Parliament, Victoria
Parliament Buildings, Victoria, BC
Victoria, BC
Victoria, BC
and the
relocated Coqualeetza Hospital
Monument
Gift to BC by Grand Chief Steven L. Point
In recent years, institutions, organizations, and businesses across British Columbia have begun embracing a profound shift in how they engage with Indigenous peoples and other diverse communities. This shift is guided by the principles of cultural safety and cultural humility, two interrelated concepts that are reshaping service delivery and relationships. Born from Indigenous advocacy and the hard lessons of colonial history, cultural safety and humility offer a pathway to more respectful, equitable interactions. Their importance is increasingly acknowledged not only in health care, where these ideas first gained traction, but across all sectors – from education and social services to government agencies – as part of a broader movement toward reconciliation and justice.
Cultural safety can be understood as an outcome: it is the condition achieved when individuals from another culture feel safe and respected in their interactions with a service or institution. Crucially, this safety is defined not by the providers or authorities, but by those who experience the service . In other words, no policy or training program can declare an organization “culturally safe” – that judgment lies with the patients, clients, or community members themselves. According to the First Nations Health Authority, cultural safety is rooted in respectful engagement that recognizes and strives to address power imbalances inherent in our systems . When those power imbalances are addressed, the result is an environment free of racism and discrimination, one in which people can engage with services without bracing themselves for prejudice or hostility . The notion of cultural safety first emerged decades ago in Aotearoa (New Zealand), where Māori nurses such as Dr. Irihapeti Ramsden pioneered it as a response to the failures of conventional “cultural sensitivity” training. They observed that it was not enough for a practitioner to simply be aware of another culture; what mattered was that Indigenous patients actually felt safe – that their identity was not being attacked or diminished – when receiving care. This radical idea, centered on the perception and experience of the service recipient, marked a departure from earlier top-down approaches to cultural competence. It acknowledged that historic and ongoing power dynamics – who has authority, whose knowledge is valued, whose culture is dominant – fundamentally shape whether an interaction is respectful or harmful. Cultural safety, then, demands an unflinching look at those power dynamics and a commitment to transforming them so that Indigenous peoples (and others) are not harmed by the very services meant to help them .
Cultural humility, a concept that arose in the 1990s in the field of medical education, complements and enables cultural safety. If cultural safety is the outcome, cultural humility is the attitude and process that helps achieve that outcome. Cultural humility means approaching others with genuine openness and humility, recognizing that one’s own perspective is not the universal norm and that learning about others is a lifelong process . It has been defined as a continual commitment to self-reflection and self-critique, wherein professionals acknowledge their own biases and limitations and humbly position themselves as learners in every encounter . In the context of health care, where the term was first articulated, cultural humility was proposed as a more realistic and ethical goal than one-time “cultural competence.” Rather than expecting to master a list of traits about a culture, providers are asked to continuously learn from the people they serve and to address power imbalances in the provider–client relationship . As described in one oft-cited medical paper, cultural humility involves redressing those power imbalances and developing respectful, non-paternalistic partnerships with communities . It is an admission that, no matter how much training one has, the patient or client is the expert in their own experience. This stance of humility creates the conditions for trust – it signals that the provider or official is not there to impose judgments but to listen and to learn. Together, cultural safety and cultural humility represent a paradigm shift: from a paternalistic model (where institutions dictate norms and expect Indigenous people to adapt) to a reciprocal model (where institutions adapt and respond to the needs and voices of Indigenous peoples).
For Indigenous peoples in British Columbia, these principles carry a particularly powerful resonance. They speak directly to the harms that need healing – the lived experiences of disrespect, discrimination, and cultural erasure that have too often characterized interactions with Canadian institutions. The urgency of cultural safety and humility becomes painfully clear when listening to Indigenous communities today. A landmark investigation in 2020 into Indigenous people’s experiences with B.C.’s health-care system revealed widespread racism “in plain sight.” In that review, 84% of Indigenous participants reported enduring racist or discriminatory treatment in health care – treatment that discouraged them from seeking care in the future and negatively affected their health . These findings, part of the report In Plain Sight delivered by former judge Mary Ellen Turpel-Lafond, confirmed what Indigenous families had long known: that prejudice and ignorance within hospitals and clinics were causing real harm, sometimes even costing lives. It is difficult to overstate the human impact behind that statistic. It means elders who avoid hospitals even when they’re seriously ill because they fear being belittled or neglected. It means mothers who hesitate to seek prenatal care, or who leave medical appointments in tears, feeling unseen and unsafe. It means Indigenous patients being misdiagnosed or not taken seriously – with dire consequences for their health. As the report bluntly stated, “in Canadian society, there is a direct line between the history and experience of colonialism and the challenges of Indigenous-specific racism within the health care system today” . In other words, the attitudes and disparities we witness now are the echoes of history – a history that cultural safety and humility explicitly aim to confront and change.
That history in British Columbia is heavy. Indigenous communities here have endured generations of policies and practices that attacked their cultures and left deep scars. Beginning in the 19th and 20th centuries, colonial authorities established systems that Indigenous people correctly read as attempts to erase them. Children were taken from their families and forced into residential schools, where they were forbidden to speak their languages or practice their traditions, and where many suffered abuse. Indigenous patients were segregated into “Indian hospitals”, receiving substandard care under often coercive conditions. The Sixties Scoop saw thousands of Indigenous children removed from their homes and placed in non-Indigenous foster care or adoptive homes, severing cultural and familial bonds. Indigenous women were subjected to forced sterilizations and other gross violations of bodily autonomy. These are just some of the stark examples of what First Nations, Inuit, and Métis peoples have survived in B.C. . The cumulative effect of these experiences was a profound mistrust of government and mainstream services, as well as intergenerational trauma that continues to affect health and well-being. When an Indigenous elder walks into a government office or a clinic today, they carry this history with them. It is the memory of a grandfather who never came home from residential school, a mother who was told by a nurse that she was a bad parent, a friend who died alone in a hospital after staff ignored his pleas. Cultural safety and humility, at their core, are direct responses to these harms. They arose from Indigenous voices insisting that “enough is enough” – that Indigenous people should never have to check their identity at the door to receive basic respect, and that they should never feel fear in reaching out for help.
What does it look like when an institution truly commits to cultural safety and humility? It begins with a shift in mindset and continuous self-examination. Organizations must ask themselves hard questions: Whose needs and worldview are at the center of our services? Have we created an environment where Indigenous people feel welcome or one where they feel alienated? This often leads to concrete changes. Many agencies start by educating their workforce – not through a token one-hour seminar, but through deep, ongoing learning about Indigenous history, rights, and contemporary realities. In British Columbia, thousands of health-care professionals, teachers, social workers, and public servants have taken part in Indigenous cultural safety training programs (such as San’yas, among others) that expose them to the histories of colonization and the subtle ways bias can pervade their work . Such training can be eye-opening, but cultural humility means recognizing that training is just the first step. What really matters is what comes after: the daily practice of humility and respect. Leaders in organizations play a crucial role here. When the CEO of a health authority or the director of a non-profit openly acknowledges the organization’s past mistakes and commits to listening to Indigenous partners, it sets a tone. For example, since signing a 2017 commitment to cultural safety and humility, all of BC’s health profession regulators – from the College of Physicians and Surgeons to nursing and allied health colleges – have taken steps to reform their practices . Some have begun board meetings or public events with territorial acknowledgments, formally recognizing the First Nations on whose land they operate . These acknowledgments, when done sincerely, remind everyone that Indigenous Peoples are not just clients but hosts in their own homeland, and that institutions have a duty to respect that status. Regulators and health authorities have also started to change internal policies: collecting data on Indigenous identity to track progress on representation, mandating cultural safety training for all staff, and even writing requirements for culturally safe practice into professional standards .
Cultural safety and humility also manifest in symbolic but powerful gestures of change. In one case, a provincial health regulator took the step of removing a colonial figure from its official crest – a small change in logo that signaled a larger rejection of colonial dominance in its institutional culture . More substantively, that regulator created new seats for Indigenous members on its board and committees, ensuring Indigenous voices help govern professional standards . These kinds of actions send a clear message that Indigenous participation and perspectives are not an afterthought but an integral part of how the organization operates. Likewise, many service organizations are re-examining their physical spaces and practices to be more welcoming. Health clinics, for instance, might invite local Elders to advise on creating a calming, culturally affirming environment – perhaps by incorporating Indigenous art, or providing space for ceremony and smudging. A community agency might adjust its intake forms and interview approaches to be less intrusive and more context-aware, so that Indigenous clients don’t feel they have to prove themselves or hide their cultural identity to receive fair treatment. Frontline workers, guided by cultural humility, learn to listen more and talk less, giving space for clients to share what is important to them. This is not a checklist or a formula – it’s an ongoing practice of empathy and respect that can take many forms.
One key aspect of cultural humility in practice is building true partnerships with Indigenous communities. Rather than designing programs in a silo and then “consulting” Indigenous people as an afterthought, culturally humble organizations strive to co-create solutions from the start. In British Columbia, we have seen how effective this can be. When the COVID-19 pandemic hit, Indigenous communities were identified as particularly vulnerable, due to systemic inequities that left them with poorer health outcomes. In response, some regional health authorities took a culturally safe approach: they partnered with First Nations and Métis leadership to design the pandemic response for their communities. One health region, for example, worked closely with 32 First Nations and several Métis Chartered Communities to plan COVID vaccine clinics tailored for Indigenous people . These clinics were run in collaboration with Indigenous health leaders and were often held in community-friendly locations. The staff made efforts to respect cultural protocols and to ensure people felt welcome and respected. The results spoke volumes – nearly 24,000 vaccine doses were administered through over 200 of these specialized clinics . Health officials noted that this culturally safe approach not only improved vaccine uptake, but also helped repair relationships with Indigenous community members who, in the past, had felt alienated or mistreated by the health system . Community members, seeing their traditions and concerns respected in the rollout of a public health program, experienced a sense of trust and care that had too often been missing.
This example illustrates how cultural safety is not abstract; it tangibly improves access and outcomes. When people trust that they will be treated with respect, they are more likely to seek care and engage with services. Indeed, across Canada, evidence is growing that centering Indigenous knowledge and practicing cultural humility leads to better results: it increases trust in systems and ultimately improves health and wellness outcomes for Indigenous peoples . In the sphere of social services, similar partnerships are emerging – for instance, child welfare agencies working with Indigenous bands to ensure children remain connected to their communities and culture, or schools working with First Nations Elders to develop curriculum that reflects Indigenous history and perspectives. These efforts are driven by the recognition that Indigenous peoples themselves know best what their communities need, and that institutions must create space for Indigenous self-determination in service delivery.
The momentum behind cultural safety and humility in B.C. has also been fueled by broader ethical and legal frameworks that demand change. The Truth and Reconciliation Commission (TRC), which documented the experiences of residential school survivors, issued 94 Calls to Action in 2015 – several of which urge governments, health systems, and other sectors to provide culturally appropriate services and education. For example, the TRC calls on medical and nursing schools to educate students on Indigenous health issues, and on all levels of government to educate public servants on the history of Indigenous peoples, including skills training in intercultural competency and anti-racism. These calls to action have set expectations across sectors that cultural competence (and by extension cultural safety/humility) is not optional. In British Columbia, the provincial government took a historic step by embedding the principles of the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP) into law. In 2019, the B.C. legislature unanimously passed the Declaration on the Rights of Indigenous Peoples Act, committing to align all provincial laws and policies with UNDRIP . UNDRIP affirms Indigenous peoples’ rights to their culture, identity, language, and self-determination – including the right to equitable access to services without discrimination. By enshrining these principles in law, British Columbia signaled that every public sector entity must work to uphold Indigenous rights and dignity. Cultural safety and humility offer practical ways to fulfill these obligations. They operationalize big ideas like UNDRIP into day-to-day conduct – how a nurse talks to a patient, how a social worker involves a family in decisions, how a museum designs an exhibit with input from local First Nations. The legal backdrop strengthens the moral imperative: now there is both a legal duty and a moral calling to reform institutional practices so that Indigenous peoples are treated justly. This convergence of ethical and legal pressure has accelerated the adoption of cultural safety and humility across sectors. It’s not just health care – schools, universities, police services, libraries, and NGOs in B.C. are all, in varying ways, grappling with how to make their spaces safer and their staff more humble in their approach to Indigenous and other marginalized populations.
Perhaps most importantly, cultural safety and humility center the lived impacts on Indigenous communities – which is where their true significance lies. For decades, Indigenous people have told stories of feeling invisible or disrespected in interactions with government or service providers. These concepts insist that those stories be heard and never dismissed. They push institutions to ask, “How do Indigenous peoples experience us, and how can we make that experience one of safety and respect?” The changes that result can be life-changing. When a clinic makes an Indigenous diabetic patient feel safe enough to come in for regular check-ups (rather than avoiding appointments out of past negative experiences), that patient’s health can dramatically improve. When a public housing agency approaches Indigenous tenants with humility – listening to their concerns about community and tradition – conflicts can be resolved collaboratively rather than through evictions or heavy-handed measures. As Dr. Michael Dumont, a Métis physician in Vancouver, has observed, building trust can be a “potentially lifesaving intervention.” Simply put, trust saves lives. It is not hyperbole: if an Indigenous person trusts that they will be cared for without judgment, they are more likely to seek help in time, follow medical advice, or access social support before a crisis escalates. Trust is built or broken in the countless small moments of interaction – a reassuring smile, a sincere apology, an openness to learn about someone’s culture, a willingness to admit mistakes. Cultural safety and humility aim to fill those moments with meaning and care, instead of misunderstanding or bias.
The implications of embracing cultural safety and humility go beyond improving services for Indigenous peoples (although that is a central goal). In many ways, these principles hold lessons for how to achieve greater equity for all groups. They remind us that one-size-fits-all approaches often privilege the dominant culture and leave others behind. By actively seeking to make environments safe for those who have been marginalized, we start to see and address barriers that, left unchecked, perpetuate inequality. An organization that learns to value Indigenous knowledge and perspectives may become more attuned to other under-represented voices as well. Cultural humility teaches a kind of listening and learning approach that can improve relationships with any community – it counters the arrogance that often comes with institutional power. In a diverse society, this humility is essential. Moreover, cultural safety and humility can help prevent conflicts and crises. Many flashpoints – whether it’s an angry public meeting about land use, or a legal battle over child welfare – have at their heart a feeling of cultural unsafety or disregard. When institutions commit to working with Indigenous communities in a safe and humble way from the outset, they lay the groundwork for collaboration instead of confrontation. This is not a quick fix or a guarantee of agreement on every issue, but it creates channels of communication and mutual respect that are the only real basis for lasting solutions. In the grand project of reconciliation, which Canada and British Columbia have declared a priority, cultural safety and humility are tools to move from apologetic words to concrete action. They operationalize reconciliation by making it part of everyday practice. Every time a government office modifies a form to be more inclusive, or a non-profit invites an Elder to advise their staff, or a manager intervenes to stop a racist remark and uses it as a teaching moment – these are acts of reconciliation in practice.
It is important to note that cultural safety and humility are not about lowering standards or offering special treatment; rather, they are about raising the standard of respect and care to be the same for everyone. The end goal is that no person’s culture or identity puts them at a disadvantage when seeking help. Achieving this often requires those in positions of privilege to change the way they work. It requires humility to say, “We don’t have all the answers – we need to listen.” It requires courage to admit, “Our system has caused harm – we must do better.” And it requires commitment to follow through with reforms even when they challenge long-standing practices or provoke discomfort among staff. There is also a personal dimension: professionals and public servants embracing cultural humility often describe it as a journey of personal growth, sometimes an uncomfortable one. Long-held assumptions may be questioned; new understanding may come through confronting painful truths about Canada’s colonial history. But many also describe this journey as deeply rewarding – leading to stronger relationships, a sense of integrity, and better outcomes in their work.
In British Columbia, the journey towards cultural safety and humility is still ongoing. Not every organization is far along; some are just beginning, prompted perhaps by the findings of reports like In Plain Sight or by the expectations of funders and communities. There will undoubtedly be missteps and learning moments on the way. However, a momentum has built that seems unlikely to reverse. The province’s adoption of UNDRIP into law, the moral weight of the TRC’s Calls to Action, and the voices of Indigenous leaders and community members all continue to propel this work forward. And as these principles take root, we see a hopeful narrative unfolding. It is a narrative in which Indigenous elders are invited to guide health programs, where their traditional knowledge is not just tolerated but celebrated. It is one where a young Indigenous student can see her culture reflected in the curriculum and feel pride rather than shame. It is a narrative where staff in a public agency might respectfully ask a client, “How can we honor your culture in this process?” and genuinely act on the answer.
Ultimately, cultural safety and humility are about dignity and humanity. They challenge institutions to live up to their highest ideals of service. They remind us that policies and systems, at their heart, serve people – and that every person carries their culture, history, and identity with them at all times. Ignoring that truth has caused enormous harm in the past. Embracing it now offers a chance to heal and to do things better. A more culturally safe and humble health system, for instance, tends to be one that listens more closely to all patients and thus improves care overall. A public service that values humility may find innovative answers by engaging diverse communities in co-creating policy.
The story of cultural safety and humility is still being written. It is a story of hard-earned change – of institutions turning a mirror on themselves and individuals opening their hearts and minds. It invites all of us to reflect on our own cultural lens and biases. It invites us to imagine how our workplaces and services appear through the eyes of someone of a different background – and to take responsibility for making those places feel safe for them. The work is challenging and at times uncomfortable, but the stakes are high. As we have seen, it can literally be the difference between life and death, between despair and trust, between marginalization and belonging. In a society as richly diverse as ours, cultural safety and humility offer a vision of inclusion that goes beyond platitudes – one that is lived in practice, moment by moment. They represent a commitment to learning from the past and acting in the present to create a better future. That future, we hope, is one where Indigenous peoples and all peoples can interact with public institutions on their own terms, with their identities affirmed, and their dignity fully respected. In moving toward that future, British Columbia is finding that cultural safety and humility are not just ideals to aspire to, but necessary foundations for any truly just and equitable society.
This website uses cookies to collect statistical data and to ensure you get the best experience on our website.