Health care provider and consumer understandings of cultural safety and cultural competency in health care : an Australian study

There is increasing recognition in Australia that racial and ethnic minority groups experience significant disparities in health and health care compared with the average population and that the Australian health care system needs to be more responsive to the health and care needs of these groups. The paper presents the findings of a year long study that explored what providers and recipients of health care know and understand about the nature and implications of providing culturally safe and competent health care to minority racial and ethnic groups in Victoria, Australia. Analysis of the data obtained from interviewing 145 participants recruited from over 17 different organizational sites revealed a paucity of knowledge and understanding of this issue and the need for a new approach to redress the status quo.

Ethics and advance care planning in a culturally diverse society

Emerging international research suggests that in multicultural countries, such as Australia and the United States, there are significant disparities in end-of-life care planning and decision making by people of minority ethnic backgrounds compared with members of mainstream English-speaking background populations. Despite a growing interest in the profound influence of culture and ethnicity on patient choices in end-of-life care, and the limited uptake of advance care plans and advance directives by ethnic minority groups in mainstream health care contexts, there has been curiously little attention given to cross-cultural considerations in advance care planning and end-of-life care. Also overlooked are the possible implications of cross-cultural considerations for nurses, policy makers, and others at the forefront of planning and providing end-of-life care to people of diverse cultural and language backgrounds. An important aim of this article is to redress this oversight.

'The Other Within' : race/gender disruptions to the professional learning of white educational leaders

Leslie Roman states 'white is a colour too'. Yet the whiteness of educational leaders is rarely questioned, although masculinism—the enduring capacity of different masculinities to remain the norm in leadership—is increasingly under scrutiny. Rarely do white men or women leaders question their whiteness, whereas indigenous and other minority groups, as a consequence of their being 'other than white', are expected to explain their exclusion. Instead, the 'problem' is depicted as the lack of 'the Other', and therefore a problem for and of 'the Other'. This article confronts normative whiteness in educational administration from the perspective of feminist and critical race theory, considering how foregrounding whiteness in leadership is a necessary condition of inclusive education and leadership.

Perceived discrimination amongst the indigenous Mapuche people in Chile : some comparisons with Australia

With similar settler-colonial histories having left them occupying the position of marginalized minority groups, indigenous people in Chile and Australia are struggling to assert their rights and retain their cultures. Research in each location suggests that there is widespread prejudice and discrimination against them, even though the mainstream society sees itself as tolerant and harmonious. This paper reports on a study in which thirty Mapuche people in Chile were interviewed about their perceptions of discrimination against them. Their responses were systematically analysed using a taxonomy of racist experiences established in a study of Aborigines in Australia. Like indigenous Australians, the Mapuche people of Chile reported that they experience extensive discrimination in all areas of life. These findings are discussed with respect to the issues related to relationships between settlers and colonized communities.

A participatory model for ethnic audience development for the arts

This paper aims to investigate strategies to increase ethnic minority group consumers' participation in arts performances in Australia. Our findings are based on focus group discussions and in-depth interviews with participants from ethnic minority groups, namely, Greek, Italian, Vietnamese, Chinese, and Indian in Australia. The findings indicate that a mixed cultural/arts events and culturally specific events are the most favoured forms for attracting participation from culturally diverse audiences. Further strategies are to provide more arts and cultural education for minority and
mainstream cultures, and appropriate marketing activities to minority groups could increase arts participation of ethnic consumers. Our research will contribute to further understanding of ethnic marketing literature and cross-cultural marketing for the arts sector.

Karl Popper on Jewish nationalism and cosmopolitanism

This paper re-contextualizes Karl Popper’s thought within the anti-nationalist cosmopolitan tradition of the Central European intelligentsia. It argues that, although Popper was brought up in an assimilated Jewish Viennese household, from the perspective of the Jewish Enlightenment or Haskalah tradition, he can be seen to be a modern day heterodox Maskil (scholar). Popper’s ever present fear of anti-Semitism and his refusal to see Judaism as compatible with cosmopolitanism raise important questions as to the realisable limits of the cosmopolitan ideal. His inability to integrate an understanding of Jewishness in his cosmopolitan political ideal resulted in his strong opposition to Zionism and the state of Israel. By comparing Popper’s positions with those of Hermann Cohen, another neo-Kantian philosopher, I argue that although their solutions fall short in certain respects, their arguments have continuing purchase in recent debates on cosmopolitanism and the problem of the integration of minority groups. In addition, the arguments of the Jewish Enlightenment thinkers offer important insights for the current debates on minority integration and xenophobia.

Opportunities or obstacles? understanding the challenges faced by migrant women entrepreneurs

Purpose - Applying theories of entrepreneurship, the paper aims to identify the factors - with theoretical explanations - that act as barriers to migrant women entrepreneurs (MWEs), particularly women from developing countries starting businesses in developed economies. The paper further explores which barriers also have the potential to act as enablers.

Design/methodology/approach - The relationship between immigration, ethnicity, gender and entrepreneurship has received little theoretical attention. Linking these discourses, the paper theoretically develops a framework of the possible barriers or enablers faced by MWEs.

Findings - The paper reinforces earlier research that MWEs are not a homogenous group; the problems they face are multifaceted, and MWEs from developing countries are the most disadvantaged of entrepreneurs. It identifies multiple factors - human capital, culture, family, institutional factors, gender and social capital- as possible barriers for MWEs. Findings further indicate, that among those barriers, culture, family, social capital and gender have the potential to play a dual role for MWEs, by acting either as a barrier or an enabler. Findings also highlight the overarching and predominant influence of culture – as explained by cultural theory -acting as a barrier for MWEs from developing countries.

Research limitations/implications - Given the increasing potential of MWEs, the paper provides implications for not only addressing the barriers but also viewing the barriers as ways to promote entrepreneurship among such minority groups. It further stresses a needs-based approach to customizing policies to benefit the diverse group of MWEs. Limitations: This is a theoretical paper. Empirical research is needed to test the framework and its different dimensions. Given the diversity of MWEs and the factors that shape their entrepreneurial endeavours, it is difficult to develop a single framework to encompass the complexity of the situation. Nevertheless, the proposed framework provides useful insights into the barriers or enablers that MWEs face, along with theoretical explanations and, thus, acts as a springboard for future research.

Originality/value - By providing a theory-based framework of the barriers or enablers faced by MWEs, along with policy implications, the paper contributes to a better understanding of the phenomenon of migrant women entrepreneurship.

Towards a diversity justice management model : integrating organizational justice and diversity management

Purpose – Contemporary organizations are increasingly paying attention to incorporate diversity management practices into their systems in order to promote socially responsible actions and equitable employment outcomes for minority groups. The aim of this paper is to seek to address a major oversight in diversity management literature, the integration of organizational justice principles.

Design/methodology/approach – Drawing upon the existing literature on workforce diversity and organizational justice, the authors develop a model based on normative principles of organizational justice for justice-based diversity management processes and outcomes.

Findings – The paper proposes that effective diversity management results from a decision-making process that meets the normative principles of organizational justice (i.e. interactional, procedural and distributive justice). The diversity justice management model introduced in this article provides important theoretical and practical implications for establishing more moral and just workplaces.

Research limitations/implications – The authors have not tested the conceptual framework of the diversity justice management model, and recommend future research to take up the challenge. The payoff for doing so is to enable the establishment of socially responsible workplaces where individuals, regardless of their background, are given an equal opportunity to flourish in their assigned jobs.

Practical implications – The diversity justice management model introduced in this paper provides organizational justice (OJ)-based guidelines for managers to ensure that OJ can be objectively benchmarked and discussed amongst diversity stakeholders to continuously improve actual and perceived OJ outcomes.

Social implications – The social implication of this conceptual paper is reduction of workforce marginalization and establishment of socially responsible organizations whereby those marginalized (e.g. people with disabilities) can effectively work in their organizations.

Originality/value – This is the first attempt to establish a diveristy justice management model, which incorporates normative principles of organizational justice into diversity management processes and outcomes.

Differences in primary health care delivery to Australia's Indigenous population : a template for use in economic evaluations

Background Health economics is increasingly used to inform resource allocation decision-making, however, there is comparatively little evidence relevant to minority groups. In part, this is due to lack of cost and effectiveness data specific to these groups upon which economic evaluations can be based. Consequently, resource allocation decisions often rely on mainstream evidence which may not be representative, resulting in inequitable funding decisions. This paper describes a method to overcome this deficiency for Australia’s Indigenous population. A template has been developed which can adapt mainstream health intervention data to the Indigenous setting.

Methods The ‘Indigenous Health Service Delivery Template’ has been constructed using mixed methods, which include literature review, stakeholder discussions and key informant interviews. The template quantifies the differences in intervention delivery between best practice primary health care for the Indigenous population via Aboriginal Community Controlled Health Services (ACCHSs), and mainstream general practitioner (GP) practices. Differences in costs and outcomes have been identified, measured and valued. This template can then be used to adapt mainstream health intervention data to allow its economic evaluation as if delivered from an ACCHS.

Results The template indicates that more resources are required in the delivery of health interventions via ACCHSs, due to their comprehensive nature. As a result, the costs of such interventions are greater, however this is accompanied by greater benefits due to improved health service access. In the example case of the polypill intervention, 58% more costs were involved in delivery via ACCHSs, with 50% more benefits. Cost-effectiveness ratios were also altered accordingly.

Conclusions The Indigenous Health Service Delivery Template reveals significant differences in the way health interventions are delivered from ACCHSs compared to mainstream GP practices. It is important that these differences are included in the conduct of economic evaluations to ensure results are relevant to Indigenous Australians. Similar techniques would be generalisable to other disadvantaged minority populations. This will allow resource allocation decision-makers access to economic evidence that more accurately represents the needs and context of disadvantaged groups, which is particularly important if addressing health inequities is a stated goal.

Examining the Suojia Ecomuseum and the Nandan Ecomuseum in China

China hosts some 55 ethnic minority groups, which together account for 8.41% of the Chinese population. These populations reside in predominantly Ethnic Minority Villages presenting great value and culture of their heritage, with living landscape, festivals, architecture and costumes, but the actual living conditions are very poor. Since the 1990s, China has adopted French concept 'ecomuseum', for the conservation of some ethnic villages to relieve the conflict between poverty and heritage conservation. ln short, this concept involves the creation of open-air museums keeping buildings and people in their original sites, with local communities serving as curators managing their own sites, which necessitates democracy in the conservation and interpretation processes. The concept seems ideal for the Chinese government, with its bilateral objectives of heritage conservation and poverty alleviation, without necessitating the relocation of any or buildings. However, does this concept really work? It remains unanswered and the subject of little academic research. In order to examine how successfully these ecomuseums are being managed, two projects has been selected for case studies - the Suojia Ecomuseum and the Nandan Ecomuseum. In-depth field studies have been conducted at the two ecomuseums, involving the methodologies of site observation, documentation and semi-structured interviews. This paper reviews the ecomuseum development in China, and then provides detailed critiques and overviews of the Suojia Ecomuseum and the Nandan Ecomuseum in terms of their backgrounds, management structures, programs and activities as well as pertinent issues. Based upon these descriptions, it is·identified that the two cases have different management structures and focuses: 1) the Suojia Ecomuseum has been under the management of government authorities whilst the Nandan Ecomuseum has been operated by local villagers, and 2) the focus of the Suojia Ecomuseum has been improving living conditions for the residents, while in Nandan Ecomuseum cultural inheritance has been operated as a core program. However, there is a lack of financial support in both cases. All these issues lead to a discussion that the Nandan Ecomuseum has made greater achievement in terms of being community-based. The conclusions are hence drawn as to the suggestions to Chinese ecomuseums--the sustainability and success requires local villagers as curators as well as external financial assistance. In addition, another and more urgent need is to pass the ethnic cultures and their values to the next generation.

Honk against homophobia : rethinking relations between media and sexual minorities

The theory of “symbolic annihilation” or “symbolic violence” has been used in academic literature to describe the way in which sexual minorities have been ignored, trivialized, or condemned by the media. This article aims to de-center research from issues of media representation to consider the capacity for minority groups to proactively use new media and its various avenues for interactivity, social networking, and feedback to fight social exclusion. This work suggests that new media has become a space in which the nominally marginal in society may acquire “social artillery”—a term used to describe how sexual minorities utilize their expanding and more readily accessible social connections in digital space to combat instances of homophobia. The research draws on the results of an inquiry into the relation between media and a regional youth social justice group in Australia tackling homophobia. The research demonstrates that the group is becoming increasingly adept and comfortable with using a cross-section of media platforms to fulfill their own objectives, rather than seeing themselves as passive subjects of media representation. This article argues that this sets an example for other socially excluded groups looking to renegotiate their relation with the media in regional areas.

Racism as a determinant of health: a protocol for conducting a systematic review and meta-analysis

Background: 

A systematic review of the extent and measurement of healthcare provider racism

Background
Although considered a key driver of racial disparities in healthcare, relatively little is known about the extent of interpersonal racism perpetrated by healthcare providers, nor is there a good understanding of how best to measure such racism.

Objectives
This paper reviews worldwide evidence (from 1995 onwards) for racism among healthcare providers; as well as comparing existing measurement approaches to emerging best practice, it focuses on the assessment of interpersonal racism, rather than internalized or systemic/institutional racism.

Methods
The following databases and electronic journal collections were searched for articles published between 1995 and 2012: Medline, CINAHL, PsycInfo, Sociological Abstracts. Included studies were published empirical studies of any design measuring and/or reporting on healthcare provider racism in the English language. Data on study design and objectives; method of measurement, constructs measured, type of tool; study population and healthcare setting; country and language of study; and study outcomes were extracted from each study.

Results
The 37 studies included in this review were almost solely conducted in the U.S. and with physicians. Statistically significant evidence of racist beliefs, emotions or practices among healthcare providers in relation to minority groups was evident in 26 of these studies. Although a number of measurement approaches were utilized, a limited range of constructs was assessed.

Conclusion
Despite burgeoning interest in racism as a contributor to racial disparities in healthcare, we still know little about the extent of healthcare provider racism or how best to measure it. Studies using more sophisticated approaches to assess healthcare provider racism are required to inform interventions aimed at reducing racial disparities in health.

Race lines and spaces of political action among migrant youth

Recently proposed Anti-Racism Strategy established within a framework of the Australian Government's multicultural policy, People of Australia, identifies ‘youth engagement’ as one of the key areas that needs to be promoted and supported. Young people have been invited to join youth councils and youth forums and work with national, state and local policy-makers. Some have taken up this challenge and became public faces and active members of anti-racism campaigns. Others, however, either remained silent about the discrimination they face, or organised their own grassroots youth-based and youth-led initiatives. This paper discusses individual and collective responses to racism among young people in Australia, focusing on Melbourne, and examines possibilities in which racism, as a common experience among migrant youth, can be utilised to form alternative spaces for political action, challenging not only interpersonal, but also systemic forms of racism. By drawing attention towards institutional and systemic forms of racism, and the historical perpetuation of racist practices, these youth initiatives rely on legal measures, and argue that racism should be discussed in the context of the broader Australian society, not only in relation to minority groups.