The quagmire of competence

Culture is a hard nut to crack. Apart from it being dynamic, deeply personal and yet systemic, it also slithers, seems resistant to change and yet is constantly morphing in new expressions, and one might be led to believe that recently it has become a key political battleground. The niche scholarly corner of the Frankfurter Schule that studied culture as an anti-capitalist human enterprise has been claimed rhetorically by rabiate right-wing conspiracy thinkers who claim that this ‘cultural Marxism’ may be blamed for any talk of gender fluidity, climate change, women in politics, Aboriginal land claims and the anti-racist Zwarte Piet discourse. No bother referencing this—Google and be fascinated. I am both troubled and fascinated by this culture thing. I have lived and worked in eight cities, in five countries, on three continents. If this mobility has taught me anything it has been cultural humility. Cities are magnets for cultures. Among the expat communities that I have encountered in those eight cities I have seen and experienced sometimes unconscionable arrogance about the world being someone’s oyster—and that it does not matter whether you live in Ulaan Bataar or Vejle. This omnicultural urban nihilism finds a—justifiable, yet inequitable—foundation in the work of urban sociologist Saskia Sassen (1991). Looking at the globalizing world she found that a number of cities had transcended their local footprints and became flashpoints for the global economy. In her first book on the topic, Sassen discusses New York, London and Tokyo as such specialist global hubs. The argument very much hinged on the economic premises of globalization. But soon the term ‘global city’ was taken to mean any big city that the metropolitan expat could easily navigate—and for some cities it became a badge of honour. What it is, though, is increasingly unclear (Renn, 2012). For most cosmopolitan global urbanites, the world city is a place that is navigated the same everywhere; whoever can traverse the Métropolitain de Paris can cope with Tokyo’s knotted public–private rail concoctions or Bangkok’s Skytrain. Whoever can order a Big Mac at a hamburger dispensary in Johannesburg will know that the Golden Arches will deliver the same in Murmansk, and an order of Tall Toasted White Chocolate Mocha will be the same in the Sydney and Zhangjiakou stores of a multinational beverage chain. For culinary entertainment, the global city dweller might step out of their comfort zone and sample Kaalikääryleet or Wittchety Grubs—and then retreat to their safe bubble. Most will forget they are merely itinerant guests. In fact, in many countries around the world pale people (‘whites’) are guests, albeit often not really itinerant any more. In many cases it appears we have overstayed our hosts’ hospitality which in so many cultures is the essence of being human. Recently I was made to feel an unwelcome guest in Australia—not by the Aboriginal people who have roamed here for more than 40 000 years and continue to be the oldest living culture in the world, but by a white Australian: in an e-mail exchange I commented on some public reflections by some close colleagues —I observed they experienced ‘drama and excitement’ in their lives. By return message I was instantly berated that my choice of words was poor; that I might be insincere and hurtful; and that I did not appreciate the policy advocacy potential of personal narrative—which they apparently pursued in their public writings. Through this virtual encounter I felt uncomfortably incompetent, and acutely aware of a paradigmatic chasm which might be generational (my correspondents are at least two decades my juniors and are fluent in memes and emoji) or due to severe differences in upbringing, beliefs and customs I hold true—my own culture. Indeed, I felt culturally challenged and contemplated the need for New Australian cultural competence training and a firmer grounding in culture’s consequences (Hofstede, 2001). A bit late perhaps, but one can never be too late with reflective practice (Chaffey et al., 2012). I considered my incompetence predicament. Often I have seen—both professionally through research, and in more private encounters—how many migrants ‘freeze’ in the culture of their land the moment they leave it. In Australia, the relative flood of Dutch (and other European) migrants after the Second World War brought a decidedly conservative flavour to Down Under. In many communities the 1950s are alive, and Elvis Presley still considered a horrid sexual predator. In doing research on health and social inequities in rural Australia many a starkly religious Dutch Reformed family would happily approach me (recognizing my Dutch-ness) and share their deeply orthodox, traditionalist and often bigoted world views (‘Oh yes we are longing for raw herring, boerenkool stamppot and by the way we hate faggots.’). Had I myself now become the victim of being frozen in a Netherlands of the 1990s, in which tolerance, inclusion, acceptance, eternal consensus seeking and a deep belief in welfare state solidarity went hand in hand with values and attitudes that dictated modesty, service, hard work and frugality? Was it time to let go, in some way, and embrace indulgence, chest thumping, parrhesic rhetoric, narcissism and egocentrism, all combined with fresh attitudes toward New Public Management, equitable policy advocacy and material accomplishment? My carefully crafted and curated cultural competence training surely had to include Hofstede’s dimensions of culture (power distance; uncertainty avoidance; individualism versus collectivism; masculinity versus femininity; and long-term versus short-term orientation) to make sense of my failure to engage. But also, I needed to be aware that the times of calligraphy on parchment, writing letters with a quill and long reads are over, and that rapid ephemeral social media bursts on (little) screens are the communication standard of the young (de Leeuw, 2018). In proper reflective practice such considerations are grounded and contextualized (Schön, 1983; Moon, 2013). Explicitly identifying and contextualizing the experience, what it did to the reflector and how they felt about it, considering alternative explanations and mapping a way forward is integral to good professional development, personal growth, and yes, catharsis… The result of my reflective stance might well be greater cultural competence. But this is not how ‘cultural competence’ is usually framed in the health field. Cultural competence (and its development through training and education) is virtually always seen as both extension and precursor of health literacy approaches to engage better with people with culturally and linguistically diverse (CALD) backgrounds, and in countries with a history of colonization and racism (such as Australia, New Zealand, the USA and Canada) to reach Indigenous populations. However, the evidence that cultural competence training does any good is at best haphazard (Horvat et al., 2014), is criticized for not actually embracing diversity dynamics, gender dimensions and historical disadvantage, or in the case of Indigenous world views, cultural ‘competence’ is regarded by some as the perpetuation of a racist knowledge paradigm (e.g. Pon, 2009). The latter is not a peripheral argument—if we see health promotion as an empowerment and liberation movement (Kickbusch, 2001; Wiggins, 2012) it must be recognized that embracing Indigenous voice and knowledge system is critical to human competence. But an assumption that one can become inter-culturally competent through a few training sessions is dangerous—for one, interculturalization would not just require individual behaviour dimensions, but needs to be firmly embedded in broader social and systems awareness, and change of personal and social practice (de Leeuw and Hussein, 1999). Also, we would need to question why precisely such competence might be important—what is to be accomplished through cultural competence: optimization of healthcare facility access? Better health? More equitable distribution of health? Health professional efficiencies? The health promotion answer to these queries has been given by seventeenth century philosopher Baruch Spinoza and twentieth century Maori health practitioners grounded in centuries of Indigenous knowledge systems. Spinoza (1670) postulated that ‘The ultimate end of the State is not dominion, nor restraint by fear, nor the exaction of obedience; on the contrary, its end is to free every man from fear, so that he may live securely.’ This idea also emerged in the 1980s among Maori midwifery students in Aotearoa—they felt unsafe within the predominantly Anglo (Pakeha) educational setting they were trained in. They moved beyond terms like cultural difference, cultural awareness, cultural sensitivity, biculturalism and cultural competence with the idea of ‘cultural safety’. According to Ramsden (2005), all of the former terms are inadequate to the task of addressing the political context in which (Maori) healthcare is situated. Cultural safety is a way of shifting from deficit-based discourses and the associated individualizing of health concerns toward a recognition that larger processes of colonization, including the loss or attenuation of traditional beliefs, practices and language, need to be taken into account in any explanation of, and attempt to improve, health for Indigenous peoples. The Maori ideas were quickly adopted by Canadian First Peoples, and now find a place in Australian Aboriginal practice, too (Australian Human Rights Commission, 2018). Cultural safety aligns very well with the values of health promotion, including salutogenesis, positive health and a strong embrace of social, political and commercial determinants of health and health equity. This year will see the 23rd instalment of the global conference of the International Union of Health Promotion and Education happen in Rotorua, Aotearoa (New Zealand). The conference is strongly driven and inspired by Indigenous value systems. One of the four official languages at the conference is Maori; Rotorua is a large Maori town; the conference advocates Waiora: Hāpai i te Hauora ā-Ao, i te Whanaketanga Tūturu mō te Katoa. Indeed, ‘waiora’ isn’t just health (the absence of the disease) or health (the more holistic WHO definition)—it is all-encompassing whole well-being on a glocal scale. Where the planetary health rhetoric tends to emphasize the environmental Anthropocene dimensions, waiora also embraces the diversely patterned cultural wholeness of our planet. The idea that something like ‘cultural competence training’ would facilitate the mastery and navigation of a human history of connected difference is of course a dangerous fallacy. From my own experience in feeling culturally incompetent I have reached a conclusion that a starting point of cultural nihilism and arrogance that could be resolved by a couple of workshops with sticky notes is dangerously wrong. It is this attitude that perpetuates (legacies of) colonialism and racist ineptitude. Politically, too, the cultural bubble of ignorance, arrogance and perilous political nativism is growing everywhere (Mudde, 2010; Mudde and Rovira Kaltwasser, 2018). Its consequence plays out in a quagmire of personal and institutional incompetence. It often feels like human traits like humility, respect and the ability for deep listening have been extinguished, and that brash and loud grandstanding is the only way of getting you ahead. This is how a sympathetic missive noting drama and excitement can be misinterpreted as a culturally incompetent personal attack. Let it be clear—there is nothing wrong with the concept of competences and their pursuit in the context of professional and individual development. In fact, the development of health promotion competences and the implementation of recognition and accreditation schemes must be applauded (cf. Battel-Kirk et al., 2009). They set firm and accountable benchmarks and provide standards for the profession (Barry et al., 2012). Existing competence/competency frameworks for health promotion all embrace a rigorous yet flexible value basis of inclusion and respect. But Hicks shows that the Aotearoa approach (Hicks, 2018) to the development and validation of competencies has been the only framework that deliberately and conscientiously applied a vision of cultural safety. Here at the Journal we are inspired by such beliefs and practices. From a position of humility and respect we aim to be inclusive and culturally safe—while at the same time recognizing that we each do have our own cultural grounding and possible preconceived ways of considering the world around us. The compositions of our editorial team and our editorial board reflect this. In our manuscript management (and therefore peer review) processes we aim to pursue these, too, and we are aware that vigilance is required. Recently we received a paper that described research in a region in the Global South. We found it unsuitable for publication in Health Promotion International because all authors appeared to be trained and based in the Global North. Not only might this have been an instance of new colonialism, unsafe cultural practice and unwarranted cultural nihilism, but we also felt that there was no evidence that local, culturally safe, capabilities were being developed in the course of the research process. We engaged in conversation with the authors and collaborators of the study, explaining our position. This has led to a new research focus of their work and a different practice in the development and reporting of its results. In aligning the publication ‘culture’ of the journal with the values of the glocal health promotion movement, we find that it is not just our task to publish high-quality research. In fact, we see the publishing task as a means to an end—support and facilitate the making of better, more culturally safe, healthy environments (World Health Organization, 1992). For instance, we recognize that the academic enterprise and its publication arm are severely gendered (e.g. Lundine et al., 2018). They are also culturally biased, we believe, although there is limited and often just anecdotal evidence for that assertion (e.g. Keshavarz Mohammadi et al., 2011). We have a responsibility to seek a better balance, not just in the pages of this journal, but in all our lives. Culture is a hard nut to crack, I started off with. Maybe we do not need to crack this nut at all, and just let it be. Its purpose may well be in the eye of the beholder, be they individuals, societies or systems. I feel a little bit safer in my cultural grounding and relations to others upon the above reflection; it is something that I intend to bring to the Journal, its staff, publishers, editors, reviewers and authors. Join us on this continuing journey.