Coalition report to inform CIHR/IDRC strategic plan on global health

Ext-consultation-Ottawa

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Executive Summary

In late 2017, the Canadian Institutes for Health Research (CIHR) and the International Development Research Centre (IDRC) invited the CCGHR to collaborate on strategic planning on the future of global health research in Canada. Among other contributions, seven “external” consultation events were held by the CCGHR involving 105 participants representing a mix of seasoned global health researchers, junior faculty, graduate students and young professionals with global health expertise. The Joint Report synthesizes the proceedings from the Montreal, Ottawa, Vancouver, London, Saskatoon, St John’s and SYPN (virtual) consultations.

Researchers who took part in CCGHR external consultations stressed the importance of Canadian values in the conduct of global health research and the need to build these values into the critical review of funding proposals. The “how” and “why” research is done is as important as what the research is about. Global health research in Canada, and for many elsewhere, has emerged out of a commitment to increasing global health equity and sustainable partnerships that build local capacity around locally identified priorities. Social accountability and reflexive, critical practice are key to enacting these goals. This means ensuring project priorities and processes have at their core a commitment to engaging and responding to beneficiaries’ priorities, concerns, understanding of equity and success.

In other words, the ‘Canadian brand’ of global health research is equity-centred. Canadians involved in the field place a high value on the reason they do this work, regardless of thematic focus. This is because there are systematic and avoidable inequities, and because Canadian policies, activities and structures are entangled in these inequities both here and globally. The important caveat is that identifying priorities and measures of effectiveness for projects and interventions cannot simply be based on what Canadian researchers, funders or policy-makers think: it is crucial to shift priority setting to what the people we hope to serve think is important.

A recurring concern during the CCGHR external consultations was the importance of considering cross-cutting themes addressed by inter-sectoral and transdisciplinary research teams with the capacity to effectively address inherently complex problems—including social determinants of health, eHealth technologies, environmental and planetary health as examples—rather than using a disease-centred approach. Many stressed that there should be less emphasis on specific topics and more emphasis on equity-centred approaches; the challenge is working together to leverage research to respond to problems entangled in health inequities.

Three main axes emerged around our strengths and expertise in Canada:

  1. what we do research on, the substantive or thematic areas;
  2. how we do research, the process and implementation aspects (equity, inclusivity, language, culture);
  3. capacity, how we prepare researchers for the future in Canada and within LMIC partners.

In line with the consultation questions provided by CIHR/IDRC the following findings emerged. It must be pointed out that these do not reflect all opportunities identified during the external consultations, but highlight shared priorities and recommendations on ways forward. A more comprehensive listing is found in the respective sections of this report.

Thematic Priorities for Global Health Research

There is general agreement that infectious diseases remain a priority, but it needs to be addressed within a health systems context and respond to social determinants. Specific topics include antimicrobial resistance as a global threat and continued Canadian leadership in vaccine development. The health impacts of climate change and mitigation strategies, and environmental/planetary health more generally, are viewed to be leading determinants of the future health of all populations. The rising burden of chronic conditions is of great concern, with mental health put forward as an area of great need and relative neglect. Further research in support of all elements of a health system, while cross-cutting, is also viewed to be a thematic priority. Other themes consistently cited are water and sanitation, reproductive and sexual health, equity and reaching marginalized populations (including First Nations) and implementation research.

Canadian Strengths and Top Opportunities in Global Health Research

The Canadian strengths that emerged are largely cross-cutting, with many individuals wishing to avoid singling out specific substantive areas of expertise. This includes equitable and sustainable partnerships, ethical conduct of research, capacity building, eHealth technologies and transdisciplinary research. Our work over several decades and lessons learned working with Indigenous populations demonstrates the need to pay attention to process. Community-based, participatory research is strong in Canada, as are patient-oriented research strategies.  Expertise in evidence assessment and knowledge translation will also be essential as we move forward.

Top opportunities identified were mostly cross-cutting as well, with participants stressing that gender and climate change analysis and a partnership-based, transdisciplinary approach to global health research should be weighted highly in all funded proposals. There was also a high level of consensus on the need to focus on addressing health inequities and reaching the most marginalized populations. In terms of the specific themes identified by CIHR/IDRC for the consultations—infectious diseases, chronic conditions and health systems—participants felt that a focus on antimicrobial resistance and water-borne diseases would favour a systems approach, looking at the entire enabling environment or ecosystem including social determinants and inter-relational factors. Exceptional opportunities are also seen in universal health care, mental health, heart disease and diabetes research, and food security.

Measuring Success

This report concludes with recommendations addressing measures of success, health metrics, and general observations on the state of global health research in Canada and recommended future directions. Most participants would like to see stronger Canadian policy and funding commitments to global health research. Evidence of greater coordination between research teams and transdisciplinary work seem essential measures of success, as are the quality of partnerships and their sustainability. The research process should be driven by the communities we work with and informed by their own priorities. Key outcomes would be successful health promotion, behaviour change and demonstrated impact on health and well-being of the most vulnerable, leading to social change and a shift towards equity.

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Acknowledgements

The CCGHR would like to thank the Canadian Institutes for Health Research (CIHR) and the International Development research Centre (IDRC) for the opportunity to provide input into the planning of their national consultation process on the future of global health research and to act as rapporteur at all four events (March 27 to May 18, 2018). We also greatly appreciate CIHR and IDRC’s willingness to incorporate a wider range of expertise from our members in their strategic planning exercise through external consultations in other regions involving the younger generation of researchers.

We wish to thank the external consultations planning teams who volunteered their time to bring together researchers from such a wide variety of disciplines for the external consultations: Theresa Gyorkos, Charles Larson, Kristin Hendricks and Kariane St-Denis (Montreal); Jerry Spiegel, Vic Neufeld, Nicole Spence and Nisrine El Amiri (Vancouver); Manisha Kulkarni and Alison Krentel (Ottawa); Elysée Nouvet and Melanie Katsivo (London); Erin Wolfson, Erin Walling and Carla Fehr (Saskatoon); Jill Allison (St John’s); and Emily Kocsis, Gertrude Omoro and Nicola Toffelmire (SYPN virtual consultation). We could not have produced such a useful report without their contributions. We also wish to acknowledge the support of the Réseau de recherche en santé des populations du Québec (RRSPQ) – Regroupement stratégique en santé mondiale  for assisting with the organization of the Montreal event.

The compilation of proceedings and synthesis for this final report was completed by Madeleine Bélanger Dumontier, CCGHR Program Manager and Charles Larson, CCGHR National Coordinator.