Advancing Culturally Safer Care for Indigenous Patients: Local Supports

Each year on September 30, the National Day for Truth and Reconciliation honours survivors of residential schools, their families, and communities. For health professionals, it is also a moment to reflect on how colonization continues to shape healthcare systems and the experiences of Indigenous patients today. This article explores several interconnected topics, with each of the sections outlined below expanding on the following themes:

• Acknowledging Systemic Racism against Indigenous Patients in Healthcare
• From Competence to Culturally Safer, Trauma-Informed Care
• Local Context and Supports in Ottawa
• Advancing Truth and Reconciliation in Medicine

Acknowledging Systemic Racism against Indigenous Patients in Healthcare

The Truth and Reconciliation Commission of Canada (TRC) made clear that health inequities among First Nations, Inuit, and Métis Peoples are directly linked to colonial policies such as residential schools, forced relocations, and the Sixties Scoop (TRC, 2015). These injustices are not confined to history as they continue to influence care access, trust in institutions, and health outcomes.

Recent evidence confirms this reality. A 2024 Statistics Canada report found that Indigenous people continue to face barriers to timely care and experience higher rates of discrimination in healthcare settings compared to non-Indigenous populations (Statistics Canada, 2024). A national scoping review of the literature further demonstrates that anti-Indigenous racism is pervasive, leading to poorer experiences and outcomes across the health system (Cooke & Shields, 2024).

Addressing these challenges calls for action at multiple levels. Browne et al. (2022) emphasise that meaningful change requires multi-tiered strategies at the policy, institutional, and front-line practice levels. For physicians and nurse practitioners, acknowledging these realities is the first step toward creating space for more equitable, culturally safer and trauma-informed care.

From Competence to Culturally Safer, Trauma-Informed Care

Traditional “cultural competence” training has often focused narrowly on cultural checklists. Cultural safety goes further: it requires providers to recognize power imbalances, address systemic discrimination, and ensure that safety is defined by the patient, not the clinician (Curtis et al., 2019).

Equally important is a trauma- and violence-informed approach. Many Indigenous patients live with intergenerational trauma rooted in colonial policies and systemic marginalization. Trauma-informed care emphasizes trust, collaboration, and patient choice while avoiding re-traumatization through stigmatizing or dismissive interactions (Government of Canada, 2022). These approaches together can help rebuild trust and foster better health experiences and outcomes.

Local Context and Supports in Ottawa

Ottawa’s Indigenous population is diverse, including First Nations, Inuit, and Métis peoples from both local and distant communities. Many residents encounter systemic barriers: limited culturally safer primary care, underrepresentation of Indigenous health care professionals, and fragmented coordination with Indigenous-led organizations.

Clinicians can respond by integrating culturally safer practices into daily care and by building partnerships with Indigenous-led healthcare organizations. Local organizations such as the Wabano Centre for Aboriginal Health and Minwaashin Lodge offer holistic, culturally grounded supports that blend Western medicine with Indigenous knowledge. Referring patients to these services and respecting self-determination in care choices strengthens both trust and outcomes.

Advancing Truth and Reconciliation in Medicine

Indigenous Cultural Safety programs, trauma-informed care modules, and other clinical supports can be found under the Physician & NP Resources section

Reconciliation in healthcare is not symbolic—it is lived out in exam rooms, clinics, and hospitals. By acknowledging systemic racism, adopting culturally safer and trauma-informed practices, and working with Indigenous-led organizations, clinicians can contribute to more equitable, respectful care. The path to reconciliation begins with the choices we make in everyday practice.

Physician & NP Resources

• National Collaborating Centre for Indigenous Health. Evidence-based resources and publications to support Indigenous health equity.
• San’yas Indigenous Cultural Safety Training. Online training program to foster culturally safe practices in health care.
• Ontario ICS Program | Indigenous Primary Health Care Council. Ontario-based program supporting Indigenous-led primary health care and cultural safety.
• Trauma and violence-informed approaches to policy and practice - Canada.ca. Guidance on policy and practice for trauma- and violence-informed care.
• Trauma-and Violence-Informed Care Education | PHN-PREP. Educational resources for public health nursing practice.
• Ottawa Aboriginal Coalition. An alliance of urban Indigenous service delivery organizations dedicated to offering front-line programs and services to Indigenous individuals residing in Ottawa.
• Wabano Centre for Aboriginal Health. An Indigenous Centre for Excellence in Healthcare Services in Ottawa.
• Minwaashin Lodge. An organization providing prevention and intervention services and programs for Indigenous women, youth, and families who are survivors of family violence and the residential school system, including those impacted by intergenerational effects in Ottawa.

Patient Resources

• Indigenous Resource Guide — Cherry Tree Counselling A complete list of all of the Indigenous resources and supports available in Canada.
• Hope for Wellness Helpline. Free, 24/7 counselling and crisis intervention for Indigenous peoples. 1-855-242-3310 |
• Wabano Centre for Aboriginal Health. Accessible primary care and cultural supports for Indigenous community members.
• Minwaashin Lodge. Services for Indigenous women, youth, and families, including counselling and housing support.

References

Browne, A. J., Lavoie, J. G., McCallum, M. J., & Big Canoe, C. (2022). Addressing anti-Indigenous racism in Canadian health systems: Multi-tiered approaches are required. Canadian Journal of Public Health, 113(2), 222–226. https://doi.org/10.17269/s41997-021-00598-1

Cooke, M., & Shields, T. (2024). Anti-Indigenous racism in Canadian healthcare: A scoping review of the literature. International Journal for Quality in Health Care, 36(3), mzae089. https://doi.org/10.1093/intqhc/mzae089

Government of Canada. (2022). Trauma and violence-informed approaches to policy and practice. https://www.canada.ca/en/public-health/services/publications/health-risks-safety/trauma-violence-informed-approaches-policy-practice.html

Statistics Canada. (2024, November 4). Health care access and experiences among Indigenous people, 2024. Ottawa: Statistics Canada. https://www150.statcan.gc.ca/n1/daily-quotidien/241104/dq241104a-eng.htm#

Truth and Reconciliation Commission of Canada. (2015). Honouring the Truth, Reconciling for the Future: Summary of the Final Report of the Truth and Reconciliation Commission of Canada. https://nctr.ca/records/reports/#trc-reports

Turpel-Lafond, M. E. (2020). In plain sight: Addressing Indigenous-specific racism and discrimination in B.C. health care. Government of British Columbia. https://engage.gov.bc.ca/app/uploads/sites/613/2020/11/In-Plain-Sight-Summary-Report.pdf

Mohammad Kibria, PhD, MPH, MBBS
Manager, Policy Indigenous Health and Business Administration Support

Raven Cotnam, Indigenous Health Specialist