Comment: B.C. health professions’ pledge to First Nations

On March 1, 23 health-profession regulatory bodies in B.C. became the first in Canada to pledge their commitment to making our health system more culturally safe and effective for First Nations and aboriginal peoples.

The acknowledgment of racism in health care paved the way for creation of the Declaration of Commitment to Advancing Cultural Humility and Cultural Safety within Health Services in B.C., which was signed in 2015 by the six provincial health authorities, Ministry of Health and First Nations Health Authority.

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Cultural safety has been defined as an outcome based on respectful engagement that recognizes and strives to address power imbalances in the health-care system, resulting in an environment free of racism and discrimination — where people feel safe when receiving health services.

Cultural humility is a process of self-reflection to understand personal and systemic biases and to develop and maintain respectful processes and relationships based on mutual trust. Cultural humility involves humbly acknowledging oneself as a learner when it comes to understanding another’s experience.

The declaration has three main pillars: creating a climate for change; engaging and enabling stakeholders; and implementing and sustaining change. It has started an important conversation resulting in the #itstartswithme campaign, which encourages health-service staff to pledge their visions or commitments in this area, along with continuous learning. This work builds on the already transformative and well-received San’yas Indigenous Cultural Safety training offered by the Provincial Health Services Authority.

As registrars and chief executive officers of two of the largest provincial health-regulatory colleges, we are aware of the impacts of unsafe care and its potential for fatal consequences for First Nations and aboriginal peoples within health and social services. Stories like the one shared by Michelle Labrecque — an indigenous woman who, instead of being treated for severe abdominal pain, was sent home from Royal Jubilee Hospital with a prescription showing a beer bottle crossed out — are not isolated incidents.

We are confident that physicians and nurses understand the need for, and the benefits of, indigenous cultural-safety training, and we will continue to promote the value of this training to the professionals we regulate.

Nurses and physicians are in a unique position to effect real change within the system. We encourage our registrants to consider how their practices can help support positive health outcomes for aboriginal peoples and to speak up and advocate for aboriginal peoples when they see discrimination or bias.

Change requires awareness, education and acknowledgment. The regulatory colleges join the health authorities in creating an expectation of change among all health professionals, so that all indigenous and aboriginal peoples will experience the culturally safe and effective care they deserve.

The declaration of commitment is based on the guiding principle that all partners, including First Nations and aboriginal individuals, elders, families, communities and nations, must be involved in development of action strategies and in the decision-making process with a commitment to reciprocal accountability. This also means individuals are able to voice their perspectives, ask questions and be respected by health-care professionals on their beliefs, behaviours and values.

As First Nations Health Authority CEO Joe Gallagher has said, this commitment gives permission to regulated health professionals in B.C. to address racism and problematic behaviours head-on, without fear of reprisal. Increasing the level of cultural safety in the health system through cultural humility, health literacy and relationship-based care can improve the quality of health services for First Nations and aboriginal peoples.

We agree that this declaration will ultimately make the health system safer for First Nations and aboriginal peoples and for all British Columbians.

This declaration commits regulatory bodies to report on progress through annual reports, outlining strategic activities and accountability measures that demonstrate how they are meeting their commitment to cultural safety.

Signing is the first step toward acknowledging the problem of racism in health care and leading with a vision of what is now expected of our health professionals.

Having health-profession regulators sign on to the declaration opens the door to implementing cultural-educational opportunities as part of certification processes. Hardwiring this work in the provincial health system will take time, but initial strides are promising and there is enthusiasm across the country for this work that is being led in B.C.


Dr. Heidi Oetter is CEO/registrar of the College of Physicians and Surgeons of B.C. and Cynthia Johansen is CEO/registrar of the College of Registered Nurses of B.C. More information on the provincial work in cultural humility and cultural safety can be found on the FNHA website:

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