This document provides background information on cultural safety and anti-Indigenous racism in Canada's health systems. It defines cultural safety and outlines key initiatives in Canada to promote it. It also compares approaches to cultural safety internationally in countries like the US, New Zealand, Australia, and in organizations like the UN and WHO. The target population is Indigenous peoples in Canada, who experience poorer health outcomes compared to non-Indigenous Canadians due to social determinants of health and racism in the healthcare system. The document provides context on these issues to inform an environmental scan of cultural safety indicators being conducted for the Canadian Institute for Health Information.

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HLTH 602B Capstone Final Report
Exploring Cultural Safety to Address An -Indigenous Racism in Canada’s Health Systems
By Group 4 – Team DAASHI
Dwar Bilimoria - d2bilimoria@uwaterloo.ca
Abinaya Ananthamurugan- a22ananthamurugan@uwaterloo.ca
Arthana Chandraraj – a72chand@uwaterloo.ca
Saadia Sarker – sisarker@uwaterloo.ca
Heather Galloway - h3galloway@uwaterloo.ca
Iman Sabra – isabra@uwaterloo.ca
Professor
Jennifer Yessis
July 21, 2023

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Table of Contents
Acknowledgements......................................................................................................................... 4
Execu ve Summary......................................................................................................................... 4
Background ..................................................................................................................................... 5
What is Cultural Safety?.............................................................................................................. 5
Cultural Safety Ini a ves in Canada ........................................................................................... 5
Comparison of Interna onal Countries and Organiza ons Measuring Cultural Safety.............. 6
United States of America (USA) .............................................................................................. 6
New Zealand ........................................................................................................................... 6
Australia .................................................................................................................................. 6
Interna onal Organiza ons .................................................................................................... 7
Target Popula on........................................................................................................................ 7
Social Determinants of Health .................................................................................................... 8
Racism Experienced in the Health System.................................................................................. 8
Gaps in Our Knowledge............................................................................................................... 8
Project Client............................................................................................................................... 9
What is an indicator and why do we use it?........................................................................... 9
Project relevance ........................................................................................................................ 9
Objec ve and goals................................................................................................................... 10
Public Health Competencies..................................................................................................... 10
Methodology................................................................................................................................. 11
Consulta on with the Librarian ................................................................................................ 11
Consulta on with the Client ..................................................................................................... 11
Environmental Scan Methodology............................................................................................ 11
Peer-reviewed Publica ons................................................................................................... 12
Grey Literature...................................................................................................................... 12
Data Abstrac on ....................................................................................................................... 13
Data Analysis............................................................................................................................. 13
Findings......................................................................................................................................... 13
Quan ta ve Findings................................................................................................................ 13
Peer Review vs. Grey Literature............................................................................................ 13
Indicators vs. Policies ............................................................................................................ 14
Indigenous-driven Sources.................................................................................................... 14

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Indicator Topics ..................................................................................................................... 14
Qualita ve Themes................................................................................................................... 14
Discussion...................................................................................................................................... 14
Recommenda ons .................................................................................................................... 14
Limita ons................................................................................................................................. 15
Challenges................................................................................................................................. 15
Next steps.................................................................................................................................. 16
Conclusion..................................................................................................................................... 16
References..................................................................................................................................... 17
Appendices.................................................................................................................................... 22
Appendix 1 – Key search terms and defini ons........................................................................ 22
Appendix 2 – Environmental Scan Checklist............................................................................. 24
Appendix 3 – Data Abstrac on Sheet Template ....................................................................... 26
Appendix 4 – Quan ta ve Table of Sources per Province & Territory ..................................... 27
Appendix 5 – Qualita ve Table of Indicator Themes................................................................ 28
Appendix 6 - Compila on of Pan-Canadian Cultural Safety Indicators and Policies for
Addressing an -Indigenous Racism in Canada’s Health Systems ............................................. 29
Appendix 7 – Group Members Roles and Responsibili es ....................................................... 37

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Acknowledgements
We acknowledge and respect the land on which the team members of this report and CIHI
offices are located. O awa is the tradi onal unceded territory of the Algonquin Na on and
Toronto is the tradi onal territory of the Wendat, the Anishinabek Na on, the Haudenosaunee
Confederacy and the Treaty land and territory of the Mississauga's of the Credit. We
acknowledge with respect the tradi onal territory of the Kanien’kehá:ka, where Montreal is
located. In Victoria, we acknowledge with respect the tradi onal territory of the Songhees,
Esquimalt and WSÁNEĆ peoples. We also wish to acknowledge the tradi onal unceded territory
of the Neutral, Anishnaabeg, and Haudenosauonee peoples, upon which the University of
Waterloo is situated. We recognize that these lands are home to many diverse First Na ons,
Inuit and Me s, and we embrace the opportunity to work more closely together.
We acknowledge all those who have experienced and con nue to experience an -Indigenous
racism. We acknowledge, with gra tude, all those who are working to eliminate it.
We acknowledge and respect the work of those before us and the ones that carry the work
forward. We wish to express our apprecia on to the authors of the informa on and resources
that we have synthesized for this report.
Execu ve Summary
This report explores cultural safety indicators to address an -Indigenous racism experienced in
the Canadian health systems through a review of the literature. Our client for this report is the
Canadian Ins tute for Health Informa on (CIHI). The environmental scan assesses the indicators
across all provinces and territories within Canada by looking at both grey literature and peer-
reviewed ar cles. The overall purpose of this report is to support CIHI in its development of
indicators, based on the literature review, to help reduce the dispropor onate health impacts
faced by Indigenous peoples, and improve cultural safety within Canada’s health systems.
Indigenous peoples comprise approximately 5% of the Canadian popula on and experience
much poorer health outcomes compared to non-Indigenous Canadians.
The findings from this scan showed that most sources were grouped under the ‘Health System
Interven on’ theme while the least number of sources were themed under ‘Health and
Wellness Outcomes’. The scan was limited by the number of publicly available indicators that
were accessible and the lack of Indigenous-driven data. Overall, this report will discuss the
methodology of the literature scan as well as the findings, which can help address an -
Indigenous racism by informing health systems and ul mately changing current prac ces.

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Background
What is Cultural Safety?
Cultural safety, a concept that primarily originated in the healthcare sector of New Zealand and
Australia (Williams, 1999), is an approach aimed at fostering an environment where individuals
from diverse cultural backgrounds feel secure, respected, and valued in healthcare se ngs. It
recognizes that culture plays a significant role in shaping people's beliefs, values, and health-
related experiences (Richardson & Williams, 2007).
This concept moves beyond cultural competence – which is mainly focused on the development
of knowledge and skills for effec ve cross-cultural interac ons. Instead, cultural safety
emphasizes power dynamics, systemic issues, and responsiveness of healthcare services to the
cultural needs and experiences of individuals and communi es (RNANT/NU, 2020).
Cultural Safety Ini a ves in Canada
Canada recognized the importance of incorpora ng cultural safety in healthcare in 2002
(University of Bri sh Columbia, 2021). It has since implemented many programs, policies, and
ini a ves to measure and promote it, mostly related to Indigenous popula ons (NCCIH, 2023).
There have been some key ini a ves leading up to the work of cultural safety in Canada. In
2007, the Truth and Reconcilia on Commission (TRC) of Canada was developed as an element
of the “Indian Residen al Schools Se lement Agreement.” It was developed to address the
legacy of residen al schools and promote reconcilia on between Indigenous and non-
Indigenous peoples. From this commission, the TRC Final Report was published in 2015, which
contained 94 calls to ac on, including specific recommenda ons related to healthcare, such as
the need for cultural competency training and the development of culturally safe healthcare
services (Crown-Indigenous Rela ons and Northern Affairs Canada, 2022).
Other Canadian organiza ons such as the Na onal Collabora ng Centre for Indigenous Health
(NCCIH), Indigenous Services Canada (ISC), Edmonton Social Planning Council (ESPC), Health
Standards Organiza on (HSO), Wabano Centre for Aboriginal Health (WCAH), and the Canadian
Founda on for Healthcare Improvement (CFHI) have developed several ini a ves and resources
to standardize cultural safety in health systems. This includes but is not limited to, educa on
and training of healthcare providers (NCCIH, 2021; ISC 2021). The ESPC offers resources for
researchers to improve the use of indigenous-specific data in health research (ESPC, 2021).
Con nuous efforts to recruit Indigenous care providers and establish rela onships with
Indigenous communi es to foster communica on between Indigenous and non-Indigenous care
providers. Standards outlining the responsibili es of healthcare providers to provide competent
culturally safe care were also developed (CFHI, 2021; HSO, 2022).

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Comparison of Interna onal Countries and Organiza ons Measuring Cultural Safety
The following sec on briefly compares how cultural safety is understood and applied in various
interna onal contexts, including the United States of America (USA), New Zealand, and
Australia, and within the frameworks of the United Na ons Declara on on the Rights of
Indigenous Peoples (UNDRIP) and the World Health Organiza on (WHO). Each of these contexts
presents a unique approach to cultural safety, reflec ng their specific societal, cultural, and
historical reali es.
United States of America (USA)
In the USA, efforts to address health dispari es have adopted terms like ‘cultural competency’
or ‘culturally responsive care’ to echo the principles of cultural safety. However, the absence of a
comprehensive na onal framework dedicated to measuring cultural safety implies that efforts
are varied and driven mostly by individual programs, policies, and ini a ves (Darroch et al.,
2018).
One ini a ve is the Na onal Standards for Culturally and Linguis cally Appropriate Services
(CLAS) in Health and Health Care, developed by the Office of Minority Health, U.S. Department
of Health and Human Services. The CLAS standards offer a framework for all healthcare
ins tu ons to best serve the na on’s diverse popula on, with the intent of advancing health
equity, improving quality, and reducing healthcare dispari es (Office of Minority Health, n.d.).
New Zealand
Cultural safety, or "Kawa Whakarurubau" in Māori, is a concept that originated in New Zealand.
The term, implying "no assault on a person‘s iden ty," underscores the importance of
healthcare services that are respec ul, safe, and responsive to diverse cultural backgrounds.
Grounded in the principles of self-determina on, social jus ce, and reconcilia on, cultural
safety is considered indispensable to effec ve healthcare in New Zealand (Williams, 1999). The
Treaty of Waitangi, a founda onal document signed in 1840, serves as a cornerstone of these
efforts. This treaty acknowledges the rights and obliga ons between the government and
Māori, the Indigenous people of New Zealand, by suppor ng the philosophy of partnership,
par cipa on, and protec on (Richardson & Williams, 2007).
Further formaliza on of the concept of cultural safety occurred in 1988, with the work led by
Māori nurses. As nurses, they recognized that health professionals are o en the first to interact
with the public in the health system. Hence, the a tude with which pa ents are treated, such
as cri cism, blame, or assump ons, may foster feelings of reluctance to seek health care or
return for health services. In 1992, nursing and midwifery organiza ons required the inclusion
of cultural safety within their training programs for registra on (Richardson & Williams, 2007).
Australia
In Australia, similar principles and ini a ves of “cultural safety” are also being adopted in the
healthcare sector. The Na onal Aboriginal and Torres Strait Islander Health Plan outlines a
strategic approach to improving health outcomes for Indigenous Australians. It emphasizes the

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importance of cultural safety, self-determina on, and partnerships with Indigenous
communi es to address health inequali es (Department of Health and Aged Care, 2021).
To complement this, the Cultural Respect Framework for Aboriginal and Torres Strait Islander
Health ensures that healthcare services uphold cultural safety. It guides healthcare professionals
on culturally respec ul prac ces, effec ve communica on, and engagement with Aboriginal
and Torres Strait Islander communi es (Australian Health Ministers Advisory Council, 2023).
Lastly, the government has also developed a monitoring framework for cultural safety in health
care for Indigenous Australians. It plans to assess indicators using three modules on how health
care is provided, accessed, and experienced by Indigenous peoples in the country (Australian
Ins tute of Health and Welfare, 2023).
Interna onal Organiza ons
Interna onal organiza ons, such as the United Na ons (UN) and the World Health Organiza on
(WHO), play an instrumental role in steering the conversa on on cultural safety, se ng global
standards, and inspiring na onal policies to address an -Indigenous racism in health systems.
The United Na ons Declara on on the Rights of Indigenous Na ons Peoples (UNDRIP), adopted
by the United Na ons General Assembly in 2007, also contributes to the global discourse on
cultural safety. This interna onal non-binding instrument affirms the collec ve and individual
rights of Indigenous peoples globally. It highlights the importance of cultural diversity and the
necessity to respect and promote Indigenous cultures as a part of coopera ve rela ons
between the State and Indigenous peoples (Department of Economic and Social Affairs, n.d.). In
2021, the Government of Canada gave Royal Assent to the UNDRIP Act, which takes legisla ve
ac on to ensure all laws in Canada are consistent with the Declara on (Department of Jus ce
Canada, 2021). Furthermore, the WHO also places significant emphasis on promo ng cultural
safety in healthcare as a key aspect of its global strategy. The WHO’s Social Determinants of
Health framework recognizes health inequi es are deeply embedded within societal structures,
including cultural norms and biases (WHO, 2010; 2022). The WHO’s Tradi onal Medicine
Strategy 2014-2023 acknowledges the role of tradi onal healing prac ces in Indigenous cultures
and seeks to integrate them into mainstream healthcare systems respec ully and safely (WHO,
2013; 2022).
Target Popula on
Indigenous popula ons in Canada make up approximately 5% (1.8 million) of the Canadian
popula on which includes and refers to First Na ons, Me s, and Inuit peoples (Sta s cs
Canada, 2022). Indigenous culture reflects diversity between each of these groups with over 70
different languages, and various cultural norms (Sta s cs Canada, 2022). Residing in both
remote and urban loca ons across the provinces and territories of Canada, Indigenous peoples
con nue to face some of the largest inequi es in health in comparison to other non-Indigenous
Canadians. Their level of health and health indicators are comparable to those living in
developing na ons. Coloniza on, racism, and discrimina on are factors influencing higher-than-
average rates of obesity, diabetes, infec ous diseases, mental health issues and more.

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Indigenous popula ons face greater nega ve impacts on health indicators and inequitable
health outcomes due to the systemic injus ces based on determinants of health and racism in
the health system.
Social Determinants of Health
Various social determinants of health nega vely impact the health status of Indigenous
popula ons and lead to greater health inequi es. In addi on to facing a dispropor onate
burden of health issues, Indigenous peoples also face the largest socioeconomic disadvantages
(Hajizadeh et al., 2018). Studies have found that Indigenous peoples have lower rates of income
and educa on levels while also having higher rates of unemployment (Hajizadeh et al., 2018).
Socioeconomic status is one of the main indicators of health as it interplays with other factors
including housing, food security, and engagement in healthy behaviours. Addi onally, higher
levels of educa on are related to higher self-repor ng of improved health outcomes (Bethune
et al., 2019). Barriers to accessing appropriate healthcare services significantly impact
Indigenous popula ons’ burden of disease. Deep-rooted colonialism and discriminatory
prac ces and policies create a culture of mistrust toward government officials and healthcare
providers. These prac ces and policies deter Indigenous peoples from seeking the healthcare
they deserve. This imbalance of power builds upon structural racism faced by an already
disadvantaged popula on.
Racism Experienced in the Health System
Structural racism affects Indigenous people at a dispropor onate rate. Reports have shown that
Indigenous women have been coerced into steriliza on and Indigenous men have been ignored
in emergency departments (Boyer, 2017). Structural racism and discriminatory prac ces have
contributed to a larger gap in health status between Indigenous popula ons and non-
Indigenous popula ons. Addi onally, western medical research aligns with colonial prac ces
and fails to consider tradi onal Indigenous knowledge and perspec ves that build inequity
(Boyer, 2017). Providing culturally competent care is key to addressing social determinants of
health and promo ng health equity amongst the Indigenous popula on.
Gaps in Our Knowledge
To understand an -Indigenous racism, cultural safety, and the health dispari es between
Indigenous and non-Indigenous peoples, it is important to understand the historical, poli cal,
social, and economic factors that have affected Indigenous people’s health. It is also important
to understand and contextualize the various social and structural determinants that impact
Indigenous health. Throughout our academic and professional careers, our team has a ained
some knowledge of Indigenous health and the importance of culturally safe health systems.
However, we recognize that our own experiences, unconscious biases, and privilege influence
what we have learned and understood about Indigenous health. We have a lot to learn about
tradi onal Indigenous values and prac ces. We also recognize that what we have learned about

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Indigenous health and cultural safety may have been taught by individuals speaking from a
se ler’s point of view and who may teach in ins tu ons that have colonial roots.
Project Client
This report has been prepared following the request from the Canadian Ins tute for Health
Informa on (CIHI). CIHI is an independent, not-for-profit organiza on that provides essen al
data and informa on on Canada’s health systems and the health of Canadians since February
1st, 1994 (CIHI, 2022; CIHI, n.d1). CIHI collaborates with the federal, provincial, and territorial
governments, and with stakeholders across Canada and around the world to collect health
informa on. Health informa on is gathered using indicators (CIHI, 2019).
What is an indicator and why do we use it?
Indicators, which are measures, provide comparable and ac onable pan-Canadian informa on
across different geographic, organiza onal, or administra ve boundaries and/or can track
progress over me (CIHI, n.d2).
Health indicators provide provinces/territories, regional health authori es and ins tu ons with
informa on to monitor the health of their popula ons and track how well their local health
systems func on (CIHI, n.d2). Furthermore, it accelerates improvements in health care, health
system performance and popula on health across Canada (CIHI, 2022). The informa on
collected by CIHI and the data generated informs policy, management, care and research,
leading to be er, more equitable health outcomes for all Canadians (CIHI, 2022).
Project relevance
Systemic racism is deeply rooted in the Canadian health system. This results in poor overall
health system performance, poor health outcomes and nega ve health experiences for
Indigenous peoples. Indigenous peoples can experience racism and discrimina on during the
provision of health services, which can have a significant impact on the quality of care they
receive. Structural racism exists in the laws, policies and prac ces of the Canadian health system
which can impede access to important resources and healthcare services and can contribute to
worsening health dispari es.
An -Indigenous racism has detrimental effects on Indigenous popula ons, but despite its
impact, there is limited data available. According to CIHI, there are no current measures of
cultural safety or racism reported on a na onal basis. There is a significant informa on gap that
needs to be addressed. This informa on can help address an -Indigenous racism by informing
health systems and ul mately changing current prac ces. Measuring and repor ng cultural
safety and racism in the health system can ensure that health providers and health systems are
held accountable for providing culturally safe and equitable care.

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In 2020, CIHI signed a Declara on of Commitment to Advance Cultural Safety and Humility. This
commitment intends to support First Na ons, Inuit, and Mé s Peoples in addressing their
health needs and data priori es. In the same year, CIHI commissioned Nohotout consul ng firm
(leads Harmony Johnson and Laurel Lemchuk-Favel) to conduct an environmental scan and
literature review of cultural safety measurement frameworks. From this work, a framework for
measuring Indigenous cultural safety in health systems was developed (CIHI, 2021). This
framework consists of four categories: Health System Interven ons, Experience of Health
System, Health System Performance, and Health and Wellness Outcomes. This comprehensive
framework looks at how culturally safe health system interven ons contribute to culturally safe
health system experiences. Posi ve health system experiences contribute to be er health
system performance and improved health outcomes. Later, in 2022, CIHI’s Indigenous Health
team conducted a scan and consulted with Indigenous and non-Indigenous organiza ons to
determine addi onal organiza ons that are working to measure cultural safety and an -
Indigenous racism in Canadian health systems. The environmental scan and literature review
findings in this report will supplement the CIHI's ongoing work of measuring cultural safety
among Indigenous popula ons in Canada’s health systems through a core set of cultural safety
indicators.
Objec ve and goals
The objec ve of this report is to inform how cultural safety can be measured to address an -
Indigenous racism in the Canadian health systems. This will be achieved by conduc ng an
environmental scan of indicators and policies across Canadian provinces and territories.
Indicators and policies will be specific to health system interven ons, pa ent experience, health
system performance, and health and wellness outcomes.
The report objec ve will aim to achieve the following goals:
1. Increase understanding of the impact of systemic racism on Indigenous people's health
and well-being in Canada.
2. Enhance knowledge of the principles and prac ces of cultural safety and their role in
reducing health dispari es and promo ng health equity for Indigenous popula ons.
3. Improve understanding of the various factors that contribute to cultural safety and an -
racism in health systems, including policy, leadership, educa on, and training.
4. Advance skills in designing and conduc ng research on cultural safety and an -
Indigenous racism in health systems, including data collec on, analysis, and
dissemina on.
5. Enhance capacity for collabora ve and culturally sensi ve work with Indigenous
communi es and organiza ons to promote health equity and support the self-
determina on of Indigenous peoples.
Public Health Competencies
The report goals will be achieved by applying the following public health competencies:

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1. Analyzing quan ta ve and qualita ve data on indicators and policies found in the scan
and interpre ng findings of health studies relevant to public health prac ce.
2. Comparing the organiza on, structure and func on of health care, public health and
regulatory systems across na onal and interna onal se ngs.
3. Discussing the means by which structural bias, social inequi es and racism undermine
health and create challenges to achieving health equity at organiza onal, community
and societal levels specific to Indigenous people.
4. Applying awareness of cultural values and prac ces to the design or implementa on of
public health policies or programs.
5. Describing the importance of cultural competence in communica ng public health
content.
Methodology
Consulta on with the Librarian
Consulta on with the University of Waterloo librarian was completed on April 27, 2023. They
guided the development of MeSH terms to build a search strategy on databases such as
PubMed and MEDLINE. They also provided helpful resources to refer to when conduc ng the
environmental scan.
Consulta on with the Client
This environmental scan also used an integrated Knowledge Transla on approach by ensuring
the stakeholder, CIHI, was engaged throughout the en re research process. A project team
member liaised with CIHI to receive feedback during the research process and project materials
were reviewed by CIHI throughout the process.
Environmental Scan Methodology
An environmental scan of published peer-reviewed ar cles and grey literature (e.g. Government
websites, organiza on’s strategic plans etc.), as informed by Charlton et al. (2021) and Godin et
al. (2015), was conducted to iden fy ac vi es and interven ons measuring cultural safety and
an -Indigenous racism in health systems in Canada. According to Charlton et al. (2021), the
most common data collec on methods for environmental scans were literature reviews of peer-
reviewed and grey literature sources.
For this scan, a list of key terms and standardized defini ons related to cultural safety and an -
Indigenous racism indicators and policies in Canada were dra ed and reviewed by the CIHI

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team. A list of key search terms used for this environmental scan and their defini ons can be
found in Appendix 1. An environmental scan checklist with details on the purpose of the scan, a
list of sources for the search, inclusion and exclusion criteria and other relevant informa on can
be found in Appendix 2. This checklist was used to ensure all team members conducted the scan
using the same methods and to ensure the rigour and validity of our findings.
Peer-reviewed Publica ons
A strategic search for peer-reviewed publica ons that looks at indicators and policies related to
cultural safety and an -Indigenous racism in healthcare systems across Canada was conducted
on Pubmed, ProQuest, Cochrane, University of Waterloo Library and Google Scholar databases
from May 1st to June 30th, 2023. The search strategy was restricted to English ar cles from 2013
onwards and u lized the list of key terms related to cultural safety and an -Indigenous racism
(Appendix 1).
The peer-reviewed publica on scan was conducted using two levels of screening. During the
first level of screening, group members conducted a search using various combina ons of key
terms to iden fy relevant tles and abstracts of sources related to the topic of interest. During
the second level of screening, the full-text ar cles of the sources found in level one screening
were reviewed to iden fy specific indicators and themes.
Inclusion and exclusion criteria
Ar cles were included if they are directly related to policies, strategies or interven ons used by
the Canadian government and non-governmental organiza ons to ensure cultural safety and
an -Indigenous racism.
Ar cles were not to be included if they:
- Did not discuss a minimum of one policy or ac vity in the organiza on related to cultural
safety or an -Indigenous racism;
- Were conference proceedings;
- Were a commentary, interview script, editorial, or news ar cle.
Grey Literature
A systema c search of Google and Proquest was conducted from May 1st to June 30th, 2023, to
iden fy key documents and policies from government and non-governmental organiza ons
engaging in ini a ves related to health and health systems. The search strategy was limited to
the first 100 results to balance comprehensiveness with feasibility and will include English
results from 2013 onwards. A snowball technique was applied to iden fy other key documents
related to cultural safety and an -Indigenous racism indicators and policies within iden fied
sources and documents recommended by CIHI. This was also included in the grey literature
findings. Other sec ons of mul page websites were also searched for relevant sources. All
sources were reviewed again to iden fy specific indicators and themes.

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Inclusion and Exclusion criteria
Key documents were iden fied as stand-alone policy documents, overarching strategic plans,
annual reports, annual reviews, evalua on reports, or other documents which described an
organiza on’s current or planned proposals to ensure cultural safety and an -Indigenous racism
in the organiza on.
Data Abstrac on
The data abstrac on template provided by CIHI was used to input the peer-reviewed and grey
literature sources. The CIHI data abstrac on template included separate tabs for each of the
provinces and territories. Each tab had columns including the type (indicator or policy),
organiza on, team, topic (ie. Pa ent experience, health system interven on etc.), resource link,
iden fying whether the indicator or policy was developed by Indigenous community members,
descrip on of the resource and any addi onal details. Refer to Appendix 3 for a template sheet
for one of the Canadian provinces. All group members par cipated in a pilot test of the data
abstrac on template for one province (Nova Sco a) using the environmental checklist and key
search terms. Following the pilot test, group members had a mee ng to discuss any
discrepancies (ie. methods for searching mul page websites) and to ensure consistency
between reviewers in the data abstrac on process. The team members used the checklist to
ensure consistency in including and excluding search results. A copy of the checklist can be
found in Appendix 2.
Data Analysis
All sources were reviewed to iden fy specific themes and indicators as iden fied by CIHI in their
report en tled, “Measuring Cultural Safety in Health Systems” (CIHI, 2021). Quan ta ve
analysis was conducted to iden fy the number of indicators and policies iden fied for each
province or territory and to iden fy the number of common themes and indicators that were
retrieved across all provinces and territories. Qualita ve analysis was conducted by iden fying
common indicators and themes across all provinces and territories in Canada.
The data were categorized into themes using the CIHI four indicators framework dimension
themes: health system interven ons, pa ent experience, health system performance and
health and wellness outcomes.
Findings
Quan ta ve Findings
Peer Review vs. Grey Literature
The literature review yielded a total of 101 resources, among which the majority were grey
literature. Specifically, 42 resources were peer-reviewed ar cles, reflec ng about 42% of the

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resources. In contrast, the remaining 58% were grey literature, highligh ng a dependence on
non-peer-reviewed sources in our analysis.
Indicators vs. Policies
Through evalua on of the indicators and policies, indicators were found to be significantly more
prevalent. Of all the documents reviewed, 77 were found to be indicators, were as 12 were
classified as policies.
Indigenous-driven Sources
Indigenous-driven sources were iden fied as those either fully led or co-led by Indigenous
groups in partnership with other organiza ons. The analysis determined that 31 ini a ves were
independently driven by Indigenous groups, and an addi onal 19 ini a ves were collabora ve
efforts with other ins tu ons.
Indicator Topics
A clear trend emerged upon analyzing the thema c distribu on of the literature. There was a
pronounced representa on of the Health System Interven ons indicator (64), followed by the
Health System Performance indicator (10) and Pa ent Experience (10). However, compara vely
fewer sources were associated with the indicator of Health and Wellness Outcomes (2).
A table summary of the quan ta ve findings can be found in Appendix 4.
Qualita ve Themes
A qualita ve analysis was performed to iden fy themes in the ini a ves iden fied through our
environmental scan. A er iden fying indicators measured by these ini a ves, they were sorted
according to the indicator categories iden fied by the Measuring Cultural Safety In Health
Systems report (CIHI, 2021). We then iden fied the five categories for which indicators were
iden fied in the scan. These five qualita ve themes are presented in Appendix 5. They include
1) human resources, 2) health services, 3) empowerment and equity, 4) accessibility, and 5)
capability.
Discussion
Recommenda ons
Among all the indicators retrieved in the scan, some were found to be common across provinces
and territories. Based on this finding, a focus should be brought to u lize these common
indicators for measuring cultural safety in Canada’s health system. These indicators should aim
to capture:
 Indigenous people are surrounded by Inuit social ac vi es and cultural programs for
families

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 Availability of culturally appropriate educa onal material
 Number of healthcare staff who have taken cultural safety training
 Percentage of recruitment of Indigenous health staff and professionals
 Number of Indigenous people among health teams
 Number of Inuit staff, count of non-Indigenous clinical advisors with long experience in
working with Indigenous peoples
 Number of health services culturally adapted and Inuit-led
 Number of Indigenous pa ents reques ng and receiving transla on services
 Availability of Departments or programs with culturally tailored resources available that
support Indigenous Peoples’ health
 Instances Indigenous clients reported experiencing racism in a health care interac on or
in a non–health system environment
 Families feel safe and at home
 Welcoming and empathe c suppor ve environment
 Percentage of pa ents receiving a therapeu c community approach
A compila on of all indicators and policies found in the scan was prepared for the client CIHI
and can be found in Appendix 6.
Limita ons
The environmental scan is limited by several factors. Firstly, all French sources were excluded
due to team members' lack of French language abili es. As such, some of the ini a ves taking
place in Quebec and other provinces with French popula ons may have been missed. Secondly,
there is a lack of Indigenous representa on on the team and the absence of important
perspec ves that would enrich the environmental scan. However, CIHI will be involving an
Indigenous advisory commi ee in the final review of the scan findings. Thirdly, the scan would
have been improved by using other data collec on methods, besides the literature search, for
example, conduc ng interviews or surveys with the organiza ons hos ng cultural safety
ini a ves. Fourth, there are many efforts and ini a ves to support cultural safety that have not
been published and were therefore not included in this scan, as per our methodology.
Developing indicators requires organiza ons to measure the impacts of their ini a ves.
Challenges
There are limited data and research driven by or led by Indigenous communi es. A significant
number of ini a ves related to cultural safety are not Indigenous-led, and some research
incorporates other visible minori es. Furthermore, a large propor on of research related to
indigenous popula ons amalgamates data from Inuit, Me s and First Na ons communi es.
There is a lack of data specific to each. This makes it challenging to iden fy indicators of cultural
safety specific to each popula on, let alone the unique circumstances of each community. We
were also challenged by the broad scope of this environmental scan. Although this large scope
introduced several limita ons, it produced a broad glance at the types of ini a ves opera ng

16. Page | 16
across Canada. Lastly, there is a lot of varia on between Canadian health systems, making it
difficult to draw comparisons and find common themes across ini a ves and research.
Next steps
Our project is part of CIHI’s indicators development process. We are currently in stage 1 of 4
which is to ini ate and evaluate the gap in our knowledge, understand what informa on exists
about the detected gap and consult with poten al experts and users to clarify what needs to be
measured, why and how o en. (CIHI, n.d3). In the next stage 2 of development, the indicator’s
methodology is developed and refined based on input from experts. Some of the ac vi es
during this stage include but are not limited to developing the indicator defini on, establishing
the inclusion/exclusion criteria for case and popula on selec on, assessing/confirming the
quality of the data, seeking expert advisory input (including clinical, research, policy and user
perspec ves), and developing a method to risk-adjust the indicator to make it comparable.
Proceeding these ac vi es, stage 3 of calcula ng is undertaken where the methodology is
applied to the full scope of data to be included. Finally, in the final stage 4 of release, the
indicator results are released according to the agreed-upon specifica ons (e.g., private, or
public) and format (e.g., data tables, visuals) with stakeholders, system leaders, and advocacy
groups. Indicators are evaluated regularly to determine which to keep repor ng on, which
should be redeveloped, and which should be re red (CIHI, n.d3).
Conclusion
Indigenous people are dispropor onately affected by racism in the health care system. Research
has shown that these experiences can contribute to adverse health outcomes and preventable
deaths. Currently, there are no measures of cultural safety and an -Indigenous racism being
reported on a na onal basis, which has made it difficult to measure and address these
problems. The objec ve of this report is to close this informa on gap and supplement the work
that is currently being done by CIHI to develop indicators that measure cultural safety and an -
Indigenous racism on a na onal basis. Measuring and repor ng cultural safety across Canadian
health care systems can help improve access to culturally safe and equitable care and close
health gaps among Indigenous and non-Indigenous Canadians.

17. Page | 17
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Appendices
Appendix 1 – Key search terms and defini ons
The following table is a lost of key terms and their defini ons use in the report.
Key terms Defini on
An -Indigenous
racism
Ongoing discrimination based on race, negative stereotyping and injustice
experienced by Indigenous Peoples in Canada (CIHI, 2023).
Cultural Safety An outcome of respectful engagement is based on recognition of the power
imbalances inherent in the health system, and the work to address these
imbalances (FNHA, 2016a). In this standard, cultural safety means Indigenous
cultural safety. A culturally safe environment for Indigenous peoples is
physically, socially, emotionally, and spiritually safe without challenge,
ignorance, or denial of an individual’s identity (Turpel-Lafond, 2020a).
Practicing cultural safety requires knowing the colonial, sociopolitical, and
historical events that trigger the health disparities encountered by Indigenous
peoples and perpetuate and maintain ongoing racism and unequal treatment
(Allan & Smylie, 2015).
First Na ons First Na ons people are Indigenous Peoples who include Status and Non-Status
Indians. There are more than 630 First Na on communi es in Canada, which
represent more than 50 Na ons and 50 Indigenous languages (Government of
Canada, 2021).
Health and wellness
outcomes
Overall goals of health systems and include health and well-being of both
individuals and popula ons (CIHI, 2023).
Health System
Interven ons
Ac ons undertaken by organiza ons or health systems to enhance cultural
safety.
Health system
performance
Capacity of health systems to provide care and the quality of that care (CIHI,
2021).
Indicators Measures designed to summarize informa on about priority topics related to
popula on health or health system performance (CIHI, n.d2
).
Indigenous Peoples Indigenous Peoples is a collec ve name for those who were originally from
North America and their descendants. In Canada, there are three main groups
of Indigenous Peoples including the First Na ons, Inuit and Mé s who all have
unique histories languages and cultures (Government of Canada, 2022).
Inuit Inuit are the Indigenous Peoples of the Arc c. About 64,235 Inuit people live in
Canada (Government of Canada, 2021)
Mé s Mé s are another group of Indigenous Peoples in Canada. About 587,545 have
self-iden fied themselves as Mé s (Government of Canada, 2021).
Pa ent Experience Pa ents’ experience with individual health service processes.
Policy Law, regula on, procedure or administra ve ac on, incen ve or voluntary
prac ce of government and other ins tu ons can o en be reflected in resource
alloca on (CDC, 2015).

23. Page | 23
The following is a list for search terms used in the scan:
 Cultural Safety OR Cultural Humility
 Healthcare OR Health System
 Injus ce OR racism OR “social
jus ce”
 Indigenous OR Na ve Or Aboriginal
OR First Na ons OR Me s OR Inuit
 “An racism” OR “An -racism”
 Canada OR Bri sh-Columbia OR
Alberta OR Saskatchewan OR
Manitoba OR Ontario OR Quebec OR
New-Brunswick OR Nova-Sco a OR
Prince-Edwards Islan OR
Newfoundland and Labrador OR
Yukon OR Northwest Territories OR
Nunavut
 “An -racism” AND “Indigenous”
 Indicator AND Policy
 Cultural safety measurement
 Cultural safety repor ng
 Cultural safety prac ces
 Cultural safety framework
 Cultural safety guidelines
 An -Indigenous racism
measurement
 Healthcare organiza on(s)
 Healthcare provider(s)
 Impact(s)
 Capability assessment
 Indigenous
 An -oppression
 Indigenous-specific racism
 Cultural safety indicators
 Indigenous-specific racism data
 Human resource prac ces
 Cultural safety improvement
 Cultural safety interven ons
 Cultural safety measurement
framework
 Cultural safety standards
 Healthcare service(s)
 Health service organiza on(s)
 Implementa on experience
 Progress
 Audit feedback
 First Na ons, Inuit and Me s
 Decolonize/decolonizing approaches
 Racism Indicators
 Racism data
 Cultural safety policy

24. Page | 24
Appendix 2 – Environmental Scan Checklist
Important
Critiques
Checklist to Consider Were the
criteria met?
Comments:
Yes/No
Source Overview
Source 1. Where is the literature from?
 Peer-reviewed
 Grey literature
2. Which databases was the peer-reviewed article search conducted?
 Pubmed
 ProQuest
 Cochrane
 uWaterloo Library
 Google Scholar
 Other: _________
3. Where was the grey literature search conducted?
 Google
 Proquest
 Other: ________
Inclusion/Exclusion Criteria
Inclusion
Criteria
Peer-review articles to be included in scan if they are:
 Related to cultural safety and anti-indigenous racism;
 Involve policies, strategies, or interventions used by Canadian
governments and NGOs
 English articles published from 2013 and onwards
Grey literature to be included in the scan if they are:
 Documents which describe an organization’s current or proposed plans
to ensure cultural safety and anti-indigenous racism in the organization
o Documents may be stand-alone policy documents, overarching
strategic plans, annual reports and reviews, evaluation
reports, or others.
 Search limited to the first 100 results
Exclusion
Criteria
Peer-review articles to be excluded from scan if they:
 Do not discuss a minimum of one policy or activity in the organization
related to cultural safety or anti-indigenous racism.
 Are conference proceedings.
 Are a commentary, interview script, editorial, or news article.
 Explore individual cultural safety or anti-indigenous racism policy
activities at a study level and are not connected to the implementation
of the policy at the organizational level.

25. Page | 25
Grey literature to be excluded from the scan if they:
 Vague policy lacking clear documentation
Literature Content Analysis
Indicators Indicators related to measuring cultural safety and anti-indigenous racism in
health systems in Canada (can refer to CIHI measuring cultural safety in health
systems addendum en document for more details):
 Health System Intervention indicators
 Experience if health system indicators
 Health system performance indicators
 Health and wellness outcomes indicators
Policy Overarching policy described within the peer-reviewed/grey literature

26. Page | 26
Appendix 3 – Data Abstrac on Sheet Template

27. Page | 27
Appendix 4 – Quan ta ve Table of Sources per Province & Territory
Provinces/Territories # Peer-
Review
Articles
# of Grey
Literature
# of
Indicators
# of
Policies
# of
Indigenous-led
resources
# of
Indigenous co-
led resources
Patient
Experience
Health
System
Performance
Health &
Wellness
Outcomes
Health
System
Intervention
British Columbia 0 4 3 1 1 3 0 0 1 1
Alberta 3 3 5 0 1 1 0 1 0 5
Saskatchewan 2 7 9 0 2 2 0 1 0 5
Manitoba 4 4 7 0 2 0 0 0 0 5
Ontario 13 18 29 2 17 0 5 0 0 26
Quebec 4 0 4 0 0 3 3 0 1 0
Newfoundland &
Labrador 0 3 0 3 0 0 0 2 0 1
New Brunswick 1 4 5 0 3 0 1 0 0 4
Nova Scotia 0 2 1 1 1 0 0 1 0 1
Prince Edward Island 0 2 2 0 0 0 0 1 0 1
Yukon 0 4 3 1 1 2 0 0 0 4
Nunavut 2 3 4 1 1 2 0 1 0 4
Northwest
Territories 4 2 5 0 0 4 1 3 0 2
Canada wide 9 3 0 3 2 2 0 0 0 5
Total 42 59 77 12 31 19 10 10 2 64

28. Page | 28
Appendix 5 – Qualita ve Table of Indicator Themes
Framework
Category
Qualita ve
Themes
Example Indicators
Health System
Interven on
Human Resources  Staff training and knowledge
 Recruitment of Indigenous staff
 Indigenous representa on among health
teams
 Healthcare staff in rural communi es
Health Services  Availability of language transla on services
 Tailoring of healthcare services to
Indigenous pa ents
 Language educa on for healthcare
providers
 Number of health services led by
indigenous groups
Pa ent
Experience of
Health Systems
Empowerment and
Equity
 Families are empowered and engaged in
care
 Parents as oral health champions
 Indigenous pa ents feel that the health
providers wanted to work with them
 Indigenous clients feel equal to their
healthcare provider
Health System
Performance
Accessible  Co-loca on of different types of health
services
 percentage of pa ents receiving a
therapeu c community approach
 Accessibility of healthcare services for
Indigenous people
 Accessibility of maternal care for pregnant
Indigenous women
Capable  Professional competencies in providing
quality treatments.
 Number of Indigenous students enrolled in
and comple ng health-related courses.
 Inuit residents paired with Inuit mentors.

29. Page | 29
Appendix 6 - Compila on of Pan-Canadian Cultural Safety Indicators and Policies for
Addressing an -Indigenous Racism in Canada’s Health Systems
This document outlines a list of cultural safety indicators and policies applied in Canada’s health
systems across provinces and territories.
The indicators are listed for each category and theme present in CIHI’s framework for measuring
Indigenous cultural safety in health systems (CIHI, 2021) , which consist of Health System
Interven ons, Experience of Health System, Health System Performance, and Health and
Wellness Outcomes. The indicators were drawn from the literature through an environmental
scan looking at indicators between 2013-2023.
Cultural Safety Indicators
Health System Interven ons
Ac ons undertaken by organiza ons or health systems to enhance cultural
safety.
INDIGENOUS PERSPECTIVES & PRACTICES
 Ea ng healthy, fresh food and
tradi onal country foods
 Tradi onal Indigenous prac ces are
integrated in health care services
 Being surrounded by Inuit social
ac vi es and cultural programs for
families
 Access to culturally-based and land-
based programming and mental
health services
LEADERSHIP, GOVERNANCE & ADMINISTRATION
 Percentage of Indigenous
representa on on governing board
 Collabora on with Indigenous
advisory boards to guide research and
prac ce
PARTNERSHIP, COMMUNICATIONS & ENGAGEMENT
 Culturally tailored tools and resources
informed by engagement with
Indigenous clients and communi es
 Partnerships with Indigenous
communi es and organiza ons
 Co-developing public health programs
with Indigenous groups
 Organiza onal policies informed by
engagement with Indigenous clients
and communi es
 Collabora on between government
authori es, non-governmental
organiza ons and Indigenous groups

30. Page | 30
PLANNING
 Presence of a strategic plan that
addresses cultural safety, Indigenous
health and equity for Indigenous
popula ons.
 The use of decoloniza on strategies in
program planning to ensure
Indigenous knowledge is incorporated
in program design
 Culturally appropriate educa onal
material
 Incorpora ng various knowledge
types in program planning and design,
including: Indigenous, tradi onal,
local, lived experience, prac ce-
based, and academic
POLICY & PROTOCOL
 Policies and prac ces that address
cultural safety and an -racism
HUMAN RESOURCES
 Number of healthcare staff who have
taken cultural safety training.
 Presence of healthcare staff in remote
or rural areas
 Social workers and mental health
workers with an understanding and
respect of Indigenous history and
culture
 Social workers and mental health
workers with training in trauma and
recovery connected to residen al
school experiences
 Availability of mental health workers
via Telehealth to provide services in
remote communi es
 Number of non-residents delivering
services (due to community rela ons
and confiden ality)
 Percentage of recruitment of
Indigenous health staff and
professionals
 Numbers of Indigenous people among
health teams
 Number of Inuit staff, count of non-
Indigenous clinical advisors with long
experience in working with
Indigenous peoples
HEALTH SERVICES
 Number of health services culturally
adapted and Inuit-led
 U liza on of simple language in
healthcare encounters
 Speaking and interpre ng the
Inuk tut language
 Hearing Indigenous language during
the provision of care.
 Health professionals’ ignorance of the
A kamekw language
 Use of medical jargon by health
professionals
 Health professionals’ lack of
knowledge of A kamekw social and
communica on codes
 Availability of interpreta on service
 Whether healthcare services are
culturally tailored to Indigenous
pa ents

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 Educa on for health professionals
regarding basic terms in the
A kamekw language
 Departments or programs with
culturally tailored resources available
that support Indigenous Peoples’
health
 Number of Indigenous pa ents
reques ng and receiving transla on
services
 Availability of appropriate services via
Telehealth for remote and rural
communi es
Pa ent Experience of Health System
Pa ent’s experience with individual health service processes.
RESPECT
 Exploring and valida ng pa ent
preferences, expecta ons, values
 Whether Indigenous clients that felt
the organiza on respects Indigenous
Peoples, their culture and tradi ons
EMPOWERMENT & EQUITY
 Shared treatment decision making  Apprecia on of public health
programmes
 Families are empowered and engaged
in care
 Parents as oral health promo on
champions
 Whether Indigenous clients felt equal
to their health care provider/staff
 Family is present and suppor ve
 Whether Indigenous pa ents felt that
the health providers wanted to work
with them to provide safe, quality
care
SAFETY
 Instances Indigenous clients reported
experiencing racism in a health care
interac on or in a non–health system
environment
 Welcoming and empathe c
suppor ve environment
 Whether Indigenous clients felt a
sense of cultural safety
 Whether Indigenous clients felt
shame or judgment by providers and
staff
 Families feel safe and at home
IDENTITY
 Indigenous clients reported that their
health care providers were open to
hearing about tradi onal medicine

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RECIPROCITY
 Whether organiza ons are
knowledgeable about the history of
Indigenous Peoples
 Whether Indigenous clients feel
listened to by their healthcare
providers
HEALTH SYSTEM UTILIZATION
 Whether Indigenous clients were
prevented from accessing the health
care needed
Health System Performance
Capacity of the health system to provide care and the quality of that care.
EFFECTIVE, APPROPRIATE & EFFICIENT
 Level of coordina on of care and
availability of human resources
RESPONSIVE
 Percentage of Indigenous people with
mental health–related problems
managed by general prac oners
 Number of Indigenous people who
received all the health care that was
needed
 Percentage of Indigenous people
repor ng barriers to receiving health
care
ACCESSIBLE
 Co-loca on of different types of
health services: e.g. primary care with
dental care
 Percentage of pa ents receiving a
therapeu c community approach
 Number of accommoda ons were
made to facilitate admission and
integra on of Inuit in the residen al
programs and/or to improve their
reten on and program comple on.
 Accessibility of maternal care for
pregnant Indigenous women or
mothers
 Transla on from French to English
 Accessibility of healthcare services for
Indigenous people compared to the
general popula on.
CONTINUOUS
 Interprofessional collabora on with
referral mechanisms
 Number of special projects to support
Inuit and improve con nuity of care

33. Page | 33
CAPABLE
 Professional competencies in
providing quality treatments
 Educa on for health professionals
regarding A kamekw culture, values
and health prac ces
 Staff is competent and knowledgeable
about Inuit health and culture
 Form of training, support, and clinical
supervision of workers regarding the
Inuits’ content or cultural sensi vity
 Inuit residents paired with Inuit
mentors (i.e., more advanced
residents in the program) and with
staff members who had more
experience working with Inuit.
 Number of Indigenous students
enrolled in and comple ng health-
related courses.
SUSTAINABLE
 Government expenditures on
Indigenous-specific health programs
over me
 How many Indigenous healthcare
providers are prac cing within remote
indigenous communi es
Health And Wellness Outcomes
Overall goals of health systems, such as popula on health and well-being.
LIFE EXPECTANCY & WELL-BEING
 Health outcomes related to Kidney
health in remote Indigenous
communi es
HEALTH CONDITIONS
 Prevalence of Kidney disease in
remote northern Indigenous
communi es
 Prevalence of mental health and
substance use disorders among
Indigenous popula ons
HUMAN FUNCTION AND BEHAVIOUR
 Percentage of people with ac vity
limita on due to mental health
reasons

34. Page | 34
Cultural Safety Policies
Resource Topic Summary
Policy paper our
commitment to cultural
safety (CPSNL, 2012)
College of Physicians and
Surgeons of Newfoundland and
Labrador
Policy paper by the College of Physicians and Surgeons of Newfoundland and
Labrador as their commitment to cultural safety as it pertains to providing
culturally safe health care to Indigenous patients in Newfoundland and Labrador.
STANDARDS FOR
CULTURAL COMPETENCE
IN SOCIAL WORK
PRACTICE (NLASW, 2016)
Standards for cultural
competence in social work
prac ce
The purpose of these standards is to:
a) Inform social workers, employers and the public on best prac ce standards for
social
work prac ce with diverse cultures.
b) Increase awareness of the prac ce considera ons, ethical responsibili es and
con nuing professional educa on guidelines for fostering culturally competent
prac ce.
c) Provide a framework from which social workers can reflect on and enhance skills,
knowledge and abili es to work with individuals, families, groups and communi es
from
diverse cultures.
d) Acknowledge the role of social workers in engaging and partnering with diverse
cultures
and the promo on of social jus ce.
e) Promote cultural competence as an integral component of social work prac ce.
LONG TERM CARE FACILITIES
IN NEWFOUNDLAND AND
LABRADOR
OPERATIONAL STANDARDS
(2005)
Standard related to Ethnicity,
Cultural Expression and Beliefs
Services and requirements of a resident of ethnic background are provided with
respect and dignity in accordance with his/her ethnic customs and cultural
preferences.
OUTCOME The resident is provided with services in accordance with his/her ethnic
and cultural expressions and beliefs.
PERFORMANCE MEASURES
11.1 There are wri en policies and procedures governing the provision of services
to a resident as a part of his/her preferences or dictates of one’s ethnic and cultural
background.
11.2 Each resident receives support to maintain desired cultural customs,
observances, prac ces and affilia ons.

35. Page | 35
11.3 Each resident is supported in maintaining desired linkages with his/her
cultural community.
11.4 Resources are obtained to aid a non-English-speaking resident to
communicate with others, and to assist staff to communicate with that resident.
11.5 Ethnicity, cultural expression and beliefs are monitored and evaluated as part
of the con nuous quality improvement plan.
University Health Network
Policy & Procedure Manual
Administra ve: An -Racism
& An -Black Racism
(University Health Network,
2021)
Unity Health Network’s An -
Racism policy for Black,
Indigenous, People of Colour
(BIPOC)
This policy aims to understand the histories of systemic racism and discrimina on
that result in unequal access for Black, Indigenous, People of Colour (BIPOC).
Indigenous Health Strategy
(Sick Kids, n.d)
Smudging Ceremony Policy and
Land Acknowledgement Policy
Two policies have been put into place through the Indigenous Health Strategy at
SickKids Hospital. A policy that facilitates open-flame smudging ceremonies in
pa ent rooms and a policy to adopt acknowledgements have been put into place.
Declaration on the Rights of
Indigenous Peoples Act -
Province of British Columbia
(Government of British-
Columbia, 2019)
The Declaration on the Rights of
Indigenous Peoples Act
(Declaration Act) establishes the
United Nations Declaration on
the Rights of Indigenous
Peoples (UN Declaration) as the
Province’s framework for
reconciliation, as called for by
the Truth and Reconciliation
Commission’s Calls to Action.
The Declaration Act aims to create a path forward that respects the human rights
of Indigenous Peoples while introducing better transparency and predictability in
the work done together. There are four key areas of the legislation:
 Section 3 mandates the government to bring provincial laws into
alignment with the UN Declaration,
 Section 4 requires the Province to develop and implement an action plan,
in consultation and cooperation with Indigenous Peoples, to meet the
objectives of the UN Declaration,
 Section 5 requires regular reporting to the legislature to monitor progress
on the alignment of laws and implementation of the action plan, including
tabling annual reports by June 30 of each year, and
 Sections 6 and 7 allow for flexibility for the Province to enter into
agreements with a broader range of Indigenous governments and to
exercise statutory decision-making authority together.
Yukon Medical Council
(2023)
Yukon First Nations 101
Continuing Education
Requirement.
The Yukon First Nations 101 program provides an understanding of six key aspects
of Yukon First Nations: history, heritage and culture, governance, residential
schools, contemporary topics and world views. All physicians must complete the
Yukon First Nations 101 course to obtain a medical license in the Yukon. A

36. Page | 36
unanimous motion was passed by the membership of Yukon Medical Association
at the 2019 Annual General Meeting to make this training mandatory for licensure.
Nova Scotia Department of
Health and Wellness,
Community Health Boards,
IWK (2011)
Cultural Competence Guidelines
for the Delivery of Primary
Health Care in Nova Scotia.
The document lists 15 guidelines that the Nova Scotia Department of Health &
Wellness, DHAs, CHBs, and
the IWK, should follow.
Registered Nurses
Association of the Northwest
Territories and Nunavut
(RNANT/NU, 2020)
CULTURAL SAFETY POSITION
STATEMENT
Position statement that contains which reiterates its stance in promoting cultural
safety for peoples of the Northwest Territories (NT) and Nunavut (NU).
 Regulations related to code of ethics:
- Promoting and Respecting Informed Decision Making
- Honouring Dignity
-Promoting Justice
 Truth & Reconciliation Commission - Calls to Action (2015)
- 23 (iii) - all levels of government to provide cultural competency training for all
health-care professionals.
- 24 - all nursing schools in Canada to require students to take a course that
requires skills-based training in intercultural competency, conflict resolution,
human rights and anti-racism.
- 53 (iii) - development and implementation of a multi-year National Action Plan
for Reconciliation, which includes research and policy development, public
education programs, and resources. (iv) - promote public dialogue, public/private
partnerships, and public initiatives for reconciliation.
 Article 15 1 - Indigenous peoples have the right to the dignity and diversity
of their cultures, traditions, histories, and aspirations which shall be
appropriately reflected in education and public information.
Government of Canada
(2009)
Truth and Reconcilliation
Comission of Canada
Agreement to facilitate reconciliation among former students, their families, their
communities and all Canadians directly or indirectly affected by the legacy of
the Indian Residential Schools system.

37. Page | 37
Appendix 7 – Group Members Roles and Responsibili es
Name Roles and Responsibilities
Iman Sabra  Facilitated and attended all team meetings
 Prepared team meeting agendas and took meeting minutes.
 Communicated with the client
 Supported with the writing of group final report specific to:
o Background on who is the client, what is an indicator and how we use it,
project relevance to the current work at CIHI, and objective and goals of the
report.
o Searched for indicators and policies specific to the provinces of Quebec,
New Found Land and Labrador, and Nova Scotia.
o Wrote the sections on recommendations, limitations of our scan,
challenges/barriers to measuring cultural safety in Canada, and next steps.
 Completed client summary report of findings for the 3 provinces assigned.
 Developed class report template, presentation template, and CIHI report
template.
 Contributed to developing the presentation slide deck
 Participated in the final review and editing of all material
Heather Galloway  Attended all general meetings
 Generated a pebble-plus group portfolio and share it with group members and
the class
 Supported with writing and editing of group final report specific to:
o Summarizing previous CIHI report on current efforts to achieve
Indigenous cultural safety in Canadian health systems
o Search for indicators and policies specific to the provinces of Manitoba
and Saskatchewan
o Completed client summary report of findings for assigned two provinces
o Identify limitations and challenges of our literature review and
environmental scan
 Contributed to the development of our presentation
 Completed qualitative analysis of themes identified within the environmental
scan, and summarized this within the final report.
Dwarti Bilimoria  Attended all general meetings
 Supported with writing and editing specifically related to:
o Target population overview (Background on Indigenous Populations including
determinants of health, racism experienced in the health system)
o Appendix
o Search for indicators and policies specific to the provinces of Alberta and British
Columbia
o Completed client summary report of findings for the 2 assigned provinces
o Final editing of the Excel report of all findings to be given to CIHI
 Contributed to the development of the presentation slide deck
 Editing and final review of the final report and all submission materials
Arthana Chandraraj  Attended all general meetings
 Supported with writing and editing the final report, specifically:
o Drafted the environmental scan methodology for peer-reviewed publications and
grey literature and inclusion and exclusion criteria for the scan
o Drafted the key term definitions for the environmental scan methodology
o Search for policies and indicators related to Ontario and New Brunswick
o Completed client summary report of findings for Ontario and New Brunswick

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o Contributee to writing and editing other sections such as results,
recommendations, limitations etc.
 Contributed to developing the presentation
Saadia Sarker  Attended all general meetings
 Supported with writing and editing the final report, specifically related to:
o Developing the environmental scan checklist
o Cultural safety overview section, with a focus on comparison with other
international countries/organizations that measure cultural safety
o Search for indicators and policies specific to the provinces/territories of
Nunavut and Nova Scotia
o Contributed to writing the sections on recommendations, limitations of our
scan, challenges/barriers to measuring cultural safety in Canada
 Contributed to developing the presentation slide deck
Abinaya
Ananthamurugan
 Attended all general meetings
 Supported with writing and editing the final report, specifically related to:
 Gaps in knowledge (focusing on the impact of our scan and its relevance to CIHI,
current indicators that measure cultural safety in Canada’s healthcare system)
 Search for indicators and policies specific to the territories of Yukon and
Northwest Territories
 Completed client summary report of findings for the territories
 Participated in the final review and editing of all material