Background: Eliminating indigenous and ethnic health inequities requires addressing the determinants of health inequities which includes institutionalised racism, and ensuring a health care system that delivers appropriate and equitable care. There is growing recognition of the importance of cultural competency and cultural safety at both individual health practitioner and organisational levels to achieve equitable health care. Some jurisdictions have included cultural competency in health professional licensing legislation, health professional accreditation standards, and pre-service and in-service training programmes. However, there are mixed definitions and understandings of cultural competency and cultural safety, and how best to achieve them. Methods: A literature review of 59 international articles on the definitions of cultural competency and cultural safety was undertaken. Findings were contextualised to the cultural competency legislation, statements and initiatives present within Aotearoa New Zealand, a national Symposium on Cultural Competence and Māori Health, convened by the Medical Council of New Zealand and Te Ohu Rata o Aotearoa – Māori Medical Practitioners Association (Te ORA) and consultation with Māori medical practitioners via Te ORA. Results: Health practitioners, healthcare organisations and health systems need to be engaged in working towards cultural safety and critical consciousness. To do this, they must be prepared to critique the ‘taken for granted’ power structures and be prepared to challenge their own culture and cultural systems rather than prioritise becoming ‘competent’ in the cultures of others. The objective of cultural safety activities also needs to be clearly linked to achieving health equity. Healthcare organisations and authorities need to be held accountable for providing culturally safe care, as defined by patients and their communities, and as measured through progress towards achieving health equity. Conclusions: A move to cultural safety rather than cultural competency is recommended. We propose a definition for cultural safety that we believe to be more fit for purpose in achieving health equity, and clarify the essential principles and practical steps to operationalise this approach in healthcare organisations and workforce development. The unintended consequences of a narrow or limited understanding of cultural competency are discussed, along with recommendations for how a broader conceptualisation of these terms is important.

The determinants of health inequities between Indigenous and non-Indigenous populations include factors amenable to medical education’s influence—for example, the competence of the medical workforce to provide effective and equitable care to Indigenous populations. Medical education institutions have an important role to play in eliminating these inequities. However, there is evidence that medical education is not adequately fulfilling this role and, in fact, may be complicit in perpetuating inequities. This article seeks to examine the factors underpinning medical education’s role in Indigenous health inequity, to inform interventions to address these factors. The authors developed a consensus statement that synthesizes evidence from research, evaluation, and the collective experience of an international research collaboration including experts in Indigenous medical education. The statement describes foundational processes that limit Indigenous health development in medical education and articulates key principles that can be applied at multiple levels to advance Indigenous health equity. The authors recognize colonization, racism, and privilege as fundamental determinants of Indigenous health that are also deeply embedded in Western medical education. To contribute effectively to Indigenous health development, medical education institutions must engage in decolonization processes and address racism and privilege at curricular and institutional levels. Indigenous health curricula must be formalized and comprehensive, and must be consistently reinforced in all educational environments. Institutions’ responsibilities extend to advocacy for health system and broader societal reform to reduce and eliminate health inequities. These activities must be adequately resourced and underpinned by investment in infrastructure and Indigenous leadership.

Climate change poses a serious threat to the health and well-being of Indigenous peoples around the world. Despite living in diverse contexts, Indigenous peoples face a number of common challenges. Disproportionate threats from climate change exist due to a range of factors including unique relationships with the natural environment, socioeconomic deprivation, a greater existing burden of disease, poorer access to and quality of health care, and political marginalization. Responses to climate change at global, national, and local levels also threaten Indigenous people’s rights. While climate action presents many opportunities to improve health and reduce inequities, there is also significant potential for climate mitigation and adaptation policies to inflict harm on Indigenous peoples. An important aspect of this is the impact on traditional lands, which are acknowledged as a fundamental determinant of Indigenous health and well-being. This article seeks to elucidate the relationships between climate change and Indigenous health and to inform health promotion solutions to achieve climate justice for Indigenous peoples. The underpinning analysis is founded on a Kaupapa Māori positioning, which seeks transformative change and involves critiquing Western knowledges and structures that undermine Indigenous rights. A central theme is that anthropogenic climate change is intimately connected to the ideologies, systems and practices of colonialism, and that the impacts on Indigenous peoples can be conceptualized as an intensification of the process of colonization. It is not possible to understand and address climate-related health impacts for Indigenous peoples without examining this broader context of colonial oppression, marginalization and dispossession. The challenge for health promotion is to engage in a process of decolonization. This involves deconstructing its own systems and practices to avoid reinforcing colonialism and perpetuating inequities. It also requires health promotion practitioners to support Indigenous self-determination and recognize Indigenous knowledges as a critical foundation for climate change and health solutions.

A range of global environmental changes are contributing to an increasing global burden of disease. Since human health and well-being are intimately associated with the health of our planet, healthcare providers will not only be charged with caring for this expanding disease burden but will also need to become more environmentally sustainable in their professional practice. There is thus an urgent need in the health professions education community to prioritize environmentally sustainable healthcare practice, which must include and prioritize Indigenous voices and Indigenous knowledge systems. Critical global dialogue on the significance of Indigenous knowledge systems in educating health professionals for a sustainable future will be required if we are ready to ensure the generations that follow us are able to live healthy lives. Indigenous ways of ‘being’ in the world, which emphasize the importance of interconnection and reciprocal stewardship with everything in the natural world, are essential for advancing education for sustainable healthcare and overall well-being. Given the colonial legacy however, Indigenous people, despite their essential knowledge systems and abilities, still face many barriers accessing safe decolonizing spaces and presence in health professions education, which needs to be addressed.

Planetary health has an important role to play in guiding humanity towards a healthy, equitable, and sustainable future. However, given planetary health's dominant colonial and capitalist underpinning ideologies, it risks reinscribing the same exploitative power dynamics that are fundamental drivers of global ecological collapse. In this Personal View, we reaffirm the need for a vision of planetary health grounded in Indigenous epistemologies, which centre relational ecocentric norms and values. We identify key tensions that planetary health scholars, practitioners, and advocates need to engage with to inform action. Finally, we offer suggestions for working progressively towards a decolonial vision of planetary health that recognises our obligations to all our (human and more-than-human) relations. The themes explored in this Personal View bring together our perspectives, strongly centring Indigenous understandings but also referencing ideas and positions emerging from a relational space between Indigenous and non-Indigenous scholars.