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.
We need to address racism directed at Indigenous people as a national health crisis
December 2020
It’s time to recognize and treat racism directed at Indigenous people as a health crisis, says Dr. Margo Greenwood, Academic Leader for the National Collaborating Centre for Indigenous Health. "In Plain Sight", by Dr. Mary-Ellen Turpel-Lafond, released this week by the BC government, highlights discrimination as a painful reality for both Indigenous people seeking health care and Indigenous health care workers in British Columbia. Indigenous women and girls are disproportionately impacted.
“This is a national issue. Our health systems reflect our society at large,” Greenwood says. “Society continues to perpetuate racism against Indigenous peoples. So it should be no surprise that systemic racism is pervasive in health care systems across this country. The number of disturbing incidents in BC documented in this report is evidence of this. As is the shameful treatment of Joyce Echequan in a Quebec hospital.”
Governments and health care organizations are urged to immediately support and implement the report’s 24 recommendations. Turpel-Lafond anchors her recommendations in the United Nations Declaration on the Rights of Indigenous Peoples. The UNDRIP clearly asserts the right of Indigenous people to health care free of discrimination. Her report also reinforces Truth And Reconciliation Commission Calls To Action and National Inquiry into Missing and Murdered Indigenous Women and Girls Calls For Justice. In Plain Sight recommends the federal government adopt Indigenous-specific health legislation, including cultural safety and anti-racism as principles of Canada’s health care system. Indigenous right to health must be affirmed and Indigenous authority over our health services must be facilitated.
“We need to build and support respectful relationships between all people, Indigenous and non-Indigenous. The work that we do today is going to impact the lives of generations to come. It is for them that we have to do better,” Greenwood emphasizes.
“This is a wake-up call for all Canadians. We must educate ourselves about First Nations, Inuit and Métis peoples and Canada’s colonial history. This is not going to be easy. As organizations and individuals we must reckon today with the injustices of the past. We do not want to carry these injustices into the future. We know now the outcomes of systemic racism. Now is the time for action. We need our health care system to be accountable to ensure a healthier and more equitable society for all.”
— Margo Greenwood, Academic Leader, National Collaborating Centre for Indigenous Health