This chapter delves into the health disparities experienced by First Nations peoples in Aotearoa New Zealand and Australia, specifically within the critical care setting. Factors contributing to the elevated rates of preventable hospital admissions including social, economic, and geographical barriers, along with systemic racism and the enduring impact of colonisation are explored. Disparities in hospitalisation rates, chronic disease burden, and admission diagnostic categories are highlighted. Despite similar illness severity scores, critical illness among First Nations patients is characterised by higher physiological derangement, and it is suggested that this is largely driven by social determinants. Communication challenges in critical care settings are discussed, with an emphasis on the need for the provision of culturally sensitive and linguistically appropriate care and improved communication practices, acknowledging the role of cultural brokers and interpreters. The chapter also addresses the importance of cultural safety in medical training, calling for greater representation of First Nations clinicians in intensive care teams. There is a need for critical care clinicians to advocate for cultural safety, inclusivity, and equity in healthcare.