The 4th Annual Amyot Lecture - "Global Indigenous Health Research: An Opportunity for Canadian Leadership"

Presented by Dr. Jeff Reading, Scientific Director of the Institute of Aboriginal Peoples' Health

Tuesday, November 5, 2002
2 p.m.
Banting Theatre, Tunney's Pasture
Ottawa, Ontario

• Biography of Dr. Jeff Reading
• Speaking Notes

Biography of Dr. Jeff Reading

Dr. Jeff Reading, a Mohawk from Southern Ontario and the inaugural scientific director of the Canadian Institutes of Health Research Institute of Aboriginal Peoples' Health, obtained his Doctor of Philosophy (1994) and Master of Science (1990) degrees from the Department of Community Health at the University of Toronto. Since 1994, he has split his time between an academic appointment as Assistant Professor at the Department of Community Health Sciences, Faculty of Medicine, University of Manitoba; health research advisor to the Assembly of First Nations in Ottawa; and as a private health research consultant in Victoria, British Columbia. He is currently a professor at the University of Toronto's Department of Public Health Sciences and is Research Chair of the TransCanada PipeLines Aboriginal Health and Wellbeing. Dr. Reading is well known nationally and internationally for his research on native health, policy and social determinants with particular expertise in participatory research and survey research methods, along with a substantive focus on diabetes, tobacco use and heart disease. Dr. Reading has numerous memberships on national boards, committees, advisory bodies and recently served on the Federal Ministers of Health's Advisory Councils for HIV/AIDS and Canadian Info-structure.

Speaking Notes for Dr. Jeff Reading Scientific Director for the Institute of Aboriginal Peoples' Health at the 4th Annual Amyot Lecture

November 5, 2002
Ottawa, Ontario

As Delivered

Thank you very much for the kind introduction.

It is an honour today to speak to you at the 4th Annual Amyot Lecture. Like Dr. J.A. Amyot, a pioneer in preventative medicine, the Canadian Institutes of Health Research (CIHR) Institute of Aboriginal Peoples' Health is a pioneer in Aboriginal health research. I'd just like to explain the banner on this slide. I think it gives a concrete explanation of some of the challenges that we face in Aboriginal health research. This is up in the tundra. Of course, it's starting to get dark up there in the far Northwest Territories. These little dots on the right hand side are actually buildings where people live. And so you get a sense of the vast desolate nature and some of the geographic problems of delivering health care services in a very difficult geographic circumstances.

We are driving an ambitious and bold agenda, both internationally and nationally. During my presentation, I will:

• introduce the Institute, explain who we are and share with your our vision, mission and goals;
• clearly illustrate how Canada is emerging as a leader in global indigenous health research by forming strategic alliances and partnerships; and
• talk about some of the challenges that are facing the Institute on our home turf and how the CIHR Institute of Aboriginal Peoples' Health is overcoming these obstacles.

We are one of the thirteen founding Institutes of the Canadian Institutes of Health Research, and each of these Institutes focuses on a different aspect of health research. Of course, we are very much interested in collaborating with other Institutes around various health research concerns.

You can see that the center piece of this slide is a connecting piece - it represents the CIHR Corporate Office. It is the programs branch and includes the four CIHR vice-presidents and their staff, who run the Corporate Office. But each of the Institutes is run by a Scientific Director, and the Scientific Directors are academics who are based in academic institutions and are expected to conduct research and teach, just like a regular professor. In addition, they are also expected to run the Institute. So it's a virtual model. It's a bold step by Canada. It's an experiment that other nations are looking at in terms of health research activities and organization.

For the CIHR Institute of Aboriginal Peoples' Health specifically, our vision is to enhance the well-being of First Nations, Inuit and Métis people in Canada by supporting innovative research programs that are based on scientific excellence and community cooperation. Our mission is actually quite simple - it is to improve the health and well-being of Aboriginal people. If we fail in that mission, as an Institute we will have failed.

Our mission is also to build research capacity among Aboriginal communities. And along the way, we will help encourage research capacity in indigenous communities around the world by forming alliances and partnerships in the global health research arena.

Building partnerships with international organizations involved in indigenous health research has been a priority for the CIHR Institute of Aboriginal Peoples' Health since 2000, when the Institute was launched. And it will continue to be over the next few years.

We are committed to developing international collaborative agreements with national health research councils to create a global network of researchers. Why? Because health disparities between Aboriginal people and the general population in Canada are strikingly similar to those experienced by indigenous people in other developed countries with minority indigenous populations. In other words, we have a lot of similarities in the health indicators among Australian Aborigines, Native Americans, Aboriginal Canadians, New Zealand Maoris and the indigenous people of the circumpolar nations of the north.

As you can see from this slide taken from a presentation from Zimmet et al with the World Bank, here are some Aboriginal people from the Northern Territory of Australia. You can see a rapid transition to highly processed foods, Coca-Cola, fish and chips, fried foods and milk shakes. This rapid transition, and the environmental change is really responsible in large part, leads to the epidemic of diabetes.

The Australian research community has initiated research to investigate indigenous people to unravel some of the complex interactions. We think it's extremely important to learn from our Australian colleagues and those in other parts of the world because these are difficult issues and we think that Canada can play a huge leadership role. In fact, if you look at our history, we have played that leadership role in the past and I think we need to continue the tradition.

A similar situation exists in Canada. This next slide is derived from the regional health survey that Ian (Potter) talked about earlier. It shows age and the percentage of type 2 diabetes sufferers among Canadian males and females - this is cause for alarm. This slide shows rapid increases in the cases of diabetes among the mainstream population and has initiated organizations like the Canadian Diabetes Association and Health Canada to respond to this urgent problem.

If you look at the situation in First Nations females and First Nations males, it is deplorable. It is unbelievable that you could actually have one out of three First Nations women between the ages of fifty-five and sixty-four with type 2 diabetes. And those of you that know anything about diabetes or clinical outcomes know that diabetes is very difficult and has a high morbidity in terms of peripheral vascular disease causing blindness, renal failure. It is a predictor for heart disease and is a cause of death all by itself.

If you look at the younger age categories here, you can see a huge difference among younger people. Not so long ago, we used to call type 2 diabetes "adult onset diabetes," but incidence is shown to be high - particularly in Aboriginal populations - as early as age seven and eight years old. I would suggest that starting on hypoglycemic agents at the age of eight is not a really good way to start your life. So this is a major epidemic and we don't know whether it's actually reached it's peak yet.

The third thing that you need to take away from this slide is that when you do age comparisons, you see that there's about a 20 to 30 year gap for earlier onset of diabetes among Native people compared to their mainstream Canadian counterparts. For example, First Nations women at the age of 25 compare to their Canadian counterparts at the ages of 55 and beyond. This is really a severe problem. It's not one that's going to go away and it needs the attention of the advanced research enterprise to be able to begin to address this kind of problem.

Now if that weren't enough - this slide is also taken from the paper by Zimmet et al on the global health pandemic and published by the World Bank - when we look at known diabetics who are identified in the medical care system, it's like the tip of the iceberg. There's a great number of unreported cases, people who haven't found out whether they're diabetic yet and of course there are those with impaired glucose tolerance (IGT). So there's a great number, probably two thirds. This really means that for the most part, First Nations and Inuit people living in their home communities - all those people in the adult category - could be considered to be at extremely high risk for diabetes. This is a really bad problem.

We can start to unravel some of the linkages or causes of diabetes by looking at the environment. I draw your attention to the early life stage and the adult life stage on this next slide. We think that high birth weight, inadequate nutrition and poverty during the early life stage are key determinants in diabetes. Of course, combined with sedentary lifestyle, dietary factors and poverty in the adult life stage all predispose to diabetes. And many indigenous people around the world live in dire poverty, which in turn contributes to poor health.

The picture in Canada is not really much better. I just want to turn your attention here to an idea that gets a bit of air play. It's a thrifty gene hypothesis and it basically states that Aboriginal people are part of a hunter-gatherer society - we've evolved to undertake feast and famine. Metabolically, this means that we can somehow store fat better. But unfortunately due to poverty, with highly processed foods and low nutrient value, where there is too much sugar and fat - there's no famine. This sort of food supply is readily available and obesity is the result.

The reason that I take a little bit of exception to the thrifty gene hypothesis is that prior to the 1940s, diabetes was not present among Aboriginal people. There were physicians who actually went to the north and did blood sugar tests and were unable to demonstrate diabetes. So in a fifty year period, we've gone from no diabetes to a huge epidemic of the problem.

And the other fact is that around the world, diabetes is a common health problem in minority indigenous populations living in developed countries. So it seems unlikely that populations so diverse and geographically dispersed around the globe could share a common genetic phenol type that would predispose to diabetes. This issue obviously needs more research and could be an exciting opportunity to engage the basic biomedical research community in unraveling a very complex problem affecting a great number of people, not only in Canada but around the world.

The CIHR-IAPH, or the Canadian Institutes of Health Research Institute of Aboriginal Peoples' Health, wants to take a leadership role abroad. Canada can learn much from research conducted outside it's borders and to this end, we have contacted several Aboriginal health research organizations around the world, and have achieved impressive results. Here are some of our key achievements.

A precedent setting memorandum of understanding was signed this April by the Chief Executive Officers of the Canadian Institutes of Health Research and National Health and Medical Research Council of Australia and the Health Research Council of New Zealand to cooperate on health research for indigenous populations.

I'd like to take this moment to thank Dr. Alan Bernstein, CEO and President of the Canadian Institutes of Health Research and his counterparts in Australia, Dr. Allan Pettigrew, and in New Zealand, Dr. Bruce Scoggins, for launching this precedent setting agreement.

This slide is from the preamble of the agreement. It says here that they realize that indigenous people want research undertaken on their own terms. It's really important to protect cultural knowledge and values, to participate in all phases of research and to promote indigenous health research as a global concern. The three nations are developing a more coordinated approach to improve health of indigenous populations and paying special attention to the social, environmental and economic determinants of health.

In January 2002, the Health Secretariat of the United Mexican States and the CIHR signed a letter of intent to develop a health research, research training, clinical training and knowledge translation based on reciprocity and mutual benefit.

Areas of potential collaboration with Mexico include:

• environmental health;
• genetics and genomics;
• the needs of indigenous people, and vulnerable populations;
• health policy development, health services; and
• electronic forms of knowledge transfer.

Last week, a Mexican delegation visited Ottawa, and this visit further cemented the relations between Canada and Mexico.

On another front, in May 2002, at the 55th World Health Assembly in Geneva, Canada's Minister of Health, the Honourable Anne McLellan, and Tommy G. Thompson, Secretary of Health and Human Services in the United States, signed a memorandum of understanding to raise the health status of First Nations and Inuit people in Canada, and the American Indians and Alaskan Natives in the United States. The effort highlights our mutual intent to share knowledge and learning experiences, which will strengthen our respective approaches to improving Aboriginal health.

Together, we are developing a work plan in partnership with Health Canada in which several joint activities to advance Aboriginal health research are being considered including:

• sharing information on the tele-medicine and tele-health capabilities of both nations;
• collaborating on studies of chronic diseases that have high prevalence rates in indigenous population;
• cooperating on strategies to support indigenous populations in the hemisphere;
• providing guidance in working with universities and other non-governmental organizations; and
• sharing information on health reform and innovative approaches to health care delivery.

I would like to take this opportunity to thank Mr. Ian Potter, Assistant Deputy of Minister of Health and a member of our Advisory Board, who was instrumental in bringing these parties together to sign the historic agreement. No doubt, this is a significant opportunity for trans-border cooperation between the national health research agencies in Canada and the United States.

In addition, Dr. Judy Bartlett, an Aboriginal researcher based at the University of Manitoba and a member of our Advisory Board, is actively engaged with colleagues from around the world in planning the first ever International Forum on Indigenous Health Research. Indigenous and non-indigenous researchers and policy experts from the four countries involved will gather in Townsville, Australia, next October to exchange information on knowledge translation strategies.

The CIHR Institute of Aboriginal Peoples' Health supports the three-day conference and we expect to send a number of graduate students to the meeting as they are our future health researchers.

In total, about 200 people are expected to attend and will examine knowledge translation which is defined by CIHR as:

"...the exchange, synthesis and ethically sound application of knowledge - within a complex system of interactions among researchers and users - to accelerate the capture of benefits of research for Canadians through improved health, more effective health services and a strengthened health care system."

To me, this really means that knowledge translation is using health research findings instead of putting them on a shelf. It's actually engaging in evidenced-based planning. And when you're working in this field, you have to ask yourself the question: Why is it that Aboriginal people are given a set amount of money to undertake their health services delivery, while the mainstream system seems to be based on addressing the problems or an evidence-based approach? I believe that this knowledge translation will give us an opportunity to develop more of a needs-based approach to health services and disease prevention in Aboriginal communities.

Dr. Bartlett is also working diligently with health researchers from Australia, New Zealand, the United States and Mexico, seeking creative ways to sustain Aboriginal collaboration among health researchers on a regular basis - not just meeting every two years at a special forum. Building a virtual, indigenous, global health research network is one option that is being considered to maintain strong links.

Another key element of our international strategy is to form alliances with circumpolar nations. Canada has a long history of being involved in and organizing some of the first meetings among the circumpolar nations of the world. Mr. Earl Nowgesic, Assistant Director of CIHR Institute of Aboriginal Peoples' Health, participated in a conference earlier this year in Copenhagen to learn more about the negative health conditions and barriers faced by indigenous people living in Alaska, Russia, the Scandinavian nations, Iceland, Greenland and Denmark, which are similar to those experienced by Aboriginal people living in Canada's north.

Advanced research in Aboriginal communities will complement the CIHR Initiative on Rural and Northern Health Research, led by the CIHR-IAPH and working with Dr. Renee Lyons of Dalhousie University. The other strikingly similar initiative, which is also of interest to us, is the development of the CIHR National Research Agenda for the Environmental Influences on Health led by Dr. John Challis, Scientific Director of the CIHR Institute for Human Development, Child and Youth Health.

In addition, the CIHR Institute of Aboriginal Peoples' Health is excited to be involved in a research initiative called the Global Health Research Program Development and Planning Grant led by Dr. John Frank, and managed by Alita Perry at the CIHR. The global initiative received full support from Senator Michael Kirby, who was the Chair of the Standing Committee on Social Affairs, Science and Technology. The Committee's final report recommends the federal government provide increased resources to the Global Health Research Initiative.

The Initiative is led by four agencies including CIHR, the Canadian International Development Agency, Health Canada and the International Development Research Centre. These agencies signed a historic memorandum of understanding to collaborate on a Global Health Research Initiative and subsequently issued an RFA - Request for Applications - that received a tremendous response from some 77 applications that were submitted by the October 1st deadline this year. Significantly, 6 of the applications are from Aboriginal health researchers. CIHR expects that award winners will be announced in January of 2003.

We contributed to this far-reaching and cross-cutting initiative, along with seven other Institutes including Public and Population Health, Circulatory and Respiratory Health, Gender and Health, Infection and Immunity, Neurosciences, Mental Health and Addiction, and Nutrition, Metabolism and Diabetes.

This Request for Applications supports full fledged partnerships between Canadian-based researchers in low- and middle-income countries. This approach paves the way for collaborative research that includes minority indigenous populations in post-colonial developed nations.

Tomorrow, I will be going to Africa along with some of my CIHR colleagues to attend the Global Forum on Health Research, a Geneva-based agency created by the World Health Organization. This event will address the 10/90 gap in which less than 10 percent of global health spending by both public and private sectors is devoted to 90 percent of the world's health problems. This is a huge disparity.

While at the event, CIHR will promote it's role as a leader in international community and promote excellence in the Canadian global health research. The CIHR-IAPH will take the opportunity to show how we are engaging efforts in communities and advanced health research enterprise through the activities of the Institute and our national network of ACADRE centres about which I will speak in more detail.

The global network of indigenous health researchers is growing rapidly, thanks in large part to Canada's push on this front. With CIHR support and the expert advice from my Institute Advisory Board and staff, our accomplishments and program goals are nothing less than remarkable.

As the Institute's inaugural Scientific Director, I am privileged to be working with an amazing group of committed researchers whose aim is to improve the health of indigenous peoples from all around the globe.

I'm happy to say that you get two lectures for the price of one today. Now that I have laid out the global and international health scene and described the work that we've done in just under two years, I think it is important to show you that we are participating in a network of networks.

So what does our Canadian network look like?

This is the flagship initiative of the Canadian Institute of Health Research which we call the ACADRE - an acronym which spells out Aboriginal Capacity and Developmental Research Environments program. The key here is to focus on the environment where research can take place.

The image on this slide shows Dr. Malcolm King, a CIHR Governing Council Member. He's a status Indian from the Mississauga's of the Credit River and a full professor in physiology at the University of Alberta. We did a CIHR presentation at an Alberta event last year and it was covered by the A channel, northern and southern Alberta.

Aboriginal health researchers from across Canada are affiliated with the CIHR Institute of Aboriginal Peoples' Health. They have made significant headway in less than two years with respect to advancing our four key priorities, which are:

• developing and nurturing health research partnerships;
• influencing policy development on ethical standards peer review and knowledge translations systems that respect Aboriginal values and cultures;
• building Aboriginal health research capacity about which I'm going to speak specifically; and also
• funding initiatives that address urgent and emergent health concerns affecting Aboriginal people.

By following these priorities, we are determined to reduce health disparities between Aboriginal communities and mainstream Canada through evidenced-based research that respects Aboriginal cultures.

The CIHR Institute of Aboriginal Peoples Health was given another strong vote of confidence by Senator Michael Kirby and the Senate Committee on Social Affairs, Science and Technology. Volume Six of the Committee's final report says:

"That the Committee believes that research is perhaps the most important element that will help improve the health status of Aboriginal Canadians. In our view, the creation of the CIHR Institute of Aboriginal Peoples' Health is an important step in this direction."

The document also goes on to say:

"...additional federal funding should be directed to research projects that can have a significant impact on the health status or that contributes substantially to improvements in health care quality and delivery. Research in such fields as ... Aboriginal health ... should be given the highest priority."

In terms of specific recommendations, the report was also unequivocal. The Kirby Committee made two key recommendations concerning Aboriginal health research. First, that the federal government provide additional funding to CIHR to increase the participation of Canadian health researchers, including Aboriginal people themselves, in research that will improve the health of Aboriginal Canadians. And second, that Health Canada is provided with additional resources to expand its research capacity and to strengthen its research translation capacity in the field of Aboriginal health.

The need to close the health gap is urgent. This is the health gap within Canada - the north-south gap between Aboriginal people and mainstream Canadians. Although the United Nations ranked Canada as number one country in the world in terms of best quality for life, the World Health Organization concluded that native reserve conditions in this country are deplorable. Reserve conditions were rated near the bottom at 63, below Thailand and Mexico.

Indeed the Canadian Human Rights Commission claims "the plight of native people in Canada is a national tragedy."

Our goals are ambitious. Yet we are faced with many challenges.

A recent report by Health Canada, Human Resources Development Canada and Indian Northern Affairs, titled Healthy Canadians - A Federal Report on Comparable Health Indicators, revealed some all too common dismaying trends. For example:

• Only 38 percent of First Nations reported very good to excellent health compared to 61 percent of all Canadians;
• There has been limited access in reducing the incidence of tuberculosis among First Nations, especially in Western Canada and the Territories. The TB rates are eight times higher among Aboriginal Canadians than among Canadians at large; and
• In 1999, First Nations lost almost five times as many potential years of life to accidental injuries and three times as many years to suicide.

Smoking rates are disturbingly high among Aboriginal youth. Of those aged 20 to 24 years, almost three quarters smoke. Smoking rates are twice as high for First Nations and Labrador Inuit youth, compared to their age-matched Canadian counterparts - some 62 percent compared to 31 percent respectively.

The largest majority of youth start smoking when they are 16 years old. If they are not smoking at 19, however, there is very little chance that they will ever start. This is one of the key findings from the First Nations and Inuit Regional Health Survey completed in 1997.

As a Scientific Director, I am expected to carry out my own research program, and we did do a survey in Winnipeg earlier this year. My research team based at the University of Toronto conducted an Aboriginal Youth Lifestyle Survey this past summer at the North American Indigenous Games held in Winnipeg, Manitoba. The Games were a unique opportunity to examine healthy, Aboriginal youth and what makes them so, as some 6,500 Aboriginal youth from all over North America participated in the Games.

It is important to focus on health and well-being in Aboriginal communities. In the past and continuing to the present day, Aboriginal people are often characterized as sick and disorganized, which reinforces unequal power relationships and, in part, undermines their legitimate aspirations for self-determination. So this study attempts to show Aboriginal youth in a more positive way, in a more positive environment, like the Indigenous Games.

Note that a small gift of a frisbee and a hackey sack was given as incentive for participation in the survey. I think it sends a positive signal about health research.

As this next slide shows, we compared smoking rates among youth involved in the Games and we characterized them as either participating in the athletics or not. The proportion of smokers among youth classified as athletes is significantly lower than for non-athletes. Also, Aboriginal youth involved in athletics were twice as likely to have quit smoking than their non-athletic native counterparts.

Findings suggest that we take more steps to promote healthy living in Aboriginal communities consistent with Health Canada's Healthy Living/Healthy Communities Strategy.

What this really shows is that there's a huge potential intervention here that should be invested in. Of course, athletics are not a panacea for all the health problems, but these are preliminary results that intuitively reinforce the idea that sport, recreation and leisure may have a significant health protective effect. Especially when one considers that smoking is considered a 'gateway drug' associated with a variety of unhealthy behaviour, including substance abuse.

This slide simply indicates that athletic youth are much less likely to be smokers in any of the age categories that we measured. So, anything below 50 percent is where athletes are smoking less than their non-athletic counterparts.

In combination with these health trends, the geographic challenge of Canada makes it more difficult to reach Aboriginal communities. There are over 630 First Nations communities, in addition to Inuit and Métis communities spread across ten provinces and three territories.

However, technology is beginning to bridge the divide, making communication and transportation faster, which facilitates delivery of our health research programs.

Each Aboriginal community is unique with its own set of traditions, issues, values and ways of healing. Contrary to a popular misconceptions, Aboriginal people are not all the same and cannot be lumped into one category. There is no panacea that will improve health - anyone who tells you there is is a liar or a fool. We must consult with individual communities and respect their ways. Our challenge is to ensure that together, we will find solutions that work.

To reach the goal of improved health, Aboriginal people adhere to research principles of data ownership control, access and possession - or OCAP. These are the capacities that we feel are important to an overall system of Aboriginal health information management. Developing these clear objectives and partnership strategies with specific lines of action is key to moving forward the Aboriginal health infostructure.

Many communities and individuals complain that they have been "researched to death" and they are very reluctant to participate in further projects by outsiders. We are determined to change these attitudes by working in full partnership with Aboriginal groups. We need to develop research capacity to avoid the rhetoric and begin to engage in meaningful partnerships with communities. We are determined to honour and balance the Aboriginal world with the scientific and academic worlds.

Now we'll discuss the flagship initiative of the CIHR Institute of Aboriginal Peoples' Health that is designed to create a national research network. It's called ACADRE - the Aboriginal Capacity and Developmental Research Environments Program.

The ACADRE program has a major focus on developing advanced research capacity to support young, aboriginal health research investigators. The ACADRE centres will provide many things to emerging researchers including:

• an appropriate environment and resources to encourage Aboriginal students to participate in health careers in Aboriginal health research;
• the appropriate environment for scientists across the four themes or pillars of CIHR to pursue research opportunities in partnership with Aboriginal communities;
• opportunities for Aboriginal communities and organizations to identify important health research objectives in collaboration with Aboriginal health researchers; and finally
• these centres will facilitate the uptake of research results through appropriate communication and dissemination strategies.

Before the CIHR Institute of Aboriginal Peoples Health was launched in 2000, Aboriginal health research centres were created under the Community University Research Alliance - one at the University of Manitoba, another at McGill, an Inter-disciplinary Health Research Team at the University of Toronto, and an operating grant based at Mount Sinai Hospital in Toronto.

On October 11, 2001, the former Minister of Health, the Honourable Allan Rock, announced four full ACADRE centre awards for Alberta, Saskatchewan, Manitoba and Ontario. That is up to $12 million over a six year period. He also awarded four, one-time planning grants totaling $200,000.

Four more ACADRE centres were added to the network this past October in British Columbia, Ontario, Quebec and Nova Scotia. Again they were awarded $12 million over six years. So, in a short period of time, we have contributed up to $25 million to a national network of research centres engaging advanced research enterprise in Aboriginal health research.

Now there are eight ACADRE centres, which represent an emerging team of advanced research environments that will focus on:

• population health and determinants of health;
• women's health and child health development;
• ethics and conducting human research, community healing and health care under Aboriginal self-government;
• prevention and control of chronic diseases;
• addictions in mental health; and, of course
• environment and health.
  

We hope to develop at least ten centres operating as a national network with a potential for a six year funding commitment. It's really necessary that these centres be sustained. And they can be by the health research enterprise. They become the place to be. Where the excitement and the passion for doing research is part of these centres. I think that we can achieve that in Canada. They will be sustained by grants and other kinds of funding, both obtained within our borders, but also from other foundations outside. That is really a big part of our international collaboration.

Sixty percent of all these ACADRE funds must go to supporting graduate students engaged in research. Under the guidance and instruction of the CIHR Institute of Aboriginal Peoples' Health and its national network of centres, a new generation of Aboriginal health researchers is emerging who are keenly aware of the need to follow ethical research standards.

In fact, the Institute of Aboriginal Peoples' Health has hosted two national gatherings of graduate student researchers, providing them with opportunities to exchange ideas, share research results and network. The 2001 meeting was held in Vancouver and the second was held in Ottawa this past March. A third is being planned for June 2003, which will take place in Montreal.

This slide shows the Saskatchewan Minister of Health at the opening our ACADRE centre in Saskatchewan. This is the Grand Chief Cyr from the Saskatchewan Indians and this is Dr. Eber Hampton, President of the Saskatchewan Indian Federate College.

The ACADRE centre will be housed in this facility, designed by the world class Cree architect, Douglas Cardinal. This is a unique opportunity because there was dollar for dollar matching funding from the province and CIHR - what was $3 million was leveraged up to a $6 million commitment. It was also a really unique opportunity for the Saskatchewan Indian Federated College to partner with the University of Regina and the University of Saskatchewan to undertake advanced research. So I believe it's a very positive step.

The last observation I would make is that you don't often get a Minister, a chief and a university president on the same stage celebrating together and agreeing that it is a good thing.

Dr. Marlene Brant-Castellano, a respected Mohawk elder and one of the leading Aboriginal health researchers and policy experts in Canada, along with being an Advisory Board member to the Institute, explains that "research that reinforces powerlessness is basically harmful to health."

Our agenda fully supports her sage advice.

In summary, in the few minutes that we've had together, I hope I presented you with a clear picture and a brief introduction to the CIHR Institute of Aboriginal Peoples' Health. There's so much more I could have talked about but I guess the time got away.

Regardless, I trust you have a good idea of our goals. Our approach to forming international partnerships and the rationale behind this activity. As for our national agenda, we have developed a sound foundation upon which to practice and promote what we think is world-class Aboriginal health research.

There are so many people I'd like to thank for their commitment and support to the CIHR Institute of Aboriginal Peoples Health, including Dr. Alan Bernstein, my Scientific Director colleagues, the CIHR Vice-Presidents and their corporate staff.

Finally, I'd like to especially acknowledge the following individuals: the CIHR-IAPH Institute Advisory Board, led by the Chair, John O'Neil at the University of Manitoba; Ms. Laura Commanda, who we recently recruited to join as our Ottawa based research project manager; Ms. Linda Day, who we were able to attract from the Summit Chiefs of British Columbia, who's now based at the University of Toronto as our research projects manager; Trudy Jacobs, our secretary; Mr. Earl Nowgesic, who we recruited from the Assembly of First Nations to come over and join us at the University of Toronto, he is also an assistant professor in the department of public health sciences; Ms. Alita Perry, the Ottawa-based manager of the Global Health Research Initiative; Ms. Sittanur Shoush, a consultant based in Edmonton; and finally, Ginette Thomas, the Ottawa based manager of the Rural and Northern Health Research Initiative, and the former institute liaison.

All my relations.