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Over the next five years, the Institute of Aboriginal Peoples' Health (CIHR-IAPH) - under the auspices of the Canadian Institutes of Health Research (CIHR) - will be leading an advanced research agenda in aboriginal health. The institute will be guided in its journey by inukshuks or markers representing the highest ethical and moral standards that are reflected in its vision, mission and value statements presented below:
Vision: CIHR-IAPH will improve the health of First Nations, Inuit and Métis people by supporting innovative research programs based on scientific excellence and aboriginal community collaboration.
Mission: CIHR-IAPH will play a lead role in building research capacity in the First Nations, Inuit and Métis communities, and will support partnerships and alliances between aboriginal communities and non-aboriginal health research organizations/institutes at the local, regional, national and international levels. CIHR-IAPH will support health research that respects aboriginal cultures, while generating new knowledge to improve the health and well being of aboriginal people.
Values: CIHR-IAPH will be guided at all times by a core set of values based on the principles of accessibility, high ethical standards, inclusion, respect, and transparency.
CIHR-IAPH supports and promotes health research that has a positive impact on the mental, physical, emotional and spiritual health of aboriginal people at all life stages.
The idea for creating a research institute devoted solely to aboriginal health was born in September 1999 when a national group of aboriginal and non-aboriginal researchers argued in a discussion paper this type of institute would serve to eliminate health disparities between aboriginal and non-aboriginal people (a).
They also recommended establishing a "cadre" of expert and emerging researchers who would form a Canada-wide network, which would facilitate information sharing and lead to heightened awareness and improved health among aboriginal populations.
After much discussion and debate over the merits of forming an aboriginal health research institute, CIHR agreed and created CIHR-IAPH in 2000. The institute's official public launch was in October 2001. The Honourable Allan Rock, the former Federal Minister of Health and a staunch supporter of CIHR-IAPH, was a keynote speaker at the celebration.
Consistent with the overall CIHR mandate, CIHR-IAPH promotes holistic and cross-disciplinary health exploration that embraces the four pillars of research - biomedical, clinical, health systems and services, and social, cultural and environmental factors affecting the health of populations. The other 12 CIHR institutes follow a similar mandate.
Despite the health challenges facing aboriginal communities in Canada over the past several decades, aboriginal people have demonstrated incredible strength, determination and resiliency to survive, thrive and prosper.
CIHR-IAPH selected the following four strategic research priorities to pursue over the next five years during its voyage of discovery:
Develop and nurture health research partnerships with aboriginal and non-aboriginal organizations in the public and private sectors at all levels - local, regional, national and international.
CIHR-IAPH identified and already contacted several potential partners at all levels. When feasible, CIHR-IAPH collaborates with its sister institutes on health research projects.
Maintain open, two-way communication with CIHR to influence policy development on ethical standards, peer review processes and knowledge translation systems that respect aboriginal values and cultures.
CIHR-IAPH contends aboriginal people must be full partners in research and not merely informants and respondents.
To ensure high standards are maintained throughout all aspects of all aboriginal health research projects, CIHR-IAPH staff and board members are willing and prepared to act in an advisory capacity as CIHR develops and refines ethical protocols, peer review processes and knowledge translation systems.
CIHR-IAPH called for a review and revision of an existing code of ethics for research involving aboriginal people in the 1998 Tri-Council Policy Statement titled Ethical Conduct for Research Involving Humans (b) . Subsequently, the trio of agencies created a panel and secretariat in November 2001 to review ethics in aboriginal health research, in consultation with CIHR-IAPH.
The institute also plans to evaluate a wide range of current information on ethical research standards and share findings with CIHR.
CIHR-IAPH also recommends more aboriginal people join peer review panels that assess funding applications and that all research proposals involving First Nations, Inuit and Métis people clearly show how study results will be communicated to their communities.
Build aboriginal health research capacity, especially among university graduate students studying aboriginal health.
CIHR-IAPH and its advisory board recognize the importance of nurturing graduate students interested in pursuing careers in aboriginal health research. As such, the institute held a national meeting with graduate students in British Columbia in March 2001 to learn more about their concerns, needs and suggestions for help. A second meeting was held in Ottawa one year later.
In response to student concerns, CIHR-IAPH developed a practical list of recommendations on how to enhance their learning experiences. For example, CIHR-IAPH plans to offer workshops and networking events to help quell feelings of isolation and enhance information sharing. CIHR-IAPH also plans to expand its funding programs targeting all level of students - from under-graduate to post-doctoral fellows.
The institute also aims to develop a singular, recognized specialty of aboriginal health research that will cover all possible fields. Currently, there is no formal defined specialty addressing aboriginal health issues at any Canadian university.
CIHR-IAPH also hosted a meeting of principal investigators in Ottawa in March 2002 to provide an opportunity for them to share their experiences on a broad range of topics. The institute may develop a set of guidelines - including roles, responsibilities and mandate - to illustrate how investigators can contribute to not only their own research objectives, but also to the broader goals of CIHR-IAPH.
Fund initiatives that address urgent or emerging health issues affecting aboriginal people.
Exclusion from socio-economic opportunities has led to health disparities between mainstream Canada and the First Nations, Inuit and Métis.
Because CIHR-IAPH is working within a strict budget, critical decisions must be made to ensure research funds are disbursed to where they are most urgently needed. As such, CIHR-IAPH supports aboriginal health research projects targeting diabetes and chronic illness, injuries, child and youth health, mental health and addiction, environmental health and traditional approaches to healing. In the future, CIHR-IAPH expects to support a range of other strategic initiatives.
CIHR-IAPH is also interested in "annualizing" the funding period to coincide with its fiscal year and to provide researchers with a predicable, annual funding plan.
CIHR-IAPH and its16-member advisory board selected nine initiatives to carry out the four strategic research priorities. The first two are broad-based and will provide valuable information to aboriginal researchers in all areas of study, while the following seven focus on specific diseases, health problems or issues:
The ACADRE program consists of a network of national and regional research centres that are electronically linked. Every centre is affiliated with a recognized research institution such as a research hospital or university.
Launched in mid-2001, the network was developed to create aboriginal-friendly research environments, undertake aboriginal health research in an ethical manner, and encourage aboriginal students to pursue careers in aboriginal health research.
To date, four centres have been selected to participate in the program, while plans are underway to fund another four centres.
The survey research centre (health information laboratory) is a primary source for collecting reliable, valid and current data on a wide span of aboriginal health research topics.
According to CIHR-IAPH, data collected from research surveys will be used to develop policies and programs that will help eliminate health disparities between aboriginal and non-aboriginal people.
The growing incidence of diabetes in aboriginal communities is cause for alarm and requires a tremendous amount of research to halt its progress, especially Type II Diabetes Mellitus (DM). Previously known as Adult Onset DM, it is now affecting growing numbers of children.
Several research programs are underway in which CIHR-IAPH is a participant. For example, a Manitoba-based inter-disciplinary team of researchers is assessing the prevalence of diabetes in aboriginal communities, likely causes, preventative measures and control methods, while another group of experts in Quebec is fine-tuning a community-based model for preventing diabetes.
Other CIHR projects underway to halt or prevent the spread of diabetes focus on gene therapy, drug therapy and cell transplantation.
CIHR-IAPH also plans to explore further the potential link between stress and DM among aboriginal people, given promising results from other related research projects.
Statistics suggest injuries from accidents are responsible for about 25% of all deaths in the aboriginal population, compared to only 6% in the mainstream population.
This area of investigation holds significant promise to improve aboriginal health. Preventative measures can significantly eliminate or reduce the incidence of unintentional injury among all demographic groups.
CIHR-IAPH envisions an inter-disciplinary research team comprised of scientists and researchers from all CIHR pillars, who will address health events and risks - such as Fetal Alcohol Syndrome, and tobacco, alcohol, drug and volatile substance abuse - by working closely with aboriginal children and youth.
A compelling need exists to evaluate the current mental health care system to identify barriers aboriginal people face when seeking treatment. Barriers could include fear of being stigmatized, systemic racism, isolation from family and friends, and lack of consideration for traditional healing practices.
The National Network for Aboriginal Mental Health Research, co-funded by CIHR-IAPH and the CIHR Institute of Neurosciences, Mental Health and Addiction, was launched in late 2001 and focuses on developing research capacity to address pressing mental health needs of aboriginal people in rural and urban settings.
Suggested areas of mental health research include alcohol and drug addictions, volatile substance abuse, compulsive behaviours, suicide, abuse of prescription drugs, and sexual abuse.
The innovative national network will train new researchers and provide research consultation services in collaboration with and for aboriginal communities.
Tuberculosis, HIV/AIDS and sexually transmitted diseases and infections will also be examined by CIHR-IAPH funded researchers. These programs are in their infancy and will be discussed in more depth as information becomes available.
CIHR-IAPH plans to support projects that examine the impact of socio-economic conditions, environmental contaminants and pollution on aboriginal health. Details on these and other projects will be provided shortly.
Spirituality and traditional medicines and foods have contributed significantly to the resiliency, health and well being of many aboriginal communities. Using a number of different approaches, CIHR-IAPH plans to fund projects that explore and document the positive impacts of traditional ways of knowing and healing.
Vision, Mission, Values
Strategic research priorities
Partnerships with the other 12 CIHR institutes
Local and regional partnerships
National partnerships
International partnerships
Ethical standards, Recommendations
Peer review process, Recommendations
Knowledge translation systems, Recommendations
Communications planning
Focus on graduate students
CIHR-IAPH strategies to encourage graduate students
ACADRE
Other initiatives
Moving towards a recognized specialtyFocus on principal investigators
Focus on opinion leaders
Budgetary restrictions
Proposed funding for partnership building
Proposed funding schedule for principal investigators
i) ACADRE - Aboriginal Capacity And Developmental Research Environments - program
ii) Survey Research Centre for Aboriginal Health
iii) Diabetes and chronic illness
iv) Injuries
v) Child and youth health
vi) Mental healthNational Network for Aboriginal Mental Health Researchvii) Communicable and infectious diseases
viii) Environmental health
ix) Traditional approaches to healing
The Institute of Aboriginal Peoples' Health (CIHR-IAPH) - under the auspices of the Canadian Institutes of Health Research (CIHR) - is embarking on a journey never before taken.
CIHR-IAPH is pursuing ambitious goals to improve the health and well being of aboriginal people in every part of Canada by stimulating aboriginal health research, creating new knowledge, forming research partnerships with organizations in Canada and abroad, and respectfully involving aboriginal communities in every project undertaken.
As its route unfolds over the next five years, CIHR-IAPH will be guided by a series of inukshuks or markers representing the highest ethical and moral standards, which are reflected in the following statements:
CIHR-IAPH will strive to improve the health of First Nations, Inuit and Métis people by supporting innovative research programs based on scientific excellence and aboriginal community collaboration.
CIHR-IAPH will play a lead role in building research capacity in the First Nations, Inuit and Métis communities, and will support partnerships and alliances between aboriginal communities and non-aboriginal health research organizations/institutes at the local, regional, national and international levels.
CIHR-IAPH will support health research that respects aboriginal cultures, while generating new knowledge to improve the health and well being of aboriginal people.
CIHR-IAPH will be guided at all times during its voyage of discovery by the core set of values described below:
CIHR-IAPH, one of 13 CIHR institutes, is leading an advanced research agenda in aboriginal health to improve the quality of life for aboriginal people living in all parts of Canada.
CIHR-IAPH supports and promotes health research that has a positive impact on the mental, physical, emotional and spiritual health of aboriginal people at all life stages.
The genesis of CIHR-IAPH was in September 1999 when Dr. John O'Neil and Dr. Jeff Reading facilitated national consultations with aboriginal and non-aboriginal researchers who recommended establishing a research institute dedicated to aboriginal health.
As outlined in a discussion paper titled Integrating a Focus on Aboriginal Health Research in the Development of the Canadian Institutes of Health Research: A Concept Paper (i) , they argued that a specialized research institute would address health disparities between aboriginal people and the general Canadian population. Discussion participants envisioned an aboriginal health research institute that would collaborate with private and public sector organizations at the community, regional, national and international levels.
The paper also recommended creating a "cadre" or network of emerging aboriginal and non-aboriginal academic researchers from all corners of Canada who would follow in the footsteps of established experts in aboriginal health. A cross-country network of highly qualified researchers would lead to an improved health system for the aboriginal population, increased information sharing, and heightened awareness among aboriginal people of healthy living options.
Supporting their contention is another seminal document on aboriginal life in Canada that clearly illustrates how aboriginal people bear the highest burden of illness in this country. Key findings from the 1996 report prepared by the Royal Commission on Aboriginal Peoples (ii) shows:
Furthermore, the United Nations (UN) proclaimed in 2001 that Canada is the third best country of all in which to live offering her citizens the best quality of life in terms of education, income and life expectancy. In a related UN study, however, the quality of aboriginal community life in this country was ranked much further down the scale at 62.
Based on this and other evidence, the national group of health researchers concluded a profound need exists to create an aboriginal health research institute that would discover new and effective ways to improve the quality of life for aboriginal people.
At the same time, they believed this type of organization would also stimulate government, academic and public interest in aboriginal health research, and it would help reduce negative perceptions commonly endured by aboriginal people.
CIHR agreed with their recommendations and subsequently approved the creation of an institute that would focus solely on improving the health of aboriginal people. However, approval did not come easy.
CIHR Interim Governing Council members debated extensively on the merits of forming such an institute. Would an institute dedicated solely to aboriginal health research be feasible? Would the other institutes actually lose interest in the topic because they would have no stake in it?
With strong support from the Honourable Allan Rock, the former Federal Minister of Health, CIHR created CIHR-IAPH in April 2000 on equal footing with the 12 other CIHR institutes. In October 2001, Minister Rock was the keynote speaker at the institute's official public launch.
In line with its mandate, CIHR-IAPH promotes holistic and cross-disciplinary health exploration that embraces the four pillars of research - biomedical, clinical, health systems and services, and social, cultural and environmental factors affecting the health of populations.
CIHR-IAPH fully understands aboriginal health research must be holistic and follow culturally appropriate models such as the medicine wheel or the circle of life. Both icons are based on the belief that good health requires balance between the physical, mental, emotional, and spiritual parts of individuals. CIHR-IAPH will respect and adhere to cultural traditions at all times.
Interestingly, the concepts of balance and multiple determinants of health have been adopted by mounting numbers of mainstream health care providers over the last twenty years or so.
Despite the health challenges facing aboriginal communities in Canada over the past several decades, aboriginal people have demonstrated incredible strength, determination and resiliency to survive, thrive and prosper.
Aboriginal people draw their strength from their traditions, their communities, and their elders. In addition, increasing numbers of aboriginal people are attaining higher education and becoming doctors, nurses, health researchers, academics, health care experts and more. Many are now giving back to their communities and in the process, are igniting a renewed vibrancy and determination.
Eliminating health disparities and research gaps were the driving forces behind the creation of CIHR-IAPH in 2000. These two factors are now the driving forces guiding the institute as it moves forward over the next five years.
To reach its destination, CIHR-IAPH advisory board members and staff selected the following four strategic research priorities to pursue. As such, CIHR-IAPH will:
These priorities are explored fully in the next section of the strategic plan.
Develop and nurture aboriginal health research partnerships with aboriginal and non-aboriginal organizations in the public and private sectors at all levels - local, regional, national and international.
Under the CIHR mandate, institutes must obtain "the involvement and recognition of and respect for health researchers from all research disciplines and the co-operation of a wide range of partners from all relevant sectors, the provinces and other countries." (iii)
Several organizations already exist that deal with or have a vested interest in aboriginal health. CIHR-IAPH is determined to forge partnerships with as many of these organizations as possible and by doing so, will tap into a wealth of knowledge gained from previous and ongoing research. CIHR-IAPH encourages the involvement of aboriginal and non-aboriginal health researchers from all disciplines.
Through partnerships with both large organizations and small groups of investigators, CIHR-IAPH is developing a network of researchers and constructing a database used for capacity assessment and monitoring. By doing so, CIHR-IAPH is gaining greater insight into the "multi-factorial nature of health problems and opportunities." (iv)
CIHR encourages cross-collaboration through partnerships between sister institutes of health research. In response, CIHR-IAPH is involved in gainful discussions with the following 12 CIHR bodies to peak their interest in CIHR-IAPH research activities and to encourage each of them to take ownership of aboriginal health issues:
Potential partners at the local level include band and community organizations, while regional level partners could include provincial governments and legislative offices, universities and regional centres of research.
The Manitoba First Nations Centre for Aboriginal Health Research at the University of Manitoba and the Institute of Aboriginal Health at the First Nations House of Learning at the University of British Columbia are now significant research partners.
Possible partners at the national level include:
CIHR-IAPH solidified partnerships with Health Canada, the National Aboriginal Achievement Foundation, and in particular, with the National Aboriginal Health Organization (NAHO).
CIHR-IAPH is looking for more partnership opportunities with NAHO and is giving consideration to:
CIHR-IAPH is also in discussions with the Canadian International Development Agency (CIDA) to learn how it can promote indigenous health research in developing countries. Poorer nations do not have the ability to fund research projects to the same degree as do Canada, Australia, New Zealand, United States and circumpolar nations such as Finland, Sweden, Norway, Denmark and Iceland.
CIHR-IAPH also sees vast potential to build relationships with the following international organizations involved in indigenous health research:
Notably, CIHR-IAPH contacted several of the above mentioned research organizations as the five-year strategic plan was being developed and began laying the groundwork for future collaborations.
Health disparities between aboriginal people and the general population in Canada are strikingly similar to those experienced by indigenous people in other developed, post-colonial countries. Thus, Canada can benefit from research conducted outside its borders.
At the same time, CIHR-IAPH can help Canada become an international leader with its bold new aboriginal health research strategy. By contributing to an emerging body of advanced knowledge, aboriginal health researchers in this country can help improve the status of indigenous populations around the world.
In this context, CIHR-IAPH is committed to developing international collaboration agreements with national health research councils to create a global network of researchers.
Significantly, collective agreements were signed with Australia and New Zealand and a letter of intent with Mexico in 2002 to promote international co-operation, collaboration and information sharing in the area of indigenous peoples' health research.
In addition, tri-lateral planning - including Canada, New Zealand and Australia - is now underway to host an international indigenous health research conference in Townsend, Australia in 2003. CIHR-IAPH is also developing an aboriginal health research journal in collaboration with these two nations.
CIHR-IAPH is also encouraging participants in the ACADRE -Aboriginal Capacity and Developmental Research Environments - program to join the growing international aboriginal health research network.
That said, CIHR-IAPH anticipates its Request for Applications (RFA's) will soon welcome researchers from other countries to apply for and explore strategic CIHR-IAPH research themes.
Maintain open, two-way communication with CIHR to influence policy development on ethical standards, peer review processes and knowledge translation systems that respect aboriginal values and cultures.
A pressing need exists to ensure research on aboriginal people is conducted in an ethical manner. In the past, research has not always helped aboriginal communities because it failed to address urgent health concerns and because there was little or no aboriginal ownership of research projects.
Furthermore, many communities and individuals claim they have been "researched to death" and are reluctant to participate in further projects managed by "outsiders."
Since the term "research" is often synonymous with "exploitation" in many aboriginal communities, it is in the best interest of both scientists and aboriginal people to resolve ethical issues. Creating appropriate ethical guidelines will pave the way to collaborations based on trust and respect, and will lead to constructive results.
Against this backdrop, some aboriginal communities are now demanding research teams demonstrate their credibility and accountability before beginning their projects. In the Northwest Territories, for example, legislation requires that researchers obtain a license before commencing work. They must clearly explain - using simple language - the purpose and scope of the proposed research program and they must share results with the community. In Nunavut, health researchers are required to outline all benefits of the proposed research to the aboriginal community prior to starting their work.
These rules and regulations strongly reflect community needs to incorporate the principles of Ownership, Control, Access and Possession (OCAP) into research activities. OCAP principles pave the way for self-determination in aboriginal health research, according to the National Aboriginal Health Organization. (v) They discourage biased, non-aboriginal analyses, while promoting broader, holistic approaches and participatory research methods.
OCAP principles are an offshoot (vi) of a code of research ethics developed by the National Steering Committee of the First Nations and Inuit Regional Longitudinal Health Survey in 1997. (vii)
An urgent need also exists to amend how codes of ethics are applied throughout the entire research undertaking. Currently, they are overwhelmingly "front-end" loaded. A code of ethics is typically drawn up at the start of a research program but monitoring and follow up are rarely implemented. That is, there are no policing or sanctioning mechanisms to preclude unethical behaviours by researchers. In fact, results are sometimes published regardless of how the research was performed.
CIHR-IAPH advisory board members agree ethical standards in aboriginal health research must be respectful and followed, if research results are to be accurate, useful and beneficial. Lack of trust and lack of power sharing between researchers and the aboriginal community must be remedied, they assert.
Aboriginal people must be full partners in research, not merely informants and respondents. The following list of recommendations was developed with this goal in mind.
CIHR-IAPH, along with its advisory board members, is ready and willing to act in an advisory capacity as CIHR develops ethical protocols for research conducted in aboriginal communities.
For example, CIHR-IAPH recommends that CIHR collaborate with the following organizations as it refines a code of ethics:
CIHR-IAPH called for immediate action to review and revise Section 6: Research Involving Aboriginal Peoples found in Ethical Conduct for Research Involving Humans, a Tri-Council document published in August 1998. (viii) Many believe power relations implicit in the document are threatening, while the language is too confusing and removed.
Subsequently, the trio of agencies created a panel and secretariat in November 2001 to review ethics in aboriginal health research, in consultation with CIHR-IAPH.
To protect aboriginal communities, CIHR-IAPH plans to identify and evaluate existing information on ethical research standards and share this information with CIHR. The institute plans to:
If the purpose of aboriginal health research is to influence positive change in aboriginal communities, that research must be relevant to the communities.
One way to ensure relevancy is to integrate people with backgrounds in aboriginal health research - regardless of their disciplines or specialties - into the peer review process at CIHR.
CIHR-IAPH advisory board members agree existing CIHR peer review panels cannot assess effectively proposals in aboriginal health research due to this gap.
To help rectify the situation, CIHR-IAPH suggests the following recommendations:
Research results and recommendations must be exchanged, synthesized and ethically applied to initiate positive change within aboriginal communities. If research results are simply recorded in academic journals and not widely communicated, aboriginal people will remain in the dark on issues critical to their health and well being.
Perhaps more important, all results and recommendations must be presented in a way that is readily understood by everyone. Unless materials are clear and concise, it is pointless disseminating them.
CIHR-IAPH is prepared to collaborate with CIHR to develop a series of suitable guidelines for disseminating and sharing research results with First Nations, Inuit and Métis communities.
In this regard, CIHR-IAPH will strive to ensure that:
And to facilitate further knowledge translation systems, CIHR-IAPH developed a communications strategy by bringing together a team of outside experts, advisory board members and CIHR personnel.
The resulting strategy includes several components ranging from communications objectives and key messages, to target audiences, implementation and evaluation. It will be rolled out in three phases over a two-year period.
Build aboriginal health research capacity, especially among university graduate students studying aboriginal health.
A key CIHR-IAPH goal is to build "capacity of the [aboriginal] health research community through the development of researchers and the provision of sustained support for scientific careers in health research." (ix) Indeed, CIHR-IAPH advisory board members have repeatedly stressed the need to accelerate learning at all levels of education - from undergraduate to post-doctorate.
Moving forward with this goal, CIHR-IAPH hosted two national meetings of aboriginal and non-aboriginal graduates students studying aboriginal health. The first meeting took place in March 2001 and the second, one year later.
CIHR-IAPH established the Aboriginal Capacity And Developmental Research Environments (ACADRE) program - its flagship initiative to date - partly in response to students' concerns and those of the CIHR-IAPH advisory board about the urgent need to develop capacity.
The ACADRE network includes groups of qualified aboriginal and non-aboriginal health researchers from across the country, which are electronically linked. Each group is affiliated with a recognized research facility such as a university or research hospital. Currently, four groups are part of the network, with plans to fund up to four more in the near future.
CIHR-IAPH also plans to help graduate students excel in aboriginal health research by:
There is no single defined specialty addressing aboriginal health issues. Instead, aboriginal health is covered by a disjointed group of recognized disciplines including medical anthropology, psychology, psychiatry, sociology, epidemiology and population health that rarely collaborate or exchange information.
CIHR-IAPH aims to build aboriginal research capacity by establishing a singular, recognized specialty of aboriginal health that will cover all possible fields of research, and similar to the other 12 CIHR institutes, "address the respective health needs of children, women and men." (x)
CIHR-IAPH hosted a meeting of principal investigators in March 2002 in Ottawa to provide an opportunity for researchers from across the country to share their experiences on a broad range of topics such as networking, partnering, and how they are applying ethical standards/methods in community-based health research projects.
CIHR-IAPH plans to sponsor about four meetings annually to build cooperation and break down competitiveness among aboriginal health researchers. Conferences and workshops are other vehicles that could also be used to unite this group. "A lot can be achieved in terms of synergy by bringing together the principal investigators," Dr. Reading maintains.
Over the next few months, the institute may develop a set of guidelines - including roles, responsibilities and mandate - to illustrate how the investigators can contribute to not only their own research objectives, but also to the broader goals of CIHR-IAPH.
Additionally, consideration will be given to building a national infrastructure involving larger research centres and networks to encourage co-operation and information sharing.
Educating aboriginal opinion leaders, such as chiefs and health care providers, in various aspects of aboriginal health research is also in the offing since these individuals can readily influence others in their communities to adopt positive behaviours. By taking a lead role, they will help build aboriginal research capacity and pave the way to improved mental and physical health of aboriginal people.
Fund initiatives that address urgent or emerging health issues affecting aboriginal people.
The federal government is not doing enough to increase the quality of life for aboriginal people, according to the 2000 annual report by the Canadian Human Rights Commission. (xi) While there has been some marginal progress in the past decade, it has been "too little, too slow," the report states. Social and economic exclusion are facts of life.
Exclusion from socio-economic opportunities has, in turn, led to health disparities between mainstream Canada and First Nations, Inuit and Métis communities. CIHR-IAPH strongly supports health research designed to minimize and eliminate these disparities.
CIHR-IAPH is working within a limited budget and must make critical decisions to ensure research funds are disbursed to where they are most urgently needed such as diabetes and chronic illness, injuries, child and youth health, mental health and addiction, and environmental health.
Nevertheless, consideration is being given to allocating funds within various RFA's to support a community person who would develop partnerships and initiate the participatory research process before investigators begin their activities.
CIHR-IAPH is moving forward fairly rapidly in funding new projects and would like to reach a "steady state" situation by developing a "predictable annual funding plan" for the research community, Dr. Reading says. CIHR-IAPH proposes to "annualize" the funding period to begin on April 1st and end on March 31st each year to coincide with its fiscal year. As such, the institute would like to issue RFA's every September giving researchers four months (until the following January) to prepare their applications. Following a peer review process, funds could be granted by April 1st to successful researchers for a 12-month period. The institute is also moving forward at a steady pace with multi-year funding for longer-term projects that generally last between three to five years. These health research projects would also fall under the proposed annualized funding schedule.
The next section on implementation strategies describes how research funds are being used to tackle urgent health matters. In the future, CIHR-IAPH expects to support a range of other strategic initiatives such as those furthering addressing health during life stages, gender issues, mental health and addictions, environment and health, northern issues, and indigenous knowledge and its link to health.
CIHR-IAPH and its 16-member advisory board selected the following initiatives to carry out the four, long-term strategic research priorities mentioned earlier.
The first two initiatives described below are broad-based and will provide valuable information to aboriginal researchers in all areas of study, while the following seven focus on specific diseases, health problems or issues.
The ACADRE program is a network of regional and national "supportive research centres" that are being developed across Canada to build capacity in aboriginal health. A unique blend of scientific leadership and community-based knowledge will characterize every research centre in the network, according to CIHR-IAPH.
ACADRE is designed to accomplish four broad objectives:
As the flagship initiative for the institute's inaugural year, CIHR-IAPH envisions funding up to eight centres of excellence across Canada over the next three years with the possibility of developing more in subsequent years.
ACADRE applicants can apply either for a full grant or for one designed to support the planning phase. "Formulation" funding enables applicants to initiate and participate in discussions on how to set up an ACADRE program. For example, this would be the time applicants seek scientific and community-based research partners.
Four centres were fully funded by CIHR-IAPH in fiscal 2001-2002, while four formulation grants of $50 000 each were awarded. ACADRE centres will be funded for three years with a possibility for renewal based, in part, on evaluation results.
Investigators wishing to apply to the ACADRE program must be affiliated with a "research-intensive public institution," such as a research hospital or university. They must also have experience overseeing health research programs and be adept at project management. Each proposal is assessed against a stringent set of criteria. All applicants must:
The ACADRE program was developed to create "aboriginal friendly" research environments, undertake aboriginal health research in an ethical manner; and encourage aboriginal students to pursue careers in health research.
The Survey Research Centre for Aboriginal Health (health information laboratory) is designed to be a primary source for accurate and timely data. Consequently, it holds an influential role in aboriginal health research and health policy development.
The centre plans to expand upon data collected for the First Nations and Inuit Regional Health Survey in 1997 and the 1991 Aboriginal Peoples' Survey. Other essential research activities the centre will undertake include:
The centre will also consider taking a closer look at how positive factors such as aboriginal resiliency, spirituality, community bonding, and traditional foods contribute to aboriginal health and well being.
Data collected from cross-sectional and longitudinal research surveys will be used to develop policies and programs that will help eliminate health disparities.
The growing incidence of diabetes in the aboriginal population is causing alarm and requires a tremendous amount of research to halt its progress. "Diabetes . is epidemic among Native people in Canada today." (xii)
Type II Diabetes Mellitus (DM) affects the aboriginal population at a rate three to five times higher than the general Canadian population. Furthermore, the prevalence of Type II diabetes among aboriginal people living in Canada is one of the highest in the world. (xiii)
Previously known as Adult Onset DM, it is now affecting aboriginal children. Diabetes is a serious health problem, which can result in serious complications including blindness, diabetes-related heart failure, and limb amputation. There are a number of theories that try to explain the high prevalence of diabetes among aboriginal people.
The Thrifty Genotype hypothesis, originally proposed by James Neel, (xiv) is often used to explain high DM rates among indigenous groups. Under this hypothesis, genes were selected over many generations that helped indigenous people survive in prehistoric periods characterized by cycles of feast or famine and high levels of physical activity. With rapid westernization - that is, reduced physical activity and dietary changes - these genes grew harmful resulting in high rates of obesity and DM.
Theories linking stress and diabetes are also interesting. Scientific evidence is growing that shows stress negatively affects our bodies and impacts such things as high fat accumulation and low glucose tolerance. Aboriginal Canadians experience a disproportionate burden of stress attributable to unemployment, poverty, lack of control, and a long history of attacks on their culture. However, very little scientific evidence exists documenting the impact of stress on diabetes or weight control.
Several research programs are underway in which CIHR-IAPH is a participant. For example, a Manitoba-based inter-disciplinary team of researchers is assessing the prevalence of diabetes in aboriginal communities, likely causes, preventative measures and control methods, while another group of experts in Quebec is fine-tuning a community-based model for preventing diabetes.
Other CIHR projects underway to halt or prevent the spread of diabetes focus on gene therapy, drug therapy and cell transplantation.
CIHR-IAPH hopes to fund an initiative investigating the relationship between stress and diabetes mellitus among aboriginal people and issued a RFA on this topic in fiscal 2001-2002 and again in 2002-2003. If a correlation is found, it follows that stress-reducing strategies should be used as part of the solution to the problem.
Other chronic illnesses that will be closely studied include obesity, metabolic diseases, cardiovascular disease, bone disease, lung and respiratory health, and cancer.
Statistics suggest injuries from accidents are responsible for about 25% of all deaths in the aboriginal population, compared to 6% for Canada as a whole. (xv) And in Manitoba, injuries are the leading cause of death for all First Nations, on and off reserve. (xvi)
Injuries and accidents experienced by aboriginal people are largely due to "increased exposure to risks" such as greater distances traveled by road and water, substandard vehicles and watercraft, and poor roads and housing conditions. Limited use of protective strategies such as seatbelts, life jackets and smoke alarms, and decreased access to effective trauma care also contribute to the relatively high level of injuries and accidents in aboriginal communities.
For every injury-related death, there are approximately 22 injury-related hospitalizations. (xvii) Injury hospitalization rates are three times higher for the aboriginal population than for all of Canada. (xviii) Leading causes of injury hospitalization among aboriginal people include falls, motor vehicle related injuries, poisoning, near drowning, and fire-related injuries.
Unintentional injuries cost the federal government $8.7 billion in 1995 in direct costs such as hospital care, physician services, prescription drugs and rehabilitation. (xx) Each unintentional injury generates an average of $4,000 in direct and indirect costs. (xxi)
The majority of unintentional injuries are preventable. Yet, numerous prevention measures effective in other populations have not proven successful in aboriginal communities. Injury prevention research has the potential to have immediate and significant community impacts.
There is a growing number of dedicated injury prevention and control researchers in Canada from numerous disciplines including epidemiology, public health, community health sciences, engineering, psychology, and a variety of medical specialties such as emergency medicine, pediatrics, geriatrics, sports medicine, neurosurgery, and rehabilitation.
Several university-based injury prevention centres now exist, with full-time researchers, assistants, trainees, and support staff. However, aboriginal health research in injury prevention and control is limited.
Even though several provincial injury prevention centres have identified aboriginal injuries as a priority, their research agendas are driven by competing funding priorities. Accordingly, activity is often focused on practical community support.
This area of investigation holds promise to improve aboriginal health. Preventative measures can significantly eliminate or reduce the incidence of unintentional injury among all demographic groups. CIHR-IAPH has put out a call for applied research proposals dealing with prevention of unintentional injuries.
CIHR-IAPH recommends establishing an interdisciplinary research team to improve the health and well being of aboriginal children and youth.
The multi-dimensional group will adopt holistic, community-based participatory tools to search for ways that will help children and youth live happy and healthy lives. At the same time, their efforts will help boost community empowerment.
CIHR-IAPH envisions an inter-disciplinary research team comprised of scientists and researchers from all CIHR pillars, who will address health events and risks - such as Fetal Alcohol Syndrome, and tobacco, alcohol, drug and volatile substance abuse - by working closely with community members.
Many aboriginal people are consumed by feelings of hopelessness - an unfortunate by-product of rapid cultural change and loss of traditional roles, practices, language, religion, and values. These feelings have led to an overwhelming number of mental health issues and personal casualties.
An alarming rate of self-destructive behaviour is evident among the aboriginal population. For example, the suicide rate of aboriginal women is about eight times that of non-aboriginal women in Canada, according to the 1996 report from the Royal Commission on Aboriginal Peoples.
Family violence in some communities is taking a heavy toll on aboriginal children and youth. As a result, "some children cannot be attentive in school, are consumed by feelings of insecurity and low self-esteem, and act-out through vandalism, self abuse and bullying," says Sharon Caudron, program director of the Women's Resource Centre in Hay River, Northwest Territories. " (xxii) There is also a high incidence of drug and alcohol abuse among aboriginal children, she adds.
A compelling need exists to evaluate the mental health care system to identify barriers aboriginal people face when seeking treatment. Barriers could include fear of being stigmatized, systemic racism, isolation from family and friends, and lack of consideration for traditional healing practices.
Once identified, this knowledge must be used to improve existing mental health care for aboriginal people.
CIHR-IAPH, in partnership with the Institute of Neurosciences, Mental Health and Addiction, launched a network of culturally-sensitive, mental health researchers known as the National Network for Aboriginal Mental Health Research in late 2001.
The network's main focus is to develop research capacity to address pressing mental health needs of aboriginal people in rural and urban settings. Suggested areas of mental health research include alcohol and drug addictions, volatile substance abuse, compulsive behaviours, suicide, abuse of prescription drugs, and sexual abuse.
The research team consists of members from several leading universities across Canada: Victoria University, Simon Fraser University, the University of British Columbia, the University of Alberta, the University of Saskatchewan, McMaster University, the University of Windsor, York University, McGill University, St. Mary's University, and Memorial University.
The national network will address mental health issues by training new researchers and will provide research consultation services in collaboration with and for aboriginal communities.
Tuberculosis, HIV/AIDS and sexually transmitted diseases and infections will also be examined by CIHR-IAPH funded researchers. These programs are in their infancy and will be discussed in more depth when they are established.
CIHR-IAPH plans to support projects that examine the impact of socio-economic conditions, environmental contaminants and pollution on aboriginal health. Details on these projects will be provided as soon as they are available.
Spirituality and traditional medicines and foods have contributed significantly to the resiliency, health and well being of many aboriginal individuals and communities.
Using a number of different approaches, CIHR-IAPH plans to fund projects that explore and document the positive impacts of traditional ways of knowing and healing.
