This week's meeting of Canada's First Ministers is not simply about how many dollars to transfer from the federal to the provincial and territorial governments, it's about building a 21st century health care system that will provide quality care for all Canadians, where they need it, when they need it.

How do we get there?  Money, even the billions of dollars on the table, is not enough.  We should set our sights higher.  Our goal should not be to paper over the cracks that are so evident, as illustrated by the waiting times issue.  New investments should be focussed and targeted to help close the growing gap between what we know and what we do.

We are in the midst of a revolution in health research - one that is accelerating the pace of discovery and the emergence of new ideas.  Advances in genetic, cellular, imaging and population health research have provided new tools to understand, diagnose, treat and possibly prevent disease.  Groundbreaking discoveries in regenerative sciences and nano-medicine, promise new approaches to replacing or repairing damaged or aged tissues.  Health informatics is allowing new ways of following very large numbers of patients and populations over time.  New developments in tele-health are allowing us to deliver health services at a distance and to link caregivers, policy makers and researchers across Canada and internationally.

We need to ensure that Canadians benefit from the full health and economic benefits from this revolution in health research. New dollars for health should be strategically targeted to help Canada compete globally for the best new ideas, technologies, and to retain the best people.  And, new money should help close the gap between standards of health care services available in some parts of Canada and unavailable in other parts.

The waiting times issue exemplifies these challenges.  In such a complex system, there are many underlying factors that contribute to long waiting times, including a shortage of health professionals, facilities and personnel to run equipment, and inefficient use of existing facilities or personnel.   Further, these factors will vary by condition and by province.  Only research and solid evidence can lead to the correct diagnosis of the bottleneck and finally to the right solutions. How can you fix the problem if you don't know what's wrong?

In the 1990s, Ontario faced a serious crisis in cardiac waiting times.  The Cardiac Care Network (CCN) was established to address this problem.  By working together and sharing expertise, the CCN team, consisting of researchers, policy makers, and health care professionals, introduced province-wide priority care to tackle cardiac waiting times in Ontario.

The CCN experience has important lessons for the First Ministers' Meeting. It illustrates the "knowledge triangle" needed to address health issues.  At the centre of this triangle are Canadians and their reasonable expectation that $120 billion annually should buy leading edge health care.  At one vertex of this triangle are our policy makers and elected representatives.  But there are other essential players.  At the second vertex are health care professionals - doctors, nurses, hospital managers, lab technicians, etc. - who are faced with the daily realities of delivering health care to Canadians. 
And, at the last vertex is Canada's health research community, providing the evidence, new science and technologies needed to drive innovation in health.  The players in this knowledge triangle need to work together and across provincial boundaries for a common goal:  an innovative, cost-effective, evidence-driven 21st century health care system available to all Canadians.  This is an attainable goal. 

There are more examples that show just how attainable this goal is.

The unprecedented cooperation between 3 CIHR-funded research, public health, and clinical teams in Vancouver, Winnipeg and Toronto led to the world first sequencing of the SARS virus genome and has opened the door to rapid diagnosis and the development of a vaccine.

The INTERHEART study, funded by CIHR and the Heart and Stroke Foundation, and led by Dr. Salim Yusuf at McMaster University, and involving 30,000 individuals in 52 countries, announced earlier this month that heart attacks could largely be prevented by making changes in lifestyle (smoking cessation, diet, exercise, weight control, stress reduction).  Heart attacks can now be considered a preventable disease - a finding that has huge health and financial implications for building a sustainable and affordable health system.  Both these accomplishments are true gold medals in the global race to improve human health- landmark contributions to the health of Canadians and people around the world.

Our future success as a society depends on the health and well being of all Canadians. That success requires harnessing Canada's most important natural resource-the intelligence and innovativeness of Canada's health professionals, researchers, and policy makers, to not only solve the waiting times issue but build a health system for the 21st century.

The outcome of the discussions that began this week should not simply be about money - it should be about building a quality health care system that closes the gap between what we know and what we do.

Dr. Alan Bernstein, O.C., FRSC
President, Canadian Institutes of Health Research
www.cihr-irsc.gc.ca