This toolkit is designed speci cally to support and guide mainstream organizations on their journeys towards creating safer environments for Indigenous People. Gathering knowledge through our own journey is ongoing and we will continue to update this guidance as we learn new lessons. The purpose of the Ne’iikaaniganaa Toolkit (Anishinaabe word for ‘All Our Relations’) is to educate workers at all levels within the health care system and equip them with tools and resources that can effectively move organizations towards addressing implicit bias and discrimination and strengthening equity and inclusion for Indigenous Peoples. The toolkit also provides tips and strategies for supporting Indigenous communities during COVID. INTENT AND PURPOSE OF THE TOOLKIT INTRODUCTION 4 Racism, including systemic racism within the health care system, is a signi cant contributor to the lower life expectancy and poorer health outcomes experienced by Indigenous Peoples. Racism is not limited to interpersonal issues during the provision of health services; rather, structural racism is evident throughout the Canadian health care system. Structural racism exists in the policies and practices of the Canadian public health system and other sectors, which has profound negative impacts on access to health care and health disparities. Racial discrimination in the health care system, as well as broader Canadian society, has direct physiological effects on health. Racial discrimination negatively impacts health through the: To combat racism successfully, it takes a collective effort to acknowledge it exists and design strategies that promote equity and inclusion. Direct effects of stress arising from interactions that are perceived to be discriminatory Denial of access to resources such as health care that ts with peoples’ needs Internalization of stigma and discrimination Vigilance that is required in anticipation of negative treatment, which leads to stress and often tense social interactions Avoidance of accessing the health care system due to negative past experiences BACKGROUND 5 Indigenous participation refers to the inclusion of Indigenous peoples in culturally safe, respectful ways. Evidence has shown that the health care system, and institutions within it, are not always the safest places for Indigenous Peoples to access and participate in, as both service providers and service receivers. We re ect on the stories of Michelle Labrecque, Brian Sinclair, Joyce Echaquan, and many more, as examples of how a system meant to protect and heal, has resulted in harm. Systemic racism occurs when an institution or set of institutions working together creates or maintains racial inequity (Ontario, 2020). The focus for combatting systemic racism should be on both individual and organizational change. While some elements of the cultural safety approach in this guidance include addressing individual level bias, it is also essential that institutions re ect on organizational policies and structures that unintentionally perpetuate discrimination and exclusion. Evidence shows that systemic racism is often caused by hidden institutional biases in policies, practices and processes that privilege, or disadvantage people based on race (Ontario, 2020). It can be the result of doing things the way they have always been done, without considering or recognizing how they impact particular groups differently. To genuinely strive towards creating safer environments for Indigenous participation as both service providers and service receivers, it is essential that organizations acknowledge that systemic racism exists and actively confront the unequal power dynamic between groups and the structures that sustain it (Ontario, 2020) . To do this work, organizations must consistently assess the systems they have in place through the implementation of outcome monitoring to ensure fairness and equity.