IIPH Five-Year Strategic Plan: 2006 to 2011

Table of Contents

Message from the Scientific Director

I am pleased to present the Canadian Institutes of Health Research- Institute of Aboriginal Peoples' Health (CIHR-IAPH) Strategic Plan for 2006 - 2011. I wish to extend sincere thanks to the CIHR-IAPH Institute Advisory Board, CIHR and CIHR-IAPH staff for their expert advice and contributions to the strategic planning process.

In setting the course for the next five years, CIHR-IAPH has renewed its commitment to building research capacity and infrastructure in Aboriginal health research, working regionally, nationally and internationally to create partnerships, and developing an advanced health research agenda that includes Aboriginal cultural values, models and culturally specific knowledge translation strategies.

CIHR-IAPH is well positioned to build on its achievements and work together with Aboriginal health researchers, trainees, national Aboriginal leadership and communities and governments to implement the strategic plan. In looking to the future, CIHR-IAPH is committed to supporting the highest quality research that is relevant to Aboriginal communities and aims to address the gap in health outcomes between the general Canadian population and Aboriginal peoples.

All My Relations,

Jeff Reading, MSc, PhD, FCAHS
Scientific Director
Institute of Aboriginal Peoples' Health
Canadian Institutes of Health Research

Introduction

The Institute of Aboriginal Peoples' Health ("IAPH", "the Institute") is one of the 13 founding institutes of the Canadian Institutes of Health Research (CIHR). Established in 2001, the IAPH is the first and only national institute of health research in the world dedicated to improving the health and well being of Aboriginal peoples. The work of the CIHR Institute of Aboriginal Peoples' Health (CIHR-IAPH) is focused on investigating factors that will improve the health and well-being of Aboriginal people living in Canada through supporting development of Aboriginal health research and ensuring that research undertaken is relevant to meeting the needs of Aboriginal communities.

In less than five years - since first beginning its work - the CIHR-IAPH has gained recognition as a leader in Aboriginal health research. Today, it leads a national research agenda on Aboriginal health that is focused largely around building capacity among First Nations, Inuit and Métis communities and supporting partnerships and alliances among Aboriginal communities and non-Aboriginal health research organizations at the regional, national and international levels.

In August 2005 the Institute held a planning retreat. The objectives of the retreat were to assess the progress made in addressing CIHR-IAPH priorities, to determine how to address key challenges, and to position itself to achieve even greater success in the next phase of its development.

Renewing our vision, mission and values

As a part of this planning process, the Institute's vision, mission and values were renewed. While holding true to its early goals, core purpose and guiding principles, the insights and experience gained over the last five years have led to a more focused vision and a clearer articulation of the Institute's mission and values.

The new vision, mission and value statements reinforce the importance of the view that Aboriginal knowledge - both traditional and contemporary - can complement Western science in developing strategies to improve health.1 The value of partnership and collaboration is central to the vision as is the heightened commitment of the Institute to focus its attention equally on its dual mandate of fostering research in Aboriginal health and promoting its use through knowledge translation.

Vision

CIHR-IAPH will improve the health of First Nations, Inuit and Métis people through the assertion of Aboriginal understandings of health and by fostering innovative community-based and scientifically excellent research.

Mission

CIHR-IAPH will play a lead role in increasing the productivity and impact of Aboriginal health research by advancing capacity and infrastructure in the First Nations, Inuit and Métis communities, enhancing knowledge translation and forging partnerships with diverse communities and organizations at the regional, national and international levels.

Values

CIHR-IAPH will be guided at all times by a core set of values based on the principles of:

  • Respect for Aboriginal peoples and traditional knowledge
  • Promotion of community-based and highest-quality scientific research
  • High ethical standards in approach to and conduct of research with Aboriginal peoples
  • Inclusiveness, trust and openness in our work
  • Partnership and collaboration

Our Roadmap for the Future: Strategic Directions

In order to fulfill its renewed vision and mission and respond to the opportunities and challenges before it, CIHR-IAPH has confirmed five strategic directions, the five strategic directions are inextricably intertwined and together are seen as integral to advancing Aboriginal peoples' health through an advanced health research agenda.

CIHR-IAPH Strategic Directions:

  1. Develop strategic regional, national and international partnerships to advance Aboriginal health research
  2. Ensure inclusion and recognition of Aboriginal values and cultures in health research
  3. Enhance capacity and infrastructure to advance Aboriginal health research
  4. Resolve critical Aboriginal health issues
  5. Facilitate and evaluate translation of Aboriginal health knowledge into policy and practice

Strategic Direction 1: Develop strategic regional, national and international partnerships to advance Aboriginal health research

Advancing the CIHR-IAPH's mandate is dependent on the Institute's role and success in bridging the interests and health needs of diverse communities as well as creating strategic alliances within Canada and around the world. Partnerships provide a key opportunity to share in the research, brainpower and infrastructure of individuals, organizations and communities as well as the ability to leverage matching funds that will expand the pool of available research dollars.

Ultimately, international partnerships are perceived as an effective mechanism to improve Aboriginal health in Canada by capitalizing on global knowledge and resources. Over the next five years, the Institute will need to build on the partnerships it has established and, at the same time, reach out to new partners within and external to Canada. While very successful in its international efforts, CIHR-IAPH will need to balance its domestic relationships with continued efforts in the global arena.

CIHR-IAPH also has a pivotal role to play in nurturing and supporting organizations with a mandate in Aboriginal health research, as evidenced in the start-up of the Aboriginal Capacity and Developmental Research Environments (ACADRE) network and potentially in the new Public Health Agency of Canada, National Collaborating Centre for Aboriginal Health.

CIHR-IAPH will increase collaboration and partnering with National Aboriginal organizations, particularly where there are common goals and objectives to build research capacity within Aboriginal communities so that the latter may participate more fully and easily in health research projects.

Goals and implementation strategies to develop strategic regional, national and international partnerships to advance Aboriginal health research

Goals Implementation Strategies
Facilitate regional and national partnerships
  • Expand opportunities for research partnerships and stronger linkages with other CIHR institutes
  • Partner with Aboriginal organizations and with new and existing players in the field in Canada to advance shared goals
  • Partner and support the Public Health Agency of Canada and its National Collaborating Centre for Aboriginal Health
Partner with policy makers and decision-makers to inform and advance Aboriginal health policy and research
  • Engage policy makers by sharing knowledge to encourage inclusion of Aboriginal health issue research in policy development
  • Position CIHR-IAPH to respond to current policy/planning related to the need to design and evaluate First Nations, Métis and Inuit models of health delivery (i.e., Aboriginal community health centres, Aboriginal health authorities)
  • Create internship opportunities for policy makers at ACADREs and researchers in government agencies
  • Partner with CIHR Institute of Health Services and Policy Research to increase Aboriginal health services research (e.g., equity in financing, access, evaluation of models of service delivery)2
Leverage and seek out international collaborations to pursue global indigenous health research
  • Promote international collaborations, building on new initiatives (e.g., US, New Zealand, Mexico, Australia), with innovative bilateral, trilateral agreements
  • Support efforts for interested parties to collaborate on areas of research, knowledge transfer and best practices in indigenous health
  • Focus on shared global priorities (e.g. gender and health)
  • Create opportunities for international student exchanges (e.g., World Health Organization or Pan American Health Organization)
  • Link to existing global health research networks and encourage indigenous policies and perspectives in these networks

Strategic Direction 2: Ensure inclusion and recognition of Aboriginal values and cultures in health research

The establishment of an Institute exclusively dedicated to Aboriginal health research is a starting point for recognizing and respecting Aboriginal values and cultures. CIHR-IAPH is unique in that it is the only exclusive national institute of its kind in the world. However, continued efforts in both understanding Aboriginal health and where appropriate, integrating traditional knowledge and Western practices, are required.

CIHR-IAPH and its partners have made steady progress in developing ethical guidelines for Aboriginal health research. The next phase will require significant education and dialogue with multiple Aboriginal communities and research institutions in advance of implementation.

A longer-term goal to be achieved is the development of an "Aboriginal paradigm for health research", similar to the framework that has been developed to address Māori knowledge in research in New Zealand3 which recognizes indigenous knowledge as central to the development of a "knowledge society". This framework would take into account the great cultural diversity of Aboriginal peoples in Canada and that of the Indigenous Peoples with whom research is conducted collaboratively at the international level.

Goals and implementation strategies to ensure inclusion and recognition of Aboriginal values and cultures in health research

Goals Implementation Strategies
Establish and implement ethical guidelines for Aboriginal health research
  • Complete and adopt the draft CIHR ethical guidelines for research involving Aboriginal peoples that are grounded in traditional values
  • Ensure that these guidelines are practical and relevant
  • Develop education and communication components (e.g., ACADRE developed handbook, orientation of Peer Review members)
  • Recognize and respect the need for sensitive processes to gain acceptance by different Aboriginal peoples
  • Establish an oversight/appeals process (potentially regional)
  • Articulate clear responsibilities and expectations of researchers and peer review members in grant process
Promote greater understanding and respect for traditional knowledge and culture
  • Develop and offer special request for applications (RFAs) that support traditional healing attributes, including models for working with Western approaches
  • Support research to develop evidence based prevention/intervention initiatives based on a holistic health approach
  • Commission options paper on how CIHR-IAPH can support the recognition of traditional knowledge
  • Demonstrate the effectiveness of Aboriginal-centred models and choices clients make to incorporate traditional and Western practices in their "blended" health continuum, with a view to developing an evidence base for these options in care
Create an Aboriginal paradigm for health research
  • Support and inform the development of Aboriginal conceptual models and methods for health research
  • Address issues of scientific merit and relevance, consultation, ownership of information, cultural safety and dissemination as part of this model
  • Facilitate the development and articulation of best practice research examples that practically demonstrate how to operationalize research that is respectful of Aboriginal values and scientifically excellent

Strategic Direction 3: Enhance capacity and infrastructure to advance Aboriginal health research

Facilitating the development of researcher capacity, infrastructure and research platforms is fundamental to the mandate of CIHR-IAPH and remains a key strategic priority for the Institute. The Institute acknowledges that there are different groups that require capacity and infrastructure building, with varying levels of need and different ways in which expertise and capabilities can be advanced, thus necessitating a diverse range of strategies. Target audiences for capacity building include researchers, community organizations, academic organizations, Aboriginal communities and all levels of government (i.e., federal, provincial health services and regional/local health services planning).

A major objective continues to be the need to increase the research capacity of Aboriginal health researchers. The ACADRE model is recognized as a major success in helping to achieve this objective and has been strongly endorsed as a vital area to be strengthened and enhanced. Sustaining and growing the ACADRE network is viewed as being an important long-term goal and investment.

Advancing Aboriginal health research also requires robust information systems, with high quality data and the ability to link databases (e.g., provincial health databases, StatsCan, and other provincial health departments). Effective large-scale databases are integral to conducting research that has the potential to inform national policy. The development of Aboriginal-appropriate health indicators will be important in ensuring that health research and program developments are responsive to Aboriginal community needs.

Support for the establishment of regional "Aboriginal Health Epidemiology Centres" has emerged as a potential solution for filling the current gap and addressing the pressing need for development of strong infrastructure platforms. There are several examples of tribal epidemiology centres in the United States that can be examined further. Options for structuring these centres effectively in Canada require further exploration given the varying needs of First Nations, Inuit and Métis. One strategy may be to consider the merits of linking regional-based epidemiology centres to existing ACADREs and partnering with tribal and regional health authorities. An initiative of this nature will be challenging at a political level and will require the support of strong champions from the Aboriginal communities and sponsors at federal/provincial levels of government. However, building on the success of the ACADRE network, the best strategy will be to start small and ramp up once a "proof of concept" has been achieved.

Goals and strategies to enhance capacity and infrastructure to advance Aboriginal health research

Goals Implementation Strategies
Sustain and evolve the ACADRE model
  • Review the future of ACADREs
  • Expand accessibility beyond institutionalized walls (need to be more virtual with greater reach e.g., Network Environments, Team Grants, urban-regional links)
Facilitate effective research platforms and infrastructure
  • Investigate options and support the establishment of First Nations, Inuit and Métis epidemiology centres
  • Ensure the necessary research platforms including reliable and consistent data and linked databases are available to researchers of Aboriginal health
  • Establish mechanisms to fund community organizations to conduct their own research
Engage researchers from across disciplines in Aboriginal health research
  • Secure an Aboriginal representative on the CIHR Governing Council and all other IABs to build capacity within CIHR and other institutes
  • Target initiatives for under-researched, low capacity areas (e.g., Métis, francophone)
  • Create Working Group to better position CIHR-IAPH for CIHR Clinical Research Initiative; target grants that revolve around clinical research
  • Leverage funding from the Canadian Academy of Health Sciences; partner with the National Aboriginal Health Organization (NAHO) in knowledge translation activities
  • Create an Aboriginal Learning Institute (e.g., partner with NAHO)
  • Establish "Learned Societies" to promote research in Aboriginal health
Enhance the pipeline of researchers at various education and career levels
  • Create incentive and rewards to attract researchers to engage in Aboriginal issues
  • Lobby for CIHR and academic institutions to give credit to "mentor" qualifications and for developing creative professional ideas as basis for academic promotion
  • Provide tenure positions, special grants; recognize community-based research as new category for investigators
  • Pursue cross pillar initiatives with senior Aboriginal mentorship and new or junior researchers
  • Develop exchanges between academic/government institutions and community-based organizations to better understand needs and issues of Aboriginal communities
  • Provide mentorship opportunities for scientists to work in Aboriginal communities; link with ACADREs (connect graduate students with different ACADREs)
  • Target high school level and undergraduate population to engage potential researchers early in their academic programs

Strategic Direction 4: Resolve critical Aboriginal health issues

Aboriginal communities continue to struggle with many critical health issues. Some of the priority health issues that have been previously identified include:

  • Infectious disease - HIV/AIDS, tuberculosis
  • Chronic disease - diabetes, cancer
  • Mental health
  • Children and youth Health services issues - e.g., urban - off reserve, Métis health services

Further needs have been identified in areas related to prevention, primary care, secondary and tertiary care. There remains a need for more high quality research to identify health determinants and successful strategies for improved health. CIHR-IAPH will support research in open competition and with other Institutes that target specific diseases (e.g., mental health, diabetes, HIV/AIDS).

While a long list of specific health conditions or diseases have been identified, the reality is that 'poverty is the driver of many of these health conditions' and that in addition to focusing on specific diseases, CIHR-IAPH must focus on the health determinants and develop and pilot effective intervention strategies. A further challenge is dealing with the misconceptions and biases about Aboriginal peoples that have an impact on access, treatment and health outcomes.

Goals and strategies to resolve critical Aboriginal health issues

Goals Implementation Strategies
Achieve better understanding of the diversity of community needs and health priorities
  • Collaborate with ACADREs and other associated researchers and institutes to conduct a survey of community priorities
  • Look at multi-disciplinary, multidimensional research approaches, holistic approaches (e.g., mental, physical, emotional and spiritual)
  • Explore innovative research approaches
Ensure partnership and collaboration in identifying, researching and addressing health priorities
  • Provide leadership in identifying and influencing strategic research agendas in Aboriginal and research communities, across CIHR institutes and other health agencies
  • Support scientifically excellent and community-relevant research in Aboriginal health that can inform health policy development through knowledge translation
Promote a health determinants focus
  • Build research platform on health determinants and outcomes
  • Support production of knowledge about what keeps communities healthy
  • Develop more tools to reorient the focus of CIHR and engage the community
Explore international indigenous health priorities and existing protocols
  • Learn from others to address and resolve critical health issues
  • Target our own global health and developing communities in Canada
  • Work collaboratively to identify health research priorities and opportunities to exchange resources with other countries (e.g. Roundtable on Native Health Research Priorities sponsored by First Nations and Inuit Health Branch, Health Canada, and Indian Health Service, United States of America)

Strategic Direction 5: Facilitate and evaluate translation of Aboriginal health knowledge into policy and practice

Knowledge translation (KT) is a fundamental component of the joint mandates of CIHR and CIHR- IAPH4. Historically, there have been concerns from the Aboriginal community that research results were not being shared or used to benefit the community. There is a need to bring together Aboriginal cultural values with more traditional academic research models to ensure effective translation of knowledge. Recent efforts with community-based research partnerships and participatory action research methods have been more successful in effectively engaging Aboriginal communities in health knowledge sharing activities (e.g., Kahnawake Schools Diabetes Prevention Project, Knowledge Translation and Indigenous Knowledge research project).5 KT consultations with stakeholders have confirmed support for working collaboratively and cooperatively with Indigenous Peoples to "develop health knowledge systems based on Indigenous philosophies and native science paradigms."6

KT needs to be skilfully incorporated and managed by researchers, governmental decision-makers, and Aboriginal leaders. Effective KT requires appropriate infrastructure and accountability - 'it must be someone's job'. Mentorship (discussed under capacity building strategies above) is also strongly linked to effective KT. This further emphasizes the need for exchanges where researchers work with Aboriginal peoples to gain a better understanding of the impacts and relevance of their research.

Advancing the KT agenda must be done in partnership with Aboriginal communities, researchers, policy-makers and practitioners. Collaboration with national Aboriginal organizations like NAHO, who have a major role in knowledge translation as part of their core mandate, will be particularly important. Formalizing the Institute's current and proposed knowledge translation activities into a comprehensive strategy will be a key priority.

Goals and strategies to facilitate and evaluate translation of Aboriginal health knowledge into policy and practice

Goals Implementation Strategies
Promote legitimization of traditional Aboriginal knowledge
  • Recognize traditional beliefs and traditional knowledge systems in health research
  • Forge bridges across cultures, Aboriginal and research communities to build relationships and enhance understanding of traditional knowledge
  • Develop process and mechanisms to bring traditional knowledge and research together as it relates to particular themes (e.g., children, diabetes)
  • Hold a national workshop on Aboriginal traditional knowledge with a view to developing research priorities in this area (Partner with NAHO in its National Dialogue on Traditional Knowledge)
  • Promote awareness that traditional knowledge of Aboriginal people can contribute to global knowledge and help all humanity
Enhance opportunities and mechanisms to facilitate knowledge sharing of traditional knowledge, community-based and scientific research
  • Provide forums for dialogue between Aboriginal communities, governments and researchers (e.g., workshops, summits) for in-person or virtual exchange
  • Participate in national strategies led by other organizations
  • Create and provide the necessary tools to conduct effective knowledge translation (e.g., develop tools that can capture and reproduce knowledge and that are "culturally appropriate")
  • Secure and provide funding directly to communities to engage in knowledge translation and exchange
  • Conduct and make available synthesis of research results to facilitate policy making (potential role for new Public Health Agency of Canada, NAHO)
  • Make community relevance and KT plans a requirement for every grant
  • Enhance ACADRE's role in KT, leveraging this function to attract resources from new funders
  • Promote collaborations between NAHO and universities for research to be translated into user-friendly policy language
  • Make research information and expertise more accessible to Aboriginal communities and organizations (e.g., technical expertise, evidence based decision-making)
  • Collaborate with partner organizations to build capacity and competencies in KT skills
Evaluate methods of knowledge translation in Aboriginal communities and share best practices
  • Investigate and evaluate existing KT concepts and processes, start dialogue in partnership with other organizations, communities and institutions (work on the "knowledge of knowledge transfer")
  • Compare Western and traditional Aboriginal knowledge translation and transfer strategies, processes and outcomes
  • As a longer term strategy, explore how cross-cultural knowledge translation and transfer can take place most respectfully and effectively

Concluding Remarks

This plan represents the continuation of a process and a trajectory initiated five years ago, in 2001, that began with a focused effort to build a solid foundation for Aboriginal health research in Canada. The ACADRE network, successful regional and international partnerships and the new ethics framework are vital building blocks that have paved the way for future success.

The next five years will focus on strengthening these early successes, with even more targeted and strategic efforts aimed at securing the infrastructure and research platforms needed to advance research capacity and enable community based and scientific Aboriginal health research to flourish. The good will, trust and collaboration of Canada's Aboriginal communities and the continued interest of Canada's policy makers will be critical to enhancing the productivity and impact of research.

CIHR-IAPH will continue to work in partnership with First Nations, Métis and Inuit communities and national Aboriginal organizations to raise the profile of Aboriginal health needs. Enhanced efforts in knowledge translation and exchange will foster a better understanding of traditional Aboriginal knowledge and values, and will move the Institute closer to its vision of improving the health of First Nations, Inuit and Métis people.

Achieving greater accountability through ongoing performance measurement will be an important activity that will be incorporated into the work and culture of the CIHR-IAPH. In order to ensure that these initiatives are being advanced and are aligned with the overall strategy, an effective performance measurement and improvement system will be developed. This strategy will involve the identification of specific performance measures and indicators related to each of the strategic directions. Where appropriate, specific benchmarks and targets will be established to measure progress and assess the challenges arising with respect to implementation of the specific goals associated with each of the directions. The Institute will build on the performance measurement system it has created in recent years to achieve a full evaluation framework and will report on its progress on a regular basis.

CIHR-IAPH is in a strong position to build on its achievements and the foundation it created in its early years. In going forward, the Institute will need to collaborate with its partners to advance researcher capacity, platforms and the leadership that is required to enhance the relevance and impact of Aboriginal health research in improving the health of First Nations, Inuit and Métis Peoples across the country.

  1. This concept is aligned with the principle of building on indigenous knowledge articulated in: Health Canada. (2005). Blueprint on Aboriginal Health: A Ten Year Transformative Plan.p.5.
  2. Of the 104 projects funded since CIHR-IAPH inception, only 12 were health services related: Lavoie, J. (2005). The Transformative Nature of the Canadian Institutes for Health Research's Institute of Aboriginal Peoples' Health: A Case Study Report. p.5.
  3. Cunningham, C. A Framework for Addressing Maori Knowledge in Research, Science and Technology. In: Proceedings of Te Oru Rangahau Māori Research and Development Conference, 7-9 July 1998, Massey University.
  4. CIHR has defined knowledge translation as the exchange, synthesis and ethically sound application of knowledge with a complex system of interactions among researchers and users, to accelerate the capture of benefits for Canadians through improved health, more effective service and products and strengthened health care system: Canadian Institutes for Health Research. (2004). CIHR Knowledge Translation Strategy: Niche and Focus 2005 – 2009.
  5. Smiley, J. (2005). Knowledge Translation and Indigenous Health: Where to go next? presentation to CIHR-IAPH Planning Retreat August 2005.
  6. Ibid.
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