Canadian Health Care


In the 18th century, before Mother Theresa of Calcutta's ministry captured the world's hearts, Saint Marguerite d'Youville, Sisters of Charity, foundress, inaugurated a similar project. After a brief and troubled marriage, the widow of Francois d'Youville and mother of three brought her passions for the disadvantaged to the Confraternity of the Holy Family. On June 3, 1753, Montreal's civic and private forces, responsible for the sick and needy, awarded d'Youville's deeds to property and resources. Throughout this period, hospitals typically served as residences for the elderly, impoverished, and sick. Les Soeurs grises or Grey Nuns, as they were called, stepped forward to deliver essential medical care at Montreal's Hotel Dieu.     

Pope John XXIII, beatified Marguerite on May 3, 1959, calling her "the mother of universal charity." The Holy Father's lofty praise honored a new canonical blessed from colonial Lower Canada.[1] In 1990, Pope John Paul II elevated Blessed Marguerite to sainthood, and the Canadian Medical Hall of Fame distinguished the new saint with induction.[2]  St. Marguerite empathized, from out of her deep personal conviction, towards the unfortunate and painful circumstances of widows, orphans, adolescents, disillusioned girls, and married women. Christians can easily imagine St. Marguerite's virtuous approach to Montreal's marginalized stemmed from devotion to Jesus' mother, who Scripture also describes as a married woman.[3] In 1755, the Sisters of Charity cared for people stricken during that year's smallpox epidemic. The sisters brought physical and spiritual medicine to the sick, being unbound by any cloister vows. First Nations people across the St. Lawrence River in Oka became among the charity's benefactors and returned the Sisters' kindness by helping to rebuild the hospital after a fire in 1765.[4]


The Ursuline Sisters are another global religious order devoted to girls' education. Ursuline nuns arrived in New France around 1639 with Blessed Marie de l'Incaration. Although the congregation's initial apostolate centered on educating Indigenous girls, the sisters gradually expanded their apostolate to include French Canadian girls. Among this order's most notable students were St Marguerite d'Youville. Canadian health care and education owe a tremendous debt of gratitude to the many devoted religious sisters' stamina and competencies.[5]   


The Canada Health Act (CHA) states that the policy's primary objective is to protect, promote, and restore the physical and mental well-being Canadian residents and facilitate reasonable access to health services, without financial, or other barriers.[6]  In 1999, federal and provincial governments signed the Social Union Framework Agreement (SUFA), which underscored the principles for designing and developing modern social policies and programs. The philosophy underlying this work, included accountability and citizenry engagement. Among the framework, the agreement re-confirmed conditions already established by pioneering religious sisters. The Canada Health Act (1984) listed the requirements that provincial/territorial, health insurance plans must respect if they are to receive federal contributions. The five conditions necessary to acquire secular funding include,  public administration, accessibility, comprehensiveness, universality, and portability. Public administration declared that provincial insurance programs must be accountable for the funds they spend. Moreover, a not-for-profit authority must manage provincial health insurance plans, which can be part of the government, or an arm’s-length agency.  

  1. Accessibility expects that Canadians will have reasonable access to insured services, without charge, or paying user fees.

  2. Comprehensiveness expounds provincial health insurance programs, including all medically necessary services. The Canada Health Act interprets comprehensiveness, broadly, to mean medically essential services "to maintain health, prevent disease, or diagnostics or treatment for an injury, illness or disability."

  3. Universality enforces provincial health insurance programs to ensure Canadians for all medically necessary hospital and physician care. The condition also means Canadians do not have to pay an insurance premium to receive coverage through provincial health insurance.

  4. Portability implies that Canadians will enjoy health coverage provided by a provincial insurance plan during short absences from that province.[7]


The Canadian Constitution established boundaries that distinguished federal, provincial, and territorial responsibilities for health care. In the Constitution Act of 1867, provinces assumed jurisdiction over establishing and managing hospitals, asylums, and charitable organizations. The federal Government withheld jurisdiction over marine hospitals and quarantine matters. Canada's department of health, created in 1919, emerged in direct response to the Spanish influenza pandemic. Religious organizations fall into the charitable organization category bringing them under the province's umbrella. Prior to World War II, health care in Canada accepted privately delivered and funded services. In many cases, those facilities were managed and staffed by religious organizations.


In 1930, Thomas Douglas, an immigrant and Baptist minister from Scotland, arrived in rural Saskatchewan. Western Canada's prairie region suffered exceedingly during this period from hopeless economic depression, low grain prices, and drought. Ninety percent of Canada's dust bowl citizens sought government relief from starvation, receiving only meager support. This generation now occupy many of the county's long-term care home. Money for education and health care seemed nonexistent for this segment of the population. According to the Canadian Encyclopedia, Reverend Tommy Douglas recalled burying a girl 14 years of age who had died with a ruptured appendix and peritonitis.


          There isn't any doubt in my mind that it was just an inability to get her to a hospital. I buried two                   young men in their 30s with young small families, who died because there was no doctor readily                 available, and they hadn't the money to get the proper care."[8]


In 1977, under the Federal-Provincial Fiscal Arrangements and Established Programs Financing Act, a new cost-sharing arrangement replaced the existing block fund.[9] The federal Government reduced tax rates, while provincial and territorial governments simultaneously raised theirs, by an equivalent amount. The new funding model enabled provincial and territorial governments' flexibility to invest in health care, as they deemed appropriate. Transfer payments for health also included post-secondary education. In 1984, The Canada Health Act, replaced the National Hospital, and Medical Insurance Acts, establishing the delivery principles built around portability, accessibility, universality, comprehensiveness, and public administration, as stated above. The new Act added provisions that prohibited extra-billing and user fees for insured services.  


Federal legislation in 1995 again passed a updated health care and post-secondary education transfer arrangement, adding monies to support social services into mechanism, known as the Canada Health and Social Transfer (CHST) program. An agreement reached in 2000 by the federal, provincial, and territorial government leaders (or first ministers) set the direction for crucial reforms in primary health care, pharmaceuticals management, health information, communications technology, health equipment, and infrastructure. At the same time, the federal Government increased transfer payments for health care. In 2004, Canada's first ministers announced updates to the earlier agreements in a document entitled, A 10-Year Plan to Strengthen Health Care. All government levels committed their jurisdictions to improvement in critical areas, such as, wait times, management, human health resources, Indigenous health, home care, national pharmaceutical strategy, health care services in the remote North, medical equipment, disease prevention, promotion, and public health. Annual increases to the CHST mechanism from 2006 until 2014 provided predictable and stable growth through federal funding.



[1] Lower Canada refers to that region between the Ottawa River and Gulf of St Lawrence in the modern Canadian province of Quebec.

[2] The Canadian Medical Hall of Fame recognizes and celebrates Canadian heroes whose work has advanced health and inspired the pursuit of careers in the health sciences.

[3]Feminist views receive marginal Church attention but secular writers in the early Enlightenment Age begin to address women’s rights. Jeremy Bentham (1781) Mary Wollstoncraft (1792) and St Marguerite (1701 -1771). 

[4] Anecdotally, St Lawrence was one of Rome’s seven deacon serving under Pope Sixtus II who suffered martyrdom in the 3rd century. 

[5] See web page five for French translation of paragraphs 1-3. Voir la page Web cinq pour la traduction en français des paragraphes 1-3.

[6] More detail available from Services Canada, Canada Health Act [CHA], R.S.C. 1985, c. C-6, s. 3.

[7] Permission received to reproduce the essence of this document. Please acknowledge the Canadian Nurses Association.

[8] Rev Tommy Douglas is widely acknowledged in Canada with being the founder of universal Medicare. He served as Premier of Saskatchewan (1944 – 1961), and public proponent of the Social Gospel. 

[9] A block fund are monies set aside by the federal government for a specific purpose.