CIHR Strategic Plan: Consensus-Building Workshop
Speech by Dr. Michael Strong, President, CIHR
September 10, 2019
Good morning everyone.
Before we start, I would like to acknowledge that we are gathered on the traditional, unceded territories of the Algonquin nation. This is significant because we, as a health research organization, commit to building respectful and reciprocal relationships with Canada’s Indigenous communities. Improving the health outcomes of First Nations, Inuit, and Métis communities is, and will continue to be, a priority for CIHR.
I would like to welcome all of you to this workshop, one in a series of steps in the development of a new strategic plan for CIHR. We have asked each of you to join us for a host of reasons, not the least of which is to benefit from your expertise and knowledge. In giving up your valuable time to participate in this workshop, you are contributing to a process that will ultimately define a strategic vision for health research in Canada.
For those of you who have not had the opportunity to hear me speak before about CIHR, I want to emphasize that my vision for the organization as we move forward is to ensure that we meet the expectations of the CIHR Act. We are a unique entity within the Government of Canada in that we are the only federal agency whose sole mandate is to improve the health of all Canadians through research. The Act speaks to the critical role of CIHR “to coordinate, focus and integrate health research” upstream, while also “informing health care and improving health outcomes” downstream.
Implicit in this is the understanding that CIHR cannot act alone in achieving this audacious goal. It was precisely because of this imperative to work together that we began a crucial dialogue last winter with our health research partners – including health charities and universities, provincial and territorial health research funders, Indigenous communities, and patient groups – with a view to develop a common vision of a healthier Canada by 2050, the halfway mark of this century. We are well aware of the health challenges that we must address today, if we are to improve health outcomes for our children and grandchildren down the road. That is our mission and how we have framed this engagement: we are stepping forward, moving beyond the near term, and challenging ourselves to think of the future.
We are all keenly aware that scientific discoveries are accelerating at an impressive pace and that this brings with it the opportunity to produce transformative, generational change – not only in health outcomes, but in the systems that drive this change. This concept of improving health outcomes for future generations through direct investment in system change is neither revolutionary nor novel. Its roots go back over a hundred years. For example in Canada, while the dream to ensure equitable access to health care for all Canadians, irrespective of wealth and opportunity, found its roots in Tommy Douglas, it has fallen to subsequent generations to protect and enshrine this right. In the United States, it was Franklin Delano Roosevelt’s “New Deal” which is often credited with changing the face of American public health. And yet, the “New Deal” simply codified the commitment for future generations. The “New Deal” and Medicare were both responses to thoughtful revolutions that called for a necessary change to the status quo.
We are here today because the time has come for another thoughtful revolution. I will argue that we have a unique opportunity for CIHR – and indeed for the health research ecosystem as a whole – to break from our current focus on short-term objectives of health research and, instead, refocus on crisply defined, long-term, aspirational outcomes.
For all of us as health researchers, this will mean returning to the motivation that inspired us to become researchers in the first place. All of us are here today because of a foundational desire to improve the human condition and to make life better for the next generation. Thus, while the core of our discussions for these next two days, and for months thereafter, will contribute to a bold new strategic plan for CIHR, this process must also include developing a vision of how we will work as a health research ecosystem to achieve transformational change that is sustainable.
You will often hear me refer to the CIHR Act. This critical piece of legislation will be 20 years old next year. It expresses clearly the core Canadian values of health, happiness, caring, cooperation, and leadership. It embodies concrete deliverables that include exercising leadership and fostering collaboration in health research; creating a robust health research environment in Canada; forging an integrated health research agenda across the country; creating knowledge and promoting its application to improve health; and building the capacity for research in the health research community. In short, the CIHR Act is akin to a promissory note the government has made to Canadians – and we are responsible for delivering on that promise.
The Act speaks to the use of three main tools to improve the health of Canadians: knowledge creation, knowledge translation, and capacity development.
We could discuss at great length whether CIHR has strayed from these guiding values and principles, but the reality is that, for many, we have. In this process of developing a new strategic plan for CIHR, we have before us an opportunity to meaningfully embrace these values and principles once again.
Many of you have also heard me refer to the health research funding ecosystem. Canada’s health research funders include federal departments and agencies, provincial and territorial governments, universities, hospitals, charities, the private sector, and individual donors, amongst others. When we look critically at this list of players, we see that the entire ecosystem of health research funders contributes approximately $4 billion each year towards health research. CIHR accounts for approximately one quarter of this total.
One also has to view this in the context of the approximately $270 billion of public spending that our country devotes each year to the health care system. It is time for CIHR to recognize that it is not alone in supporting health research, nor are we alone in having a vision of better outcomes for Canadians. I will argue, convincingly I hope, that while CIHR has always been a part of a larger ecosystem, we have at times forgotten that fundamental tenet. We now have the opportunity – and indeed the mandate – to re-engage in this ecosystem.
This will be a challenge. It will come as no surprise to you that the topic of funding health research in this country produces much spirited debate. Each of us sees ourselves as being critical to the system. But if we are to move forward, we need to view the role that CIHR plays in the health research ecosystem more broadly. As I mentioned earlier, we are approaching the 20th anniversary of the founding of CIHR. It is a critical moment in our history. You don’t have to read too far into the report in your meeting package to understand that there are widely divergent views in this country about the proper role of CIHR.
Many would seem to wish that we return to being the Medical Research Council and the National Health Research and Development Program without actually stating so – in essence, simply becoming a tool for the distribution of government health research dollars. Others fully embrace the CIHR Act and, in doing so, demonstrate an understanding that it is the Act that defines us. If the former and not the latter were to be the case, then we are simply a conduit for the distribution of grants in aid of health research and nothing more. I would submit that we are more than that.
CIHR was created from the MRC and the NHRDP because those latter funders were no longer effective in serving the needs of Canadians. Indeed, this is a point of emphasis within the CIHR Act, which states that CIHR’s mandate is to improve the health of Canadians through health research. This mandate includes the robust and uncompromising delivery of knowledge creation, knowledge translation, and capacity building. It is this concept that is at the very core of who we are and must form the core of any long-term vision and strategic plan.
So what might this look like? As you are probably aware, over the course of the last nine months, we’ve made a few decisions that have been met largely with acceptance, but also with some controversy. That’s healthy and, in fact, desirable. But as an agency that is committed to evidence-informed decision-making, we must make defensible decisions on the basis of a critical analysis of all data and inputs, and then hold these decisions to the test of clearly defined outcomes. Where we fail to meet the mandate of the CIHR Act, we must critically evaluate these outcomes. We cannot be driven by the voice of a few.
So, going forward, you can expect that CIHR will look carefully at all aspects of the organization, including understanding the genesis of current programs while also examining the basis upon which previously successful programs have been discontinued. We should evaluate our activities not just on the best outcomes for CIHR, but also as vital members of a health research ecosystem.
Let us take as an example the issue of individual researcher funding and success rates. As an active researcher, I know all too well that this strikes at the heart of our existence. You should thus not be surprised to see a wide range of views with respect to how CIHR distributes its budget. Some argue that we do not distribute our investments in the optimal manner, calling for the movement of funding from one pot to another and stating that the best science is done when we simply “let the chips fall where they may” and let the market decide through open competitions. Others argue that we must have priority-driven research competitions to fill gaps and address emerging priorities.
But do not be mistaken. Like all researchers in the country, I have spent much of my research career lamenting the individual success rates of competitions. And not once did I ever pause to consider whether CIHR is meeting some broader mandate. So I get it. But these arguments miss the point. The question must be “What is it that we are hoping to attain through our funding and are we optimally configured to deliver that?” And are we using the dollars of Canadian taxpayers, and that includes each and every one of us, to optimally achieve the goal of improved health outcomes for all Canadians?
You could also ask “To whom does the strategic plan belong?” and ultimately, “To whom are we accountable for the delivery of such a plan?” Well, in the simplest of terms, I am accountable for developing and delivering a strategic plan. But in reality, it is to the Governing Council that I am held accountable for this process. Perhaps not surprisingly, given the recent history of CIHR, we have been working closely with our Governing Council and its new Chair to ensure that we are well positioned to exercise this accountability. Importantly, we separated the role of President and Governing Council Chair, and our Governing Council is now fully populated and includes members with deep research expertise and a broad representation from across the country. Members of Governing Council – including our new Chair, Dr. Jeannie Shoveller – are attending this workshop in an observer capacity, listening closely to your feedback so that it can be factored into their ongoing deliberations. Jeannie will also provide some closing remarks at the end of tomorrow’s session.
This involvement of Governing Council is critical as it is this council that is accountable for setting the strategic direction of CIHR, as laid out in the new strategic plan. I would add that we are in the midst of a two-year process to fundamentally rebuild our governance structures with the goal of being amongst the leading, if not the leading, exemplar of contemporary governance principles. Once completed, processes and accountabilities will be clearly defined and well understood, as this is the foundation of effective and efficient decision-making.
In short, we are ensuring that we have in place all the pieces necessary to successfully deliver on the new strategic plan.
I should also note that this strategic planning process is being undertaken in a unique environment in which I am also directly accountable to the Minister of Health, and through her, to all Canadians as a public servant. We must at all times understand that we are delivering better health outcomes through health research for Canadians, and in doing so, are part of an integrated federal mosaic.
In preparing for today, I imagine that you likely developed a better understanding of CIHR’s mandate – and an appreciation that this mandate is a complex beast that does not exist in isolation. However, as we learn more about CIHR’s mandate, we also gain a better understanding of the challenge that lies before us: to truly understand the health of Canadians and how this will evolve over the next 30 years. As you know, our population (and that of the world) is dramatically aging. There are now more people in Canada over the age of 65 than under the age of 15. As with many countries around the world, this aging of the population is most dramatic for those over the age of 100.
To fully understand this demographic shift, we should also look outside our borders. This is consistent with the view of our founders that CIHR must be an active and fully engaged partner with the international research community. Simply look at the data on aging in Japan; our future is already upon them. This is an international problem and Canadian researchers must have the ability to engage broadly across the globe to better understand this problem. As such, we must have a strategic plan that embraces our role as a leader in global health.
I believe that the time truly has come for Canada’s health research funders – the Government of Canada, provinces and territories, health charities and philanthropic organizations, universities and hospitals, the private sector, and others – to work in unison to harness the enormous pool of talent and expertise in this country. By working together as one cohesive research funding ecosystem we could avoid duplication and marshal our collective resources to pursue shared goals and, ultimately, improve the health of Canadians.
What might this look like?
This country has significant challenges with health inequity. One can witness this by going 20 minutes down the street, or by looking farther afield. By way of an example, let’s look at diabetes. Diabetes is among the top 10 causes of death globally. It is estimated that almost 9% of adults between the ages of 20 and 79 have diabetes. Over 7% of Canadians aged 12 and older have been diagnosed with diabetes. But this pales in comparison to our Indigenous communities. In some First Nations, approximately eight in 10 people will develop diabetes in their lifetime. This underscores not just a bleak picture, but also the importance of paying attention to health inequities and vulnerable populations within Canada.
I could have picked a number of examples other than diabetes. Take for instance the deplorable rates of TB amongst the Inuit – almost three-hundred-fold that observed in the rest of Canada and amongst the highest in the world. Just a couple of weeks ago, I listened to Natan Obed, the President of ITK, ask the question of a CBC interviewer: “At what number does this become a crisis?” I would submit, as President Obed implied, that we passed that number long ago. So where do we as Canadian researchers come to the table to understand this crisis?
Of course, the list of health challenges we face as Canadians is virtually endless. I could just as easily have chosen a compelling example involving heart disease, hypertension, mental health, dementia, obesity, arthritis, antimicrobial resistance, hospital wait times, and on and on.
So what does this have to do with why are we here? On the one hand, it is an opportunity for us to consider these broad societal challenges, and on the other hand, to be strategic in our discussions and our thinking. This is a process. We began this process last fall with discussions with our health sector colleagues across this country in order to understand whether there was an appetite to look at strategic initiatives that would address long-term outcomes for Canadians. We have been tremendously gratified to see that this was indeed an area of great interest, and we were able to conduct a robust environmental scan of provincial and territorial health priorities.
We continued the process by asking a broad range of Canadians for their opinions on the strategic initiatives of CIHR. We sought advice and feedback from international research leaders and organizations, including the Heads of International Research Organizations (HIRO), the NIH, and the Global Alliance for Chronic Disease, among others. We created websites, conducted town halls, met with specific groups, worked closely with Indigenous communities, and, working with Statistics Canada, asked Canadians themselves what they viewed as their health research priorities.
We were aided and encouraged at every step of this process. Thank you to all those who participated in these various engagement activities. I would also like to take a moment to thank all those who are providing expert advice to CIHR on its strategic planning engagements. There is the Citizen Advisory Committee, whose members are helping to ensure that citizens’ voices are included in our next strategic plan. The Funding Partners Advisory Committee continues to ensure that we meaningfully engage with our funding partners throughout this process. And the four researchers who make up the External Expert Validation Panel have advised us on methodology, analysis techniques, and data interpretation regarding what we have heard from the community to date.
What you are being presented with today is a summary of the various inputs to the strategic planning process to date. This includes some very divergent sets of views as to how health research should look in this country. However, within this sea of ideas, there are collective views that are very closely aligned to the core values and principles of CIHR to which I alluded earlier. It will be our task, over the next two days, to find our way through this data to arrive at common principles upon which a strategic plan for CIHR could be formulated. As I mentioned to you in my cover letter to the workshop report, this data is but one point in the process. But it is a critical point in time and we are turning to you to help understand the core issues.
Let me give you an example of our expectations. You will see within the document a wide range of views with regard to the Institutes. Some argue that the Institutes should be dissolved. Others argue for an increase in the number of Institutes and indeed have lobbied for such. But if the question is “Can we and are we using the Institutes as strategic tools with which to change the health outcomes of Canadians?” then neither argument is germane. And if one accepts the premise that we should be looking at a long-term approach to eliminating health inequities in this country, then we must ask whether CIHR Institutes are best configured to deliver this mandate – not about which ones should or should not exist. What are the principles?
You will also hear widely divergent views on the amount of funding that should be provided – not only to individual investigators, but also how CIHR funds should be allocated, and to which groups. You will have read arguments for a 20 to 25% success rate for each open grant competition. However, as difficult and antithetical as it may seem (and believe me, I hear you), let’s set the numbers argument aside and ask the fundamentally critical questions: What are the principles around which we will fund investigators and how can we do so in a manner that will be equitable across a range of research entities?
Before we tackle these issues, let’s have a look at how the day will unfold. You will see that we have engaged outside help in ensuring that these two days are successful. Gestalt Consulting has helped to shape these sessions using best practices from similar large, national visioning exercises. You will notice that, in addition to the members from Governing Council whom I mentioned earlier, my senior leadership team are also here and are available to answer your questions as you deal with these very difficult topics. Think of us as a real-time research resource and please don’t hesitate to wave us over to your table.
There will be observers in each session, largely made up of the above-mentioned individuals, in addition to representatives from the external research community. Their role is to listen carefully because, as we move to the next phase of the strategic plan, we will need to start to put pen to paper and to write the plan. The leads for each session are not here to influence your decisions, but rather, to help facilitate your discussions. This first day will prove to be very iterative. Tomorrow, we will come back together as a group to identify commonalities from amongst the working groups.
Importantly, I would ask, contrary to our nature, that we set aside our individual agendas. Let’s be realistic – we all have them. However, this is not a lobbying opportunity for a particular point of view or agenda. There’s nothing to be gained or lost today or tomorrow. This is about a conversation and about better understanding the views of our colleagues and Canadians with regard to CIHR moving forward. Therefore, I would ask that, if you have a very specific view that you would like to see advanced, please set it aside during this process.
Finally, we are maturing as a young nation and so too is our research enterprise. CIHR is not yet 20 years old; it is still in its formative years – or as a neuroscientist might offer, it is not yet fully myelinated. This maturation has occurred in a time window that is truly unprecedented in terms of the breadth of knowledge and tools available to the average researcher. Further, as researchers, we operate less in silos than we did in the past. We are able to clearly see the interconnections of shared goals amongst many players in their fields, both nationally and internationally. This shift towards greater collaboration is also happening among Canada’s health research funders. It is our collective desire to accelerate this organic evolution. But in doing so, we must also accept that the individual researcher also remains a critical piece of the health research puzzle. How do we support such individuals across the lifespan of their career? As alluded to earlier, we must come together as one united system of funders to create a shared vision, align our efforts, avoid duplication, and maximize our collective return on investment. Please think about this in the course of your deliberations.
I know that not everyone who wanted to join us could be here in person, and that is why the Phase 1 engagement results report and the outcomes of this workshop will be shared with the broader community following this workshop.
I want you all to know that the development of this new strategic plan is CIHR’s highest priority. Thank you for taking the time to be here. I look forward to hearing your ideas.
And now, over to my colleague Michel Perron, CIHR’s Executive Vice-President, who will guide us through the particulars of the workshop.
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