Cultural Safety and Humility

Prior to European contact, the health and wellness of Indigenous Peoples across North America were upheld through an interconnection between family, community, and Nation. These health systems were severely disrupted by European settler colonialism and, consequently, First Nations, Inuit, and Métis Peoples, families, and communities have experienced colonially inherited disparities across multiple key indicators of health and wellness. Furthermore, Indigenous-specific racism in healthcare has caused vast health inequities in the experience, quality, and access of care, with numerous reports and studies demonstrating associations between systemic Indigenous-specific racism and unacceptably high morbidity and mortality among Indigenous Peoples compared to the non-Indigenous population in Canada. [1,2,3,4,5]

In 2018, HSO partnered with the First Nations Health Authority (FNHA) to develop HSO 75000:2022 British Columbia Cultural Safety and Humility, which specifies the requirements for governing bodies, organizational leaders, teams, and the workforce from health authorities and health and social services organizations to address Indigenous-specific racism in service delivery and provide culturally safe services to First Nations, Métis, and Inuit Peoples and communities in BC.

In 2023, the Canadian Indigenous Nurses Association (CINA), in collaboration with HSO, launched a national survey to hear from First Nations, Inuit, and Métis governing bodies, communities, and Peoples about their experiences with the healthcare system. 95.4% (n=539) of Indigenous survey participants agreed that it is necessary to establish a national standard to address Indigenous cultural safety and humility. When asked if they believe health and social services are providing culturally safe care, higher proportions of Indigenous participants compared to non-Indigenous participants disagreed or strongly disagreed (72.9% vs. 54.7%). When asked how they would rate their last experience with the healthcare system, Indigenous participants rated their last experience as poor (27.8%) or fair (39%) more frequently than non-Indigenous participants (17.9% and 34.2%, respectively).

Through this national scoping, CINA and HSO heard a resounding call to action from Indigenous governing bodies, communities, and organizations to develop a National Cultural Safety and Humility Standard. This call to action has been widely echoed by health care systems, regulatory bodies, and associations from coast-to-coast-to-coast who are actively introducing new anti-racism and cultural safety initiatives to address longstanding inequities with Indigenous Peoples’ experience, quality, and access to essential health care services.

These recent Indigenous-led initiatives signify a critical shift towards advancing Indigenous Peoples’ right to equally participate in decision-making on matters which would affect their rights, including the right to accessing health care that is free of discrimination. While this work is making meaningful impact, it is often inconsistent in scope, funding, and implementation, and thus can fall short of achieving cultural safety for Indigenous peoples accessing health services across Canada.

Building upon HSO 75000:2022 British Columbia Cultural Safety and Humility, CAN/HSO 75001:2026 Cultural Safety and Humility will specify the requirements for governing bodies, organizational leaders, and teams in health and social service organizations to provide culturally safe services to First Nations, Inuit, and Métis Peoples and communities and address Indigenous-specific racism in service delivery. 

[1] Gracey M, King M. (2009). Indigenous health part 1: determinants and disease patterns. The Lancet 374(9683). DOI: 10.1016/S0140-6736(09)60914-4. 

[2] Hahmann T, Kumar MB. (2022). Unmet health care needs during the pandemic and resulting impacts among First Nations people living off reserve, Métis and Inuit. Statistics Canada. https://www150.statcan.gc.ca/n1/pub/45-28-0001/2022001/article/00008-eng.htm.

[3] King M et al. (2009). Indigenous health part 2: the underlying causes of the health gap. The Lancet 374(9683). DOI: 10.1016/S0140-6736(09)60827-8.

[4] Loppie C, Wien F. (2022). Understanding Indigenous Health Inequalities Through a Social Determinants Model. National Collaborating Centre for Indigenous Health. https://www.nccih.ca/Publications/Lists/Publications/Attachments/10373/Health_Inequalities_EN_Web_2022-04-26.pdf.

[5] Public Health Agency of Canada. (2018). Key Health Inequalities in Canada: A National Portrait. https://www150.statcan.gc.ca/n1/daily-quotidien/180528/dq180528e-eng.htm.