Indigenous Cultural Safety & Humility

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What this competency asks of you, and how to use this hub.

The competency in plain language

You are being asked to demonstrate three connected things:

Knowledge of the harm. Understand how settler colonialism and systemic racism have damaged — and continue to damage — Indigenous Peoples' health and wellbeing, and how this produces today's health disparities and barriers to care.
Commitment to act. Show you will identify, challenge, and work to eradicate Indigenous-specific racism and discrimination against all equity-deserving groups — through self-reflection on personal bias, naming institutional barriers, ongoing anti-racism education, and advocating for systemic change. This is cultural safety and humility.
Knowledge of the obligations. Know the foundational documents and laws — TRC, In Plain Sight, UNDRIP, DRIPA, the Declaration Act Action Plan, MMIWG Calls for Justice, Remembering Keegan, the BC Human Rights Code, and the BC Anti-Racism Act — and how they intersect across the health system, including in molecular genetics / laboratory contexts.

How to use this hub

Read Core Concepts for the foundational ideas (cultural safety vs. humility, systemic racism, determinants of health).

Work through the Foundational Documents deep-dives — each links to the health-care relevance.

Trace the Timeline to connect history to ongoing impacts.

Quiz yourself, then rehearse Talking Points for interviews or assessments.

One idea to anchor everything

Settler colonialism is not a single event in the past. It is an ongoing structure — laws, institutions, and everyday practices — that continues to shape who gets safe, equitable health care and who does not. Cultural safety is judged by the patient, not the provider.

Cultural safety is an outcome — defined by the person receiving care, based on respectful engagement that makes them feel safe. Cultural humility is the lifelong process of self-reflection that gets you there. You can intend to be safe and still cause harm; what matters is the experience of the Indigenous patient.

Core Concepts

The ideas every other section builds on.

Settler colonialism

Settler colonialism is a form of colonialism in which settlers come to stay and build a permanent society, displacing Indigenous Peoples from their lands and seeking to replace Indigenous social, legal, and governance structures with their own. Unlike extractive colonialism (which exploits and leaves), settler colonialism is an ongoing structure, not a finished historical event.

How it operated in Canada/B.C.

Dispossession of land — much of B.C. is on unceded territory (never surrendered by treaty), yet Indigenous Peoples were confined to reserves.
The Indian Act (1876) — federal control over identity, governance, and daily life; banned ceremonies (e.g., the potlatch) and restricted movement.
Residential schools — government-funded, church-run institutions that forcibly removed children to erase language and culture; the TRC called this cultural genocide.
The Sixties Scoop and continued overrepresentation of Indigenous children in child welfare.
Segregated "Indian Hospitals" and coercive medical practices, including forced and coerced sterilization of Indigenous women — some documented into recent years.

Why it matters in health: These structures produced loss of land, language, family, and self-determination — the root causes of today's health inequities. They also created deep, rational mistrust of health systems that still shapes whether Indigenous patients seek and receive care.

Cultural Safety vs. Cultural Humility

These two terms are the heart of the competency. They are related but distinct.

Cultural Humility

A lifelong process of self-reflection. You examine your own biases, assumptions, and privilege; you recognize you are not the expert on another person's culture; and you commit to learning and unlearning. It addresses power imbalances between provider and patient.

Cultural Safety

An outcome, defined by the person receiving care. Care is "safe" only if they experience it as free of racism and discrimination, where their identity is respected. The provider does not get to decide they were "safe."

The concept of cultural safety originated with Māori nurses in Aotearoa (New Zealand) and was adapted in Canada. In B.C., the First Nations Health Authority (FNHA) and the San'yas Indigenous Cultural Safety Training program are central to embedding it. It moves beyond "cultural competence" (learning facts about a culture) toward changing the power dynamic and the system itself.

Key distinction to remember: Competence = knowledge about others. Humility = ongoing self-reflection. Safety = the patient's lived experience of care. The first can slip into stereotyping; the goal is humility producing safety.

Interpersonal vs. Systemic racism

Interpersonal

Racism between individuals — stereotyping, slurs, dismissive treatment, assumptions that an Indigenous patient is "drug-seeking" or intoxicated. In Plain Sight documented this extensively.

Systemic / Structural

Racism built into policies, procedures, funding, and "normal" ways of operating — producing unequal outcomes even with no individual intent. E.g., underfunded services, jurisdictional gaps, lack of Indigenous data, geographic barriers.

Indigenous-specific racism is the term used in B.C. (notably by In Plain Sight) to name the unique racism Indigenous Peoples face, rooted in colonialism and stereotypes — distinct from racism experienced by other groups, though it intersects with them.

Social determinants of Indigenous health

Health is shaped far more by social and structural conditions than by clinical care alone. For Indigenous Peoples these include distal determinants (colonialism, racism, self-determination), intermediate determinants (health systems, education, community infrastructure), and proximal determinants (housing, food security, employment). Colonialism sits at the root of them all.

~9 yrs

Shorter life expectancy for First Nations people in B.C. vs. other residents (In Plain Sight)

2×

Higher infant mortality rate

84%

Of Indigenous respondents reported direct experience of discrimination in B.C. health care

Barriers to care include: fear of being judged or mistreated; past traumatic experiences; geographic isolation and travel costs; jurisdictional disputes over who pays (the gap that Jordan's Principle addresses for children); lack of Indigenous staff; and services not designed with or for Indigenous Peoples.

What "embedding" cultural safety looks like in practice

Self-reflection: notice your assumptions before and during an interaction; ask "whose comfort am I centring?"
Anti-racism education: complete training (e.g., San'yas), and treat it as ongoing, not one-and-done.
Naming institutional barriers: identify policies, forms, or defaults that disadvantage Indigenous patients and raise them.
Advocacy & systemic change: support Indigenous leadership, Indigenous data governance (OCAP®), and accountability — not just individual kindness.
Trauma-informed, strengths-based care: recognize resilience and self-determination, not only deficits.

Who: First Nations, Métis & Inuit — a distinctions-based approach

"Indigenous" is an umbrella term. In Canada it covers three constitutionally recognized Peoples (Constitution Act, 1982, s.35), each with distinct histories, rights, and relationships to the Crown. Lumping them together erases that distinctiveness — a "distinctions-based approach" means policies and care respond to each People's specific rights and needs.

First Nations

Over 630 communities and 50+ Nations/languages. "Status" vs. "non-status" is a legal distinction created by the Indian Act, not an Indigenous one. Most of B.C.'s Indigenous peoples are First Nations on unceded territory.

Métis

A distinct People emerging from unions of First Nations and European ancestors, with their own culture, language (Michif), and homeland centred in the Prairies. Not simply "mixed ancestry."

Inuit (singular Inuk) are the Indigenous People of the Arctic (Inuit Nunangat), with their own language (Inuktut) and governance. Avoid the outdated term "Eskimo."

Why it matters in care: Never assume a pan-Indigenous identity, language, or set of practices. Ask, listen, and don't treat one person as a spokesperson for all Indigenous Peoples. Respectful, current terminology is itself part of cultural safety.

Intergenerational & historical trauma

Trauma from colonial policies — residential schools, the Sixties Scoop, family separation, loss of language and land — is not confined to those who lived it. Intergenerational (transgenerational) trauma is transmitted to children and grandchildren through disrupted attachment, parenting, grief, and altered stress responses. Historical trauma is the cumulative, collective wounding across a People over generations.

How it shows up in health

Higher rates of chronic stress, mental-health distress, and substance use as responses to trauma — not moral failings or "lifestyle choices."
Rational mistrust of institutions (schools, hospitals, child welfare) that historically caused harm.
Trauma can be re-triggered by power-imbalanced, impersonal, or coercive clinical encounters.

The reframe: Ask "what happened to this person and their community?" rather than "what's wrong with them?" This is the core of trauma-informed care — safety, trustworthiness, choice, collaboration, and recognizing strength and resilience.

Two-Eyed Seeing & holistic health

Two-Eyed Seeing (Etuaptmumk), articulated by Mi'kmaw Elders Albert and Murdena Marshall, means learning to see with the strengths of Indigenous knowledges through one eye and the strengths of Western knowledges through the other — and using both together. It rejects the idea that biomedical science is the only valid way of knowing.

Many Indigenous health frameworks are holistic: wellness is a balance of physical, mental, emotional, and spiritual dimensions (often represented in a medicine-wheel teaching), grounded in family, community, land, and culture. The FNHA's perspective on health and wellness reflects this.

In practice: Respect and make room for traditional medicines, healers, and ceremony where a patient wants them (echoing TRC Call 22). Even in a lab, recognize that "objective" Western frameworks are a way of knowing, not the only one.

Microaggressions & stereotyping in care

Microaggressions are subtle, often unintentional slights that communicate bias — and they accumulate. In health care they frequently take the form of diagnostic overshadowing: attributing symptoms to assumed alcohol or drug use ("drug-seeking," "non-compliant") rather than investigating. In Plain Sight and the deaths of Keegan Combes and Joyce Echaquan show how these assumptions become fatal.

"Are you sure you're really in pain?" — disbelief of Indigenous patients' reported pain.
Assuming intoxication, addiction, or that a patient won't follow through.
Talking over, rushing, or dismissing — centring provider comfort over patient experience.

Antidote: Notice the assumption before you act on it; investigate symptoms fully; believe patients; and ask "whose comfort am I centring?" Safety is judged by the patient, not your intent.

Indigenous data sovereignty — OCAP® & beyond

Indigenous Peoples have the right to govern the collection, ownership, and use of data and biosamples about their communities. In Canada the foundational framework is OCAP® (a registered trademark of the First Nations Information Governance Centre):

Ownership — communities own their cultural knowledge, data, and information collectively.

Control — First Nations control how data is collected, used, and disclosed.

Access — communities can access data about themselves wherever it is held.

Possession — physical stewardship of data as a mechanism of control.

Related global principles include CARE (Collective benefit, Authority to control, Responsibility, Ethics) and Free, Prior and Informed Consent (FPIC) from UNDRIP.

Direct relevance to molecular genetics: Genetic data and tissue are among the most sensitive data of all. Collection, storage, reuse, and sharing must follow FPIC and Indigenous data-governance principles — not just generic research ethics. "Helium-light" defaults, reference ranges built on non-Indigenous populations, and secondary data use can all carry bias or breach sovereignty.

Allyship: from good intentions to action

Cultural humility points outward into allyship — using your position to support Indigenous-led change rather than centring yourself. Effective allyship is ongoing and accountable, not a label you claim.

Listen and follow Indigenous leadership — support, don't speak over or "rescue."
Do your own learning — don't make Indigenous colleagues or patients teach you.
Use your power — name barriers, interrupt racism when you witness it, and advocate where you have influence.
Accept discomfort and feedback — get it wrong, own it, repair, and keep going.

Key idea: Allyship is judged by impact and by the people you aim to support — mirroring how cultural safety is defined by the patient, not the provider.

Foundational Documents

The nine documents named in the competency. Each card: what it is, key contents, and the health-care / molecular genetics relevance. Expand for detail.

1. Truth & Reconciliation Commission — Calls to Action

2015National

The TRC documented the history and legacy of Canada's residential school system after years of testimony from Survivors. Its final report included 94 Calls to Action to redress the legacy and advance reconciliation. The TRC characterized the residential school system as cultural genocide.

Key health-related Calls to Action (18–24)

Call 18 — Acknowledge that the current state of Indigenous health is a direct result of previous government policies, and recognize and implement Indigenous health-care rights.
Call 19 — Establish measurable goals to close health gaps and publish annual progress reports.
Call 20 — Address the jurisdictional disputes over health services for Indigenous people living off-reserve.
Call 22 — Recognize the value of Aboriginal healing practices and use them where requested by patients.
Call 23 — Increase the number of Indigenous professionals in health care, retain them in Indigenous communities, and provide cultural competency training for all health-care workers.
Call 24 — Require medical and nursing students to take a course on Indigenous health, including residential schools, UNDRIP, Treaties and rights, and skills-based training in intercultural competency, conflict resolution, human rights, and anti-racism.

Relevance to your work: Calls 23–24 directly mandate anti-racism and cultural-competency training for all health professionals — including laboratory and molecular genetics staff. Call 22 underpins respect for Indigenous knowledge; Call 18 frames health inequities as a policy outcome, not a deficit of Indigenous people.

Sources: NCTR — TRC Calls to Action · LHSC summary

2. In Plain Sight

2020B.C.

A landmark independent review led by Dr. Mary Ellen Turpel-Lafond into Indigenous-specific racism and discrimination in B.C. health care. It drew on nearly 9,000 participants (about 2,780 Indigenous people and 5,440 health workers), plus data analysis and a province-wide survey.

Key findings & recommendations

11 findings confirming widespread Indigenous-specific racism, and 24 recommendations. Highlights:

84% of Indigenous respondents reported personal experience of discrimination in health care.
Racism ranged from stereotyping (e.g., assumptions of alcohol/drug use) to denial of care and worse outcomes.
Documented inequities: First Nations life expectancy ~9 years shorter; ~2× infant mortality; earlier and more complex chronic disease.
Recommendations called for Indigenous leadership in the system, mandatory cultural-safety training, complaints processes, and accountability.

Relevance to your work: This is the defining B.C. document naming the problem this competency addresses. It established "Indigenous-specific racism" as the operative term and triggered system-wide cultural-safety mandates across all of B.C. health — including diagnostic and laboratory services.

Sources: In Plain Sight Data Report · UBC SPPH overview

3. UN Declaration on the Rights of Indigenous Peoples (UNDRIP)

2007International

Adopted by the UN General Assembly in 2007, UNDRIP is the most comprehensive international instrument on Indigenous Peoples' rights. It affirms rights to self-determination, culture, language, lands, and — critically — health. Canada removed its objector status and fully endorsed it; the federal UNDRIP Act (2021) and B.C.'s DRIPA implement it domestically.

Health-relevant articles & concepts

Article 21 — right to improvement of economic and social conditions, including health.
Article 23 — right to determine and develop their own health programs.
Article 24 — right to traditional medicines and health practices, and equal access to health services without discrimination.
Free, Prior and Informed Consent (FPIC) — a cross-cutting principle: Indigenous Peoples must be meaningfully consulted on decisions affecting them. Highly relevant to research and data/biosamples.

Relevance to your work: UNDRIP is the rights framework underneath B.C. law. In molecular genetics, Articles 24 and FPIC connect directly to Indigenous data sovereignty and biosample governance — Indigenous Peoples have rights over how their genetic data and tissue are collected, used, and shared.

Sources: UN — UNDRIP

4. Declaration on the Rights of Indigenous Peoples Act (DRIPA)

2019B.C.

B.C. became the first jurisdiction in Canada to legislate the implementation of UNDRIP. DRIPA (passed November 2019) requires the province to align its laws with UNDRIP over time, develop an action plan, and report annually. It allows agreements for shared and joint decision-making with Indigenous governing bodies.

What DRIPA actually requires

Bring provincial laws into harmony with UNDRIP.
Prepare and implement an action plan (the Declaration Act Action Plan — see next card).
Report to the legislature annually on progress.
Enable decision-making agreements with Indigenous governing bodies.

Relevance to your work: DRIPA turns UNDRIP from aspiration into a legal obligation for B.C. public bodies — including health authorities. It is the legislative backbone the rest of B.C.'s commitments hang from.

Sources: declaration.gov.bc.ca · DRIPA (BC Laws)

5. Reclaiming Power and Place — MMIWG Calls for Justice

2019National

The final report of the National Inquiry into Missing and Murdered Indigenous Women and Girls (June 2019). It concluded that the violence amounts to a genocide rooted in colonialism, and issued 231 Calls for Justice — framed as legal imperatives, not optional recommendations — addressed to governments, institutions, and all Canadians.

Health & wellness Calls for Justice (Section 7)

Provide equitable, sustained funding for Indigenous-led health and wellness services.
Ensure culturally safe, trauma-informed care and access to traditional healing.
Establish culturally appropriate crisis-response and mental-health supports.
Address the specific safety and care needs of 2SLGBTQQIA+ people.

The report also centres the safety of Two-Spirit and gender-diverse Indigenous people, and the role of all professionals in recognizing and interrupting violence.

Relevance to your work: Connects gender-based violence to the health system and to intersecting discrimination against equity-deserving groups. Health workers are explicitly called on to provide culturally safe, trauma-informed care and to be alert to the safety of Indigenous women, girls, and 2SLGBTQQIA+ people.

Sources: MMIWG Final Report · Calls for Justice (PDF)

6. Declaration Act Action Plan

2022B.C.

Released March 2022 under DRIPA, this five-year plan sets out 89 priority actions co-developed with Indigenous Peoples, organized into four goals:

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

Health connections

The "Ending Indigenous-specific Racism and Discrimination" goal directly carries forward In Plain Sight, including actions on cultural safety, distinctions-based health legislation, and Indigenous-led health governance. The "Social, Cultural and Economic Well-Being" goal includes health, mental health, and wellness actions.

Relevance to your work: This is the operational roadmap that turns DRIPA into concrete deliverables. One of its four goals is specifically about ending Indigenous-specific racism — the exact commitment this competency asks you to embody.

Sources: Declaration Act Action Plan

7. Remembering Keegan — A First Nations Case Study

2022B.C.

A case-study reflection released by B.C. First Nations (gifted in ceremony, February 2022) on the death of Keegan Combes, a 29-year-old man from Skwah First Nation who died in 2015 after a delayed diagnosis following an accidental poisoning. Keegan was a gifted student and musician who lived with disabilities and was non-verbal by choice.

What it teaches

The case study is a narrative learning tool for health professionals. It maps the points in Keegan's care where Cultural Safety and Humility — and recognition of intersecting biases (about Indigeneity and disability) — could have changed the outcome. It was co-authored by his caregiver and advocate, Rhianna Millman.

It demonstrates how interpersonal and systemic racism, plus assumptions about disability, combine to produce fatal failures of care — and what culturally safe care would have looked like instead.

Relevance to your work: A concrete, B.C.-specific example showing that cultural safety is literally a matter of life and death. It models the kind of reflective practice the competency asks for — examining your own biases against a real case, including intersecting discrimination (race + disability).

Sources: FNHA — Remembering Keegan · Case Study (PDF)

8. BC Human Rights Code

B.C.in force

B.C.'s anti-discrimination law. It prohibits discrimination in services customarily available to the public — including health care — on protected grounds such as race, ancestry, place of origin, colour, and Indigenous identity, as well as disability, sex, gender identity/expression, and more. Complaints are heard by the BC Human Rights Tribunal.

How it intersects with health care

Provides an enforceable legal remedy when an Indigenous patient experiences discrimination in care.
Recognizes intersectionality — a person may face discrimination on multiple, overlapping grounds (e.g., Indigeneity and disability, as in Keegan's case).
The Code includes a positive purpose: identifying and eliminating persistent patterns of inequality.

Relevance to your work: The Code is the legal floor. Indigenous-specific racism in care is not just unethical — where it denies or worsens service, it can be unlawful discrimination. It also grounds the duty to accommodate and protects all equity-deserving groups.

Sources: Human Rights Code (BC Laws) · BC Human Rights Tribunal

9. BC Anti-Racism Act (& Anti-Racism Data Act)

2024B.C.

The Anti-Racism Act (in force May 2024) requires government to build and maintain a provincial anti-racism strategy and action plan to identify and remove systemic racism from public policies, programs, and services. It builds on the earlier Anti-Racism Data Act (2022), which authorizes the careful, community-governed collection of race-based data to expose systemic barriers.

Key requirements

Establish a provincial anti-racism committee and a "whole-of-government" action plan.
Public bodies must assess policies/programs against an anti-racism framework and report publicly each year.
Develop training on Indigenous history; set recruitment/retention targets for Indigenous, Black, and racialized public servants.
The Data Act (2022) enables race-based data collection with Indigenous and community data-governance safeguards — so disparities can be measured rather than hidden.

Relevance to your work: Together these Acts make anti-racism a legal, measurable, reported obligation for B.C. public bodies — including health authorities and labs. The Data Act is especially relevant in molecular genetics: it models how race-based and health data must be collected and governed with, not just about, Indigenous Peoples.

Sources: Anti-Racism Act (CanLII) · Anti-Racism Data Act

How they intersect across the health system

Think of these as layers reinforcing each other:

International rights (UNDRIP) →
B.C. law implementing them (DRIPA) → made operational by the Declaration Act Action Plan.
Evidence of the problem (In Plain Sight; MMIWG; the TRC) names the harm and sets directions.
A human face (Remembering Keegan) shows what the failure — and the fix — looks like in real care.
Enforcement & accountability (BC Human Rights Code; Anti-Racism Act + Data Act) give legal remedy and measurable, reported obligations.

For someone in molecular genetics / laboratory medicine, the throughline is: provide care and handle data in ways that are culturally safe, anti-racist, and respectful of Indigenous data sovereignty and consent — because that is now both an ethical expectation and a legal obligation in B.C.

Further key documents & principles

Beyond the nine named documents, these shape the landscape — and often come up in assessments.

10. Royal Commission on Aboriginal Peoples (RCAP)

1996National

A landmark five-volume, ~4,000-page report (commission established 1991, reported 1996) that examined the relationship between Indigenous Peoples, government, and Canadian society. It set out a 20-year agenda and called for a fundamental restructuring of the relationship based on recognition, respect, sharing, and responsibility.

Health-related recommendations

Train roughly 10,000 Indigenous health professionals over a decade.
Establish Indigenous-controlled health and healing systems and an Aboriginal peoples' university.
A major sustained funding increase ($1.5–2 billion/year) to address health, housing, education, and employment.

Twenty years on, many recommendations remained unimplemented — a critique echoed by the TRC, which built on RCAP's foundation.

Relevance: RCAP is the intellectual predecessor of the TRC and much that followed. It established, decades early, that health inequities are rooted in colonialism and require Indigenous-led, structural responses — context for why later documents exist.

Sources: Canadian Encyclopedia — RCAP · First Nations Caring Society

11. Jordan's Principle

2007National

A child-first, needs-based legal rule named for Jordan River Anderson, a First Nations child from Norway House Cree Nation (Manitoba) who was born with complex medical needs and spent more than two years unnecessarily in hospital while the federal and provincial governments argued over who would pay for his at-home care. He died at age five, never having lived in a family home. The House of Commons affirmed Jordan's Principle in 2007.

What it requires

First Nations children must receive the public services and supports they need when they need them — the government of first contact pays, and jurisdictional disputes over reimbursement are settled afterward, never at the child's expense. The First Nations Child & Family Caring Society's human-rights case forced its proper implementation.

Relevance: The clearest example of a "jurisdictional gap" causing harm — directly relevant to TRC Call 20 and to understanding systemic, not just interpersonal, racism. Care should never be delayed because of who pays.

Sources: Caring Society — Jordan's Principle · Canadian Encyclopedia

12. Joyce's Principle

2020Québec

Named for Joyce Echaquan, a 37-year-old Atikamekw mother of seven who died on September 28, 2020, in a Joliette, Québec hospital after live-streaming staff mocking and demeaning her as she begged for help. The coroner found racism contributed to her death and that it was preventable. Atikamekw leaders put forward Joyce's Principle in November 2020.

What it asks for

It demands that all Indigenous people have equitable access to health and social services without discrimination, and the right to the best possible physical, mental, emotional, and spiritual health — and that Indigenous traditional knowledge be recognized in health care. It explicitly calls for the recognition of systemic racism (which the Québec government has resisted).

Relevance: A parallel to B.C.'s In Plain Sight and Remembering Keegan — another documented, fatal example of Indigenous-specific racism in care, and a national touchstone showing the problem is not unique to one province.

Sources: Joyce's Principle · Death of Joyce Echaquan

13. B.C.'s First Nations health system & San'yas training

2011–2013B.C.

B.C. has a unique Indigenous health-governance structure. The B.C. Tripartite Framework Agreement on First Nation Health Governance (2011) led to the creation of the First Nations Health Authority (FNHA) in 2013 — the first province-wide First Nations health authority in Canada, which took over the federal government's former role in First Nations health programming in B.C.

Cultural safety vehicles in B.C.

FNHA — leads cultural safety and humility work, including the #itstartswithme declaration of commitment signed by health organizations' leaders.
San'yas Indigenous Cultural Safety Training — an Indigenous-led, facilitated online program (designed in B.C., first offered 2008; delivered via PHSA) now used across sectors and provinces.
Cultural safety is embedded as an expectation across B.C. health authorities and regulatory colleges.

Relevance: These are the concrete B.C. institutions and trainings that turn principle into practice. Knowing FNHA and San'yas by name — and that B.C. was first to create such an authority — is often expected in B.C. health roles.

Sources: First Nations Health Authority · San'yas ICS Training

Timeline

From the structures of colonialism to today's legal commitments. Click any event to expand. The story is continuous — colonialism is ongoing, not over.

Test Yourself

Five ways to drill the material. Every answer includes an explanation. Flashcards remember what you find hard and bring it back.

Talking Points & Model Answers

Prompts you might face in an interview or competency assessment, with a structured way to answer. Adapt them in your own words — authenticity and humility matter more than memorization.

A useful structure for these answers: Acknowledge the history/structure → Connect it to health impacts today → Commit to specific anti-racist action → Cite a relevant document. Lead with humility, not certainty.

"What do you understand by the ongoing impacts of settler colonialism on Indigenous health?"

Frame colonialism as an ongoing structure, not a past event. Name concrete mechanisms — residential schools, the Indian Act, segregated Indian Hospitals, coerced sterilization, child welfare removal — and connect them to root causes of today's inequities: loss of land/language/self-determination and justified mistrust of the health system. Cite the disparities (≈9-year life-expectancy gap; 2× infant mortality) and explain these flow from policy, per TRC Call 18 and In Plain Sight.

In Plain SightTRC Call 18ongoing structure

"What's the difference between cultural safety and cultural humility?"

Humility is the process; safety is the outcome. Humility = lifelong self-reflection on my own biases and power. Safety = defined by the Indigenous patient — care is only "safe" if they experience it as respectful and free of racism. I don't get to declare myself safe. Mention origins (Māori nursing) and B.C. vehicles (FNHA, San'yas training). Avoid conflating it with cultural competence (which risks stereotyping).

patient-definedFNHA / San'yaspower imbalance

"How would you identify and challenge Indigenous-specific racism in your workplace?"

Show both individual and systemic awareness. Individually: notice my assumptions, complete and refresh anti-racism training, speak up when I witness stereotyping, and centre the patient's experience. Systemically: examine policies, forms, and defaults that disadvantage Indigenous patients; support Indigenous data governance and complaints processes; advocate for Indigenous leadership. Reference In Plain Sight's recommendations and the Anti-Racism Act's requirement to assess and report.

interpersonal + systemicIn Plain SightAnti-Racism Act

"Which legislation and documents shape this work in B.C., and how do they fit together?"

Layer them: UNDRIP (international rights) → DRIPA (B.C. law implementing it) → Declaration Act Action Plan (89 actions, one goal explicitly on ending Indigenous-specific racism). Evidence and direction come from the TRC, In Plain Sight, and the MMIWG Calls for Justice. Remembering Keegan shows it in a real case. Accountability comes from the BC Human Rights Code and the Anti-Racism Act + Data Act.

UNDRIP→DRIPA→Action Planenforcement

"How does this apply specifically in molecular genetics / the lab?"

Even without direct patient contact, the obligations apply. Emphasize Indigenous data sovereignty and consent: genetic data and biosamples must be collected, stored, used, and shared with Indigenous Peoples' free, prior and informed consent (UNDRIP Art. 24 & FPIC) and under Indigenous data-governance principles (e.g., OCAP®). The Anti-Racism Data Act models governed, community-led race-based data. Reflect on how "neutral" lab defaults, reference ranges, or reporting can still carry bias.

data sovereigntyFPIC / OCAP®consent

"Tell us about a time you reflected on your own bias." (behavioural)

Use a real, honest example and the cultural humility lens: what assumption did I notice, how did I catch it, what did I change, and how do I keep learning? The point isn't to prove you're bias-free — it's to demonstrate ongoing self-reflection. The Remembering Keegan reflection is a good model of examining intersecting biases (race + disability).

honesty over perfectionRemembering Keegan

Glossary

Quick definitions of the terms used throughout this hub.

Settler colonialism: Colonialism in which settlers stay permanently and seek to replace Indigenous societies — an ongoing structure, not a past event.
Cultural safety: An outcome of care, defined by the person receiving it, in which they feel respected and free of racism. Judged by the patient, not the provider.
Cultural humility: A lifelong process of self-reflection on one's own biases, power, and limits — the practice that leads to cultural safety.
Cultural competence: Knowledge/skills about other cultures. Useful but insufficient and can slip into stereotyping; humility + safety go further.
Indigenous-specific racism: The unique racism Indigenous Peoples face, rooted in colonialism and stereotypes; the operative term in In Plain Sight.
Systemic / structural racism: Racism embedded in policies, procedures, and institutions that produces unequal outcomes regardless of individual intent.
Self-determination: Indigenous Peoples' right to govern themselves and make decisions about their own communities, health, and futures.
FPIC: Free, Prior and Informed Consent — Indigenous Peoples must be meaningfully consulted and consent before decisions affecting them; central to UNDRIP.
OCAP®: Ownership, Control, Access, and Possession — First Nations principles for governing how their data is collected and used (First Nations data sovereignty).
Unceded territory: Land never surrendered or ceded by treaty; most of B.C. is on unceded Indigenous territory.
Cultural genocide: The TRC's term for the residential school system's deliberate destruction of Indigenous language, culture, and family.
Jordan's Principle: A child-first rule ensuring First Nations children get needed services without delay from jurisdictional funding disputes.
Two-Spirit / 2SLGBTQQIA+: Terms for Indigenous people of diverse genders and sexualities; centred in the MMIWG Calls for Justice.
Equity-deserving groups: Communities that face barriers to equal access, opportunity, and outcomes due to systemic disadvantage and discrimination.
First Nations: Indigenous Peoples in Canada who are neither Métis nor Inuit; 600+ communities and many distinct Nations and languages. "Status/non-status" is an Indian Act legal category.
Métis: A distinct Indigenous People arising from First Nations and European ancestry, with their own culture, language (Michif), and Prairie-centred homeland — not simply "mixed ancestry."
Inuit (sing. Inuk): The Indigenous People of the Arctic (Inuit Nunangat), with their own language (Inuktut) and governance. "Eskimo" is outdated and inappropriate.
Distinctions-based approach: Recognizing First Nations, Métis, and Inuit as distinct Peoples with specific rights and needs, rather than treating "Indigenous" as one homogeneous group.
Intergenerational trauma: Trauma transmitted across generations (e.g., from residential schools) through disrupted attachment, grief, and altered stress responses. Historical trauma is its collective form.
Trauma-informed care: Care that recognizes the prevalence of trauma and prioritizes safety, trust, choice, collaboration, and resilience — asking "what happened to you?" not "what's wrong with you?"
Two-Eyed Seeing (Etuaptmumk): A Mi'kmaw framework (Elders Albert & Murdena Marshall) of using the strengths of both Indigenous and Western knowledges together.
Holistic health: Wellness as a balance of physical, mental, emotional, and spiritual dimensions, grounded in family, community, land, and culture (often a medicine-wheel teaching).
Microaggression: A subtle, often unintentional slight communicating bias; in care, includes diagnostic overshadowing (assuming intoxication/"drug-seeking" instead of investigating).
Allyship: Using one's position to support Indigenous-led change — listening, learning, interrupting racism, and accepting feedback. Judged by impact, not self-label.
CARE Principles: Collective benefit, Authority to control, Responsibility, Ethics — global principles for Indigenous data governance, complementing OCAP®.
Indigenous data sovereignty: Indigenous Peoples' right to govern the collection, ownership, and use of data (and biosamples) about their communities.
Jordan's Principle: Child-first rule (affirmed by the House of Commons, 2007; named for Jordan River Anderson) ensuring First Nations children get services without delay from funding disputes.
Joyce's Principle: 2020 Atikamekw-led principle (named for Joyce Echaquan) demanding equitable, discrimination-free health and social services and recognition of systemic racism.
RCAP: Royal Commission on Aboriginal Peoples (1996) — a 4,000-page report and 20-year agenda; intellectual predecessor of the TRC.
Calder case (1973): Supreme Court of Canada decision (Nisga'a) that first recognized Aboriginal title in Canadian law; influenced s.35 of the Constitution Act, 1982.
Section 35 (Constitution Act, 1982): Constitutional provision recognizing and affirming the existing Aboriginal and treaty rights of First Nations, Métis, and Inuit.
Potlatch ban: Indian Act prohibition (in force 1885–1951) criminalizing the potlatch and other ceremonies — a tool of cultural suppression.
FNHA: First Nations Health Authority — created in B.C. in 2013 (after the 2011 Tripartite Agreement); the first province-wide First Nations health authority in Canada.
San'yas: Indigenous-led Indigenous Cultural Safety Training program, designed in B.C., delivered online to embed anti-racism in health and other sectors.
Reconciliation: Establishing and maintaining a respectful relationship between Indigenous and non-Indigenous Peoples — requiring awareness, atonement, and changed behaviour (per the TRC).
Decolonization: Dismantling colonial structures and restoring Indigenous self-determination, lands, knowledge, and governance — more than symbolic gestures.
UNDRIP / DRIPA: The UN Declaration on the Rights of Indigenous Peoples (2007) and B.C.'s Act implementing it (2019).