Honourable senators, I rise today as the friendly critic to speak to Bill S-204, An Act to establish a national framework on heart failure. Last week, I only got a few minutes into my speech, and I should be able to do it all in the time I have allotted today.

I want to thank and recognize Senator Martin for bringing this bill forward.

Heart failure is the clinical syndrome with symptoms and signs caused by structural or functional cardiac abnormality with objective evidence of pulmonary or systemic congestion. Heart failure impacts hundreds of thousands of Canadians. This bill recognizes the need for better coordination, data and access to care.

Today, I will focus on three main points: first, the intent and importance of this bill; second, the current state of health care in Canada; and, third, a broad reflection on what Bill S-204 reveals about health policy.

At its heart, this bill is aspirational. It imagines what health care should look like for every Canadian no matter where they live. It imagines health care where everyone has timely access to diagnosis, guideline-directed care and holistic, multidisciplinary supports.

The bill’s intent is clear: to create a coordinated evidence‑informed national approach that improves outcomes for patients, families and caregivers.

As we discuss this bill, we should also reflect on why it is needed. Each time we pass a framework bill for a specific condition, whether it is dementia, diabetes or eye care, we are reminded that our health care system is fragmented. People living with health conditions should not need siloed frameworks. They need a consistent, coordinated system that provides safe, high‑quality health care.

The bill is important because behind it are people and families whose stories remind us of the human cost of unequal, inadequate and delayed access to care. In particular, I think of the patients and families in northern Manitoba who have to travel for hours to Winnipeg for specialized and complex cardiac care.

As a reminder, while I will refer to “Canada’s health care system” in this speech, what we have, in fact, is not a national system, but 14 provincial, territorial and federal health insurance plans that cover defined, medically necessary services to patients at no cost at the point of care.

Also, please remember that the administration and service delivery of health care falls primarily under provincial and territorial responsibility. This complexity shared among multiple jurisdictions should give you an idea of why we are seeing more framework bills for various health conditions.

Now I move to my second point, the current state of health care in Canada, because Bill S-204 must be grounded in today’s realities.

Canada is one of the highest health care spenders among the Organisation for Economic Co-operation and Development, or OECD, countries, spending 11.2% of GDP on health, above the OECD average of 9.2%.

Global data confirms that access to primary care decreases health care costs by emphasizing prevention, early detection and management of chronic diseases, which then leads to fewer hospital and emergency department visits. Countries with strong primary care systems consistently show lower overall health care costs compared to those with weaker systems. Yet millions of Canadians continue to struggle to access care.

Geography also shapes health outcomes. In 2019, Statistics Canada found that where you live can quite literally determine how long you live. Data showed that preventable and treatable mortality rates rise the further you live from an urban centre, regardless of sex or age. The disparities are linked to geographic barriers, limited access to health services, unmet care needs and the social and historical conditions that shape the health of many Indigenous and rural communities.

A more recent Ontario study on proximity to primary care reinforces these findings. The study found that people who live closer to primary care providers have higher rates of primary care use, lower rates of emergency department use and greater uptake of recommended cancer screening. In contrast, those who live further away from primary care providers face greater odds of having non-urgent emergency room visits, longer time periods without seeing a family physician and more missed cancer screenings.

These findings highlight the importance of health care system reforms that improve access to care and provide care close to home.

These gaps affect everyone, but people living with chronic diseases, like heart failure, acutely feel the pain of the system’s shortcomings. Heart failure remains one of the leading causes of hospitalization in Canada. When access to care depends upon where you live, it is not just a systems issue but an equity issue.

Inequitable outcomes are not only shaped by geography. They also vary across demographic and ethnic groups. Many communities face higher rates of heart disease and worse outcomes because of differences in risk factors, social conditions and unequal access to prevention and treatment.

Data gaps exist if provinces and territories do not collect or report the same health data, particularly if disaggregated race‑based, ethnicity-based and socio-economic data sets are incomplete or unavailable. Without standardized, comprehensive data, inequities can remain hidden, and the people most affected are left out of the policy response.

This brings me to a key point: While the bill has a strong focus on diagnosis and guideline-directed treatments, this focus risks underemphasizing prevention.

Heart failure prevention should be a core pillar of this framework because, too often, Canada’s health care system responds downstream rather than upstream.

As Senator Martin noted in her speech, 750,000 Canadians are living with heart failure, a condition that leads to frequent hospitalizations, high mortality and significant caregiver burden.

The economic impact to the health care system is significant. Between 2019-39, projections show heart failure-related hospitalization costs reaching $19.5 billion.

Bill S-204 sets out a vision for what coordinated care for heart failure could look like across Canada, from early detection to treatment, management and long-term support.

The bill would require the Minister of Health, in collaboration with provinces, territories, Indigenous governing bodies, experts and patient groups, to develop a national framework that promotes early detection and accurate diagnosis of heart failure, strengthens patient and caregiver education and support, encourages guideline-directed therapy and multidisciplinary care, addresses existing disparities in care, closes the data gap, builds national health data infrastructure including a national heart failure registry and establishes national system-level performance indicators.

After Senator Martin’s second reading speech, Senator Duncan asked about data collection by the Canadian Institute for Health Information, or CIHI. Indeed, CIHI collects data from the provinces and territories on heart failure, including data on hospitalizations, quality indicators, ambulatory care, long-term care and surveillance. In fact, data from CIHI is used by the Public Health Agency of Canada for the national surveillance of heart disease, including heart failure, through the Canadian Chronic Disease Surveillance System.

Committee study of Bill S-204 could examine for gaps in data collection, diagnosis, treatment and performance indicators to ensure collaboration and not duplication.

The bill also calls for a national heart failure registry. A patient registry is a collection of standardized information about a group of patients who share a condition or experience. Currently, there is no consistent definition of what a patient registry is and what it is used for. Committee study could explore the purpose, mandate, funding and ownership of a national heart failure registry.

Ultimately, the success of any framework — especially in improving health and saving lives — depends on sustained federal-provincial-territorial collaboration, adequate funding and clear accountability mechanisms.

Now for my third and last point. I support this bill. Timely access to care matters. Multidisciplinary teams matter. But I also believe we should think more broadly about health policy in Canada.

This bill and other framework bills are well intentioned and can be powerful. They bring attention to important health conditions and to gaps that demand action.

Among others, we have framework legislation on dementia, diabetes, eye care and now, potentially, heart failure. Each framework adds value and helps people.

But taken together, disease-specific frameworks reveal a pattern: We are treating symptoms, not the cause. Each framework adds another layer of standards, reports and multi‑jurisdictional coordination.

As we reflect on this bill, I’m reminded of the landmark 2002 Standing Senate Committee on Social Affairs, Science and Technology final report on the health care system in Canada, often called the Kirby report. That report called for renewed federal leadership in health, rooted in accountability, national coordination and measurable outcomes.

The report warned that our health care system, as then structured, was not fiscally sustainable and that continuing the status quo would lead to an eventual collapse of the public system.

It urged the federal government to align the provinces and territories around shared principles, transparent reporting and equitable access. It called for federal leadership, not micromanagement.

More than 20 years later, the message of the Kirby report still resonates. We are still grappling with many of the same challenges in access, information and health care coordination across the country, which is, in many ways, what Bill S-204 is working towards.

Honourable senators, I urge you to support Bill S-204 and send it to committee to further explore the goal of better health for Canadians.

Thank you. Meegwetch.