Cultural safety is not a buzzword but a critical component of First Nations healthcare and healing, according to experts. First Nations people in Australia experience worse health and lower life expectancy than other Australians, a gap closely linked to the ongoing impacts of colonisation and genocide. These historical forces create inequities in social determinants of health—such as housing, education, and income—and increase exposure to health risks like smoking and reduced physical activity. However, social and environmental factors alone do not fully explain the disparity; how people experience the health system, particularly whether care is culturally safe, plays a significant role.
What Is Cultural Safety?
While the term is now used more broadly, cultural safety originated in healthcare. 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 healthcare. At its core, cultural safety means providing care that recognises and respects a person's identity, culture, and experiences. It goes beyond cultural awareness or competence, focusing 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 healthcare.
Why It Matters
Past government policies, including forced removal of children, institutionalisation, and cultural suppression, have had lasting effects on First Nations peoples, leading to deep mistrust of government and health services. This mistrust is reinforced by experiences of racism, 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 that a lack of cultural safety prevents them from accessing healthcare. Evidence shows they are less likely than non-Indigenous Australians to use health services, even when needed, and more likely to leave emergency departments without being seen. Cultural safety in healthcare is therefore crucial: when services are culturally safe, people are more likely to feel respected, understood, and safe when interacting with health professionals, leading to positive care experiences and continued service use. Over time, this should help close the gap in health outcomes. Cultural safety is particularly important in mental health care because distress can manifest differently across cultures; without this understanding, misdiagnosis and inappropriate care are more likely.
What Cultural Safety Looks Like in Practice
Several actions can improve cultural safety, but no single effort is sufficient. Cultural safety is achieved when these approaches are used together across the entire service.
Prioritise Trust and Relationships
Cultural safety starts with trust, which takes time to build. Services can foster trust through social yarning, clear communication, and focusing on people's strengths rather than 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, a team worked with Aboriginal community members in Boorloo (Perth) to co-design “safe yarning cards”—conversation cards using words, artwork, and stories to facilitate discussions 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, guide non-Indigenous colleagues, and contribute to decisions about service delivery. They should be represented at all levels of the health system, from reception and administration to clinical and leadership roles. However, 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 must recognise the important role of family, community, and kinship in First Nations health and wellbeing. Care should be flexible and take cultural obligations into account. Services should also incorporate First Nations knowledges and ways of understanding health and wellbeing into 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.
Build Genuine Partnerships with the Local Community
Culturally safe services require strong partnerships with First Nations communities. This involves working closely with Aboriginal community-controlled organisations, participating 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. According to experts, addressing cultural safety is essential for closing the gap in health outcomes and ensuring equity for First Nations Australians.
