In the decades after the Second World War, Canada built a publicly funded health care system that was celebrated as an important step towards universal, equal health care access. For First Nations peoples, however, this expansion unfolded in tandem with a political project that denied Indigenous political sovereignty, marginalized treaty and Indigenous rights, and positioned integration into Canadian institutions as the sole path to well-being – an approach that, rather than improving health outcomes among First Nations communities, produced profound harm.

Drawing on federal and Ontario government records and close readings of settler discourse, Earning the Right to Health traces the political ideas and administrative decisions that shaped First Nations health care policy from the 1940s to the 1970s. In particular, Lucy Vorobej reveals how postwar policymakers used the language of equality to recast settler-colonial approaches to First Nations health care as progressive reform. She traces how the structure of the Department of National Health and Welfare, the introduction of universal hospital and health-care insurance, and the 1979 Indian Health Policy shaped a policy model of First Nations health care designed to serve political priorities. Viewed as problematic citizens and denied meaningful control over their own health care, First Nations challenged these policies, even as the federal government sought to devolve its responsibilities to First Nations individuals and communities, and the provinces.

Through demonstrating the settler-colonial objectives and racialization embedded in the development of First Nations health policy, Earning the Right to Health offers crucial context for contemporary conversations on health jurisdiction, treaty rights, reconciliation, and Indigenous sovereignty.