Cultural Safety and Humility

Added to Interpretation Guidelines: May 2019

PURPOSE

To enhance awareness of cultural safety and humility, and assist dental hygienists in applying these concepts in their practice settings.

BACKGROUND

It is respectfully acknowledged that prior to the European settlement in and colonization of
the territory now known as Canada, populations known as Indigenous were thriving and living
autonomously under their own governance, having lived on this land since time immemorial.
Section 35 of the Constitution Act of Canada 1982 defines an “Aboriginal” (Indigenous)
person in Canada as identifying with one or more of three distinct cultural groups: First
Nations, M├ętis, and Inuit. It is recognized that Canada’s history of colonization continues to
have profound impacts on Indigenous peoples and their communities and has created
vulnerabilities in social determinants of health that have spanned generations. It is also
acknowledged that Indigenous individuals and communities are disproportionately subject
to discrimination and trauma in various ways, and societal efforts towards reconciliation
are ongoing.

In March 2017 the “Declaration of Commitment to Cultural Safety and Humility in the
Regulation of Health Professionals Serving First Nations and Aboriginal People in BC
” was
signed by the BC Ministry of Health, the First Nations Health Authority and the 23 provincial
health regulators. This declaration pledged a commitment to advancing cultural safety and
humility among all regulated health professionals in BC.

Cultural humility focuses on delivering care in a culturally safe manner that respects
Indigenous clients’ role as decision makers regarding their own care. [2] By virtue of their
education and training, health care providers are generally in a position of power relative
to their clients in terms of knowledge of the discipline and the delivery of care. While this
power imbalance broadly exists between health care providers and clients, some groups are
more vulnerable than others. A particularly unjust power imbalance can exist between a
health care provider and a client of Indigenous ancestry based on differences in cultural
values and experiences, as well as the impacts of colonization. Historic and ongoing social
determinants of health caused by colonization and ongoing colonialism can make it further difficult
for Indigenous populations to access healthcare services in equity to non-Indigenous Canadians. The
practice of cultural humility and safety in health care positively contributes to reducing
unjust power imbalances and ensuring that each client receives health care free from
indirect or unintentional discrimination.

Cultural safety includes but is not limited to awareness of the different world views between
cultures and sensitivity to how cultural differences are perceived.[1] It has been identified by
the First Nations Health Authority as “an outcome based on respectful engagement that
recognizes and strives to address power imbalances inherent in the healthcare system”. [1] In
addition to addressing power imbalances, providing culturally safe care “results in an
environment free of racism and discrimination, where people feel safe when receiving
health care”.[1] Key elements of cultural safety identified by the First Nations Health
Authority include [2]:

• Recognizing the role of history and society and past traumatic experiences, and their
impacts in shaping health, wellness and health care experiences;

• Understanding that culture is related to history and society, and is understood as
something that is complex and dynamic, rather than a static set of beliefs or
practices. It requires having an understanding of how colonization has impacted and
continues to impact First Nations peoples’ health, rather than just having an
understanding of specific cultural practices;

• An understanding of what health and wellness means to First Nation individuals with
recognition of the diversity of these understandings;

• Health care professionals’ self-reflection on their own assumptions and positions of
power within the health care system;

• Emphasizing peoples’ experiences of safety within the health care system and during
interactions with health care professionals.

Cultural humility focuses on delivering care in a culturally safe manner that respects
Indigenous clients’ role as decision makers regarding their own care.[2] Cultural humility has
been identified by the First Nations Health Authority as “a process of self-reflection to
understand personal and systemic conditioned biases, and to develop and maintain
respectful processes and relationships based on mutual trust. Cultural humility involves
humbly acknowledging oneself as a life-long learner when it comes to understanding
another’s experience”.

It is important to recognize that some Indigenous people and communities have suffered
past traumatic experiences specifically in conjunction with the delivery of health services,
which may adversely impact their ability to form trusting relationships with health
professionals.

Dental hygienists can foster cultural safety in their practices by engaging in respectful
dialogue with clients and taking the time to listen and learn about their clients’ backgrounds
in order to understand how it may potentially impact care delivery. For some clients it may
be appropriate to ask whether they would like to involve a family member, community
support person, or another trusted health professional in discussions about their dental
hygiene diagnosis, proposed care, consent (or informed refusal to consent), and/or
referrals.

POLICY

Dental hygienists have an ethical responsibility to practice in a manner that is culturally
safe for the diverse clients in their care. This is underpinned in a number of principles
contained in the CDHBC Code of Ethics, including that dental hygienists shall:

• Hold paramount the health and welfare of those served professionally (Principle #1);

• Provide competent and appropriate care to clients (Principle #2);

• Treat clients with respect for their individual needs and values (Principle #4);

• Regard the clients’ right to control their own care (Principle #5);

• Inform clients of the dental hygiene care available to them, clearly advise them of
probable consequences of not following recommended action, but respect the
clients’ right of informed choice (Principle #6);

• Uphold the principle that the public should have fair and equitable access to dental
hygiene services (Principle #8);

• Represent the values and ethics of dental hygiene before others, and maintain the
public trust in dental hygienists and their profession (Principle #12).


Examples of ways in which dental hygienists can enhance their knowledge and practice of cultural safety and humility include:

• Learning about the history of colonization in a given Canadian region and the impacts
on Indigenous individuals and communities, including the residential school system
and segregated hospital system*,

• Completing education on cultural safety, such as the San’yas Indigenous Cultural
Safety Training Program (Core ICS Health stream) offered by BC’s Provincial Health
Services Authority,

• Reviewing the First Nations Health Authority Policy Statement on Cultural Safety and
Humility, and watching some of the publicly available webinars on the First Nations
Health Authority website on cultural safety and humility,

• Learning about health programs offered by the First Nations Health Authority and
BC’s regional Health Authorities regarding potential unique referral options for
Indigenous clients (e.g. Aboriginal Liaison Nurse services).

The College of Dental Hygienists of British Columbia gratefully acknowledges the First Nations Health Authority for reviewing this Interpretation Guideline while it was being developed.

* At the time of their existence hospitals in the segregated system were referred to as
“Indian hospitals”.

REFERENCES

1. Cultural safety and humility: key drivers and ideas for change. Coast Salish Territory
– West Vancouver: First Nations Health Authority. Available from:
http://www.fnha.ca/Documents/FNHA-Cultural-Safety-and-Humility-Key-Driversand-Ideas-for-Change.pdf

2. FNHA’s policy statement on cultural safety and humility. Coast Salish Territory –
West Vancouver: First Nations Health Authority. Available from:
http://www.fnha.ca/Documents/FNHA-Policy-Statement-Cultural-Safety-andHumility.pdf