Centring Aboriginal and Torres Strait Islander Voices: A Framework for Culturally Safe and Racism-Free Healthcare.

Culturally safe, racism-free healthcare is essential in Australia, yet Aboriginal and Torres Strait Islander people continue to face inequitable access, experiences and outcomes. Although cultural safety is widely cited, implementation remains shallow and disconnected from patients' realities. We argue that meaningful cultural safety requires Aboriginal and Torres Strait Islander governance, robust measurement and institutional accountability. Evidence shows that culturally unsafe care, including racism, creates psychological distress, leads to care avoidance and results in poorer outcomes, whereas Indigenous-led models perform considerably better. We propose a framework to strengthen cultural safety through Aboriginal and Torres Strait Islander community-governed assessment, greater accountability, data sovereignty and mandated cultural safety and anti-racism standards.