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Call to Action # 22 : Health (18-24)

Institute of Indigenous Health Action Plans and Progress Reports: 2016 -2019

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In its latest strategic plan, Roadmap II, the Canadian Institutes of Health Research (CIHR) established the health and wellness of Indigenous populations as one of the agency’s four priority areas of research. Consistent with a number of the calls to action of the Truth and Reconciliation Commission, CIHR recognizes the importance of stepping up its efforts to build the research evidence that is critical for improving the health status of First Nations, Inuit, and Métis peoples.

As part of this commitment, CIHR has enhanced its relationship with First Nations, Inuit, and Métis communities.  Based on their advice, it has committed to immediately implement a series of concrete actions to further strengthen Indigenous health research in Canada. Specifically, CIHR will:

  1. Increase its capacity to interact with Indigenous communities in a culturally appropriate manner, through the creation of a dedicated team assigned to work directly with Indigenous peoples, researchers, and communities;
    • Progress Reports : 2017
      • CIHR has established a dedicated Indigenous Health Research Support Office. This team is responsible for supporting initiatives such as Pathways to Health Equity for Aboriginal Peoples, a major program of research focused on suicide prevention, diabetes/obesity, tuberculosis and oral health; supporting the iterative peer review process, which is designed to ensure higher success rates for applications with an Indigenous health focus; and supporting the development of policies and resources to strengthen Indigenous health research generally across CIHR.
      • We know that delivering on these 10 commitments will require a concerted effort on the part of the whole organization, and to that end, we have made cultural competency and cultural humility classes available to staff, with more training opportunities to follow in the future. To build on what is being taught in these classes, last week’s employee recognition event, held during National Public Service Week, had an Indigenous theme, including Elders, a smudging ceremony, and traditional dancing and food.
    • Progress Report: 2018
      • To reflect current respectful terminology and alignment with other federal departments, CIHR renamed the CIHR Institute of Aboriginal Peoples’ Health to the CIHR Institute of Indigenous Peoples’ Health (IIPH).
    • Progress Report: 2019
      • To prioritize Indigenous Peoples leading their own research and to ensure appropriate engagements, we also developed a definition of culturally safe involvement. It defines research environments as socially, spiritually, emotionally and physically safe, which requires understanding the root causes of health inequities among Indigenous Peoples, including the impact of colonization.
  2. Ensure that the Federal Government is made aware that the membership of CIHR’s Governing Council should reflect the diversity of Canada’s Indigenous peoples;
    • Progress Report: 2017
      • We recognize that Indigenous voices must be heard around the management table, and that is why we are working with our government partners to encourage the inclusion of representatives of the Indigenous community on Governing Council and other committees. As a first step, we have ensured that at least half of the membership of the Institutes Advisory Board for Indigenous Peoples’ Health is made up of representatives from the First Nations, Inuit and Métis communities, with three seats reserved for representatives of the national Indigenous organizations.
    • Progress Report 2018
      • To respond to the need for improved Indigenous leadership in governance at CIHR, we are pleased that Dr. Mark S. Dockstator, President of the First Nations University of Canada, has been appointed to CIHR’s Governing Council. We also look forward to working with the newly reconstituted IIPH Institute Advisory Board which will help guide IIPH in the development of its emerging strategic plan, and validate the criteria by which CIHR is counting its investments in Indigenous health research. The advisory board is a valuable resource for IIPH, the institutes and CIHR as a whole. Complementing the work of the advisory board, which has seats reserved for delegates from the Assembly of First Nations, Inuit Tapiriit Kanatami and the Métis National Council, CIHR upholds its commitment to meet with senior leadership from Indigenous organizations and has had initial discussions with the National Association of Friendship Centres, and more recently, the Native Women’s Association of Canada. We believe this ongoing dialogue will help ensure our investments align with Indigenous priorities
    • Progress Report 2019
      • In 2018, the IIPH Indigenous Advisory Board (IAB) was reconstituted and now counts among its members two Elders, Elder Mary Wilson and Mabel Horton who will provide guidance, cultural and spiritual support to IIPH in the development of its activities. Other CIHR IABs also increased Indigenous representation, including the Institute of Gender and Health and the Institute of Population and Public Health. The CIHR Indigenous Health Research Support Unit is now fully staffed at CIHR and it increases CIHR’s capacity to support and interact meaningfully with Indigenous Peoples, researchers and communities.
  3. Accept the definition of “Indigenous health research” as drafted by the Institute of Aboriginal Peoples’ Health in consultation with Indigenous stakeholders;
    • Progress Report 2017
      • The words we use matter, and, as a sign of respect, it is important that, when discussing Indigenous health research, we use the vocabulary favoured by First Nations, Inuit and Métis communities. We wish to thank the Indigenous stakeholders who helped our Institute of Aboriginal Peoples’ Health draft a new, more encompassing and culturally sensitive definition of “Indigenous health research.”
    • Progress Report 2019
      • Adopted in 2017, CIHR’s definition of Indigenous Health Research (IHR) emphasizes research by and with Indigenous Peoples.
  4. Develop, in collaboration with the newly appointed Institute Advisory Board on Indigenous Peoples’ Health, performance indicators to validate CIHR investments in Indigenous health research;
    • Progress Report: 2017
      • With a new definition of Indigenous health research now in place, CIHR is working closely with its Institutes Advisory Board on Indigenous Peoples’ Health to refine its performance indicators. This will support our goal of being open and transparent when reporting on our progress on investing in Indigenous health research.  CIHR has also been collaborating with the Social Sciences and Humanities Research Council (SSHRC) and Natural Sciences and Engineering Research Council (NSERC) in order to standardize the practice for collecting data on applicants’ and other stakeholders’ identities (including Indigenous identity), with the goal of gaining a better sense of participation rates across applicant and stakeholder groups.
  5. Increase its investments in Indigenous health research to a minimum of 4.6% (proportional to Canada’s Indigenous population) of CIHR’s annual budget;
    • Progress Report: 2017
      • CIHR continues to take steps to ensure its investment in Indigenous health research totals 4.6% of its annual budget. For our recent Project Grant competition, all 38 applications for Indigenous health research projects went through our iterative peer review process where at least two of the reviewers had expertise in Indigenous health and wellness and who provided their written reviews through a mentorship lens. This resulted in 22 of the 38 Indigenous health research projects being awarded funding, with an additional 12 projects receiving one-year bridge grants, for a total investment of $16.5M.  This topic will be discussed in detail at the next meeting of the Institutes Advisory Board on Indigenous Peoples’ Health.
    • Progress Report 2018
      • As part of its Action Plan, CIHR adopted a new definition of IHR that put emphasis on research by and with Indigenous Peoples. As a result of the new definition, CIHR revalidated its estimates in funding for IHR and calculated a new baseline estimate (based on the previous three years) of ~2%. In 2017/18, CIHR increased its investment in Indigenous health research to 3% of its total budget. We are confident that this will continue to grow towards our commitment of 4.6% investment in IHR through some key actions.
    • Progress Report: 2019
      • In 2016/17, CIHR revalidated its investments for IHR to develop a baseline of 2.1% of the total annual budget (based on fiscal years 2014/15 to 2016/17). In 2017/18, CIHR increased its investment in IHR to 3% of its total annual budget. For the 2018/19 fiscal year, investment in IHR increased again to 3.3%. The 0.3% increase represents an additional $5M invested in IHR in 2018/19, for a total of over $36M. CIHR will continue to implement key actions to ensure its investment in IHR increases to a minimum of 4.6% of its annual budget. Creating impactful strategic initiatives developed by and with Indigenous Peoples is a priority across the organization and all 13 institutes.
  6. Seek to grow these investments as research capacity and additional financial resources allow;
    • Progress Report 2017
      • CIHR launched the refresh of the Indigenous Mentorship Network Program on December 13, 2016, with an $8M investment over five years, enough to fund eight teams, including seven regional nodes (in British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Quebec and Atlantic Canada) plus an international/coordinating node. The goal of this program is to break down the barriers hindering participation of First Nations, Inuit and Métis trainees and new investigators in health research. CIHR has also begun discussions with partners around collaborative and innovative strategies to support capacity for Indigenous health research across the spectrum, from entry level (high school) to post-doctoral, including building capacity for communities to engage in research. In May, CIHR’s Institute of Aboriginal Peoples’ Health hosted a national gathering of graduate students in Indigenous health attended by 20 students and a new investigators meeting. At these two events, the interest in supporting scholarship using an Indigenous research paradigm was evident. In September 2017, CIHR will be supporting Indigenous new investigators, as well as Elder/youth pairs, to attend the third annual Pathways Annual Gathering, an event that brings together community members, researchers, national Indigenous organizations and CIHR staff to encourage respect for and inclusion of Indigenous Ways of Knowing in CIHR’s Indigenous health research projects, and support networking and community building.
    • Progress Report 2018
      • The first is launching the Network Environments for Indigenous Health Research (NEIHR) – an $89M, 15-year capacity building investment – which is being supported financially by all 13 institutes. Second is a careful and ongoing review of potential administrative barriers that currently disadvantage true community-led research, including institutional eligibility. Third, we are continuing our commitment to iterative peer review for IHR which allows for promising applications to receive feedback from the peer review panel and resubmit in order to strengthen their applications. Iterative review has been implemented in the last three rounds of the Project Grant competition (including current competition in progress) and some of our priority-driven initiatives. We are now formalizing the terms of reference and selection process for the Reference Group on Appropriate Review Practices for Indigenous Health Research, which will include Elders.
    • Progress Report 2019
      • In December 2018, CIHR launched the second component of the Network Environments for Indigenous Health Research (NEIHR) – a $100.8M, 16-year capacity building investment – which is supported financially by all 13 CIHR Institutes. The purpose of the NEIHR Program is to establish a national network of centres focused on capacity development, research and knowledge translation (KT) centered on First Nations, Inuit and Métis. The network of centres is intended to provide supportive research environments for Indigenous health research driven by and grounded in, Indigenous communities in Canada. It will also ensure continued growth, broad regional development and national collaborations.  In addition to the NEIHRs, CIHR continues to invest in initiatives that address Indigenous specific health needs. For example, CIHR has recently launched the Pathways Implementation Research Teams Component 3 request for applications which focus on equitable reach, access and sustainability of interventions in four priority areas: mental wellness, diabetes/obesity, tuberculosis, and oral health. CIHR also launched the Team Grants for the Indigenous Healthy Life Trajectories Initiative. These grants will support four (4) teams to build infrastructure and capacity along the continuum of care and prevention from pre-conception to pregnancy, infancy and early childhood with a life trajectory perspective relevant to the following research areas: a Developmental Origins of Health and Disease (DOHaD) life trajectory approach, a focus on the prevention of Non-Communicable diseases (NCD) and an intervention cohort design. The funded research teams will collaborate to develop the partnerships, and leverage the necessary expertise and resources to establish an Indigenous-driven I-HeLTI Intervention Cohort. In March 2019, IIPH launched the Indigenous Research Chairs in Nursing. This initiative will support nurses of both Indigenous and non-indigenous ancestry to conduct research in Indigenous Health Nursing, thus furthering the development of knowledge and best and wise practices in the area of nursing practice, education, research and administration. The Chairs will undertake research to understand social, economic and cultural determinants of health and Indigenous holistic health practices to improve the health of Indigenous Peoples. CIHR’s Science Council recently endorsed the SPOR Capacity Development Initiative. The first component of this initiative is the Patient-Oriented Research Awards – Transition to Leadership Stream. This funding opportunity will include an Indigenous Peoples’ Health Pool to supports trainees transitioning into independent patient-oriented research careers. Other initiatives launched during the last year include Indigenous components in their funding opportunities. The Food security and Climate Change in the Canadian North under the scientific leadership of the Institute of Nutrition, Metabolism and Diabetes, will support research that will provide a deeper understanding of food security and climate change in the Canadian North, with a particular focus on Indigenous populations. There is an Indigenous component in the Transitions in Care – Best and Wise Practices Grants, to support groups of researchers and knowledge users to identify best and wise practices in the areas of transitions in care, led by the Institute of Circulatory and Respiratory Health. The Institute of Gender and Health launched the Indigenous Gender and Wellness Travel Awards to bring interested First Nations, Inuit and Métis Peoples, researchers, organizations, Indigenous community members, and other allies of Indigenous Peoples to attend an Idea Fair and Learning Circle on “Indigenous Gender and Wellness”. The event, held on June 18-20, 2019 in Montreal, on the traditional unceded territory of the Kanien’keha:ka (Mohawk) people, provided an opportunity for Indigenous Peoples and allies to meet each other and share their ideas and goals. The Cannabis Research in Priority Areas funding opportunity was launched in March 2019 by the Institute of Neurosciences, Mental Health and Addiction (INMHA). Its purpose is to explore in more detail the potential therapeutic benefits and harms associated with cannabis use on Indigenous Peoples’ health. Additional funding opportunities are planned under CIHR’s Integrated Cannabis Research Strategy, including research to evaluate policies related to the legalization and regulation of cannabis that may impact the health of Indigenous Peoples. 
  7. Continue working with the Reference Group on Indigenous Health Research ‎ to implement iterative peer review processes for applications relevant to Indigenous health, so as to ensure better success rates for Indigenous-focused investigator-initiated grant applications;
  8. Create, with the advice of the Institute Advisory Board on Indigenous Peoples’ Health, impactful strategic initiatives aimed at improving the health of Indigenous peoples;
    • Progress Report: 2017
      • CIHR continues to look for ways to integrate Indigenous health research into its funding opportunities, and has recently earmarked funds for Indigenous components in funding opportunities for the microbiome, HIV/AIDS, maternal, reproductive and child and youth health, and improved immunization coverage, among others. The CIHR Institute of Aboriginal Peoples’ Health will be working with its community to identify other opportunities for investment.
    • Progress Report: 2019
      • Consistent with the CIHR Health Research Roadmap II and the CIHR Action Plan: Building a healthier future for First Nations, Inuit and Métis Peoples, IIPH committed to support more community-based participatory research and to build capacity within Indigenous communities in a culturally safe way. In order to achieve that, and with guidance from its Institute Advisory Board (IAB), Indigenous communities, Elders and Knowledge Holders, IIPH has developed a new strategic plan, released on June 27th, that maps out four strategic directions for the next 5 years:
        • To support First Nations, Inuit and Métis Peoples and communities to drive Indigenous health research and knowledge translation.
        • To contribute to the process of improving First Nations, Inuit and Métis health using multiple Indigenous and non-Indigenous research paradigms simultaneously to support research and innovation.  
        • To advance research beyond acknowledged notions of health equity and give primacy to wellness, strength and resilience of First Nations, Inuit and Métis Peoples at the individual, group and structural levels.
        • To encourage and champion Indigenous community-based health research networks across Canada to develop capacity for First Nations, Inuit and Métis health research and knowledge translation. 
        • IIPH and its partners will strive to improve the health of Indigenous Peoples by recognizing Indigenous knowledges and being respectful of Indigenous values, cultures and ways of knowing.
  9. Hold annual meetings between the President of CIHR and leaders of the Assembly of First Nations, Inuit Tapiriit Kanatami, and the Métis National Council to discuss Indigenous health research priorities
    • Progress Report 2017
      • We are committed to strengthening our relationship with the Indigenous community, including the national Indigenous organizations, and have made significant strides in building positive and collaborative relationships. For example, we have been working closely with Inuit Tapiriit Kanatami (ITK) on one of their biggest health priorities – suicide prevention. In Iqaluit in March 2017, CIHR and ITK cohosted an important international symposium on suicide prevention. CIHR is also pleased to have become a member of a Health Portfolio Table which will strengthen our ability to engage with the Métis National Council. And to make certain that we listen and hear from the community about its needs, the national Indigenous organizations will once again be participating in our third annual Pathways Gathering in September.
    • Progress Report 2019
      • In January 2019, consistent with the Action Plan commitment to meet with senior leadership from Indigenous organizations, CIHR’s President, Dr. Michael J. Strong, met with Inuit Tapiriit Kanatami’s (ITK) President, Natan Obed. This meeting was held to discuss how CIHR could support ITK in the implementation of their National Inuit Strategy on Research (NISR), which was released in March 2018. The presidents agreed to meet on a regular basis to assess progress towards the commitments made. CIHR’s President subsequently participated in the ITK Executive Training Program, an experiential learning opportunity on the realities and priorities of Inuit, on the land in Inuit Nunangat. CIHR was also invited to participate in the NISR Roundtable in February 2019. The relationship built with the Indigenous communities in recent years will continue to be an invaluable source of strength to address gaps in Indigenous health research together. Efforts to build and maintain engagement with the leadership of other Indigenous organizations with a national mandate will continue.
  10. Work with other federal research councils to develop strategies to strengthen Indigenous research capacity development through training and mentoring along the entire career continuum from undergraduate to postdoctoral levels.;
    • Progress Report: 2017
      • CIHR staff have joined a Tri-Agency working group convened by SSHRC to identify areas of collaboration for Indigenous research between SSHRC, CIHR and NSERC. This group will focus on strategies for capacity building, investments for improved management of Indigenous data, and administrative efficiencies to support Indigenous community-based research. CIHR is also exploring opportunities to leverage investment funds with the other Tri-Agencies to achieve the greatest impact when it comes to supporting Indigenous research.