Cultural safety key to narrowing First Nations health gap in Australia, researchers say
First Nations people in Australia experience worse health outcomes than other Australians, and researchers argue that cultural safety in health care — recognising and respecting patients' identity and experiences — is essential to closing that gap.
First Nations people in Australia face a significant health disadvantage: they have worse health outcomes and lower life expectancy than other Australians. According to reporting from The Conversation, this disparity stems partly from the ongoing impacts of colonisation and genocide, which have created inequities in what researchers call social determinants of health — non-medical factors like housing, education and income that shape wellbeing. These structural gaps also increase exposure to health risks such as smoking and reduced physical activity.
But social and environmental factors alone do not fully account for the health gap. Experts argue that how First Nations people experience the health system itself — particularly whether the care they receive is culturally safe — plays a vital role.
What is cultural safety?
"Cultural safety" originated as a health care concept in the 1990s, when Māori nurse educator Irihapeti Ramsden developed the framework in Aotearoa New Zealand in response to the harmful impacts of colonisation on Māori health care experiences. At its core, the concept means providing care in ways that recognise and respect a person's identity, culture and experiences.
It is more than "cultural awareness" or "cultural competence" — instead, it focuses on how health systems respond to power imbalances, institutional discrimination and the ongoing impacts of colonisation.
The distinction matters. Cultural safety specifically addresses systemic inequalities and historical trauma, rather than simply training staff to be aware of or competent in different cultural practices. For example, historical experiences such as the forced removal of children can influence whether families feel safe engaging with health care at all.
Why trust matters
Past Australian government policies — including the forced removal of First Nations children, institutionalisation and cultural suppression — have created deep mistrust of government and health services among First Nations communities. This mistrust is reinforced by ongoing experiences of racism and discrimination in health settings, poor communication from health professionals and services that do not reflect First Nations views of health and wellbeing.
These experiences can lead people to delay, avoid or disengage from care entirely. According to the reporting, many First Nations people report that a lack of cultural safety prevents them from accessing health care. Evidence shows they are less likely than non-Indigenous Australians to use health services even when they need them, and more likely to leave emergency departments without being seen.
Closing the gap
When services are culturally safe, researchers argue, people are more likely to feel respected, understood and safe when interacting with health professionals. This makes positive care experiences more likely and encourages ongoing use of services — which over time should help narrow health outcome disparities.
Cultural safety is considered particularly important in mental health care, where distress can manifest differently across cultures. Without this understanding, services risk misdiagnosing or failing to support First Nations people effectively.
The reporting underscores that cultural safety is not a buzzword but a structural necessity for addressing entrenched health inequities tied to colonisation's ongoing effects.