Acknowledging colonialism in the room: Barriers to culturally safe care for Indigenous Peoples

Indigenous peoples worldwide continue to face health inequities compared to non-Indigenous populations. Frameworks like cultural safety can be used to mitigate these inequities; however, this is not widely implemented in healthcare settings. Thus, additional research into barriers to providing culturally safe care are critical. To address this need, we examined the existing barriers to culturally safe care for Indigenous peoples in Canada, and Māori in Aotearoa New Zealand, through the perspectives of key informants. Major issues identified by key informants included systemic racism, lack of organisational accountability and/or buy-in, ineffective health-provider education, funding, health system structure, undervaluing Indigenous knowledge, negative framing, terminology, and changes to the concept of cultural safety over time. When examined closely, systemic racism and ongoing settler colonialism are the key driving forces underpinning many of the barriers identified. Findings from this research point to barriers at every level and require a system-wide, intersectoral approach in order to provide culturally safe care for Indigenous peoples and advance Indigenous health equity.