Indigenous health at the heart of new research network

Heart disease rates for Indigenous people are close to 50% higher than in the general Canadian population. Nevertheless, Indigenous people continue to be under-represented in cardiovascular research in Canada.

That may soon change, thanks to a new heart health research network announced this May, called the Canadian Heart Function (CHF) Alliance.

Its goal is to improve the prevention, diagnosis, treatment and care of people with heart failure and other heart conditions. Heart failure is a form of heart disease whereby the heart is too weak or stiff to function properly, often as a result of a heart attack.

A total of $32 million has been invested in the network so far. This includes $5 million over five years from the Canadian Institutes of Health Research (CIHR), in partnership with Heart and Stroke, Mitacs, and the U.S. National Heart, Lung, and Blood Institute. The network has also attracted matching funds (cash and in-kind) of more than $27 million from academic, foundation and industry partners.

The CHF Alliance is led by Dr. Jean Rouleau, a cardiologist at the Montreal Heart Institute. It brings together 100 researchers at six university-based research hubs across Canada. They include McMaster University, the University of British Columbia, Western University, the University of Ottawa, l’Université de Montréal and the University of Saskatchewan.

Among the priorities of the network is improving the heart health of First Nations, Inuit and Métis Peoples in Canada, as well as increasing their influence on cardiovascular research in Canada. Leading the charge are Dr. Alexandra King and Professor Malcolm King — partners in work and life.

Dr. Alexandra King is a member of the Nipissing First Nation. She is Cameco Chair in Indigenous Health and Wellness, and an internal medicine specialist, at the University of Saskatchewan.

Professor Malcolm King is a member of the Mississaugas of the Credit First Nation. He is Professor of Community Health and Epidemiology at the University of Saskatchewan, and Scientific Director of the Saskatchewan Centre for Patient-Oriented Research.

Together, they run the pewaseskwan Indigenous Wellness Research Group, which focuses on research on Indigenous health and wellness. pewaseskwan (Cree for “the sky is starting to clear”) takes a different approach to research. It helps Indigenous communities develop their own research agendas and advocate for their needs, instead of passively waiting for researchers to initiate studies.

“Our ultimate goal is to achieve better health for Indigenous people in Canada and getting them involved in the research is a big part of it,” explains Malcolm King. “There’s been a lack of health equity for hundreds of years. We won’t reverse that in five years. But if we can at least make some progress, that would be really encouraging.”

Like most of the other researchers in the CHF Alliance, the Kings will be using what is called a “patient-oriented research” approach — engaging patients, their caregivers and families as partners in the research process. In the Kings’ case, they’ll also be working with Indigenous Elders and Knowledge Holders to develop research priorities.

They are establishing an Indigenous Peoples Engagement Research Council (IPERC), which will advise the new heart health network on Indigenous patient perceptions. The heart health IPERC is patterned after the successful IPERC for chronic kidney disease that, along with Indigenous patients, Knowledge Holders and Elders, has several researchers acting as senior advisors, most of whom are also Indigenous.

“The members of the kidney disease IPERC really developed their own capacity over the course of four or five years,” says Malcolm King. “For example, they created training modules for non-Indigenous researchers, in areas such as cultural competency and sensitivity. We even have two patient partners who are now formal co-investigators, including one who is part of the executive of the new network.”

Among other things, the heart health IPERC will take part in the internal review of research projects and ensure that the principles of the Tri-Council Policy Statement: Ethical Conduct for Research Involving Humans are kept.

According to Malcolm King, “By using this approach, we might also help other equity-seeking groups. These principles of community and patient engagement will help every group that is seeking equity, not just Indigenous people.”

The Kings and their team also aim to interweave Indigenous ways of knowing with Western science, in what is called etuaptmumk or “two-eyed seeing.”

“Our research brings traditional Indigenous knowledge and medicines to the forefront, as these are as important to promoting good health among Indigenous people in Canada,” says King. “Our hope is that as Indigenous people get more involved in health research, Indigenous ways of knowing will add value to the Western approach.”

King emphasizes that this “two-eyed seeing” approach to Canadian health care and research supports the Truth and Reconciliation Commission’s Call to Action #22. It says, “Aboriginal Healing practices should be recognized by the Canadian health-care system…and should occur [in] collaboration with Aboriginal healers and Elders.”

“I’m delighted that my colleague Jean Rouleau is so passionate about Indigenous health – this wouldn’t have happened without him,” King says. “We can’t do these things ourselves. We need the help of our allies.”

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