Cultural democracy: the way forward for primary care of hard to reach New Zealanders.

The use of cultural democracy, the freedom to practise one’s culture without fear, as a framework for primary care service provision, is essential for improved health service in a multicultural society such as New Zealand. It is an effective approach to attaining health equity for all. Many successful health ventures are ethnic specific and have gone past cultural competency to the practice of cultural democracy. That is, the services are freely taking on the realities of clients without discrimination or malice from those of other ethnicities. In New Zealand, the scientific health services to improve the health of a multicultural society are available but there is a need to improve access and utilisation by hard to reach New Zealanders. This paper discusses cultural democracy and provides examples of how successful health ventures that have embraced cultural democracy were implemented. It suggests that cultural democracy will provide the intellectual impetus and a robust philosophy for moving from equality to equity in health service access and utilisation. This paper provides a way forward to improve primary care utilisation, efficiency, effectiveness and equitable access, especially for the hard to reach populations. It uses the realities of Pacificans in New Zealand to illustrate the use of cultural democracy, and thus equity to address the ‘inverse care law’ of New Zealand. The desire is for primary care providers to take cognisance of and use cultural democracy and equity as the basis for the design and practice of primary health care for the hard to reach New Zealanders.