand why they do what they do and treat accordingly.

‘Cultural safety is a concept whereby we think more about the power relationships between the patient or professional and the client or patient. We like the professional person to think about their own culture, their own biases, the way they think about the interaction and how their biases affect the outcomes for the patient.’

In late 2019, the New Zealand Medical Council published a statement on cultural safety, and He Ara Hauora Māori – a pathway to Māori health equity.

Cultural competence

Standards of competence, including cultural competency, are regulated by the Health Practitioners Competence Assurance Act 2003 and its 2019 amendment. The amendment requires health practitioners to have effective and respectful interaction with Māori.

The Act requires health practitioners to observe standards of cultural competence that are set by responsible authorities, such as the Pharmacy Council, the Podiatrists Board, the Nursing Council or the Medical Council. This is why many colleges, associations and societies have requirements around cultural competence.

There are different definitions of cultural competence.[1] The New Zealand Medical Council definition is:

‘Cultural competence requires an awareness of cultural diversity and the ability to function effectively and respectfully, when working with and treating people of different cultural backgrounds. Cultural competence means a doctor has the attitudes, skills and knowledge needed to achieve this. A culturally competent doctor will acknowledge that:

  • New Zealand has a culturally diverse population
  • a doctor’s culture and belief systems influence his or her interactions with patients and accepts this may impact on the doctor-patient relationship
  • a positive patient outcome is achieved when a doctor and patient have mutual respect and understanding.’

Sixteen responsible authorities set the standards of competence that health practitioners registered with them must meet. These standards also cover how the medical profession can address inequities in patient care and patient outcomes for different groups. The responsible authorities and a link to their respective standards are listed below.

Responsible authority Links to cultural competency standards
New Zealand Chiropractic Board

Competency-based professional standards for chiropractors

Standards of cultural competency policy

Dental Council of New Zealand

Standards framework for oral health practitioners

Best practices when providing care to Māori patients and their whānau – practice standard

Cultural competence practice standard

Dietitians Board Website (external link)
Medical Sciences Council of New Zealand Website (external link)
Medical Radiation Technologists Board Website (external link)
Medical Council of New Zealand Statement of cultural competence
Midwifery Council of New Zealand Website (external link)
Nursing Council of New Zealand

Standards and guidelines for nurses

Occupational Therapy Board Website (external link)
Optometrists and Dispensing Opticians Board Website (external link)
Osteopathic Council of New Zealand Website (external link)
Pharmacy Council Website (external link)
Physiotherapy Board Website (external link)
Podiatrists Board of New Zealand Website (external link)
Psychologists Board Website (external link)
Psychotherapists Board of Aotearoa New Zealand Website (external link)

Learn more about cultural competence

Health professionals are encouraged to learn more about cultural competence. Below are some links to organisations providing cultural competence education.


  1. Medical Council of NZ Statement of Cultural Competence. Downloaded on 9 October 2019 from

Last updated 05/12/2019