New 10-year CIHR strategy focuses on health equity, Indigenous research and knowledge mobilization

The Canadian Institutes of Health Research has released a strategic plan that calls health equity “the most pressing health-related challenge in our country” and charts a course toward reducing health inequalities across Canada over the next decade.

The new plan — CIHR’s fourth since the Institutes launched in 2000 — also commits to strengthening equity, diversity and inclusion (EDI) across the health research ecosystem, including embedding those values into a renewed concept of research excellence.

Those issues emerged as top priorities during a two-year consultation, the most extensive in the agency’s history, and were thrust into focus during the past year by the COVID-19 pandemic and worldwide protests against systemic racism. 

In an interview with Research Money, CIHR President Dr. Michael Strong (PhD) said that as the agency approached its 20th anniversary, it needed to take an intensive look at whether it was still delivering on its mandate. "Science has evolved, but our approach hasn't necessarily evolved,” he said.

"One of the things we heard across the community, with a clear voice, was the need for equitable health outcomes in this country. It was just resounding. I think it is unique for a federal granting agency to say, 'We're doing the long game here, it's our responsibility to do the research to help get us to that state,'" he said.

Entitled “A Vision for a Healthy Future,” the plan will guide research investments from 2021 to 2031. In addition to pursuing health equity through research, the strategy’s other research priorities are:

• advance research excellence in all its diversity
• strengthen Canadian health research capacity
• accelerate the self-determination of Indigenous Peoples in health research
• integrate evidence in health decisions

(See Table 1 at the bottom of the page for a complete list of the priorities and strategies outlined in the plan.)

Dr. Yves De Koninck (PhD), professor of psychiatry and neuroscience at Laval University and director of a national neurophotonics centre, participated in the consultation process. He said it strongly reflects the priorities identified by the health research community, but the challenge that remains is funding.

Following Budget 2018, CIHR has seen increases to its operating budget. But that increase hasn't translated to higher success rates among investigators applying to its major funding competitions. The pandemic further exacerbated the problem. Other funding sources, such as Canada's universities and health charities, have declined or dried up, leaving health researchers more dependent on CIHR's funding streams.

In the new plan, CIHR states that it is committed to addressing "the challenges underlying low success rates" in the investigator-initiated funding stream.

"I think it's important that it is written into the strategic plan. It's to the credit of the President that he is not sidestepping this problem," De Koninck said in an interview with Research Money.

Addressing COVID-19

Strikingly, the strategic plan makes little mention of the pandemic and the need to ensure Canada is better prepared for the next one. CIHR was on the verge of publishing the strategic plan when the pandemic was declared last year. Instead, it put the release on hold and held additional engagements with stakeholders, which Strong said confirmed the priorities the health research community had already identified, especially the importance of healthy equity, EDI for health researchers and knowledge mobilization.

In fact, the new strategic plan puts a renewed emphasis on knowledge synthesis and mobilization, which were part of the agency's roots. The pandemic has laid bare the challenge of getting policy makers, public health officials and clinicians the information they need to make evidence-based decisions in a timely manner.

"We need to take a lead again on the science of how do you transfer knowledge into where it needs to be used in communities, including Indigenous communities, but also in policy decisions," Strong said.

He acknowledged that the pandemic has made the need for pandemic and emergency preparedness "really crisp." "The pandemic has highlighted that you can't have a sine wave function of a lot of activity and then quiescence. So, the question is, how do we get into a steady state where we actually have a consistent focus on preparedness for health emergencies or pandemics?" he said.

That response may not satisfy some members of the community who see the pandemic, and CIHR's response to it, as an opportunity to reimagine Canadian health research.

"I would be the last person to say that the plan will be the Marshall Plan to get us out of this. That has to be done in parallel. The strategic plan gives you the tools to do it," said Strong.

Strengthening Indigenous Research

Health and wellness for Indigenous people was a priority in CIHR's last strategic plan, and it led to the development and implementation of an action plan to strengthen Indigenous health research and reduce the striking disparities in health outcomes between First Nations, Inuit and Métis Peoples and non-Indigenous Canadians.

CIHR’s new strategic plan recommits to this priority — and aims to goes further faster, especially toward removing barriers to Indigenous-led research. The agency aims to reduce administrative barriers that restrict access to research funding, expand eligibility and enhance financial and operational support for Indigenous health research. 

Strong said the clarity of voice in the strategic plan about accelerating self-determination of Indigenous Peoples in health research and rethinking how we learn, share knowledge and measure research excellence is unique in the world.  

In response to the plan, Indigenous scholar Chelsea Gabel told Research Money that CIHR’s emphasis on self-determination of research and progress toward putting research back into the hands of Indigenous communities should be commended, including a recent change in policy that allows Indigenous communities and organizations to hold research funds.

But she said there are still significant barriers to Indigenous research. “Academic institutions have consistent and sustained access to resources that community-based research organizations do not,” said Gabel, who is both an assistant professor in the Department of Health, Aging and Society at McMaster University and a Canada Research Chair in Indigenous Well-Being, Community Engagement and Innovation.

Instead, organizations rely on project-based funding — a funding pattern she called “problematic.”

“It discourages and interrupts the leadership and research development that is so crucial to Indigenous data sovereignty and community sustainability, and to the broader goal towards decolonizing the Academy," she added.

Advancing Research Excellence

CIHR's new strategic plan states it is committing to "developing, implementing, and championing a more inclusive concept of excellence," which Strong said the agency "heard about in spades."

It also intends to strengthen support for interdisciplinary and team science, and promote open science to increase access to the results of Canadian health research — a reflection of the how science is evolving domestically and internationally.

De Koninck said the plan's emphasis on collaborative, transdisciplinary research and team science resonated with most stakeholders during the consultations, in part because it fits with Canadian values. But, in the past, funding has been a challenge. "Team research doesn't work if it is evaluated and implemented as just the sum of a number of individuals. A team really has to be evaluated and it has to be operated as a real team of complementary expertise," he said.

Redefining research excellence is critical, said Gabel. Though Canada's research funders and universities keep talking about the need for a more inclusive approach to research, she said it is not trickling down to specific disciplines and individual researchers. As a result, important research continues to be grossly undervalued.

"When we talk about inclusivity, we need to expand the gamut of research outputs by which Indigenous scholars and faculty are judged," she said. 

TABLE 1: Priorities and strategies in "A Vision for a Healthy Future," CIHR's 2021-31 Strategic Plan

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