Davidf/GettyWe know First Nations people encounter frequent and pervasive racism in every facet of their daily lives. But since the 2023 Voice referendum, these experiences have increased significantly – including in health care.When First Nations people face racism at the doctor’s office or in a hospital or pharmacy, it can profoundly impact both their mental and physical health. Evidence shows it can lead to significant health disparities. First Nations people are less likely than other Australians to get screened for a medical condition, or receive a diagnosis, follow-up care or treatment. As a result of past negative experiences, they may delay or avoid seeking care altogether.In our research with First Nations people in New South Wales, we’ve gathered more than 400 accounts of being in hospital. Participants described both the racism they experienced, and what made them feel culturally safe. We found the single biggest factor was having access to an Aboriginal hospital liaison officer to help them navigate the system while in hospital. Here’s why that works, and what else First Nations people need.First, what is cultural safety?This concept originated in Aotearoa New Zealand in the late 1980s, when Māori nurses identified the need to counter institutional racism and cultural bias encountered by both Māori patients and clinicians in the mainstream health system. Cultural safety means creating an environment where people are safe and their identity, culture and experience are recognised and respected. In health care, this can look like a clinician taking the time to build rapport and trust with a patient, involving them in decisions, making the physical environment more welcoming for families, respecting cultural practices and being explicitly anti-racist. Why it’s urgentFirst Nations participants in our study told us about the psychological toll of overt and widespread racism in hospital. One person told us:Staff don’t even try to hide being racist.Another said:I’m just another Aboriginal person, a body in a bed — they don’t really give a shit. You can see how they talk to other patients differently. They spend more time, more kindness and respect.Providing culturally safe care is a way of closing the gap in health between First Nations and non-First Nations people, by removing access barriers and improving the quality of care and health outcomes.There is also an economic argument for improving cultural safety and eliminating racism: the health impacts of racism are estimated to cost the Australian economy A$37.9 billion each year. What our research foundThe only way to determine whether or not a service is culturally safe is to ask the patient and, in some cases, their family or community.This is why our team developed a tool to measure the experiences of First Nations patients in hospitals.Between 2018 and 2021, we used this tool with more than 413 First Nations people across 49 hospitals. Participants, who had been in hospital at some point in the previous 12 months, completed a survey about their experience. This included questions about how hospital staff spoke to them and whether they communicated clearly and honestly, if the participant’s family felt comfortable visiting, and whether there was genuine respect for the participant’s culture and health concerns. Participants were also able to add more detail about what made them feel safe or unsafe.We then did a statistical anaylsis of the survey responses that produced a cultural safety score for each hospital, as well as for individual participants.One of the most significant findings was that participants who had access to an Aboriginal hospital liaison officer during their stay had the highest scores overall.So, what do Aboriginal hospital liaison officers do?Aboriginal hospital liaison officers help patients navigate the health system and feel supported while they’re in hospital.They can explain medical information in culturally appropriate ways, advocate for First Nations patients and families, help them make informed decisions about their care and connect them with other services. One participant told us the role:is much needed and appreciated. She is a beautiful woman and made my stay so much better than last time. I feel like there is someone looking out for us.Another said:talking to (the Aboriginal hospital liaison officer) really helped because I knew someone was listening and that she would protect me. She has authority in that hospital, and she would fight for me and make them listen.Aboriginal hospital liaison officers also work alongside hospital staff to provide care that is more culturally responsive and respects individual cultural and family needs. They can improve trust and communication and educate non-First Nations staff about cultural considerations. One participant said:I felt like I had to beg for them (the hospital) to listen. That’s why it was good to have (the Aboriginal hospital liaison officer) there and have someone on my side who would listen and look after me. Aboriginal hospital liaison officers work with First Nations patients as well as hospital staff, to improve communication and trust. But one person is not enoughDespite their crucial role, it isn’t mandatory for hospitals to employ Aboriginal hospital liaison officers. Those that do are often under-resourced. In the hospitals we looked at in our research, the majority had just one person doing this role for the entire hospital.First Nations staff also frequently face racism when supporting patients, either directly or vicariously.Addressing cultural safety and institutional racism in hospitals is a systemic issue. The responsibility should not, and cannot, rest on one person.But we need to make sure those who do work in this essential role are properly remunerated, have manageable workloads, and are given proper access to resources and support, so they are also culturally safe.If you or anyone you know is experiencing mental health challenges, please contact WellMob. This resource has a list of culturally responsive organisations for First Nations people.Elissa Elvidge receives funding from the National Health and Medical Research Council (NHMRC) and the Medical Research Future Fund (MRFF). Yin Paradies does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.