Культурная безопасность в здравоохранении: ключ к улучшению здоровья коренных народов Австралии

First Nations people in Australia have worse health and a lower life expectancy than other Australians. This health gap is closely linked to the ongoing impacts of colonisation and genocide. These continue to create inequities in what are called social determinants of health – the non-medical factors that influence health and wellbeing, such as housing, education and income. They also increase exposure to health risks, such as cigarette smoking and reduced physical activity. But social and environmental factors alone do not fully explain the gap. Another important part of the picture is how people experience the health system, especially whether care is culturally safe. What is cultural safety? While the term is often now used more widely, “cultural safety” actually originated in health care. Māori nurse educator Irihapeti Ramsden first described the concept in Aotearoa New Zealand in the 1990s, in response to the harmful impacts of colonisation on Māori experiences of health care. At its core, cultural safety means providing care in ways that recognise and respect a person’s identity, culture and experiences. It is more than “cultural awareness” or “cultural competence”. Instead, it focuses on how health systems respond to power imbalances, institutional discrimination and the ongoing impacts of colonisation on First Nations health. For example, historical experiences such as the forced removal of children can influence whether families feel safe engaging with health care. Why it matters Past government policies, including the forced removal of children, institutionalisation and cultural suppression, have had lasting effects on First Nations peoples, and led to a deep mistrust of government and health services. This mistrust is reinforced by experiences of racism and discrimination, poor communication from health professionals and services that do not reflect First Nations views of health and wellbeing. Together, these experiences can lead people to delay, avoid or disengage from care. Many First Nations people report a lack of cultural safety prevents them accessing health care. Evidence shows they are less likely than non-Indigenous Australians to use health services, even when they need them, and more likely to leave emergency departments without being seen. These experiences help explain why cultural safety in health care is so important. When services are culturally safe, people are more likely to feel respected, understood and safe when they interact with health professionals. This makes it more likely people will have positive experiences of care and continue to use services. Over time, this should help close the gap in health outcomes. Cultural safety is particularly important in mental health care because distress can look different across cultures. Without this understanding, there is a higher risk of misdiagnosis and inappropriate care. What cultural safety looks like in practice There are several things services can do to improve cultural safety. However, no single action is enough. Cultural safety is achieved when these approaches are used together across the whole service. Prioritise trust and relationships Cultural safety starts with trust, and trust takes time to build. Services can build trust by using approaches like social yarning, communicating in clear and accessible ways and focusing on people’s strengths rather than only their challenges. Trust can also be built before a person uses a service, through community outreach led by First Nations staff and recommendations from family, friends and community members. Culturally appropriate resources can support conversations between health professionals and patients. For example, our team worked with Aboriginal community members in Boorloo (Perth) to co-design “safe yarning cards”. These are conversation cards that use words, artwork and stories to support conversations between clients and health professionals. Build a culturally responsive workforce Culturally safe services need a strong First Nations workforce. Indigenous staff provide culturally informed support to patients and families, help guide non-Indigenous colleagues and contribute to decisions about how services are delivered. They should be represented at all levels of the health system, from reception and administration through to clinical and leadership roles. But cultural safety is not the responsibility of First Nations staff alone. Non-Indigenous staff also need ongoing opportunities to learn about local cultures, kinship systems, cultural protocols and how colonisation continues to affect health and access to services. Move beyond Western models of care Services need to recognise the important role family, community and kinship play in the health and wellbeing of First Nations peoples. Care should be flexible and take cultural obligations into account. Services should also include First Nations knowledges and ways of understanding health and wellbeing in assessment and treatment. This can include using culturally appropriate assessment tools and treatment approaches based on social and emotional wellbeing, such as healing on Country. Read more: Screening Indigenous people for this heart condition at 55 can prevent strokes and save lives Build genuine partnerships with the local community Culturally safe services need strong partnerships with First Nations communities. This involves working closely with Aboriginal community-controlled organisations, taking part in cultural and community events and ensuring First Nations people have a leading role in how services are designed, delivered and evaluated. Cultural safety requires system-wide change Evidence shows cultural safety is an important part of improving health and wellbeing outcomes for First Nations peoples. It cannot be achieved through individual effort alone or through small changes at the edges of the system. Instead, it requires sustained, fully funded reform across the whole health system.