The Canadian Institutes for Health Research: A Healthy New Approach

Since its inception in June 2000, the Canadian Institutes for Health Research ( CIHR), a sponsor of Next Wave Canada, has established itself as a model for the world. Health agencies from more half a dozen countries are considering emulating the novel approach taken by Canada's primary federal funding agency for health research.

This attention appears to be well deserved. In fewer than two and a half years, CIHR has begun to apply its broad and dynamic vision. "CIHR is a problem-based agency that brings together every aspect of health," explains CIHR president Alan Bernstein. The most notable feature of CIHR's innovative approach is the emphasis on transdisciplinarity. (For more on transdisciplinary research trends, read Next Wave's recent feature on the topic.) To realize this convergence of disciplines, CIHR has, for example, conceived the Strategic Training Initiatives in Health Research, a program designed to fund novel approaches to training and to stimulate multidisciplinary research in the coming generation of health researchers. For instance, seven such initiatives (bioinformatics, health informatics, health ethics, transplantation, community research, neurobiology and behavior, and public policy) were created recently in British Columbia.

"When it replaced Medical Research Canada," Bernstein relates, "CIHR was mandated to be a proactive organization that anticipates new research opportunities, while balancing these research and health opportunities with the diversity of views and values of Canadians." CIHR's focuses include biomedical research, clinical science, and the social, cultural, and other factors that affect the health of populations. CIHR's goal--to improve health, health services, and the health system in Canada--reflects the attitude of the Canadian government. "I think the government understands that health research is key to the future of Canada," says Bernstein.

The recent reports by the Commission on the Future of Health Care in Canada, chaired by Roy Romanow, and by the Kirby Senate Committee confirm the importance of health research to the future of the health system. CIHR's annual funding from the federal government has increased by 56%, from CA$360 million to $562 million (supplemented by $100 million to indirect costs such as research ethics boards, grants administration, and costs of patenting via technology transfer), since the time of its inauguration, including a $75 million increase last year. Bernstein describes the government's commitment as "stunning" in light of the current economic situation. He is hopeful that the government will sustain and increase long-term funding. In their reports on the Canadian health budget, Romanow and Senator Michael Kirby each called for an increase from 0.5% to 1% of the $100 billion health care budget within the next 5 years.

The Canadian government has developed an integrated federal Innovation Strategy, which aims to double Canada's investment in research and development by 2010, thereby helping realize Prime Minister Jean Chrétien's goal of ensuring "that our research and development effort per capita is amongst the top five countries in the world." Although at nearly $1 billion, health research spending per capita in Canada is still lower than that in the rest of the Western world (fivefold less than in the United States, for example), it is finally approaching the levels in Europe.

In contrast to the trend of growth in Canada, however, researchers in countries such as France, Germany, and Italy are dealing with research spending cuts or freezes imposed by their governments. Even American basic science funding is feeling the effects of the global economic decline. Bernstein considers the Canadian government's funding decisions to be "an amazingly good investment," as they will generate potentially profitable spin-off companies, cultivate excellent mentors, and address the oft-overlooked need to accumulate evidence toward changes in health care practice--all of which will be invaluable tools in developing the knowledge-based economy of the 21st century.

Bernstein does not believe that CIHR has entirely fulfilled its mandate in its two-and-a-half year history, but he does believe that it is well on its way: "We're not there yet, but we're on the right track." All 13 of the Virtual Institutes developed by CIHR, which range from the Institute of Cancer Research to the Institute of Population and Public Health, have developed strategic plans--the first in Canada's history--and are up and running. CIHR has also launched new programs that include Interdisciplinary Health Research Teams as well as Community Alliances in Health Research, each of which will receive $50 million over the next 5 years. These programs bring together an amalgamation of ethicists, engineers, physicists, chemists, biologists, clinicians, and social scientists, reflecting the broadened CIHR mandate.

Bernstein radiates optimism and confidence as he predicts the status of health research in Canada in 5 years. He foresees Canada placing among the top countries in the world, as he anticipates that internationally competitive funding levels will accompany the dynamic, multidisciplinary opportunities. Not only does Bernstein believe that health research in Canada will be seen as outstanding and relevant by Canadians, but he also envisions an excellent reputation "across the whole waterfront" in the international health community, suggesting that Canadian researchers should be receiving Nobel Prizes on a regular basis.

There will undoubtedly be challenges to confront over the course of the next few years, including the size of CIHR's budget; the alignment of universities, hospitals, academics, and institutions; and knowledge translation (implementing findings to construct a health system based on the best evidence-based research available). Nonetheless, CIHR, as an organization, and health research in Canada, as a system, appear to have extremely healthy futures. Graduate students pursuing a future in health research in Canada have good reason to be excited, as funding and grants for graduate students and junior faculty are approaching competitiveness with those offered in the United States. The Canadian government has wisely recognized the importance of health research and is encouraging the development of world-leading research institutes. While CIHR will not rival NIH anytime soon, the elements are in place for a sustainable infrastructure that will make Canada a scientific world leader in the health sciences in years to come.

The views of the author, who has received no benefits from CIHR at any point during his studies, are his alone; they do not necessarily reflect those of Next Wave.

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