Health research advocates push for balanced approach to future funding

National strategy needed

A funding imbalance facing health research in Canada could be rectified with the development and implementation of a sectoral framework and roadmap, according to Research Canada, an advocacy group for the creation of a health research strategy. It warns that without an integrative approach to funding health research, investments in research infrastructure and skills attraction and retention will ultimately be squandered.

Last year, Research Canada released a proposed model to achieve what it terms a functional innovation system and followed it up last week with the results of a survey showing strong public support for investments in health research. The ultimate goal is a "comprehensive Canadian Health Research Strategy" that will allow the federal government to make new funding decisions with a greater awareness of how all the pieces of the health research enterprise work together.

Research Canada contends that the federal government could use assistance in developing a holistic policy framework in which new investments in research have the most impact. Health care is just one of several key industrial sectors that are evolving without a national strategy — an indication that Ottawa's policy capacity has been seriously degraded in recent years.

"In recent years we've spent $50 or $60 billion on infrastructure and programs to enable recruitment of the best and the brightest. It's like driving a Ferrari but when you pull up to the pump there's no gas. There's an imbalance," says Dr Michael Julius, Research Canada's board chair and VP research at the Sunnybrook Health Sciences Centre in Toronto. "The last granting cycle was typical. Excellent proposals did not get funded … We need a simple approach which is to understand the continuum better and create the framework."

Ottawa currently spends about $1.8 billion on health research or 1% of the estimated $183 billion in annual health care expenditures. Research Canada is proposing a further 1-2% be allocated to health research in areas that are currently underfunded. Julius says that a disproportionate amount is devoted to infrastructure and an ever-growing stable of research chairs program, leaving the Canadian Institutes of Health Research (CIHR) and other health-related granting bodies unable to support research deemed excellent through peer review. It also leaves industry on the periphery, resulting in stagnant investment and the loss of world product mandates to other jurisdictions.

Research Canada's push for increased health research investment follows CIHR's request during the current Budget cycle to increase its funding by 76% to $1.7 billion within five years (R$, October 26/09). The Research Canada model supports the assertion that greater health innovation can only be achieved by making balanced investments in the four pillars of research — discovery and clinical trials, technology, delivery and policy.

glaring imbalance

A case in point is the research component of the recent federal economic stimulus package which devoted $2 billion to university and college infrastructure through the Knowledge Infrastructure Program. Universities received 70% of the funding, which provided 50% of approved programs, translating into a $2.8-billion infusion of stimulus money.

In the US, stimulus funding allocated for research was primarily directed to supporting direct costs, whereas in Canada the opposite was true. Many in the Canadian health research community were concerned that the one-shot funding did not extend to the granting councils and they communicated their displeasure — a response that did not sit well with the government.

"The community was up in arms and the government circled the wagons. Our community did not have its advocacy act together," says Julius. "All players in the health care system are making requests and we must put it together for the government to make decisions … It's not all about more money. Investing in one area will have an impact on the others," says Julius.

According to the Research Canada model — developed in conjunction with SHI Consulting — a careful balance between push (knowledge creation) and pull (market forces) is an essential starting point to achieving health care improvements.

"The model extends from creative inception to new products, health services and health care delivery paradigms," says Julius. "The aggregation of activity will interface with the policy cycle."

Key to achieving a better health care system is the participation of industry. Julius says changes in tax law and regulatory legislation must be considered as part of the totality if the benefits of discovery research are to be realized.

"The private sector plays a fundamental role ... in our capacity to deliver health care. New ideas must go through the rigorous process of commercialization before we can bring new technology to our clients," he says. "The private sector is not getting a sense that they are part of the process and they're pulling back. They're bottom line driven ... We need a policy framework and environment to incent the private sector to do business in Canada."

That pull-back can be seen in the stagnating R&D outlays made by big pharma and health biotech. According to the latest data from the Patented Medicine Prices Review Board, expenditures of patent-holding firms were stagnant at $1.3 billion in 2008. Of even more concern, the R&D-to-sale ratios of those firms fell to 8.1% — the lowest in 20 years and well below the 10% target the pharmaceutical industry committed to in the late 1980s (R$, September 2/09).

survey results encouraging

Julius acknowledges that the minority status of the Conservative government coupled with a ballooning deficit makes it "difficult to go forward with bold steps that lead to bold policy". Research Canada has been far more successful in gauging public support for health research, however with a new poll showing that a large majority of Canadians favour increased investments.

Conducted last December by Angus Reid Strategies, the on-line survey of 1,003 Canadians found that 90% of respondents believe basic research should be supported by the government, despite a weak economy and the long lead time between investment and results. The same percentage support investments in the education and training of health researchers by the federal and provincial governments.

In addition to Research Canada, the survey was supported by the Association of Faculties of Medicine of Canada, BIOTECanada, the Canadian Healthcare Association , Canada's Research Based Pharmaceutical Companies (Rx&D) and MEDEC, an industry association representing medical devices and related technologies.

The survey also found that 80% of respondents would support tax and regulatory policies to encourage private sector investment in health research while 68% see the value of clinical research.

Surprisingly, the survey found that Canadians significantly underestimate the amount of funding that goes to health research, believing that it accounts for nearly 24 cents of every health care dollar. If true, that would amount to an annual expenditure of $44 billion.

"That's a dream that is unattainable," says Julius. "The stunning message I took from the report is that Canadians at large have connected the dots. They understand that discovery research has an impact on the treatment they receive when they go to the hospital."

R$