[Report] 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.