What is cultural safety and why does it matter in eye health care?

Cultural safety is a cornerstone of effective eye health care, ensuring that it is safe, respectful, and inclusive for Aboriginal and Torres Strait Islander peoples.

This approach goes beyond simply providing services and ensures every patient feels seen, valued, and understood.

It is fundamental to addressing health inequities and improving eye health outcomes.

But what exactly is cultural safety, what does it have to do with eye health, and how is The Fred Hollows Foundation working to increase culturally safe health practices?

Read on to find out…

What is cultural safety?
Why cultural safety matters in eye health
Key principles of cultural safety
Examples of cultural safety in practice
How The Fred Hollows Foundation promotes cultural safety
Our commitment to cultural safety

What is Cultural Safety?

Cultural safety means creating an environment in which Aboriginal and Torres Strait Islander peoples feel respected, valued, and secure in their identity. It is about how health care is provided, not just what is provided.

The practice centres on recognising and respecting patients’ identities, values, and beliefs, to create environments that are free of racism and discrimination to deliver safe and effective care.

The concept of cultural safety was first developed in Aotearoa (New Zealand) within the nursing profession to address power imbalances. As the Australian Institute of Health and Welfare notes about cultural safety, it emerged "in response to the harmful effects of colonisation and the ongoing legacy of colonisation on health and healthcare."

Don with his eye patch off, smiling at the camera, giving the 'ok' hand gesture to the camera.

Photo credit: Michael Amendolia

The National Aboriginal and Torres Strait Islander Health Plan defines cultural safety as requiring health practitioners "to deliver safe, accessible and responsive health care that is free of racism by: recognising and responding to the power imbalance between practitioner and patient (and) reflecting on their… conscious and unconscious biases.”

As a non-Indigenous ally organisation, The Fred Hollows Foundation acknowledges the United Nations Declaration on the Rights of Indigenous Peoples (UNDRIP), which affirms the right of Aboriginal and Torres Strait Islander peoples to self-determination, including in matters of health and well-being.

Article 24 of UNDRIP states that Indigenous peoples have the right to their traditional medicines and to maintain their health practices, as well as the right to access all social and health services without discrimination.

We uphold these principles by embedding cultural safety across our work and ensuring our health care initiatives are community-led, culturally responsive, and respectful of the rights of Aboriginal and Torres Strait Islander peoples.

Why Cultural Safety Matters in Eye Health

Fred Hollows was dedicated to making health care accessible but also culturally respectful and empowering.

Fred’s work with Aboriginal and Torres Strait Islander communities laid the foundation for our continued focus on delivering culturally safe eye care in a way that upholds self-determination and community leadership.

The Fred Hollows Foundation believes cultural safety is not an ‘add-on’ — it is fundamental to closing the gap in eye health outcomes for Aboriginal and Torres Strait Islander peoples.

Dr Kris Rallah talking to an Indigenous patient outside a remote eye health facility.

Photo credit: Michael Amendolia

"One of the big barriers is fear - fear of the system, fear of the unknown… walking into a space where they don't feel welcome and understood,” says Australia’s first Aboriginal ophthalmologist, Dr Kris Rallah-Baker.

For many Aboriginal and Torres Strait Islander people, hospitals and clinics can feel alienating.

European colonisation excluded Aboriginal and Torres Strait Islander peoples from social structures, the economy, and healthcare policies and practices.

The lack of recognition of Aboriginal and Torres Strait Islander peoples meant mainstream services were unable to develop practices and services that were culturally responsive and welcoming, which fostered an understandable level of distrust.

Accessibility, language barriers and cultural protocols can be additional barriers to accessing care and impact how comfortable patients feel accessing eye care.

When policies, practices and staff are appropriately educated, trained and able to confidently implement culturally safe care, patients are more likely to access the care they need, improving both trust and health outcomes.

While progress is being made to make health service delivery more culturally responsive, there is still a long way to go.

Cultural safety in eye health care plays a vital role in:

Building trust between patients and health providers.
Removing barriers to accessing care, such as discrimination or cultural misunderstanding.
Improving eye health outcomes by ensuring that care is patient-centred and culturally responsive.

Associate Professor Angus Turner preparing Mavis Arnott for cataract surgery

Photo credit: Alan McDonald

Key Principles of Cultural Safety

Self-Reflection: Health providers critically examine their own biases and cultural assumptions.
Patient-Centred Care: Care is designed to meet the cultural needs and preferences of Aboriginal and Torres Strait Islander patients.
Partnership: Services are developed in collaboration with communities to ensure they are inclusive and effective.
Recognition of Power Dynamics: Health providers acknowledge and address imbalances in patient-provider relationships.

Examples of Cultural Safety in Practice

Language Support: Providing interpreters and health information in Aboriginal and Torres Strait Islander languages.
Welcoming Spaces: Designing clinics that incorporate culturally significant symbols and artwork to create a sense of belonging.
Community Engagement: Partnering with local Elders and cultural leaders to shape service delivery and ensure community-led solutions.

How The Fred Hollows Foundation Promotes Cultural Safety

Fred Hollows was committed to working alongside Aboriginal and Torres Strait Islander communities, ensuring they had the skills and resources to deliver their own health care.

"Aboriginal groups should be calling the shots, hiring and firing resource personnel, and they should be deciding policy," Fred said.

Fred’s legacy continues today through The Foundation’s commitment to cultural safety in eye health, including:

Partnering with Aboriginal Community Controlled Health Organisations (ACCHOs) as these services are best placed to deliver eye health programs centred on culture, self-determination and locally led and developed service delivery.
Investing in the Aboriginal and Torres Strait Islander eye health workforce because we recognise the crucial role representation and cultural education in health care plays in creating culturally safe environments. In partnership with ACCHOs, we support a number of eye health trainee, fellow, cadetship and coordinator roles.
Supporting training non-Indigenous healthcare providers on cultural safety and Aboriginal and Torres Strait Islander perspectives in health.
Advocating for systemic changes in health policy and practice to prioritise cultural safety and eliminate racism in healthcare settings.

Fred Hollows and Gordon Briscoe talking.

Photo credit: The Fred Hollows Foundation

Our commitment to cultural safety

Cultural safety is not just an ideal—it is a necessity and a fundamental right to ensure Aboriginal and Torres Strait Islander peoples receive eye health care that is culturally responsive, respectful and free from discrimination and racism.

At The Fred Hollows Foundation, we continue to honour Fred’s vision of equitable and culturally safe eye health care by championing for Aboriginal and Torres Strait Islander rights to sight, good health and self-determination.

As a non-Indigenous ally organisation, we are committed to listening, learning, and working in partnership with Aboriginal and Torres Strait Islander communities to ensure our efforts are led by and for community.

We will continue advocating for systemic change in programs and policies to improve eye health outcomes and end avoidable blindness in Aboriginal and Torres Strait Islander communities.

To learn more about cultural safety, we recommend visiting our friends at the Indigenous Allied Health Association or the Lowitja Institute.