CIHR- Institute of Population and Public Health Joint Advisory Board Meeting June 10th, 2004

“Strengthening Pillar Four Research”
- Summary Notes

Introduction

CIHR needs to engage “Pillar Four ” researchers to address its mission. Many Pillar Four researchers want to contribute to this mission; however, there is a perception that there are barriers to Pillar Four researchers fully participating in CIHR research, arising in part from the fact that the “Pillar Four community at large” has not traditionally been a major beneficiary of health research funding in the MRC era. “Pillar Four” researchers on IABs are in a unique position to create the interface between the broad public health, health promotion and health public policy community and CIHR, and to help CIHR in further supporting this kind of research in a forward thinking fashion.

A one-day invitational meeting of the Institute of Population and Public Health (IPPH) Advisory Board and representatives from the other 12 Institute Advisory Boards, CIHR’s Governing Council and CIHR staff (see attached participants’ list) was organized with the following purpose in mind:

  • To identify important structural barriers that CIHR might be able to address, to enable the Pillar Four community to more fully contribute to CIHR’s mission, to set priorities for that effort, and to develop practical constructive steps to begin to address key issues.

Plenary Presentations

Dr. John Frank, IPPH’s Scientific Director provided an overview of “Pillar Four research at CIHR”, within the context of CIHR’s strategic and open funding initiatives, to help set the stage for the discussion. His presentation covered such topics as: CIHR’s health research investments by funding program and research theme (for example) over the last few years and success rates; Pillar Four definitions; the role of IPPH and other CIHR Institutes in strengthening Pillar Four research, funding, peer review and capacity challenges facing the Pillar Four research community. He then presented an analysis of Pillar Four designated applications and showed the limitations of relying on investigator self-designation by research theme (i.e. biomedical, clinical, health services and population and public health) and how this approach lacks the sensitivity and specificity required to confirm, with confidence, what proportion of total research funds truly go to the Pillar Four research community. A copy of the presentation is attached.

Dr. Roy Cameron, member of the Institute of Cancer Research’s Advisory Board, provided a compelling presentation on the emerging science of population intervention research, which is needed to generate the evidence base for policy makers and practitioners to address complex public health problems. He suggested that an evidence base founded solely on randomized controlled trial designs is not the answer. He further noted that there is currently a misalignment between potential and often rapidly arising opportunities to study natural experiments and what researchers are currently funded to do. He provided a number of population intervention research examples from the tobacco control experience and described the characteristics of “core funded” supportive environments required for encouraging this kind of research.  He also gave a brief snapshot of what kind of ‘intervention research’ was currently supported by CIHR and the required funding mechanisms to support the study of natural experiments and other ‘fleeting’ opportunities.  Finally, he addressed the conduct of international comparative studies and the measurement and data collection systems ideally required to support this work in the Canadian context. A copy of the presentation is attached.

Plenary Discussion

An opportunity for questions was provided following each presentation.  Questions focused on the need to strengthen CIHR’s analytic and monitoring capacity to systematically conduct the kind of analyses that IPPH staff had prepared to inform discussions at this meeting. Concern was raised about the potential ‘blurring’ of the pillars, which may result from not systematically and consistently tracking what percentage of total funding was being allocated to each of the pillars. With an increased focus on interdisciplinarity, these boundaries can understandably become less well defined, at the expense of not addressing the needs of individual ‘pillar’ research communities. This may lead to further marginalization of communities such as population and public health (PPH) research, which historically have not been receiving their fair share of the health research funding pie. Given recent hires in the Performance Evaluation and Analysis Unit, there is considerable optimism that these “portfolio analysis” issues will be further addressed centrally by CIHR. It was also felt that a more systematic effort was required to examine the role of other drivers affecting the support of PPH research – are pillar researchers getting their proportionate share of personnel awards and Canada Research Chairs? What can the Canadian Foundation for Innovation (CFI) be doing to better support infrastructure needs of the Pillar Four research community? How can the contribution of the Pillar Four communities to health research and improving the health of Canadians be better communicated and understood?  

Other issues raised during the discussion related to: 1) the need to distinguish between controlled trials (including prospective community trials) vs. opportunistic research that takes advantage of natural experiments; 2) the need to support the kind of research that looks at questions of intervention generalizability and “ramp up”/sustainability rather than only efficacy; and 3) the need to set up a separate funding stream to support PPH intervention research (e.g. quasi-experimental designs to study policy and program interventions). This funding stream may need to be initiated through a purpose-built RFA-led competition, but with the cautionary note that sustainable long-term funding trajectories must be created rather than only relying on one-off pilot/short-term funding opportunities.  This is especially problematic when there appears to be no obvious appropriate funding vehicle in the open operating grants competition (especially with the discontinuation of the health information and promotion peer review committee, which received these kinds of applications). In addition, it was felt that to support this kind of research, university-based public health training programs need to integrate courses on quasi-experimental and observational intervention effectiveness research, we need to have a better sense of how many researchers do this kind of research, and partnerships need to be forged with government and other funders of policy and program interventions, as CIHR will only be in a position to fund the ‘research’ component of interventions. It was further suggested that the recently announced national Collaborating Centres for Public Health could potentially have a mandate for priority-targeted intervention research.

Summary of Small Group Discussions

 Participants were divided into three groups and were asked to address a range of issues that arose during the morning’s discussions. These discussions are summarized below.

Group 1: Barriers to Pillar Four Research and Knowledge Translation

  • Cultural differences between research communities exist
    • Thorngate’s report demonstrated that there are two cultures of peer review: biomedical vs. ‘health’ peer review committees that contribute to differential scoring across these committees and favour the former.
    • Traditional health science centre research culture(s) do not appear as supportive of Pillar Four
    • Diversity needs to be encouraged but not at the expense of any one pillar’s unique requirements
    • The culture needs to embrace and support research with demonstrable impacts and relevance to various agendas, in addition to “curiosity-driven research”
  • Definitions for Pillar Four research
    • There are questions about how Pillar Four is currently defined in the CIHR Act and in the context of IPPH’s mandate. Are these definitions too narrow? (For example, there was question about why research on ‘patient populations’ and policies to address them should not be considered Pillar Four research)
    • It was acknowledged that Pillar Four is a way of thinking (which could be applicable to a range of research domains) characterized by: looking at whole populations, seeking root causes and understanding social change.
  • The need for improving data quality monitoring and reporting of funding allocations needs to be improved by CIHR. Issues that were raised related to the quality and subjectivity of current analytic processes, and the fact that results of such work are not widely publicized.

Common Potential Themes

  • What constitutes “levels of evidence” (examples of varying qualities of evidence for causation) across all pillars?
  • How is evidentiary uncertainty handled? (i.e. “weight of evidence” approach)
  • Knowledge Translation (KT):
    • How do users requiring evidence emanating from clinical vs. health services and policy, vs. population and public health research understand and use this evidence?
  • We need to acknowledge legitimate behavioural/social sciences and humanities researchers’ reticence to participate in:
    • Interdisciplinary teams
    • Knowledge Translation activities
  • Mechanisms for funding
    • RFAs are too often offered as  “one-off”
    • There is usually no resubmission option and therefore no opportunity for feedback and learning.
    • Some feel it is a wasteful effort to apply to RFAs to elicit four complex but unsuccessful proposals for each one funded, and not offer a second chance
  • Differing histories of different research communities need to be acknowledged
    • We can’t expect the same funding level trajectories of growth and development across research communities
  • Researchers in population health research are still very partial and at times conflicted
  • “Changing research paradigms” is a concept not itself well-understood/studied
    • For example, what are the risks/benefits/costs of large team/KT research?
  • Mandate of other research funding agencies
    • SSHRC’s role and mission is currently “under review” and may result in an increase or decrease in SSHRC funding for health research
    • Is this process in its own silo?
    • What could/should CIHR do about it?

Group 2: Partnership Activities/Strategies

There are partnerships that are internal to CIHR (e.g. Institutes) and external to the organization (e.g., the new Canadian Public Health Agency, the Canadian Public Health Association and the Coalition for Public Health in the 21st Century, other funders, “policy, program, practice and public” research users and universities).

To advance partnership activities in support of Pillar Four research, the following suggestions were made:

  • Objectives to frame and direct this effort are required. Possible goals include:
    • To advance CIHR mission in the Pillar Four community
    • To harmonize/maximize “return on investment” by creating synergies between the CIHR Institutes’ efforts in this area (for example, the Institute of Genetics shares with IPPH population genetics and genetic epidemiology)
    • To optimize/enable the potential for impact of the Pillar Four research community
    • The mission of CIHR overall is to impact the health of Canadians
      • How can we position Pillar Four research as a major contributor to this mission?
  • The CIHR Legislation outlines four domains, which are very broad and enabling. There is a need to redefine/sharpen/clarify the existing Pillar Four definitions without changing legislation. This need for clarification will evolve from the community.
  • There is a lack of knowledge among researchers and possibly funders regarding the relevance and value of Pillar Four. Therefore, there is a need for a:
    • Clearer definition and mission
    • Education program about Pillar Four
    • Greater understanding of the perspective from stakeholders regarding what they “need” in terms of outcomes
  • Research is a “means to an end” as it both generates knowledge and generally, in Pillar Four at least, leads to impacts
    • Do we require a value proposition and/or vision of what could be accomplished?
  • Such a vision could be created through partnerships. 
    • Consider approaching partners involved in agenda setting (for example policy makers, regional health boards, the public, non-governmental organizations, professional associations, etc)
    • There is a need to integrate/synergize our efforts with the Pillar Three community where appropriate 
    • How can we channel the needs of regional health authorities into research agenda?
    • How can we capitalize on existing venues (e.g. CPHA) to facilitate priority setting?
  • There is a lack of capacity in specific core areas (e.g. epidemiology)
    • Lack of undergraduate programs; limited funding opportunities; But…
    • A renewed excitement about the field of public health and the potential availability of exciting new jobs
  • How do we capitalize on our partnership strengths?
  • We need to project future health research human resource needs to inform CIHR, universities, governments, non-governmental organizations
  • A forum to determine research needs of the public health community is required
  • How do we facilitate this cycle: Produce research results  transfer knowledge back  evaluate? A look at existing models (CHSRF) with built-in incentives. These are key.
  • Partnership opportunity for CIHR and Public Health Agency needs to be further explored.
  • We need to recognize that basic research (eg. cohort studies with biological measures) has implications for population health (e.g. the etiology of various degrees of nicotine dependence)
  • Recognition/acceptance of health determinants is critical to increase awareness (for example, the effect of income inequality on health at aggregate level) and to help shape public perception.
  • There is resistance to use data
    • People respond to local data, not aggregate
    • Must be localized
  • The audience involved needs to be broader  - for e.g. civic planners (urbanization)
  • Recognize and capitalize on the role of charities in influencing the political process
  • Take into account that badly designed ethical review procedures can be barriers in light of ill-informed privacy and other concerns, etc.
  • Establish partnerships with organizations such as Statistics Canada for the conduct of national longitudinal studies. Domains include such areas as:
    • Participation in design
    • Access and use of data
    • Design of piggyback studies
    • Managing political perception

Group 3: Improving the Environment for Pillar Four Research/Knowledge Translation

Challenges/Barriers

  • CIHR structure
    • Has it ‘morphed’ sufficiently from MRC?
  • Image
    • Partnerships are very time-consuming and costly
  • Heterogeneity of Pillar Four researchers (i.e. challenges of interdisciplinarity)
  • Peer review composition
  • Need to support and sustain people capacity (bringing people in and mentoring them)
  • CIHR should be a “home” for all health researchers
  • Need to recognize different research cultures (e.g. behavioural scientists and social science researchers vs. health science researchers)

Academic Setting Challenges / Solutions:

  • Capacity
    • Bringing people in and sustaining them; mentoring
    • Need for grant facilitators
    • Need to address publication barriers
  • Culture change is needed in some journals with respect to publishing qualitative research/KT
    • Recognizing KT broadly
    • Change recognition of these activities in CV module and in application process

CIHR/Funding Agencies Challenges/ Solutions:

  • Interagency collaboration on RFAs
  • Application
    • Forms should be friendly to all Pillars
  • Review panels
    • Recognize peer reviewers (e.g. in university-tenure promotion committee assessments of faculty)
    • KT/interaction activities should be documented on CV module or application form
  • Improve the process for application and redevelop collaborations among disciplines
  • Provide seed money to allow time to develop/start up projects (pilot funding)
  • Provide core infrastructure and personnel funding (in lieu of equipment grants, which don’t benefit Pillar Four researchers)
  • Determine strategies to address diversity on Pillar Four panels
    • For example, CIHR could offer courses on grant reviewing
  • Promote a better understanding/strategies for setting up peer review panel process
  • Promote understanding of approaches/traditions for different disciplines in Pillar Four

KT Structures Challenges / Solutions:

  • Facilitate priority setting with stakeholders (like Listening for Direction initiated by IHSPR, CHSRF and other partners) in Pillar Four. These priorities could inform the work of the Conference of Deputy Ministers, Coalition of Regulatory Health Agencies, etc.

Summary: Suggestions for Change

  1. Continue to improve peer review process
    1. Examine panel composition to ensure breadth and expertise required
    2. Training to sensitize peer reviews (for example, on respectful interdisciplinary practices)
  2. Develop CV Tradition
    1. Document knowledge translation activities on CV module
  3. Strengthen people capacity
    1. Mentoring
    2. Grant facilitators
  4. Provide core infrastructure and personnel funding (analogous to Pillar One and Two equipment grants)
  5. Encourage appropriate publication vehicles for Pillar Four research (e.g. journals)
  6. Support the full and creative use of data sets already in the public domain/paid for
  7. Facilitate a culture shift within universities regarding interdisciplinarity and knowledge translation
  8. Support funding for collaborative research (national/major issues)
  9. Build interest at the top-levels to increase funding for Pillar Four research

Next Steps

Following a report back by each small group, there was further discussion about the kinds of next steps that could be taken to move the Pillar Four research agenda forward. These are summarized below.

  1. Implement a systematic data collection and analysis system to continue to monitor what proportion of funds are going to each of the pillars and counter the tendency to ‘blur’ what funding is going towards different types of health research, irrespective of pillar.
  2. Improve the definition of ‘Pillar Four research’ and include a complementary list of key words that can be used by researchers to categorize their research projects in a standardized fashion, as well as document the knowledge translation activities and implications of their research. Ensure that these changes are reflected in the application process (i.e. this could involve changes to the application form, common CV module, etc.).
  3. Continue to improve peer review panel composition and processes to support Pillar Four research.
  4. Continue to work collaboratively with the Institute of Health Services and Policy Research and the ‘Pillar Three research’ community, which faces similar challenges. 
  5. Develop a communications strategy that helps to translate the benefits and impact of ‘Pillar Four research’ through, for example, strategic partnerships with non-governmental organizations, proactive engagement of relevant university department chairs and other key stakeholders, the use of compelling stories of innovative research, and other strategies.
  6. Encourage training initiatives to include curricula addressing the science of population intervention research.
  7. Develop alternative funding program options to such programs as CIHR’s equipment and maintenance grants (consider “human capital” grants such as salary support for technical personnel and research assistants) and the RCT funding stream (e.g., intervention research program for research initiatives not requiring an RCT design).