When an Indigenous woman gives birth at a Canadian hospital, saving the placenta is treated as a given. Multiple family members crowd the birthing room. A quiet space is made available. These aren't special accommodations, they're how care is supposed to work.
That example, drawn from one of 15 studies reviewed in new research from The George Institute for Global Health's Guunu-maana (Heal) team, illustrates what decolonising healthcare looks like in practice. Not a policy slogan. Not a training module. A fundamental reshaping of who holds power in a medical encounter.
The systematic review, published in the International Journal for Equity in Health, is believed to be the first to examine the practical elements of healthcare decolonisation across global settings. Researchers analysed studies from Canada, Australia, Aotearoa New Zealand, the United States, Chile and South Africa, drawing on qualitative data from 835 participants.
Why it matters
Western biomedical systems were built within colonial frameworks that dismissed Indigenous knowledge as inferior or invalid. That legacy persists. Indigenous peoples globally continue to experience racism and discrimination within health systems and are less likely to receive timely, quality care for conditions ranging from pain management to cancer treatment.
"Colonial structures have not disappeared from healthcare, they have simply been reshaped. Although calls to decolonise healthcare have been prominent for some time, far less is understood about how this translates into everyday healthcare delivery.
By:Camila Kairuz Santos
PhD Candidate & Research Associate, Aboriginal and Torres Strait Islander Program
The review finds that closing these gaps requires more than good intentions or cultural awareness training. It requires structural change.
Six elements of decolonised care
The researchers identified six core elements that characterise genuinely decolonising healthcare: community governance and ownership, holistic care, relationality and trust, storytelling, reflexive practice and colonisation-informed care.
Underpinning all six is a shared principle: cultural, ontological and epistemic equity. In plain terms, Indigenous ways of knowing, being and doing must be treated as equally valid, not merely accommodated.
Community governance means Indigenous communities hold real decision-making authority over service design and resource allocation, not advisory roles bolted onto Western-designed systems. Holistic care extends beyond physical symptoms to encompass spiritual, emotional, environmental and family wellbeing. Relationality means healthcare built on genuine trust, not transactional encounters. Storytelling acknowledges that narrative is itself a form of knowledge. Reflexive practice asks clinicians to examine their own assumptions and biases continuously. And colonisation-informed care requires providers to understand trauma, intergenerational harm and systemic racism as health determinants.
What the research found
When these elements were present, outcomes improved. Patients reported greater satisfaction and trust. Some studies documented increased empowerment and willingness to engage with services. One program recorded a 680% increase in psychology consultations after integrating Indigenous-led approaches, with 82% of those patients being Indigenous.
"For practitioners, we hope these findings clarify concrete actions they can take to improve their services. For policymakers, the key message is that decolonising healthcare cannot be reduced to checklists or one‑off initiatives.
By:Camila Kairuz Santos
The researchers caution against applying findings as a checklist. Decolonisation is a continuous process, not a series of one-off actions and any approach must be shaped by local communities, not imported wholesale from elsewhere.
The review was led by the George Institute's Guunu-maana team, with Aboriginal, Torres Strait Islander and Māori researchers central to its design, analysis and interpretation.
