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.

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