Indigenous cultural safety - An environmental scan of cultural safety initiatives in Canada
Cultural Safety and Respectful Relationships
Cultural safety is a response to systemic and structural barriers and health inequities that have affected access to and quality of health care provided to First Nations, Inuit, and Métis peoples. First introduced into nursing education and practice in New Zealand, cultural safety seeks to address health inequities experienced by Indigenous peoples within all health care interactions and embodies principles of cultural humility, competency, and awareness.
Touted as a best practice, this model of care values and empowers minority and marginalized clients, including First Nation, Inuit, and Métis clients, and works to disrupt power imbalances and deeply held biases, attitudes, and practices expressed by health care providers to ensure a safe environment. It responds to the unique needs of clients by incorporating respect for their cultural traditions and identities, and accounting for the systemic and structural barriers that affect their access to and quality of care received. A culturally safe environment leads to respectful communication and patient-provider interactions, and ultimately better health outcomes for First Nations, Inuit, and Métis peoples. An environment is perceived as culturally safe environment by patients and clients, not practitioners and managers.
While originally conceptualized as a decolonizing model of practice and policy for Indigenous populations in a health care setting, the concept has since expanded to encompass other marginalized populations who may experience barriers to care, including those based on ethnicity, age, sexual orientation, religious beliefs, gender, and (dis)abilities. It has also expanded to other settings beyond the health sector where marginalized individuals may encounter racism or discrimination, including education, social work, employment, justice, corrections, and others.
To varying degrees, initiatives are being implemented across Canada and diverse sectors to ensure First Nations, Inuit, and Métis individuals experience cultural safety when interacting with mainstream systems. The NCCIH has prioritized cultural safety and respectful relationships as one of its key pillars, with a wide range of resources intended to enhance the capacity of practitioners, policy makers, and decision-makers to provide anti-racist, respectful, and culturally safe services.
Indigenous cultural safety: An environmental scan of cultural safety initiatives in Canada
Recent reviews of health systems across Canada have shown the legacy of colonialism, prejudice, and racism against Indigenous Peoples remains widespread in Canada’s health care systems. Further, the dominant culture of health care continues to be rooted in a Western bio-medical paradigm, while access to Indigenous healing approaches is lacking. As a result, many Indigenous people are reluctant to access the mainstream health care system and are denied timely access to culturally safe and relevant treatment and care. Complex health system change is needed across structural, systemic, and service delivery levels to ameliorate these inequities in care that lead to poorer health outcomes for Indigenous people.
Funded in part with contributions from Health Canada and Indigenous Services Canada, the National Collaborating Centre for Indigenous Health completed an environmental scan to identify the diverse actions and initiatives implemented across Canada to improve access to culturally safe health services for Indigenous Peoples. This environmental scan covers initiatives undertaken up to June 2022, with emphasis on the past decade, and targets professionals and practitioners working with Indigenous children, families, and communities. The environmental scan contains separate chapters for cultural safety initiatives at the national level and for each province and territory. These initiatives are organized using Greenwood’s (2019) change model for cultural safety, which demands simultaneous action across structural, systemic, and service delivery levels. Structural change initiatives include legislation, policy, and agreements, while system level initiatives occur within organizations such as provincial health systems and regulatory bodies. These initiatives may include Indigenous health policies, programs and services, and engagement activities. Together, structural and systemic changes enable change at the service delivery level, through activities such as cultural safety education and training opportunities for healthcare professionals. This resource is designed to aide health policy makers, practitioners, and professionals in undertaking their own initiatives to enhance cultural safety for Indigenous people at all points of care.
Indigenous cultural safety chapters
These publications are available in PDF format only as they feature links to online resources.