The relationship between Indigenous health and relevant sector Standards in Aotearoa New Zealand, Australia, and Canada: a scoping review

Abstract

Background: Health sector Standards in Aotearoa New Zealand, Australia, and Canada increasingly acknowledge the importance of culturally appropriate care for Indigenous populations. Despite this, inequities persist. This review explores how national health Standards intersect with Indigenous health, focusing on Cultural Safety, Indigenous-led governance, Indigenous knowledge, and anti-racism. Methods: A scoping review methodology was employed to map the breadth of literature across Aotearoa New Zealand, Australia, and Canada. Guided by a six-stage framework and the PRISMA-ScR protocol, the review used the qualitative variant—Population/Problem, Interest, Context approach—to structure inclusion criteria and search strategies. Literature was sourced from five major databases and supplemented by grey literature. Data from 36 records were charted, synthesized, and analysed through narrative synthesis and stakeholder engagement. Results: Cultural Safety was consistently identified as more impactful than cultural competency alone, yet most Standards fall short of indicating how Cultural Safety will be measured. Across records, 75% highlighted the need to address social determinants of health, and 67% advocated anti-racism and structural reform. Indigenous-led governance and self-determination were linked to improved health outcomes in 50% of the records, though practical implementation was uneven. Integration of Indigenous knowledge and holistic approaches was supported in 47% of records, but limited by weak policy infrastructure. Racism, both systemic and interpersonal, was identified in all studies as a persistent barrier to equity. National Standards often lack the enforcement mechanisms to address these issues meaningfully. Conclusion: This review identified significant gaps between the intent and implementation of health sector Standards across Aotearoa New Zealand, Australia, and Canada in relation to Indigenous health. Despite formal commitments to culturally appropriate care, systemic barriers, rooted in colonization and policy-practice disconnects, continue to undermine equitable outcomes. The findings highlight the need for Indigenous-led evaluation, stronger accountability, and the embedding of Cultural Safety, Indigenous leadership, and holistic health approaches to drive meaningful and lasting change.