Dr. Alan Bernstein

Making the case for health research

Dr. Alan Bernstein

Accountability is the new buzzword in Ottawa. Today, like all investors, Canadians want evidence that their funds are being invested wisely and their investments are producing results. This new focus comes at an appropriate time for the Canadian Institutes of Health Research (CIHR).

After five years, and as required by its legislation, CIHR recently embarked on a significant and comprehensive quinquennial evaluation by a prestigious international review panel. In February, the panel met with more than 100 young and senior investigators, university and government leaders, industry partners, health charities and the provinces, and with CIHR management and staff. That was preceded by extensive surveys of researchers from across Canada and evaluations of CIHR's 13 Institutes.

The review's overall purpose is to examine if CIHR is delivering on its mandate and to assist the organization in learning from its first five years. The final review, to be presented this June, will represent an authoritative and objective assessment of CIHR's performance relative to its mandate, and will include recommendations for improvements. However, as we at CIHR prepared ourselves for this review, we soon realized that just as important as the final outcome, was the exercise of self-examination itself.

Since its creation in 2000, CIHR has moved carefully and deliberately from its origins as a largely reactive biomedical granting council to an outcomes-driven, excellence-based strategic research organization. Our health research Institutes are each led by an internationally recognized scientific director. More than 225 Institute advisory board members provide advice and support to their respective Institutes, linking individual Institutes to CIHR overall, to the health research and research user communities, to the public and other stakeholders. CIHR has a strategic plan (Blueprint) that was the culmination of national consultations with health researchers and other stakeholders. And each of our Institutes has a strategic plan from which national research agendas have been implemented on everything from obesity and access to quality health care to regenerative medicine.

Beyond our development as an organization, CIHR has had profound impact on the Canadian health research landscape. Today, more health researchers are being funded at higher levels of funding than ever before. Not only has the average value of an operating grant risen by 40%, equally significant is the fact that there are now dozens of researchers who are now awarded grants in excess of $200,000 a year - values unheard of five years ago. And the number of investigators receiving CIHR grants and awards has increased from 4,974 in 1999 to 9,400 in 2004. These increases have been essential in allowing Canadian investigators to remain internationally competitive.

In addition to funding more people at higher levels, CIHR has also broadened its mandate to fund more health services research (up 20-fold) and population health research (up 16-fold) in the past five years.

Knowledge translation activities - moving research from the lab or research office into clinical practice, policy, or the private sector -- has increased from essentially no activity in 1999 to over $20 million annually. New programs in knowledge translation and innovation (e.g. Proof of Principle, Science to Business) aim to fill key gaps in this pipeline. New companies and new health policies are in place because of these programs, but we recognize that there are huge opportunities to do much more.

CIHR has transformed the way health research is conducted in Canada, funding researchers in all health-related disciplines, from the biosciences, to engineering and bioinformatics, to the humanities and social sciences. CIHR also directs a growing percentage (currently 30%) of its funds into strategic initiatives that respond to important scientific opportunities and/or Canadian health priorities. These initiatives are led by CIHR's 13 Institutes, which have built research communities that include funders, researchers and research users. These communities include policy-makers and practitioners, collaborating to set strategic priorities for research and to ensure that Canadians realize the value of research through results that are applied quickly and effectively.

CIHR has developed important new partnerships in Canada -- with federal departments, provincial health research agencies, provincial and territorial ministries of health, industry, trade unions and health charities - and internationally. In five years, these partnerships have contributed nearly $500 million in support of common national health research priorities.

The impact of our investments and new programs is beginning to be felt. In objective international analyses of research activities around the world, the Canadian health research community always ranks at or near the top. It is clear that health is perceived internationally as one of Canada's key research strengths.

And CIHR is producing research outcomes that matter to Canadians. Just last year, in partnership with the provincial/territorial DMs of health, CIHR funded research to assist them in meeting provincial commitments outlined in the Ten-Year Plan to Strengthen Health Care related to establishing evidence-based benchmarks for medically acceptable wait times. Eight teams, funded last Spring, delivered their second report synthesizing the world's best research evidence related to a number of key priority areas (hip and knee replacement, cataract surgery and some forms of cancer). Their work helped lead to the landmark announcement last December in which the provinces agreed to national wait time benchmarks.

A great deal has been accomplished over the last five years and without question there is more to do. In many ways, CIHR is about to enter the most interesting part of its development. CIHR began with much anticipation and uncertainty, and a sense that it was time to bring to life its vision. We therefore decided to rapidly implement new programs and new ways of doing things, recognizing that not everything we did would be perfect or universally accepted by the research community.

I believe that the International Review Panel will give CIHR a positive endorsement of its first five years in operation. This objective assessment by an outside group of the world's leading researchers will provide Canadians with the accountability expected from all of us in the research community. The CIHR review might be a useful template for both other publicly funded research organizations and perhaps for a broader review of the entire federal research enterprise.

Dr. Alan Bernstein is president of the Canadian Institutes of Health Research