As we reflect on the accomplishments over the past year, we would like to acknowledge the wise council of our voluntary advisory board members and significant dedication of our professional staff in Toronto and Ottawa.
The Institute has taken great strides to strengthen population and public health research capacity across the country. Of significant note are: three research development grant competitions to address priority PPH research topics - health disparities, global health and the impacts of physical and social environments on health, the first ever Centres for Research Development opportunity to strengthen PPH research infrastructure, and a Summer Institute for doctoral and post-doctoral students on "Doing Interdisciplinary Partnered Health Research".
In addition, the Institute has played a catalytic role in highlighting the need for a robust national public health infrastructure - through the establishment of the Future of Public Health Steering Committee, which guided the implementation of a comparative study to examine international models of organizing and funding public health services, as well as Québec's public health system. Through strategic partnerships and frequent interactions with research users, the Institute has helped put population and public health research evidence back on the map in Canada, with a constant eye to supporting the application of that evidence into effective programs, policies and practice. IPPH also has paid particular attention to its "pillar 4" role, as exemplified by our contributions and involvement in a number of requests for applications, and cross-Institute activities.
Looking ahead, the Institute plans to continue developing research and knowledge exchange opportunities with CIHR, other Institutes and partners, that are responsive to the current and emerging population and public health priorities in Canada, and globally. Priorities on the horizon are the Canadian Lifelong Health Initiative - including a national birth cohort with multi-generational features, reducing health disparities, responses to emerging diseases (SARS), as well as strengthening connections and maximizing synergies between our funded Centres and with IPPH-affiliated Training Initiatives. As we approach 2004, additional resources will also be dedicated to the implementation of the Institute's evaluation framework.
As always, we welcome your feedback and suggestions for improvement, and we look forward to working with our many stakeholders to improve health for all! Canadians deserve no less.
Warm regards,
John Frank MD, CCFP, MSc, FRCP(C)
Scientific Director, CIHR - Institute of Population and Public Health;
Professor, Public Health Sciences,
University of Toronto;
Senior Scientist, Institute for Work and Health, Toronto
Jean-Yves Savoie, PhD
Chair, CIHR-Institute of Population and Public Health Advisory Board
Conseiller au Président du conseil d'administration et au chef de la direction
Commission de la Santé et de la Securité du Travail(CSST)
The Institute of Population and Public Health (IPPH) is one of the thirteen institutes of the Canadian Institutes of Health Research (CIHR). In keeping with CIHR's mandate to "excel in the creation of new knowledge and its translation into improved health for Canadians, more effective health services and products and a strengthened Canadian health care system", the Institute is concerned with the biological, social, cultural and environmental factors, which determine the health of populations locally and globally, and how this knowledge can be utilized to inform policies, programs and practice, so as to improve Canadians' - and global - health status.
More than ever, there is increasing recognition that we must pay more attention to disease prevention, instead of merely dealing with disease after it occurs. To implement effective prevention program and policy interventions, we will need to develop a much more sophisticated understanding of the population determinants of health. "Canadian researchers have been the most influential force in the world in demonstrating the importance of population determinants of health, but research to realize these ideas has generally been conducted elsewhere in the world", says Dr. Leonard Syme, Professor Emeritus of Epidemiology, School of Public Health, University of California at Berkeley and IPPH Advisory Board Member. The reasons for this are two-fold -- there are actually very few population health researchers in Canada and there have been very limited funds to support their work.
With the advent of CIHR and the Institute of Population and Public Health, however, steps are being taken to address the situation. Workshops have been held bringing together young researchers who will devote their careers to this field. There is renewed confidence and hope because research funds are now available to explore important ideas in this field, as training programs are being established all over the country. As a result, some of the best scholars in the world who work in other disciplines are being encouraged to work in the area of Population Health. These efforts are transforming the landscape in Canada. Researchers in other parts of the world are watching closely and the impact elsewhere is already being felt (even as far as in New Zealand and Australia)", further adds Dr. Leonard Syme.
Vision
Canada will be a world leader in interdisciplinary PPH research and research application, fostering evidence-based policies and programs, and training in the fields of public health, health promotion, and occupational and environmental health. The Institute will also influence, through scientific consultation, the wide range of broader public, voluntary, and private sector activities that profoundly impact on the health of populations.
Mission
The CIHR Institute of Population and Public Health (IPPH) will support: research into the complex interactions (biological, social, cultural, environmental), which determine the health of individuals, communities, and global populations; and, the application of that knowledge to improve the health of both populations and individuals, through strategic partnerships with population and public health stakeholders, and innovative research funding programs.
Our Community
A number of fields of practice have in fact contributed to the development of population health sciences. These include the basic sciences (such as various branches of human biology), epidemiology and biostatistics, the social and behavioural sciences, and more recently political science, law, geography and the humanities.
Our community consists of researchers, policy makers and practitioners working in academia, government, and non-governmental organizations, at national, provincial/territorial, regional and local levels. These intermediaries have strong connections to the general public, amongst whom we must muster the political support required to address the complex population and public health problems of our time.
Advancing a coherent research agenda for population and public health (PPH) in Canada
CIHR-IPPH actively supports research that seeks to understand and address the fundamental determinants of human health, especially the interaction of physical and social environments with genetic predispositions, over the life-course, at both individual and community levels, in whole societies. In its five-year Strategic Plan developed under the guidance of its Advisory Board and including the results of national consultations, the Institute has identified the following strategic research priorities:
1) Building research capacity to stimulate the development of PPH knowledge
In 2002-03, the Institute continued to support a number of initiatives to strengthen PPH research capacity by:
CIHR Strategic Training Initiative in Health Research
In keeping with its objectives to train and retain researchers in a variety of research domains, CIHR launched a second round of its Strategic Training Initiative in Health Research. IPPH specifically partnered with IHSPR to encourage training initiative applications that involve policy and other stakeholder participation in the training experience, give attention to regional disparities in training capacity and which embrace shared core training opportunities at the interface of population and public health research, and health services/policy research.
IPPH co-funded two interdisciplinary training initiatives, which are described below:
Dr. Gilles Paradis, McGill University and Régie régionale de la Santé et des Services sociaux de Montréal-Centre - Programme de formation transdisciplinaire en recherche en santé publique et en santé des populations: accroître la capacité de recherche et d'action dans le système de santé publique au Canada.
Co-funded with IHSPR, this interdisciplinary capacity building initiative will train the next generation of applied public health researchers and will equip them with the knowledge and research skills to support evidence-based health system policy and decision-making.
"Our training grant entitled "Enhancing the capacity for research and action in public health in Canada" brings together into a single training program future researchers who have an interest in population health and health services and policy because we believe the two are intimately woven into the fabric of modern public health research and practice. The training grant is a partnership between several departments in the five largest universities in Quebec with the four major university-affiliated public health departments in the province. On another level the training program is also a partnership between the CIHR and the Quebec population health research network of Quebec which assembles the researchers of the province involved in population and public health research as well as in health services and policy research. Our program will closely link university and public health researchers as well as expertise from various disciplinary fields to provide meaningful and applied learning experiences from a truly multidisciplinary perspective. In addition, we wish to develop close links with other universities across the country and with related training programs to augment the potential learning base for all future public health researchers and professionals. At the beginning of this new century, public health is at a turning point in Canada, and our program will aim to prepare highly trained investigators who will generate the knowledge required to inform policy making and best practices for Canada's public health system over the next decade."
Dr. Gilles Paradis, Scientific Director, Québec Public Health Research Network
Wendy Levinson, St. Michael's Inner City Health Research Unit - An integrated training program in health and social science research to improve the health of marginalized populations.
IPPH, with contributions from IAPH, IGH and IHSPR, funded this training initiative to support the training of the next generation of researchers to use mixed research methods to improve the health of marginalized populations. This initiative is not only in keeping with our institute's PPH research capacity building priority but also addresses the theme of health disparities, with its focus on marginalized urban populations.
''The Inner City Health Research Unit, Institute for Clinical Evaluative Sciences and the University of Toronto are thrilled to have received this grant. The funds will provide us the opportunity to teach young investigators the knowledge and skills needed to address critical health problems of marginalized populations and hopefully to inspire them to invest their careers in this area. Further, we are excited to have the opportunity to build and deepen our collaborations with social scientists, with whom we share our passion for studying the challenging problems that face these disadvantaged populations'' - says Dr. Wendy Levinson.
Eastern Canada Consortium on Workplace Health and Safety: The Institute is co-funding with IHSPR and IGH this interdisciplinary capacity enhancement (ICE) grant, based at Memorial University, in St. John's Newfoundland. Under the leadership of Dr. Neis, in collaboration with Drs. Mario Roy and Esther Cloutier, this consortium will support interdisciplinary research and knowledge translation capacity in the area of workplace injury, through innovative partnerships with SafetyNet, the IRSST and the Université de Sherbrooke.
Summer Institutes in Interdisciplinary Health Research
IPPH held its Inaugural Summer Institute in June 2002, involving seven tutors and 25 student participants. The theme of Doing Interdisciplinary Partnered Health Research was selected, given the growing international tendency in health research granting agencies, including CIHR, to issue requests for applications for initiatives involving several academic disciplines, "mixed methods" and the active engagement of research users. By bringing together doctorate students, post-doctorate students and researchers, the Summer Institute facilitated connections between researchers at different stages in their career. Building on this success and lessons learned, IPPH collaborated with IHSPR and the Population Health Research Network in Quebec, under the able leadership of Dr. Gilles Paradis, to plan and implement the 2003 Summer Institute, with a focus on interdisciplinary health research. The program will include an emphasis on the formulation of research questions from different disciplinary perspectives, grantsmanship, and ethical considerations in conducting HSP and PPH research as well as on its application into policy and practice
Summer Institute 2002 participants and tutors:
"The students were most enjoyable, and I learned a great deal from each and every one of them. Congratulations on a well-run and imaginative approach to student (and mentor!) learning." - Summer Institute Tutor
The best part of the Summer Institute was "making contacts and getting outside of my institutional silo" - Summer Institute Student
What I liked most about the Summer Institute was " the intellectual vibrancy and commitment to interesting research" -Summer Institute Tutor
"The opportunity to network with colleagues and senior researchers reinforced the importance of interdisciplinary research that addresses complex population health issues" - Summer Institute Student
Centres for Research Development
In September 2002, IPPH launched the first-ever CIHR Centres for Research Development initiative in one theme area, "Understanding and Addressing the Impacts of Physical and Social Environments on Health." This RFA provided interdisciplinary teams of researchers and their stakeholders with core infrastructure support, to enable access other research funds, to develop integrated programs of research and knowledge exchange. These programs will be designed to understand and examine the health impacts of policy and programs that affect the quality of such environments, and design and test new interventions to achieve population-level health benefits.
Development and Planning Grants
The Institute has launched research development and planning grant RFAs that are intended to encourage development and build capacity in addressing strategic research priorities - global health, understanding and addressing the impacts of physical and social environments on health and health disparities. These are further described below.
Advancing Theories, Frameworks, Methods and Measurement In Health Services & Policy, Population and Public Health Research and Knowledge Translation
This groundbreaking RFA, co-launched with IHSPR, aimed to support research likely to lead to new breakthroughs in advancing theory, conceptual frameworks, research methods or measurement approaches (qualitative or quantitative) that have broad application to health services (including public health), health systems and policy research and population health research, or to understanding the translation of research into a strengthened Canadian health care system and improved health for Canadians. With over 100 applications received, the response rate speaks for itself. A number of interested applicants remarked how this competition clearly resonated with their research interests and "what the field needs". Proposals will be peer reviewed in the Fall 2003.
Workshop Funding Support Program
The Institute has viewed this as a mechanism to build research capacity by supporting collaborative meetings of individuals from a variety of disciplines, backgrounds and roles (e.g. researchers, program managers, policy-makers and providers), to address specific PPH research problems. The Institute funded a total of twelve workshops, often in partnership with other Institutes totalling $288,583. We also received reports of workshops on such topics as "Toward an agenda for literacy and health research in Canada" (Dr. Irv Rootman in partnership with the Canadian Public Health Association), and, "Behavioural and Social Sciences Health Research in Canada: Building an Integrated Future held in September 2002 (Dr. Allan Best and colleagues), which are informing future RFAs and Institute activities.
An analysis of the workshop program suggested that some workshops were leading to proposals in response to Institute-sponsored strategic funding initiatives (e.g. Advancing Theories), briefings with senior levels of government, the development of policy papers, and permitting groups of new investigators from a variety of disciplinary backgrounds to come together to discuss complex population and public health research questions. However, on balance, Institute staff and the IAB felt that the workshop program guidelines needed to be revised to more closely align with the Institute's strategic research priorities. The Institute Advisory Board therefore recommended changes to the program, which will be implemented in the Summer 2003. A few workshops are highlighted below. See Appendix 1 for a complete list of workshops funded.
Defining Rural and Rurality. Integral to the acquisition of knowledge about the health and well-being of rural communities is an understanding of the concepts of 'rural' and 'rurality'. Fran Racher at the Rural Development Institute of Brandon University, with colleague Dr. Judith Guernsey at Dalhousie University organized a workshop to bring together a diverse group of rural health researchers, program administrators and policy makers from Canadian universities and agencies, as well as experts from Australia and the USA to discuss and further define these essential concepts. The results will be shared with staff leading CIHR's Rural and Northern Health Cross-Cutting Initiative.
Chronic Stress as a Key Determinant of the Social Gradient of Health: Drs. Shona Kelly (University of Nottingham), Heather Orpana (University of Ottawa), Mark Daniel (University of Montreal) and Clyde Hertzman (University of British Columbia) organized this workshop to link together and facilitate the development of a network of interdisciplinary researchers to advance research on chronic stress and mechanisms underlying the social gradient in health. The workshop is intended to address domains of theory, measurement and analysis by developing a preliminary model of potential causal pathways for use by researchers, recommendations for research on the development of multi-level population health measures and inform developing national surveys such as the Canadian Health Examination Survey, to be undertaken by Statistics Canada.
Inserting Social Theory into Population Health: Dr. Katherine L. Frohlich and colleagues organized two workshops to discuss topical population health issues, particularly social inequalities in health, from diverse theoretical perspectives; to map out hypothetical mechanisms suitable for evaluating how social phenomena influence health; to develop and document recommendations for health policy and research; and to initiate the development of an interdisciplinary, Canada-wide research group comprised of junior researchers and senior mentors on population health research issues.
"I was truly taken aback by the ease and sophistication of the discussion. It was the first time that I felt that I could speak comfortably in a population health setting about who I am as a scholar and researcher. People were operating from very different theoretical, intellectual and research locations but there was a remarkable degree both of humility and openness and an incredible degree of understanding for such a diverse group".
"My sense is that there is still a great deal of work to do to produce what is a truly trans-disciplinary form of collaboration on population health research. CIHR has been at this for some time. I think that the workshop was a model of how to produce collaborative interdisciplinary dialogue on the practice of population health research. A first really." Dr. Eric Mykhalovskiy, Dalhousie University, Workshop Participant
Integrating behavioural, social sciences, humanities and health research in Canada
Strengthening the research potential of population base health and health services data in Canada
In light of the limited response to the May 2002 launch of the Request For Proposals (RFP): "Population Based Health and Health Services Data in Canada: Current Status and Future Health Research Potential", IPPH, IHSPR, other CIHR Institutes, in collaboration with Health Canada, Statistics Canada and the Canadian Institute for Health Information - Canadian Population Health Initiative re-launched this important initiative in December 2002. Due, in large part, to more proactive promotion and teleconference to entertain questions from potential bidders, the response was more successful in the second round. Following peer review, IPPH hopes to make funding decisions by May 2003 and hopes that the successful team can begin their work over the course of the summer of 2003.
Adverse Events in Canadian Hospitals
Co-funded by CIHR, IPPH, IHSPR and CIHI, the Adverse Events In Canadian Hospitals research project is unique in its commitment to engage the users of the research findings early in the research cycle, through a series of stakeholder meetings. The first national stakeholder forum meeting was held in Aylmer, Quebec in June 2002. CIHI and CIHR engaged over 50 stakeholder representatives to orient them to the Canadian research project led by Drs. Peter Norton and Ross Baker. The research methodology, the anticipated findings and international research results were shared with stakeholders including the Canadian Healthcare Association, the Canadian Medical Association, Canadian Nurses Association and the Association of Canadian Academic Healthcare Organizations. The data collection phase of the research is complete and a second stakeholder forum meeting is scheduled for May 2003 where stakeholders are expected to report progress in organizational preparedness for the research results. The research will likely be published by the CMAJ in early 2004 when a final stakeholder meeting will be held.
" The successful implementation of the Adverse Events in Canadian Hospitals Study (with CIHI and IHSPR) is [one of the] biggest achievements of the Institute from a practical perspective", says Dr. John Millar, VP Research and Development, Canadian Institute for Health Information and IPPH IAB Member.
2) Understanding and Addressing the Impacts of Physical and Social Environments on Health
The Institute's Centres for Research Development competition was launched to provide interdisciplinary teams of researchers and their stakeholders with core infrastructure support in order to access other research funds to develop integrated programs of research and knowledge translation that help to understand and examine the health impacts of policy and programs that affect the quality of these environments, and design and test new interventions to achieve population-level health benefits. Centres are expected to be mission-driven and to include a formal and integrated research and knowledge exchange plan, along with evidence of institutionalized planning and evaluation cycles. A total of 39 letters of intent were received from across Canada (see Figure 1) and 25 interdisciplinary teams were invited to submit full applications (see breakdown by province in Table 1). LOI topics included: school effects on child and youth development; asthma in the workplace, rural health, urban environmental health, injury prevention, health and social inequalities, obesity, determinants of health in Aboriginal populations, substance use and health, and improving the health of marginalized populations. Results will be available in the summer 2003.
| Province (where PI Institution is located) | Number of Centre LOIs invited to submit a full application |
|---|---|
| Alberta | 5 |
| Saskatchewan | 1 |
| Ontario | 10 |
| Quebec | 7 |
| Nova Scotia | 2 |
| Total 25 LOIs | |
Research Development Grants
IPPH, in collaboration with IGH, launched a research development grant RFA to enable interdisciplinary groups of researchers in health and other sectors to develop programs of research to examine the health impacts of policy and programs that affect the quality of physical and social environments. Sixteen applications were adjudicated in March 2003 and eight were funded, totalling $764,655. Topics included: the roles of media in structuring normative influences on population health, research into the potential of the school as a setting for health promotion and the impacts of local, family and work contexts on health inequalities. For a complete list, please see Appendix 2.
Needs, Gaps, Opportunities and Assessment Grants - a year later
One-year environmental scans of current and planned research activity and capacity in Canada were completed over the past year, and addressed the topics of infectious disease control; housing as socioeconomic determinant of population health; income, health and disease in Canada; and social assistance and health. These reports are expected to inform future Institute funding initiatives such as the planned re-launch of the Health Disparities RFA in June 2003.
Closing the Gap: Needs, Gaps and Opportunities Assessment of Communicable and Infectious Disease Research in British Columbia: Key findings of the BC communicable and infectious disease research needs, gaps, and priorities, led by Dr. Robert Brunham, BC Centre for Disease Control, closely paralleled those identified for population and public health research in general by IPPH. Participants in the study represented a broad range of Regional Health Authorities, as well as health care researchers and practitioners. Key findings included participant identification that a need exists for more multi-disciplinary, multi-level research collaborations as there are currently few linkages among investigators, corporations, and public health to foster and/or facilitate interaction and synergies that could lead to a shared agenda.
Housing as a Socio-Economic Determinant of Health: Led by Dr. James Dunn, University of Calgary and colleagues, this consultation took the form of an electronic questionnaire and eight, one-day regional workshops across Canada (Vancouver, Calgary, Saskatoon, Winnipeg, Ottawa, Toronto, Montreal and Halifax). Participants included people and organizations in the housing sector, the health sector and those at the interface of the two. Some key outcomes of the NGOA included: the need to study the impact of housing interventions, especially those focused on socio-economic dimensions of housing (e.g., affordability, stability), may have on the health and well-being of children, low-income families, seniors, immigrants and Aboriginal peoples.
Income, Health and Disease in Canada: Current State of Knowledge, Information Gaps, and Areas of Needed Inquiry: In an effort to examine the relationship between income and health, Dr. Dennis Raphael and colleagues conducted a carefully organized consultation process with a diverse group of researchers and stakeholders across Canada, as well as examined key research activities in the United Kingdom and Finland. Key findings of the study include: an identification of a lack of interdisciplinary work in the areas of pathways that mediate the income-health relationship; a lack of longitudinal studies of the impact of income-related issues upon health (including population health) across the life-span; and, the need to bring broader conceptualizations of income and its relationship to health into population health activities that consider income and its distribution as relevant variables.
3) Health Disparities
Led by the Institute of Gender and Health, IPPH contributed to the establishment of "analyzing and reducing health disparities" as a CIHR cross-cutting research priority.
Research Development Grants
Launched in collaboration with the Institute of Gender and Health, other Institutes and funders (Health Canada, SSHRC and the National Secretariat on Homelessness), the "Reducing Health Disparities & Promoting Equity for Vulnerable Populations" RFA resulted in a total of 45 applications. These were peer reviewed in March 2003, leading to the funding of 13 interdisciplinary teams of researchers and stakeholders to develop programs of research that help understand and address a range of research domains under the health disparities umbrella, with a total investment of $1,151,453.
Topics included: strategies for research and action on Indigenous women, inequality and health, family and community medicine for patients without health insurance, development of migrations and reproductive health studies, health care equity for intellectually disabled individuals, racialized groups and health status, and health status disparities in the urban ethnic elderly. For a complete list, please see Appendix 3.
The Institute's Scientific Director participated in a winning Training and Research Centre proposal to the Robert Woods Johnson Foundation in the US that will include international student and scientist exchanges and colloquia focused on health disparities. He expects to participate as a university faculty member annually, at the two campuses where he was involved in developing the proposal -- UC Berkeley and UCSF.
The Institute supported and participated in a range of conferences, workshops and consensus-building meetings, either as presenter, a member of the scientific committee and/or funder, which addressed the health disparities research theme. A few are highlighted below:
Inaugural Inner City Health Conference (October 2002), organized by Drs. Stephen Hwang and Ahmed Bayoumi at the St. Michael's Inner City Health Research Unit attracted over 400 researchers, policy makers and community members, to discuss four themes of import to the health of disadvantaged populations - inequalities, healthy communities, effective interventions and research methodologies. The conference featured two presentations by Institute staff on "Inequalities in Health" and "Defining a Paradigm in Inner City and Urban Health Research". The Institute, along with other CIHR Institutes, contributed financially to the conference and was represented on the scientific committee.
Social Determinants of Health Across Lifespan Conference (December 2002), organized by Dr. Dennis Raphael at York University and featuring a presentation on "Understanding and Addressing Inequalities in Health" by the Scientific Director.
4) Environmental and Genetic Determinants of Disease in Human Populations
Since 2001, The Institute, in collaboration with the Institute of Genetics has held a number of expert workshops to begin defining the need for a program of research to study the complex interactions of individual genetic endowments and the sequence of environmental factors that are manifested over the life course. An April 2002 "Population Platforms for the Study of Genes and Environments in Human Health, Over the Life Course" workshop involving 13 national and international experts in population genetics and genetic epidemiology explored the feasibility of conducting population-based studies of complex and multifactorial diseases in Canada. Given IA's focus on the Canadian Longitudinal Study on Aging and following further discussions with experts, IPPH, IG and IHDCYH began to explore the potential of an early life platform.
Defining Canada's scientific niche in a birth cohort study
Recognizing that an early birth cohort potentially provides a powerful design for studying all "determinants of health" (bio / psycho-social / gene-environment) with prospective "real-time" measures - of both environmental exposures and evolving health outcomes, IPPH, IG and IHDCYH hosted a Canadian National Birth Cohort Design Workshop in February 2003. It was attended by 80 people, including Canadian and international experts from a range of disciplinary backgrounds and countries (i.e. U.S., UK, New Zealand, Australia, Norway) who were convened to discuss methodological, measurement, sampling, accrual, ethical, legal, social and management issues related to the design of a National Birth Cohort Study.
IPPH's Scientific Director prepared a backgrounder outlining key issues in planning a Canadian national birth cohort. The sponsoring Institutes also commissioned a series of background papers listed below:
In his opening remarks, Dr. Alan Bernstein, CIHR President commented that the birth cohort will involve biologists, geneticists, statisticians, psychologists, sociologists, anthropologists, and ethicists - all of whom will be "harvesting the fruits and tilling the fertile soil of the CNBC for years to come." He further noted the "intersection of epidemiology and biological sciences is where the action will be . . . This is a time of convergence, a bring together of all disciplines to bear on human health."
The meeting featured a key note presentation by Dr. Clyde Hertzman, IAB member, who encouraged CNBC designers to put the interplay among nature and nurture, developmental trajectories and biological embedding at the core of the study. He further encouraged geneticists to be interested in "the genetics of the commonplace . . . the way the genome behaves day to day in children, and variations in the way genes express themselves in different environments."
There was convergence around the utility of a "three generation study" (combining the visions of the CNBC and the Institute of Aging's Canadian Longitudinal Study on Aging) - resulting in a true Canadian Lifelong Health "Extended Family Cohort" Initiative. Plans are now underway to examine the feasibility of integrating both studies, and to recruit an ethical, legal and social issues expert to help resolve the challenges ahead. If funded, the combined cohorts, "Canadian Lifelong Health Initiative", a CIHR cross-cutting endeavour, will provide the research platform for hundreds of subsequent sub-studies to further our understanding of the bio-psychosocial determinants of health over the life-course.
Chris Power of the UK Institute of Child Health commented that this type of meeting wouldn't happen in the UK She recommended that careful attention be paid to how subjects are involved in such studies. "The way you treat people in your study will be paid back with their respect and study", she concluded.
Stephen Zubrick of Australia's Institute for Child Research stated that the current concept of an intergenerational longitudinal study with strategic sampling and nested sub-samples would be of exceptional scientific and social significance.
Facing Our Future: Human Genetics, Ethics, Law and Society RFA
In response to its commitment to develop specific Canadian research expertise in genetic, ethical, legal and social ("GELS") issues, IG, IPPH and IA launched Facing Our Future: Human Genetics, Ethics, Law and Society RFA. This competition aimed to support a critical analysis of current ethical, legal and social practices involving population-based genetic research as well as implications for future studies in Canada. A list of funded initiatives is found in Appendix 4.
In June 2002, IG and IPPH launched the "Novel Population Genetic and Genetic Epidemiological Methods for Studies of Complex Genetic Diseases" RFA to build research capacity in the area of population genetics and genetic epidemiology of complex diseases with important environmental co-determinants. This initiative is intended to support individuals or teams to develop new theories, strategies and methodologies needed to facilitate more conclusive, high-quality etiological studies of such diseases. Results are expected in the Summer 2003.
5) Global Health
As lead Institute for the Global Health Cross-Cutting Initiative, IPPH is very fortunate to have the dedicated team of Dr. Vic Neufeld, National Coordinator; Alita Perry, Manager; GHRI; Roberta Lloyd, Project Officer; and Leticia Lopez supporting the activities of the global health research initiative. The Global Health Research Initiative (GHRI) refers to a Memorandum of Understanding signed in the fall of 2001 between CIHR, the International Development Research Centre (IDRC), the Canadian International Development Agency (CIDA) and Health Canada, to strengthen and build capacity for global health research in Canada and in developing countries, and to strengthen the effectiveness of overseas development assistance. To accomplish its mission, the GHRI partners work in collaboration with the members of the ever-growing Coalition for Global Health Research-Canada (CGHRC) and their colleagues in community-based organizations, non-governmental organizations, and governments (including agencies and departments) in the developed and developing world.
Global Health Research Planning and Research Program Development Grants Program
Launched by the GHRI partners, the Global Health RFA to build Canada's global health research community, in partnership with researchers in low and middle-income countries, resulted in proposals addressing a range of research topics (e.g. equity and health, HIV/AIDS, Hep C, TB, Malaria, water-borne infections, violence, gender, governance and health, improving health status and strengthening health systems, health of Indigenous populations). Due to an overwhelming response, two peer review panels were established to adjudicate the 71 applications. CIHR (9 participating institutes) and the IDRC supported 31 winning applications, totalling $2.65 Million. As a result of these projects, Canadian researchers have forged partnerships with their counterparts in Africa, Central & East Asia, Latin America and the Caribbean, as well as with countries such as Australia, which are concerned about the health of Indigenous populations. A "Building Partnerships Workshop" is being planned for June to give successful teams the opportunity to share lessons learned and best practices for conducting partnered global health research projects Please refer to Appendix X for a complete list of funded projects.
"The tremendous response to the Global Health Initiative [was] a real first for Canada as MRC and NHRDP never did anything like this before (as the sole route was for IDRC- NHRDP funding with NHRDP agreeing to fund only the Canadian component), says Dr. Catherine Hankins, Associate Director, Strategic Information & Chief Scientific Advisor to UNAIDS, and IAB Member
The GHRI-CGHRC joint Steering Committee implemented a number of Working Groups addressing a number of priority areas. Selected working group activities are highlighted below:
Several members of the CGHRC Steering Committee participated in the Global Forum for Health Research (GFHR), attended by over 700 participants from dozens of countries. The event further underscored the need for coordinated Canadian action, in both research collaboration abroad, and overseas development assistance in the health sector. Canada's national health research, policy and international assistance agencies therefore have a unique opportunity, through the Coalition, to bring coordinated, effective, evidence-based programs to bear on these countries' urgent health problems - and the world is watching us closely.
The goal of the GFHR is ". to help correct the 10/90 gap in health research." This gap refers to the fact that less than 10% of the world's health research resources are directed at the health problems of the developing world, where 90% of the world's burden of ill health occurs.
The event was highlighted by the official launching of the newly formed African Forum for Health Research (AfHRF) and involved discussions with the CGHRC to plan a novel, bilingual program of Africa-based leadership training for senior personnel in African health research institutions, together with their governmental and "civil society" counterparts in the research-user communities of each participating country. The Coalition's contributions to the meeting also included a very well received plenary presentation about the CGHRC, as a possible model for the national coordination of health-research-related development assistance and collaboration, by Jerry Spiegel and John Frank (who dusted off his Swahili for the trip!).
Partnerships and Stakeholder Engagement
The institute continued to be engaged in a range of collaborative initiatives nationally and globally, in partnership with other CIHR Institutes and Portfolios, as well as a range of governmental and non-governmental agencies, resulting in a number of effective collaborations to advance PPH research and knowledge exchange.
Partnerships
Cross-Cutting Initiatives
IPPH is very committed to working with other Institutes to offer a "pillar 4" perspective (i.e. societal, cultural, and environmental influences on health and the health of populations), as exemplified by its involvement in and support of a number of cross-cutting initiatives:
"IPPH has taken very seriously its mission of improving the health of Canadians through not only research and the use of best evidence, its own activities but by equally playing a "pillar" role, in close collaboration with other institutes and partners", says Dr. Jean-Yves Savoie, IPPH Advisory Board Chair.
Response to emerging diseases
Given its interest in supporting Canada's research capacity to address emerging and recurring infectious diseases, the Institute is partnering with the Institute of Infection and Immunity on a number of recently launched programs, with results expected later in 2003 (e.g., Safe Food and Water Initiative, SARS RFA). In 2002-03, the New Emerging Teams in Antimicrobial Resistant Bacteria competition resulted in support from IPPH to the following initiative.
Community Acquired Antimicrobial Resistant Bacteria in Northern Canadian Communities: Under the leadership of Dr. Michael Mulvey, University of Manitoba, this NET will study the factors influencing the emergence and spread of antimicrobial resistant organisms (AROs) in two comparative settings - hospital-acquired AROs in urban communities vs. northern communities in Saskatchewan. This NET is co-funded by IPPH, III and the Canadian Bacterial Disease Network.
Support for complementary initiatives
Canadian Longitudinal Study on Aging (CLSA) led by the Institute of Aging -The Institute provides financial support to the CLSA and participates on the initiative's steering committee.
External Partnerships
IPPH continues to work closely with the Canadian Institute for Health Information - Canadian Population Health Initiative (CPHI) to proactively and strategically support the Canadian PPH community. The Canadian Institute for Health Information - Canadian Population Health Initiative (CPHI), was established, in large part, during the "Charting the Course" (CTC) consultative process in 2001. 1920 copies of CTC were distributed in both languages (English - 1440; French - 480). Together, CPHI and IPPH are currently drafting a "report card" that is intended to report to PPH stakeholders on progress achieved to date by the two organizations, both individually and collectively, in addressing the priorities identified through the CTC consultations. This report includes illustrative examples of ways in which IPPH and CPHI are delivering on their commitment to address the important population and public health priorities identified by stakeholders across the country.
"CPHI and IPPH sowed the seeds for a fruitful partnership through a joint cross-country consultation process as reported in the Charting the Course. While striving to realize our respective mandates, we have come to recognize that much can be gained from working together to support the generation of new knowledge on the determinants of health, the synthesis and analysis of the best available evidence necessary to inform the development of healthy public policies. We agree on the importance of creating opportunities for the exchange of knowledge amongst researchers and decision makers. CPHI looks forward to a bright future of collaboration with IPPH as we strive to realize a shared vision of advancing population health in Canada and internationally" - Carmen Connolly, Director, Canadian Population Health Initiative
In keeping with our two organizations' commitment to synthesize the best available evidence on the determinants of health and making it available to a range of policy and public audiences, IPPH's Scientific Director, Dr. John Frank is pleased to be co-chairing with Dr. John Millar of CIHI, the expert advisory committee overseeing the development of the CPHI Flagship Report, Improving the Health of Canadians scheduled for release later in 2003.
In addition, IPPH has actively developed and is strengthening collaborative relationships with a number of key partners including Health Canada, Statistics Canada, provincial ministries of health (e.g., via interactions with and participation in federal/provincial/territorial Advisory Committees) and provincial funding agencies across the country.
The Institute is frequently consulted for advice and expertise. A few examples are highlighted below:
"I especially want to thank you personally for the superb effort you put into reviewing the Women's Health Surveillance Report. Your comments were extremely helpful.I hope to have the opportunity to work together on another project" - Donna E. Stewart, Lillian Love Chair in Women's Health, University Health Network
In 2000, the Heart and Stroke Foundation made some changes to its funding mechanisms, creating a national fund for partnering with other agencies in key strategic areas - the Heart and Stroke Foundation Research Fund. A new committee, the Research Policy and Planning Committee, was also created to oversee Fund activities and research policies for the Foundation. At the same time, the Foundation recognized the need to fund more initiatives from pillars 3 and 4, so that overall, the research supported by the HSF Research Fund would cover all 4 pillars.
John Frank was invited to present to RPPAC about population health, the need for research in this area and the activities of the Institute of Population and Public Health. In January 2003, John and Erica Di Ruggiero gave a presentation, which reinforced the importance of research in population health in Canada and described the initiatives where the Foundation could collaborate in accordance with its mandate and mission.
Population and public health studies hold promise for such things as a better understanding of the environmental, social, and behavioural factors influencing the cardiovascular health of Canadians.
As a result of this presentation and discussion, along with direction from its Board, the Heart and Stroke Foundation is currently participating in two programs: the "Centres for Research Development - Understanding and Addressing the Impacts of Physical and Social Environments on Health" and "Reducing Health Disparities and Promoting Equity for Vulnerable Populations -- Research Program Development Grants". The Heart and Stroke Foundation is excited by this new direction for its research support and looks forward to further collaborations with the Institute of Population and Public Health in the future. --Alison M. Stephen, PhD, Director, Research, Heart and Stroke Foundation of Canada
Translation and Use of Knowledge
The Institute is committed to facilitating the uptake and translation of population and public health knowledge by understanding, engaging and influencing policy-makers and by developing and implementing mechanisms for synthesis and knowledge exchange. In this area the Institute has, for example:
Required engagement of research users (e.g. policy makers, program administrators, public health practitioners) and the general public, and incorporate incentives for the development of mechanisms to facilitate knowledge exchange in all IPPH funding initiatives - notably the three research development grant competitions and the Centres for Research Development RFA. The Centres competition required of interdisciplinary research teams a co-governance structure to explicitly involve research users.
Supporting Knowledge Translation Research
IPPH contributed to the following applications funded under the Knowledge Translation (KT) Strategies for Health Research competition. Led by the CIHR KT Branch in collaboration with the thirteen institutes, the goals of this RFA were (1) to strengthen the foundations of research that underpin knowledge translation; (2) to encourage researchers in knowledge translation (KT) to focus their work increasingly on the health research priorities of CIHR institutes; and (3) to promote research on how best to integrate KT principles and practice into the training and continuing education of health professionals.
Strengthening Public Health Infrastructure
As Dr. John Frank and Erica Di Ruggiero note in an article published in the Canadian Journal of Public Health (May 2003), "Research funding applied to public and population health programs in Canada cannot achieve its goals if the basic functioning of the public health system is inadequate".
Widespread recognition of concerns regarding the current state of preparedness of the public health system to deal with the major public health problems of our time led the Institute to undertake an international comparative study. Under the guidance of a multi-stakeholder steering committee, comprised of two dozen public health leaders from across the country, an expert consultant conducted a review of the organization and funding of public health services in comparative nations - the UK, Australia, New Zealand and the US. Quebec's recently redesigned public health system was also reviewed in the context of this analysis, with a view to developing recommendations that will lead to improvements in the current public health infrastructure and its funding in Canada. The resulting report outlined the scope and functions of public health, current challenges faced by the system, and proposed the required elements for creating and sustaining a robust public health infrastructure in Canada, for action by federal/ provincial/ territorial and local levels of government. The report was prepared to inform discussions at a Think Tank to be held in Calgary in May 2003, which will serve to review and debate the report's findings and recommendations, as well as devise a concrete strategy to move towards a stronger public health system in Canada.
A real highlight accomplishment of the Institute in my view was mobilizing the public health community to attend the Future of Public Health in Canada meeting, says Dr. Catherine Hankins, IAB Member.
Building Public Health Research Infrastructure
Under the guidance of an advisory committee with representation from academia and applied public health research and practice, the Institute hosted a highly successful national meeting in March 2003 in Toronto. This gathering aimed to facilitate development of a network and infrastructure for public health researchers, practitioners, community advocates and policy makers in Canada. Participants included 80 public health opinion leaders from research, practice, community and policy-making arenas. Building on the scan of existing public health models that integrate research, education and service (e.g. SEARCH, PHRED, Community-Campus Partnerships, ACADRE), the meeting provided a meeting ground to identify opportunities for strengthening public health research infrastructure in Canada. CIHR-IPPH and many participants such as representatives from CPHA and CPHI committed to moving forward on the issues and recommendations identified at this meeting. Proceedings will be available in the Summer 2003.
Presentations
Over the course of the year, Institute staff has delivered numerous presentations to increase awareness of the Institute and its activities, and to impart existing scientific knowledge about key PPH concepts and research findings to a variety of researchers and research users (e.g. policy makers, political representatives) and other key stakeholders. Examples include:
Articles
The Scientific Director and Assistant Director have submitted articles for publication and contributed to stakeholder newsletters. Examples include:
"John Frank and Erica Di Ruggiero's paper, "Prevention: Delivering the Goods," with its focus on prevention, is very timely as current developments in infectious diseases, in particular SARS, bring the field of public health to the forefront.Frank and Di Ruggiero stress the importance of opening up a public dialogue if we want large-scale prevention to work.We all have a great deal to learn about how to make the case for prevention stick." - Peggy Leatt, PhD, Editor-in-Chief, Longwoods Review.
Institute Staff
Under the strong leadership of its Scientific Director, Dr. John Frank, the Institute continues to work very arduously to implement the objectives as outlined in the strategic plan, while remaining responsive to emerging priorities, thanks to the tireless efforts of very dedicated staff based in Toronto and Ottawa.
The Toronto team consists of Ms. Erica Di Ruggiero, Assistant Director, Vera Ndaba, Financial Officer/Event Planner, Ms. Gail Davis Bryant, Executive Assistant, and a more recent addition to our team Ms. Rathika Vasavithasan, Part-time Administrative Assistant.
In its second year of operation, the Institute was fortunate to recruit a strong complement of superb staff, based in Ottawa, who are shared with the Institute of Health Services and Policy Research, namely, Ms. Michelle Gagnon, Senior Associate, Partnerships and Knowledge Translation, Ms. Michèle O'Rourke, Associate, Strategic Initiatives, as well as Ms. Kim Gaudreau, Project Officer, who also works with INMD and ICRH in addition to IPPH and IHSPR.
Communication
Web Excellence
In keeping with the objectives and principles articulated in the Institute's comprehensive communication plan, staff have worked diligently to reduce the complexity and improve the functionality of our website by (a) improving accessibility, (b) simplifying navigation, (c) sharing information in a more timely manner, particularly with respect to granting opportunities and funding decisions, and (d) ensuring clarity of information, which results in better communication with our research, policy and practice stakeholders.
Communication Materials
The Institute finalized and distributed a range of communication materials related to its strategic plan in French and English. Over 2500 strategic plans and executive summaries were distributed across the country.
"I want to congratulate you on putting together a superb document. I am proud to be a part of the IAB" - Dr. Robert Brunham, Director, Centre for Disease Control, University of British Columbia
The Institute launched its inaugural newsletter, featuring articles on global health, the Summer Institute, and upcoming funding opportunities of interest to the PPH community.
The Institute maintains a contact database of over 1300 individuals from a range of disciplinary backgrounds, working in a variety of PPH research, policy and practice settings, to facilitate interactions with its growing PPH network across Canada.
Contributions to Continuous Improvement and Organizational Excellence
Staff has actively participated in a number of planning meetings, collaborative activities or represented the Institute on a number of working groups and committees, which manifests IPPH's commitment to continuous improvement and organizational excellence. These include:
Joint planning day with IHSPR
IPPH staff retreat to discuss roles and responsibilities, resulting in the further development and implementation of an operational plan and communication plan for the Institute
Staff played an instrumental role in the development of templates to facilitate inter-institute co-funding of workshops and other joint activities
Advisory Board Membership
The Institute Advisory Board continues to provide guidance and advice, and serve a critically important monitoring and evaluation function, as the Institute implements its strategic plan. During this time period, the IAB met a total of three times - twice in Toronto and once in Montréal, which coincided with a joint IAB meeting with the Institute of Health Services and Policy Research. A joint meet and greet reception was also held, attended by over 80 individuals who were treated to a highly informative presentation by Dr. Richard Lessard, Director of Public Health, Régie régionale de la Santé et des Services sociaux de Montréal-Centre. This inaugural joint meeting specifically focused on opportunities and challenges of common interest to both Institutes - the 'pillar' role played by the institutes, evaluation and knowledge translation.
A joint IHSPR & IPPH Advisory Board meet and greet reception held in Montreal on September 10th, 2002 for the research, policy and practice communities was highlighted by a thought provoking presentation by Dr. Richard Lessard, entitled "Research needs to support the organization of health and public health services: perspectives of the Director of Public Health of Montréal-Centre"
IAB membership did not change significantly during this reporting period, except for the resignations of Dr. Danielle Laberge and Ms. Marilyn Knox in March 2003.
April 1st, 2002 - March 31st, 2003
Dr. Robert Brunham, MD, FRCPC
Director, Centre for Disease Control,
University of British Columbia
Dr. David Butler-Jones, MD, MHSc, CCFP, FRCPC, FACPM
Associate Clinical Professor,
Faculty of Medicine and Community Health,
University of Saskatchewan;
Medical Health Officer,
South Eastern Saskatchewan
Dr. Nancy Edwards (Vice-Chair), BScN, MSc, PhD
CHSRF/CIHR Nursing Chair; Director,
Community Health Research Unit;
Director, Centre for Multiple Interventions;
Professor,
School of Nursing & Department of Epidemiology and Community Medicine,
University of Ottawa
Dr. Paul R. Gully
Senior Director General,
Population and Public Health Branch,
Health Canada
Dr. Catherine Anita Hankins, MD, MSc, CCFP, FRCPC
Associate Director,
Strategic Information & Chief Scientific Advisor to UNAIDS
Dr. Clyde Hertzman, MD, MSc, FRCPC
Professor,
Department of Health Care and Epidemiology,
Faculty of Medicine,
UBC;
Associate Director,
Centre for Health Services and Policy Research
Ms. Marilyn Knox
President,
Nutrition & Senior Vice-President,
Nestlé Canada Inc.
Dr. Danielle Laberge, MSc, PhD
Professeure, Départment de Sociologies,
Université de Québec à Montréal
Dr. John McLaughlin, MSc, PhD, FACE
Head,
Henry S. Rosenberg Division of Epidemiology and Biostatistics,
Samuel Lunenfeld Research Institute,
Mount Sinai Hospital;
Associate Professor,
Department of Public Health Sciences,
University of Toronto
Dr. John Millar, MD
Vice President,
Research and Population Health,
Canadian Institute for Health Information
Dr. Annette O'Connor, BScN, MScN, PhD
Interim Director,
Clinical Epidemiology Unit - OHRI Professor,
Faculty of Health Sciences,
School of Nursing and Faculty of Medicine,
Department of Epidemiology & Community Medicine,
University of Ottawa
Dr. Lesley J. Pinder, MD
Family Physician,
St. Stephen, New Brunswick
Dr. Christiane Poulin, MD, MSc
Associate Professor,
Department of Community Health & Epidemiology,
Faculty of Medicine,
Dalhousie University
Dr. Jean-Yves Savoie (Chair), PhD
Conseiller au Président du conseil d'administration et au chef de la direction
Commission de la Santé et de la Securité du Travail (CSST)
Dr. S. Leonard Syme, PhD
Professor Emeritus of Epidemiology,
School of Public Health,
University of California at Berkeley
Dr. Michael Wolfson, PhD
Assistant Chief Statistician,
Analysis & Development,
Statistics Canada
Dr. T. Kue Young, MD, CM, MSc, FRCPC, DPhil
Department of Public Health Sciences,
University of Toronto
