Cultural safety, health equality, diversity and inclusivity

Question 17 from the first paper of 2025 asked the candidates to define these terms and "outline the key differences" for each pair. "You may choose to illustrate your answer with clinical examples", the examiners added compassionately, knowing that, like obscenity (and sepsis), some of the candidates may know examples of diversity and inclusivity when they see them, but could not articulate a definition for either. The question is tagged with a syllabus entry which points to "Professional Behaviour",  Section 2.6.2 in the second edition of the CICM Syllabus for the Second Part Examination, which makes intuitive sense, but the domain itself has three short statements which read less like syllabus items than motivational exhortations for us all to improve our manners.  It is hard to know where cultural safety and inclusivity belong among these items, but the author found it easier to appreciate the best fit by considering what the absence of these characteristics might look like in an Intensive Care unit. A culturally insensitive and non-inclusive place might be full of weird casual racism and sexism, discriminatory against members of the LGBTIQ+ community, compassionless towards staff with disabilities and disrespectful towards patients from minority groups or indigenous populations.  One might consider the kinds of things an appalled member of a CICM unit accreditation committee might say to such colleagues, confronting them about their conduct. "Behave with compassion, integrity and honesty towards colleagues, patients, and the public", they might implore, "for fuck's sake". 

It is fortunate that all of these answers are available in the CICM website, but one feels reluctant to create links to their website, given that the website changes every fifteen minutes and the links will surely break in three different ways before the next paper. At the time of writing, on a stormy November morning in 2025, the "CICM Aboriginal and Torres strait Islander online resource" mentioned in the examiner comments was trapped in the CICM elearning hell dimension. It appears to have formed from some kind of heavily mutated moodle, and has some classically infuriating design choices meant to generate engagement, eg. forcing the user to interact with an animated banner to reveal a definition (as if CICM trainees would disengage in boredom if there was not something constantly in their field of vision to click on).  The author has returned from this underworld with the following answers:

• The difference between cultural safety and cultural competence
  • Cultural safety: the candidate's reflection on how their own culture influence their practice with and their skill in advocating for Indigenous Peoples.
    the ongoing critical reflection of health practitioner knowledge, skills, attitudes, practising behaviours and power differentials in delivering safe, accessible and responsive healthcare free of racism".  
  • Cultural competence:  the candidate's knowledge of /skill  with working with Indigenous Peoples’ cultures. 
    "the awareness of one’s own culture, plus knowledge, understanding of, and sensitivity towards other cultural beliefs and practices, combined with the ability to interact with and advocate for people from different cultural backgrounds in ways that are considered appropriate by those people"
  • Example: The author may have skills for communicating with human patients, and some understanding of human culture (so he may be culturally competent), but he is not culturally safe unless he reflects on how his practice may be affected by his programming.
• The difference between health equality and health equity
  • Equality: everyone receiving equal treatment
    - concerned with output and delivery of care
    (however: not all have equal needs)
  • Equity: everyone developing equal outcomes
    - concerned with fairness and meeting needs
  • Example: Equality would be all patients having thick warm blankets. Equity is all patients enjoying a comfortable temperature, with thick warm blankets only for those patients who are reporting feeling cold.
• The difference between diversity and inclusivity
  • Diversity:  the variety of representation in patients and practioners; presence of a wide range of differences; recognition of this range.
  • Inclusivity:  ensuring members from diverse groups feel respected, valued and empowered to participate. 
  • Example: staff have different chronotypes with different periods of peak alertness and productivity. To practice diversity would be to hire a range of such people, and to recognising their spectrum with a colourful poster. To practice inclusivity would be a roster that accommodates some staff to start at 2am and finish at 10.