Cultural Safety and Humility
“We die at the hands of police, we die at the hands literally of health care workers. ... It is a country’s shame that this continues to happen.”
—Dr. Neil Wieman (as cited in Kirby, 2020).
Systemic racism and ongoing inequities are entrenched in societies and health care systems in Canada, United States, and other countries with Original Peoples and a history of settler colonialism. Within the societies of Canada and the United States, Black and Indigenous Peoples are literally ignored to death in health care, and regularly die from colonial violence.
In the United States, Indigenous Peoples “born today have a life expectancy that is 4.4 years less, and they continue to die at higher rates than other Americans in many categories of preventable illness, including chronic liver disease and cirrhosis, diabetes, and chronic lower respiratory diseases” (American Bar Association).
Indigenous Peoples in Canada and the United States experience disproportional health disparities and families live daily with degrees of direct, intergenerational, multigenerational and historical trauma (Bombay et al. 2014; O’Neill et al. 2016) caused by the ongoing colonial violence of the Indian Residential School system (Truth and Reconciliation Commission of Canada Report), Boarding School system (Federal Indian Boarding School Investigative Report) and apartheid policies and legislation enacted by these colonial governments with the sole purpose of co-opting lands and resources – and in the case of Canada, assuming full jurisdiction over the lives of First Nations, Inuit and Métis Peoples.
Despite this, Indigenous Peoples continue to maintain and revitalize cultural practices and healing traditions, but in a health care system with systemic Indigenous-specific racism which may result in death.
“Cultural safety includes and goes beyond cultural awareness, which refers to awareness of differences between cultures. It also goes beyond cultural sensitivity, which is about realizing the legitimacy of difference and the power of one’s own life experience can have on others” (Koptie, 2009). In the context of healthcare for Indigenous Peoples, a culturally safe environment is one where an Indigenous Person does not experience profiling or discrimination. Instead, a culturally safe environment allows an Indigenous Person to live their full sense of self and identity including emotionally and spiritually. To work towards cultural safety means to constantly reinforce anti-racist policies and programs and commit to the continuous learning from Indigenous Communities.
Cultural humility is an ongoing journey of self-evaluation and introspection that is essential for creating a culturally secure setting. Unlike Western medical approaches which usually focus on studying the client, cultural humility begins with a thorough exploration of the beliefs, assumptions, and privileges that the health professional holds within their own knowledge and methods, as well as the objectives of the health-professional-client relationship. Embracing cultural humility enables Indigenous perspectives to take precedence and fosters health-professional-client relationships characterized by respect, shared decision-making, and honest and productive communication.
Shared Responsibility
As a person providing mental health services in the health care system, all therapists have a responsibility for ensuring health equity and eliminating racism. By addressing your own knowledge gaps in the past, present, and ongoing history of colonialism and the inequities experienced by Black, Indigenous, and People of Colour, by spending time in critical self-reflection by examining your assumptions, beliefs, biases, and position of privilege, by being active in anti-racism and not complicit in ongoing colonial violence, we can collectively ensure the delivery of culturally safe care.
Below are some useful terminology to better acquaint yourself with cultural safety and humility.
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Note
Because settling comes with free agency, “the term settler does not, and can never refer to the descendants of Africans who were kidnapped and sold into chattel slavery (King 2013). Black People, cut off and removed from their own Indigenous lands could not be agents of settlement” (Vowel 2018).
Activity
It is becoming a standard practice for a verbal Land Acknowledgement for the local Indigenous Peoples, lands, and territories to be given at the very beginning of any large meeting or formal gathering where attendees are participating. Land Acknowledgements are a great way to practice anti-racism and combat the colonial narrative (or script) of Indigenous erasure and visiblize Indigenous Peoples within their own sovereign lands and territories.
To help you identify the Indigenous Peoples, lands, and territories, where you live, work, reside or are visiting, we recommend utilizing Native Land Digital as an initial resource to help you get started.
Step 1
As a commitment to cultural safety and humility, visit Native Land Digital, search for your city/town or geographical area, and identify the traditional territory on which you live.
Step 2
Conduct further research by visiting the webpages of each of the Indigenous Peoples and/or Nations identified to ensure correct and respectful acknowledgement. It is important to use and respect the term the Indigenous Peoples or Nations use to self-identify.
Step 3
Visit Flip, and record a video of yourself which includes:
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A brief introduction of yourself and please consider your relationship to the land (e.g., self-identifying as a settler or White settler).
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A Land Acknowledgement for the local Indigenous lands and territories you currently work, live, reside, or are visiting.
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Sharing your statement of commitment to cultural safety and the lifelong practice of humility.
Cultural Safety and Humility
In doing a Land Acknowledgement, it’s important to avoid Tokenistic or Performative Land Acknowledgements by holding yourself accountable, and spending time in critical self-reflection asking yourself: what actions you are taking locally to support the Indigenous Peoples and/or Nation(s) where you live, work, and reside? What actions are you taking to support Indigenous Peoples nationally, and what further actions are you taking in the process of Truth and Reconciliation beyond this acknowledgement?
References
Allan, B. & Smylie, J. (2015). First Peoples, second class treatment: The role of racism in the health and well-being of Indigenous peoples in Canada. The Wellesley Institute
Barker, A. J. 2009. The contemporary reality of Canadian imperialism: settler colonialism and the hybrid colonial state. The American Indian Quarterly, 33(3), 325, pp. 328.
Cook, A. 2018. Recognizing Settler Ignorance in the Truth and Reconciliation Commission of Canada. Feminist Philosophy Quarterly 4(4). Article 6.
First Nations Health Authority (FNHA). (2016). #itstartswithme FNHA’s policy statement on cultural safety and humility. Definition adapted from original source.
Harding, L. (2018). What’s the harm? Examining the stereotyping of Indigenous peoples in health systems. SFU.
Health Council of Canada. (2012). Empathy, dignity, and respect: creating cultural safety for Aboriginal people in urban health care.
Kirby, K. ‘A country’s shame’: Indigenous woman’s cries for help, abuse before death spur calls for action on systemic racism in health. Globe and Mail.
King, T. J. (2013). In the Clearing: Black Female Bodies, Space and Settler Colonialism. PhD diss., University of Maryland.
Reading, C. (2013). Social determinants of health: Understanding racism.
Vowel, C. 2016. Indigenous Writes: A Guide to Frist Nations, Métis & Inuit Issues in Canada. Highwater Press.
Watters, H. (2015). Truth and Reconciliation chair urges Canada to adopt UN declaration on Indigenous Peoples. CBC.