Jordan's Principle: The Struggle to Access On-Reserve Health Care for High-Needs Indigenous Children in Canada

Beginning in the late 1950s, the federal and provincial governments of Canada introduced legislation intended to provide hospital and insured medical services for all Canadians. With the passage of the Medical Care Act in 1966 these services were extended to include all hospital care and medically necessary services. All services were to be informed by five principles: universality, comprehensiveness, public administration, portability, and accessibility.¹ This health care system is protected by federal law and administered by the provinces and territories. However, despite these five principles, many services remain difficult to obtain. Governments are cost-conscious, and decision making within the health care system and in health care policy making is not always about the best interests of individual patients.² This is particularly true with regard to expensive in-home services such as those required for the care of children with special needs.³ These problems are particularly acute for Indigenous people living on reserves in Canada. The unequal and different treatment of First Nations children and Indigenous people more generally is enshrined in the legal and constitutional foundations of Canada and results in disproportionately high rates of poverty and diseases of poverty.⁴ The federal government is responsible for those deemed to be "Indians" under the Indian Act, but provincial governments are responsible for health and social services, leaving a service gap for people on-reserve. Among those who suffer are children with special needs who live on-reserve.

The structural inequalities within Canada's health care system were embodied in the 2005 death of five-year-old Jordan Rivers Anderson, a Cree child from Norway House Cree Nation. Norway House Cree Nation is a reserve located almost 500 kilometers north of Winnipeg, Manitoba, with a population of 6,918 on-reserve members.⁵ Jordan suffered from Carey Fineman Ziter Syndrome, a neurological disorder, and spent the first two years of his life in a Winnipeg hospital. When his condition improved, doctors determined that "he could leave the hospital to receive care in a home tailored to his medical needs," but the federal government refused funding for the necessary renovations of his family home. Norway House Cree Nation raised money for a van to transport Jordan to various community and family activities, but costs with regard to "transportation to medical appointments, special food, and even a $30 showerhead" were disputed between the federal and provincial governments, and Jordan remained in the hospital pending the resolution of these arguments. Jordan died in hospital.⁶ Jordan's mother, who had moved to Winnipeg to be with her son, was overcome by grief and died only a few months after Jordan.⁷ Following Jordan's death, his family and supporters rallied to force the federal government to provide ongoing health services and care for on-reserve children with special needs.

In response to this public pressure, in 2007 the federal government adopted Jordan's Principle. This principle asserts that when an Indigenous child requires care, the government of first contact should pay up front and that jurisdictional disputes should be resolved after care is provided.⁸ In order for Jordan's Principle to come into effect, however, it needed to be ratified by provincial and territorial governments. This has not happened, and federal and provincial governments have failed to implement the policy. In recent legal disputes, the federal government has defended policies that harm Indigenous children with special needs by spending tax dollars fighting First Nation organizations, band councils, and individual parents over funding. Ongoing battles between federal and provincial governments prevent health care in Canada from being universal, comprehensive, publicly administered, portable, and accessible, despite the principles enshrined in the Medical Care Act. This article uses the story of Jordan's Principle to illustrate how the federal system has ensured that Indigenous people generally and on-reserve Indigenous children specifically remain without access to basic medical services. First, we briefly sketch the breadth of the social and economic inequities that exist for Indigenous peoples in Canada and how those inequities translate into...