Indigenous Cultural Safety, Cultural Humility and Anti-Racism

Indigenous Cultural Safety,
Cultural Humility and Anti-Racism 

Introduction to Indigenous Cultural Safety, Cultural Humility and Anti-Racism

Systemic racism and intolerance toward Indigenous worldviews and traditional approaches to health, as well as the enduring legacy of colonialism all present as persistent barriers and poorer health outcomes for Indigenous people when accessing health services in British Columbia and Canada.  

The College believes that cultural safety and humility are vital for the provision of fair and equitable health services, as well as the creation of a healthcare environment free of racism and discrimination, where individuals feel safe and respected.

As one of the most accessible health care professions, BC’s pharmacy professionals have a duty to protect the public by acknowledging the harmful impacts of Indigenous-specific racism within our health system and working to incorporate Cultural Safety, Cultural Humility and Anti-Racism within their individual practices.

We call on all health professionals to practice vigilant cultural humility and safety. To learn about and understand the impacts of residential schools on First Nations Communities in Canada; to acknowledge and reflect on the social issues faced by Indigenous Peoples; and to understand the historical contexts from which these issues originate. 

PRACTICE STANDARD - INDIGENOUS CULTURAL SAFETY, CULTURAL HUMILITY AND ANTI-RACISM 

Eagle flies up so high it looks down and sees all of humanity as one, cannot see our various nations or small differences, Eagle just sees us as one people. When we hold a feather, we remind ourselves of that perspective, and can speak with respect and honesty to each other like the family that we all are.

– Aaron Nelson-Moody / Tawx’sin Yexwulla, Artist

The College of Pharmacists of BC, alongside ten other BC health profession regulator colleges, has adopted the Indigenous Cultural Safety, Humility & Anti-racism Practice Standard. The Standard sets clear expectations for BC health professionals on the provision of culturally safe and anti-racist care for Indigenous patients and clients.  

The Indigenous Cultural Safety, Humility & Anti-Racism Practice Standard was approved by the College Board on September 23, 2022. 

The Colleges that have adopted the Indigenous Cultural Safety, Humility and Anti-Racism Practice Standard regulate more than 28,000 health professionals. The Standard supports the Colleges’ shared goals of eliminating Indigenous-specific racism and fostering culturally safe practice in BC’s health care system.  

The development of this Standard comes in response to Dr. Mary Ellen Turpel-Lafond’s December 2020 report: In Plain Sight: Addressing Indigenous-specific Racism and Discrimination in B.C. Health Care.  

The report found that “requirements for cultural safety and humility and addressing Indigenous-specific racism are not adequately embedded throughout policy and standards,” and goes on to recommend the implementation of standards, definitions and expectations requiring health services to be free from all forms of racism and discrimination against Indigenous peoples.  

The 11 Colleges agreed to build on the significant work done by BCCNM and CPSBC and adapt and implement the standard as is, with only minor customization changes. This collaborative approach is intended to promote consistency by ensuring that all regulated health professionals in BC are subject to the same requirements and expectations for providing culturally safe and anti-racist care, as recommended in the In Plain Sight report.   

This collaborative work was guided by Sulksun (Shane Pointe), proud member of the Coast Salish Nation, Musqueam Indian Band and Knowledge Keeper to all and Joe Gallagher (k’wunəmɛn), Tla’amin Nation, Principal at Qoqoq Consulting.  

Words from the Knowledge Keeper regarding this work

“I heard the words of the Hon. Dr. M.E. Turpel-Lafond as did you the Luminaries of the universe of Health here in British Columbia.  I have also witnessed you launch your collective canoe into an ocean of troubled waters with both Courage and Strength of heart, to bring into balance health care equity for the 150,000 First Nations People and the Citizens of British Columbia who live on our Ancestral Lands.  You are doing this by addressing and alleviating the systemic racism within the Health Care System.

I am proud of you for your industry in this most important history making task and look forward to supporting into the future.”

Sulksun (Shane Pointe)
Musqueam Nation

The adoption of the standard was commemorated with a blanketing ceremony on September 30, 2022, as part of Orange Shirt Day and the National Day for Truth and Reconciliation.  

1. Self-Reflective Practice (It Starts with Me)  

Cultural humility begins with a self-examination of the pharmacy professional’s values, assumptions, beliefs, and privileges embedded in their own knowledge and practice, and consideration of how this may impact the therapeutic relationship with Indigenous clients. Cultural humility promotes relationships based on respect, open and effective dialogue, and mutual decision-making.

Principles
Pharmacy professionals:

1. Reflect on, identify, and do not act on any stereotypes or assumptions they may hold about Indigenous Peoples.

2. Reflect on how their privileges, biases, values, belief structures, behaviours, and positions of power may impact the therapeutic relationship with Indigenous clients.

3. Evaluate and seek feedback on their own behaviour towards Indigenous Peoples.

2. Building Knowledge Through Education

Pharmacy professionals continually seek to improve their ability to provide culturally safe care for Indigenous clients.

Principles
Pharmacy professionals:

1. Undertake ongoing education on Indigenous health care, determinants of health, cultural safety, cultural humility, and anti-racism.

2. Learn about the negative impact of Indigenous-specific racism on Indigenous clients accessing the health care system, and its disproportionate impact on Indigenous women and girls and two-spirit, queer, and trans Indigenous Peoples.

3. Learn about the historical and current impacts of colonialism on Indigenous Peoples and how this may impact their health care experiences.

4. Learn about the Indigenous communities located in the areas where they work, recognizing that languages, histories, heritage, cultural practices, and systems of knowledge may differ between Indigenous communities.

3. Anti-Racist Practice (Taking Action)

Pharmacy professionals take active steps to identify, address, prevent, and eliminate Indigenous- specific racism.

Principles
Pharmacy professionals:

1. Take appropriate action when they observe others acting in a racist or discriminatory manner towards Indigenous Peoples by:
   

   1. Helping colleagues to identify and eliminate racist attitudes, language, or behaviour.

   2. Supporting clients, colleagues and others who experience and/or report acts of racism.

   3. Reporting acts of racism to leadership and/or the relevant health regulatory college.

4. Creating Safe Health Care Experiences

Pharmacy professionals facilitate safe health care experiences where Indigenous clients’ physical, mental/emotional, spiritual, and cultural needs can be met.

Principles
Pharmacy professionals:

1. Treat clients with respect and empathy by:

   1. Acknowledging the client’s cultural identity.

   2. Listening to and seeking to understand the client’s lived experiences.

   3. Treating clients and their families with compassion.

   4. Being open to learning from the client and others.

2. Care for a client holistically, considering their physical, mental/emotional, spiritual, and cultural needs.

3.  Acknowledge and incorporate into the plan of care Indigenous cultural rights, values, and practices, including ceremonies and protocols related to illness, birth, and death, where able.

4. Facilitate the involvement of the client’s family and others (e.g., community and Elders, Indigenous cultural navigators, and interpreters) as needed and requested.

5. Person-Led Care (Relational Care)

Pharmacy professionals work collaboratively with Indigenous clients to meet the client’s health and wellness goals.

Principles
Pharmacy professionals:

1. Respectfully learn about the client and the reasons the client has sought health care services.

2. Engage with clients and their identified supports to identify, understand, and address the client’s health and wellness goals.

3. Actively support the client’s right to decide on their course of care.

4. Communicate effectively with clients by:

   1. Listening to and seeking to understand the client’s lived experiences.

   2. Providing clear information about the health care options available, including information about what the client may experience during the health care encounter.

   3. Ensuring information is communicated in a way that the client can understand.

6. Strengths-Based and Trauma-Informed Practice (Looking Below the Surface)

Pharmacy professionals have knowledge about different types of trauma and their impact on Indigenous clients, including how intergenerational and historical trauma affects many Indigenous Peoples during health care experiences. Pharmacy professionals focus on the resilience and strength the client brings to the health care encounter.

Principles
Pharmacy professionals:

1. Work with the client to incorporate their personal strengths that will support the achievement of their health and wellness goals.

2. Recognize the potential for trauma (personal or intergenerational) in a client’s life and adapt their approach to be thoughtful and respectful of this, including seeking permission before engaging in assessments or treatments.

3. Recognize that colonialism and trauma may affect how clients view, access, and interact with the health care system.

4. Recognize that Indigenous women, girls, two-spirit, queer, and trans Indigenous Peoples are disproportionately impacted by Indigenous-specific racism in the health care system and consider the impact gender-specific trauma may have on the client.

The College acknowledges that we are still very much at the beginning of our journey toward dismantling Indigenous-specific racism within our healthcare system. The implementation of this practice standard is by no means a conclusion. Moving forward, the College will continue to engage with Indigenous peoples to ensure that this Standard is adequately and effectively addressing the challenges they face when accessing pharmacy and other health services.

The College’s Cultural Safety and Humility Journey  

Declaration of Cultural Safety and Humility in Health Services Delivery for First Nations and Aboriginal People in British Columbia.  

On March 1, 2017, former College Registrar, Bob Nakagawa, pledged the College’s commitment to improving BC pharmacy professionals’ work with Indigenous Peoples by signing the “Declaration of Cultural Safety and Humility in Health Services Delivery for First Nations and Aboriginal Peoples in BC.”  

Signing this declaration committed the College and other health regulators to report on progress through annual reports, and outlining strategic activities and accountability measures that demonstrate how they are meeting their commitments to cultural safety.  

This Declaration of Commitment reflected the high priority placed on advancing cultural safety and humility for Indigenous people among regulated health professionals by committing the Colleges to actions and processes intended to embed culturally safe practices within all levels of health professional regulation.

In order to fulfill this commitment the College developed a comprehensive strategy focused on improving BC pharmacy professionals’ work with Indigenous clients and communities.  

In Plain Sight: Addressing Indigenous-Specific Racism and Discrimination in BC Health Care  

Released in December 2020, the In Plain Sight: Addressing Indigenous-specific Racism and Discrimination in BC Health Care Report found significant evidence that the majority of Indigenous Peoples in BC have encountered racism and discrimination within our healthcare system, both as patients and as health care workers. Indigenous Peoples described unacceptable personal interactions and poorer quality of care, as well as feeling unsafe when accessing health care services and interacting with health providers.

(Read the Full Report)

This runs in direct opposition to our mandate which is to ensure that all British Columbians are provided with safe and ethical pharmacy care.  

In Plain Sight places added urgency on the College to continue to work toward fulfilling its commitment to Cultural Safety and Humility for First Nations and Aboriginal peoples within our healthcare system.  

The findings within the report reinforce the need to create a healthcare environment free of racism and discrimination, that ensures Indigenous people in BC can access and receive safe and equitable health care services.  

The report also provides a number of recommendations that the College continues to incorporate into the way we regulate pharmacy professionals and serve Indigenous peoples. 

Apologizing for Our Actions  

In response to the In Plain Sight Report, in May 2021, working alongside the College of Physicians and Surgeons of BC (CPSBC), the College of Dental Surgeons of BC (CDSBC), and the British Columbia College of Nurses and Midwives (BCCNM), the College issued an apology to the Indigenous peoples and communities who have experienced racism while engaging with us and the health professionals we regulate.  

• Racism in Healthcare: An Apology to Indigenous People and a Pledge to be Anti-Racist

As part of this apology, the Colleges pledged to take specific actions both within our organizations, and as partners in the broader health landscape, to address and dismantle the Indigenous-specific racism that exists within our health care system. 

As leaders, we will: 

• Apologize to Indigenous people for the harms suffered in a racist health-care system, of which we are a part 
• Be anti-racist leaders who will foster a speak-up culture, where stereotypes, discrimination and racism are called out and eliminated 
• Establish clear accountabilities for cultural safety and humility within our leadership teams 

As health regulatory colleges, we will: 

• Draw on Indigenous Knowledge Keepers and professionals to guide our work 
• Provide education and develop practice standards to ensure Indigenous people receive culturally safe health care 
• Invest in supports and remove barriers to ensure that Indigenous people do not feel isolated or unsafe when filing a complaint 
• Ensure board, staff, and committee members are trained in cultural safety and humility, anti-racism, unconscious bias, and, as appropriate, trauma-informed care 
• Broaden Indigenous participation on our boards and committees and staff teams 
• Promote anti-racism and Indigenous cultural safety and humility as core competencies for current and future health-care providers 

​As part of the health-care system, we will: 

• Build partnerships with Indigenous-led organizations to promote system change and dismantle racism 
• Work with our fellow provincial health regulators to implement the recommendations of the In Plain Sight report 
• Identify and support changes in legislation and bylaws to deconstruct colonialism, value Indigenous ways of knowing, and eliminate harm for Indigenous people

Self-Education for Health Professionals

As stewards of public health and safety in Canada, we have a responsibility to recognize and address the power imbalances inherent in our health care system, and work to ensure that the environments in which we practice are free of racism and discrimination, and that Indigenous people feel safe when receiving care.  

Self-education for health professionals is especially important in addressing systemic racism and intolerance toward Indigenous worldviews and traditional approaches to health, as well as the enduring legacy of colonialism present in our healthcare system.   

A commitment to self-education by pharmacy professionals helps to remove the burden from Indigenous clients. Indigenous peoples face a unique set of issues, risks and challenges when it comes to accessing and receiving healthcare in Canada. As such, cultural safety and humility is an essential and ongoing process for health professionals to learn about and understand these issues and to recognize the barriers faced by Indigenous peoples within our healthcare system.

UBC Faculty of pharmaceutical sciences: Building Cultural Safety and Humility for First Nations Clients into Pharmacy Practice

The UBC Faculty of Pharmaceutical Sciences offers, “Building Cultural Safety and Humility for First Nations Clients into Pharmacy Practice”, which contains two educational courses.

These courses aim to help pharmacy team members learn how to address systemic anti-Indigenous racism and barriers to healthcare access in pharmacy care settings. They are part of a collective effort to reduce experiences of culturally unsafe care for First Nations clients' across the British Columbia health system and feature culturally informed content developed with the First Nations Health Authority and with guidance and teachings from a First Nations Advisory Group, led by an Indigenous facilitator, and a Pharmacy Advisory Group. Evelyn Alec, a First Nations artist from the Penticton Indian Band, created the designs used in the courses.

These courses are available online at no cost to you:

Cultivating Relationships and Creating Safer Spaces in Pharmacy for First Nations Clients

This course provides general information and knowledge for pharmacy team members to build healthy and trusting relationships with First Nations clients. It touches on important aspects of colonialism in Canada, racism and anti-racism. You are encouraged to complete this course first.

• Estimated time required:  2 hours (can be completed in multiple sittings)
• Register and access this course here.

A Case-Based Approach for Pharmacy Teams on Providing CARE for First Nations Clients

This course builds on lessons from the first course and provides pharmacy team members with cases and examples of how to advance cultural safety in daily practice.

• Estimated time to complete:  2 hours (can be completed in multiple sittings)
• Register and access this course here.

Cultural Safety and Humility ReadLinks Series 

Since signing the “Declaration of Cultural Safety and Humility in Health Services Delivery for First Nations and Aboriginal Peoples in BC” in 2017, the College has regularly published articles in response to current events impacting the health and well-being of Indigenous Peoples in Canada, as well as in celebration of Indigenous culture.  

These articles are intended to raise awareness among registrants of the social and historical factors impacting Indigenous communities, as well as provide them with valuable perspectives to incorporate into their practices to help ensure the provision of culturally safe care.  

• These articles are compiled in our Cultural Safety and Humility ReadLinks Series. 

BCCNM & CPSBC Cultural Safety and Humility Learning Resources  

In order to help registrants prepare for the implementation of the Practice Standard, the BC College of Nurses and Midwives and the College of Physicians and Surgeons of BC have compiled a list of learning resources focused on Indigenous Cultural Safety, Cultural Humility and Anti-Racism.  

As part of these resources, the two colleges also collaborated on a series of videos to support registrant learning.  

• BCCNM Learning Resources – Cultural Safety and Humility
• CPSBC Indigenous Cultural Safety, Cultural Humilty, and Anti-Racism Resources

These resources have been shared with permission from the BC College of Nurses and Midwives and the College of Physicians and Surgeons of BC. 

San’Yas Indigenous Cultural Safety Online Training  

San’Yas Indigenous Cultural Safety (ICS) training is a unique, facilitated on-line training program designed to increase knowledge, enhance self-awareness, and strengthen the skills of those who work both directly and indirectly with Indigenous peoples. Participants learn about terminology; diversity; aspects of colonial history such as Indian residential schools and Indian Hospitals, time line of historical events; and contexts for understanding social disparities and inequities. Through interactive activities participants examine culture, stereotyping, and the consequences and legacies of colonization. Participants will also be introduced to tools for developing more effective communication and relationship building skills. 

• San'yas Indigenous Cultural Safety course: Core ICS Health 

Core ICS Health Training was designed for Health Authority, Ministry of Health, and other professionals working in the health care field. It includes the foundation provided in Core ICS with an additional two modules that focus on health care issues for those working with Indigenous people in British Columbia. 

Core ICS Health Training is Accredited 

The British Columbia Core Health program is an Accredited Self-Assessment Program eligible for up to 8.0 Section 3 credits as defined by the Maintenance of Certification Program of The Royal College of Physicians & Surgeons of Canada. This program has been reviewed and approved by UBC Division of Continuing Professional Development. 

• Learn how to register for the Core ICS Health Training 
• See other San'yas Indigenous Cultural Safety Training options and resources

Indigenous Canada Course – University of Alberta

Indigenous Canada is a 12-lesson Massive Open Online Course (MOOC) from the Faculty of Native Studies at the University of Alberta that explores the different histories and contemporary perspectives of Indigenous peoples living in Canada. From an Indigenous perspective, this course explores complex experiences Indigenous peoples face today from a historical and critical perspective highlighting national and local Indigenous-settler relations. Topics for the 12 lessons include the fur trade and other exchange relationships, land claims and environmental impacts, legal systems and rights, political conflicts and alliances, Indigenous political activism, and contemporary Indigenous life, art and its expressions.

• Access the Indigenous Canada Course for Free on Coursera

Challenging Racist British Columbia: 150 Years and Counting 

150 Years and Counting (150YC) is a new open-access, multi-media resource that documents how this recent cycle of anti-racist activism is part of a broader history of Indigenous, Black and other racialized communities challenging white supremacy for over 150 years – particularly since 1871 when BC joined Canada. Co-authored by activists and scholars from diverse communities, this resource will assist anti-racist educators, teachers, scholars, and policymakers in piercing the silences that too often have let racism fester in communities, corporations, and governments. 150YC is co-produced by the UVIC History project Asian Canadians on Vancouver Island: Race, Indigeneity and the Transpacific and the Canadian Centre for Policy Alternatives – BC Office. 

• Challenging Racist British Columbia: 150 Years and Counting

Foundational commitments, reports,  policies and Resources  

To help pharmacy professional begin or continue their individual journeys toward truth and reconciliation, we have compiled a list of policies, reports, commitments, and other resources aimed at addressing and rectifying the historical and ongoing injustices faced by Indigenous Peoples in Canada. 

Truth and Reconciliation Commission of Canada 94 Calls to Action

The Truth and Reconciliation Commission of Canada (TRC) was established as part of the Indian Residential Schools Settlement Agreement in order to provide those directly or indirectly affected by the legacy of the Indian Residential Schools system with an opportunity to share their stories and experiences. 

In June 2015, the TRC held its closing event in Ottawa and presented the executive summary of the findings contained in its multi-volume final report, including 94 "calls to action" (or recommendations) to further reconciliation between Canadians and Indigenous Peoples.

• Truth and Reconciliation Commission of Canada: Calls to Action

United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP)

The United Nations Declaration on the Rights of Indigenous People (UNDRIP) is a comprehensive international human rights instrument on the rights of Indigenous Peoples around the world. UNDRIP contains 46 articles outlining collective and individual rights, identifying states and governments as responsible for protecting and upholding these rights. The purpose of UNDRIP is to contribute to the survival, dignity and well-being of Indigenous Peoples.

• For additional Information please have a look at the National Centre for Truth and Reconciliation’s UNDRIP FAQs, as well as the Canadian Museum for Human Rights’ UNDRIP page.

BC Declaration on the Rights of Indigenous Peoples Act 

BC’s Declaration on the Rights of Indigenous Peoples Act (DRIPA) commits the province to align its policies and laws with UNDRIP. The DRIPA Action Plan outlines the steps the province will take to address the inequities experienced by Indigenous Peoples, emphasizing reconciliation, respect for Indigenous rights, cultural revitalization, and collaboration on decision-making processes.

The actions contained in the plan are organized under the following four themes:

• Self-determination and inherent right of self-government
• Title and rights of Indigenous Peoples
• Ending Indigenous-specific racism and discrimination
• Social, Cultural and Economic Well-Being

National Centre for Truth and Reconciliation (NCTR) 

The NCTR was created as part of the mandate of the Truth and Reconciliation Commission of Canada, and continues the work started by the TRC. The TRC created a historical record of the residential schools system. As part of this process, the Government of Canada provided over 5 million records to the TRC.

The NCTR is now the permanent, safe home for all statements, documents, and other materials gathered by the TRC. 

The NCTR educates Canadians on the profound injustices inflicted on First Nations, Inuit and the Metis Nation by the forced removal of children to attend residential schools and the widespread abuse suffered in those schools.

The NCTR preserves the record of these human rights abuses and promotes continued research and learning on the legacy of residential schools. 

• Residential School History
• Residential School Timeline
• NCTR Archives

National Inquiry into Missing and Murdered Indigenous Women and Girls

The National Inquiry into Missing and Murdered Indigenous Women and Girls was a federally funded inquiry that took place between 2016 and 2019 to investigate, report on and end the systemic and institutional causes of the disporportionately high levels of violence against Indigenous women and girls. The inquiry was also the Government of Canada's response to Truth and Reconciliation Commission Call to Action #41. The 2019 final report inclues 231 calls for justice. 

• Reclaiming Power and Place: The Final Report of the National Inquiry into Missing and Murdered Indigenous Women and Girls
• National Inquiry into Missing and Murdered Indigenous Women and Girls Calls for Justice
• Missing and Murdered Indigenous Women, Girls, and 2SLGBTQQIA+ People National Action Plan

Remembering Keegan: A BC First Nations Case Study Reflection

Remembering Keegan: A BC First Nations Case Study Reflection provides an in-depth look at the tragic story of Keegan Coombes of Skwah First Nation. Keegan was a high school graduate, a grade-10 pianist and a chess champion living with developmental disabilities whose untimely death in hospital came as the result of a delayed diagnosis and improper clinical management of a treatable accidental poisoning. A first of its kind report, Remembering Keegan can help health professionals learn from and reflect on personal and systemic biases that shape their practice by exploring examples of what culturally safe care should look like, and how it could have contributed to a different outcome in Keegan's case.

• Remembering Keegan: A BC First Nations Case Study Reflection

Indian Residential School History & Dialogue Centre: Collections

The collections website of the Indian Residential School History and Dialogue Centre responds to the desire of residential school Survivors and their families to have increased access to residential school records. The Collections also support education about the history, legacy, and ongoing impacts of the Indian residential school system on Indigenous Peoples and Indigenous-settler relations in Canada.

The Centre's online database brings together digital copies of records that include:

• Survivor testimonies
• Truth and Reconciliation Commission events and hearings
• Photographs
• Maps and site plans
• Government documents
• Church documents
• Belongings
• Newspaper articles
• Library resources

ORANGE SHIRT DAY 

Orange Shirt Day was born St. Joseph Mission Residential School Commemoration Project and Reunion events that took place in Williams Lake, BC, Canada, in May 2013. At the event, Esk’etemc (Alkali Lake) Chief Fred Robbins brought together residential school survivors and their families in order to honour them, help in the healing and contribute to reconciliation.

One of the speakers at the event was Phyllis Webstad, a Northern Secwepemc (Shuswap) woman and residential school survivor who told the story of the “orange shirt” given to her by her grandmother for her first day of school at St. Joseph’s Mission residential school in British Columbia.

The first Orange Shirt Day took place on September 30, 2013 in Williams Lake. In the years that followed, the Orange Shirt has become a national symbol of truth, reconciliation and the inter-generational impacts of Residential Schools in Canada.

• Learn more about Orange Shirt Day

Government Resources

• Maps of Indigenous Peoples and Lands
• Learning resources about First Nations, Inuit and Métis across Canada
• Government of British Columbia – Addressing Racism: Working Glossary
• Indian Residential School History & Dialogue Centre: Collections