The Univeristy of Melbourne The Royal Melbourne Hopspital

A joint venture between The University of Melbourne and The Royal Melbourne Hospital


26 Feb 2024

Cultural safety key to better access to health for Indigenous peoples living in urban settings in Canada

Canada has universal healthcare and some of the world’s best health facilities and specialists, still, research has shown that more than half of Indigenous peoples living in the cities face a myriad of barriers when seeking and accessing these health services.

A systematic review published in the International Journal of Environmental Research and Public Health by Indigenous researchers at the Doherty Institute (Australia), Well Living House (Canada), York University (Canada) and the CEO of the National Association of Indigenous Friendship Centres (Canada) explored barriers and facilitators to health service access for First Nations, Inuit and Métis peoples in living in urban and related homelands. The review included 41 studies published between 1981 and 2020.

University of Melbourne’s Associate Professor Simon Graham, a National Health and Medical Research Council Fellow and lead of the Indigenous Health cross-cutting discipline at the Doherty Institute, said this review underscores the harms discrimination and racism can have on an individual’s overall health, especially their health-seeking behaviours. Some studies highlighted that racism was such a deterrent that some Indigenous people held off seeking health services until they became very sick and needed to attend emergency departments in hospitals.

“We found that difficult communication with health professionals, dismissal by healthcare staff, long wait times, mistrust and avoidance of healthcare, racial discrimination, poverty and transportation issues are some of the barriers impacting the health of Indigenous people living in urban areas of Canada,” said Associate Professor Graham.

One of the studies showed that 71 per cent of Indigenous adults living in Toronto, one of Canada’s largest cities, reported experiencing racism from healthcare professionals which then prevented, stopped or delayed them from returning to seek healthcare.

“The healthcare workers treated me like crap, and I know it was because I am Native… When you need the medical care, we put up with it. We shouldn’t have to,” one participant said.

On the other hand, the review revealed that Indigenous people highly valued access to Indigenous-led and run health services. These community-based health services are commonly rooted in Indigenous ways of knowing and doing, identity and inclusion and cultural protocols—contributing to cultural safety.

Professor Janet Smylie, a medical doctor, research chair and Director of the Well Living House at St Michael’s Hospital in Toronto, Canada, and senior author of the paper believes implementation of policies and programmes that remove barriers could improve health access for Indigenous people.

“There is a need for longer-term funding of Indigenous-led healthcare, child and youth services, for healthcare institutions to collaborate with Indigenous organisations and individuals to design and implement cultural training, and for Indigenous organisations and individuals to evaluate these cultural safety programs,” said Professor Smylie.

“It is also important to provide continuing cultural awareness and education opportunities for non-Indigenous healthcare workers.”

Peer Review: Graham S, et al. First Nations, Inuit and Métis Peoples Living in Urban Areas of Canada and Their Access to Healthcare: A Systematic Review. International Journal of Environmental Research and Public Health (2023). DOI: 10.3390/ijerph20115956

Collaboration: Doherty Institute, Australia; York University, National Association of Friendship Centres, University of Toronto and St Michael’s Hospital, Canada.

Funding: University of Melbourne Dyason Fellowship, NHMRC, Canada Research Chair in Advancing Generative Health Services for Indigenous Populations in Canada.