Year 5 - International Review Panel Report, 2000-2005

Appendix 1 - Reports on Individual Institutes and Their Related Open Competition Research

[ Table of Contents ]

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Institute of Aboriginal Peoples' Health (IAPH)
Institute of Aging (IA)
Institute of Cancer Research (ICR)
Institute of Circulatory and Respiratory Health (ICRH)
Institute of Gender and Health (IGH) 
Institute of Genetics (IG)
Institute of Health Services and Policy Research (IHSPR)
Institute of Human Development, Child and Youth Health (IHDCYH)
Institute of Infection and Immunity (III)
Institute of Musculoskeletal Health and Arthritis (IMHA)
Institute of Neurosciences, Mental Health and Addiction (INMHA) 
Institute of Nutrition, Metabolism and Diabetes (INMD)
Institute of Population and Public Health (IPPH)

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Institute of Aboriginal Peoples' Health (IAPH)

Breadth of Research in This Area

Mandate of Institute: Supports research to address the special health needs of Canada's Aboriginal people.

Status of the Institute of Aboriginal Peoples' Health (IAPH)

This is an area of health research where capacity is currently limited but where significant opportunities for interactions with other Institutes exist. The Institute has a strong and well-informed Scientific Director. It has focused on building capacity, both amongst researchers and within Aboriginal communities to participate in research. ACADRE centres have been particularly effective in developing this participation. The improved competitiveness has led to a significant increase in open competition resource that has come to this field. This Institute has been successful in developing interdisciplinary research as well as national and international partnerships, in particular partnerships with the New Zealand and Australian Research Councils on Aboriginal health programs. There are significant opportunities for interactions with other Institutes, particularly those interested in the major chronic diseases which are often prevalent in Aboriginal populations. There is an opportunity for a "Grand Challenge in Aboriginal Health" which might provide additional interest in this particular area.

This Institute has made very considerable progress in broadening the discipline base engaged in this area and in integrating research across research pillars. Its research program is highly strategic as capacity building remains an important component. Knowledge translation in this setting moves in both directions between researchers and Aboriginal communities and back again. Similarly, Ethics has been handled well in this setting, but needs to be extended with a focus on setting standards for conducting research in Aboriginal communities.

The open and targeted competition systems in this area of health research have largely been strategic in nature. This balance should probably be maintained for the immediate future, but it would appear that the CIHR is investing appropriately in this strategic area. The training program looks successful and should not be altered.

Recommendations

General recommendations should be to maintain the present policy settings and strategy. The ACADRE program should be extended to eight centres and ethics guidelines should be finalised and widely disseminated. Partnerships remain a key opportunity for this Institute and its associated open competitions. Importantly, the presence of this Institute has been crucial in establishing and maintaining the trust of Aboriginal communities necessary to undertake research in this setting. No fundamental changes are recommended in the status of this Institute or its mandate.

Institute of Aging (IA)

Breadth of Research in This Area

Mandate of Institute: The advancement of knowledge in the field of aging to improve the quality of life and the health of older Canadians. The Institute supports research to promote healthy and successful aging and to address the causes, prevention, screening, diagnosis, treatment, support systems, and palliation for a wide range of conditions associated with aging.

Status of This Area of Health Research in Canada

Aging research faces many challenges: it is a small research community with a diverse research portfolio. The CIHR is seen to have facilitated the growth of aging research in Canada. IA and CIHR have made progress in building capacity in this area by creating two new committees: Biological and Clinical Aspects of Aging (BCA) and Social Dimensions of Aging (SDA). More applications are received in BCA as compared to SDA. Many biomedical and clinical researchers have introduced topics in aging into their work to take advantage of these funding opportunities (though they do not necessarily identify themselves as scientists specializing in aging). However, there is a strongly perceived need to continue to build capacity and critical mass in aging research, especially in pillars three and four.

The launch of the Canadian Longitudinal Study on Aging (CLSA) has been a major initiative of the IA that has the potential to be a highly influential study in this field. This initiative is recognized internationally as a major innovation in multidisciplinary aging research.

Introduction of Pilot Project grants has been successful in the attraction of new researchers into this field. IA also participates in doctoral research awards and fellowships. Funding below the open competition funding cut-off for young researchers is also done. CIHR must develop continuing programs for scientists in this field, particularly mid-career researchers. Researchers get pilot grants in aging, but often there is no mechanism for continued support.

Some funding for aging research comes from outside sources. Many agencies in the aging field support research in pillars two to four but there are none for biomedical research on aging. The discontinuation of the CIHR group grants had a negative effect on continuity of research in this area. The CIHR budget is not increasing sufficiently to maintain current capacity.

Transformative Features of This Health Research Area

The CLSA has been an important vehicle for scientific development across most CIHR Institutes and has served as an integrative and multidisciplinary focus across a broad front. It has also been important in the development of ethics issues related to long-term longitudinal population studies. IA has also been a leader in pursuing KT strategies by obtaining input from older people as to issues of relevance to them and educating the population on aging issues. The Institute recognizes the importance of multidisciplinary collaborations in the field of aging.

Status of Open and Targeted Competition Systems in This Area of Health Research

There is some discontent within the field about the failure to raise funding in line with demand. The current system of two reviewer committees works well and researchers in this area feel that their proposals are assessed fairly. However, there is a disconnection between the Institute and the peer review committees so there is a lack of feedback in the process and, consequently, the Institute is not able to take action in response to the committee's collective experiences. Open communication would improve matters.

Status of Training Systems in This Area of Health Research

There has been successful investment in capacity building in this area and the Institute has taken a leading role in this with CIHR support. There is a perceived lack of capacity, however, in the field of clinical science. The CLSA offers a great opportunity for research training. There is a major need for mid-career support to ensure that the new cohorts of young scientists develop into tomorrow's leaders.

Status of the Institute of Aging (IA)

The Institute appears to be soundly based and fit for the future. The fact that it successfully managed the transition from one SD to the current one is a sure sign of the strength of the Institute (and this provides some learning for CIHR as a whole). It has clear strategic priorities and has striven to develop a KT focus even though it has not received consistent support with this endeavour. The Institute has contributed substantially to the mandate of CIHR and would clearly like to do more in terms of KT. Its budget is a major constraint. The Institute is well regarded by its scientific community. It has only recently embarked on international partnerships and their role and purpose need to be clarified. The Institute is also encouraged to benchmark its portfolio internationally and prioritise the need for Canadian research in the aging field.

A number of issues and potential problems were identified in relation to the IA:

• integration of the biomedical side with other researchers in aging is a challenge;
• small community of researchers;
• problems with mid-career support;
• researchers doing aging-related research not identifying with IA;
• capacity raised but budget not;
• CIHR needs to clarify role of KT;
• CIHR should support IA with advice on ethics;
• invest in training clinical scientists in aging;
• Scientific Director transition lessons to learn for other Institutes;
• CIHR support for interdisciplinary research needs to be maintained or expanded;
• IA leadership role in this field.

Institute of Cancer Research (ICR)

Breadth of Research in This Area

Mandate of Institute: To support research to reduce the burden of cancer on individuals and families through prevention strategies, screening, diagnosis, effective treatment, psychosocial support systems, and palliation.

Funding distribution currently 90/5/2.5/2.5 across the four pillars, but good efforts are being made to address pillars two to four, e.g. with palliative care, tumor banks, wait list initiative, proposed cohort studies.

Status of This Area of Health Research in Canada

The overall impression of cancer research across Canada is good, based on the personal knowledge of panel members and the 2004 publication 'snapshot' provided to us. Basic cell and molecular biology are strong; epidemiology and population health studies seem relatively weak on an international comparison. Clinical trials activity was not well documented but seems moderately strong; we were told this is supported largely through the National Cancer Institute of Canada (NCIC). ICR has plans to catalyze population/epidemiology research, e.g. with a large cohort study, but we were not able to assess these plans. Substantial funds will be needed for a study of adequate scale.

Transformative Features of This Health Research Area

Efforts to broaden the discipline base are good: see above. They have had limited impact so far because of limited resources. Similar comments apply to integration across pillars.

Strategic research priorities: The ICR has led successful initiative in palliative care and in infrastructure e.g. tumor bank and training fellowships. There are substantial opportunities if the ICR/CIHR strategic plans can be interfaced with those of the NCIC and of the Canada Foundation for Innovation (CFI) in particular.

KT integration and action by the ICR is currently quite low but the Institute has helped in the creation of the Canadian Cancer Research Alliance (CCRA). In general, the ICR does not see KT as a priority because it is being taken forward by others; but they see opportunities through increase of communication with the Minister of Industry, and if increased resources can be obtained to bring drugs and diagnostics to market.

The ICR also so far had little activity in the area of ethics, although it has started discussion on an ethics board for Clinical trials and Ethics issues in the human papilloma virus (HPV) studies. It may be that ethics is better taken forward centrally in CIHR with individual Institutes making specialist input.

Status of Open and Targeted Competition Systems in This Area of Health Research

The review team saw almost no functional relationship between the ICR and the open competition for cancer funds. This seems a major structural weakness in the CIHR organization. It is recommended that linkages be put in place. The panel suggested that the ICR might have a more direct influence on the open review process.

Status of Training Systems in This Area of Health Research

The training systems for younger researchers seemed to be very good. The panel did not however specifically discuss clinical research training pathways. As in most countries, continued career support after the initial stage was less clearly defined. Attention to this may be important for retaining the best young researchers in Canada. The four young researchers the panel was able to speak to were particularly positive about the role of CIHR in supporting new investigators meetings set up between the Institute of Genetics and other Institutes.

The panel was also concerned about disconnect between large capital investments (e.g. from CFI), and the difficulty in matching these with provision of training grants and operation grants. There would appear to be an opportunity to improve the training pipeline if better alignment of these can be achieved.

Status of the Institute of Cancer Research (ICR)

The Institute has several key accomplishments: It has carried out an extensive consultative process to determine its priorities; it has funded 22 training grants; it has carried out strategic initiatives under pillars two, three and four described above. By far the strongest area of cancer research in Canada is cell and molecular biology. Recognizing these strengths and the need to build capacity in other areas, ICR has focused on pillars two to four. Perhaps as a result of this, ICR seems somewhat disconnected from the majority of the cancer research community. However, the Panel concluded that it has made an effective contribution and should be encouraged to pursue its current plans.

Institute of Circulatory and Respiratory Health (ICRH)

Breadth of Research in This Area

Mandate of Institute: To support research into causes, mechanisms, prevention, screening, diagnosis, treatment, support systems, and palliation for a wide range of conditions associated with the heart, lung, brain (stroke), blood and blood vessels, critical and intensive care, and sleep.

Status of This Area of Health Research in Canada

Basic research in this area is thriving; there is an established talent base with many new investigators. The Institute has integrated these groups effectively. Outcomes research is world class in heart failure and ICU medicine.

Transformative Features of This Health Research Area

ICRH has mobilized the community and created partnerships from bench research to clinical research to outcomes research. Examples include: the Resuscitation Outcome Consortium (ROC), Heart Failure group and the BREATHE program with the Cystic Fibrosis Foundation.

Status of Open and Targeted Competition Systems in This Area of Health Research

As a result of intense public relations work by the Scientific Director, many grants have been received leading to grant overload. More resources are necessary in terms of money to fund grants and review infrastructure. We recommend the introduction of Modular Grants Budgets with small, $50,000, medium, $150,000 and large, $450,000. ICRH has used its targeted funds wisely, driven by the priorities of training, gene/environment, regenerative medicine, maternal/fetal interactions and others.

Concern was expressed about the lack of continuity between health care funders and health research. The view was also expressed that not all sports are team sports and support for single investigators remains crucial. The community has noticed severe application pressure and lack of resources to support operating grants in this scientific area. In the training area, the STIHR program has been a major priority although concern was expressed about the need for uniform application.

Recommendations for the future suggest that attention be paid to the Scientific Director replacement, given the importance of the current SD to the success of the program. Modular budgets have been suggested for the open competition and it has also been suggested that more attention be paid to easing in new investigators. Evaluation of the impact of the teams established in terms of health economics or quality of life measurements as well as publications would be helpful. Many opportunities exist in the areas of sleep, stroke and environmental impacts. These can be delivered if the budget permits.

Status of Training Systems in This Area of Health Research

Major priority was the STIHR program with 10 funded programs now extant. Recommendation to have a uniform application with a menu of options among programs.

Status of the Institute of Circulatory and Respiratory Health (ICRH)

One strength of this Institute is its Scientific Director who has vision and energy. It is sad that such an excellent Director must end his term. This Institute has an exemplary record.

Institute of Gender and Health (IGH)

Our panel was impressed with the IGH and gave it high marks in almost all areas. We were very impressed with the leadership, evidenced by the well-organized thoughtful presentation by the leader and by the perception of her team [as presented by the four individuals who visited with our panel] that she is the power driving IGH forward. Under her leadership, the IGH took advantage of the CIHR opportunities and filled nearly all of their goals. IGH developed 5 research priorities, leading to the creation of 16 strategic initiatives. There were 226 grants, 61 training awards, 22 strategic proposals and 67 interdisciplinary teams. IGH has invested > $18 million in grants and awards.

IGH used many small grants, training programs, national workshops, and expanding diversity career support to attract and train many new women scientists. Building capacity and increase in grant funding have accelerated. IGH dedicated 60% of its budget to building research capacity. In open competition, 414 grants (of 1643 applications) were funded. National partnering (49) and international partnering (23) increased, the highest levels of partnering achieved by any Institute. This rapid expansion fostered the development of multi-focus multidisciplinary teams, which our panel thought was the most successful transdisciplinary program among the Institutes. IGH also appears to have done a good job in emphasizing knowledge transfer, by making knowledge transfer a requirement of all RFAs, and funding 44 grants emphasizing knowledge transfer. IGH also assumed leadership roles in medical ethics and law.

Therefore, our panel is enthusiastic about the IGH program, and thought this would not be a good time to recommend major changes, in view of the progress and momentum of IGH in its first years. Every young scholar and senior investigator with whom we spoke to about IGH said they would not be where they are today without the inspirational, educational and financial support from IGH. We recommend continuation of the multidisciplinary multi-focus teams, the training and support of women in science, the continuation and expansion of national and international partnerships, and the focus on health [vs. disease] outcomes.

The main limitations at this time are their inability to describe the content or quality of funded IGH grants in women's research, or their evaluation. We were told that evaluation activities are now in the planning stages. We were also told about the paucity of qualified grant reviewers with no conflict of interest - a problem common to other research systems and not unique to IGH.

We make several recommendations, many self-identified by the IGH faculty as areas for improvement. We agree that the timing is right for considering the value of smaller vs. larger or longer grants, defining methods to evaluate existing programs and the quality of the science, and deciding what criteria constitute success.

Our panel noted that the avenue for junior to mid-career faculty needs to be widened. The IGH faculty self-identified the need for increasing the amount of funding for new investigators, for early mid-career investigators, and for correcting the absence of grants for longer term research. Few if any current long-term grants exist, and most 2-year grants are not renewable. This limits the type of cohort studies which are necessary for health planning, and will also limit evaluation of knowledge transfer's impact on policy, practice and awareness. The IGH should consider whether larger or smaller grants have a greater impact per dollar.

We suggest IGH consider some larger longer grants, the development of a Women's Health Newsletter [for lay women], a focus on ethical issues related to women's reproductive health and freedom, and that they further expand diversity career support.

Institute of Genetics (IG)

Breadth of Research in This Area

Mandate of Institute: To support research on the human and model genomes and on all aspects of genetics, basic biochemistry and cell biology related to health and disease, including the translation of knowledge into health policy and practice, and the societal implications of genetic discoveries.

Funding: Fair distribution between the four pillars.

Status of This Area of Health Research in Canada

The Canadian genetic community is a strong community with a long tradition and history of successes and major achievements. The overall impression of the review team regarding the quality of genetic research and investigation in Canada is extremely positive. The Scientific Director has invested much time and energy by setting a strong bottom-up organization, responding to needs of the investigators and ensuring that goals and priorities are addressed. The strength of the community and the strong leadership capacities of the Scientific Director have resulted in the remarkable achievement of the IG.

Transformative Features of This Health Research Area

The IG has identified 6 research priorities to address what they regard as weaknesses (Population Genetics and Genetic Epidemiology of Complex Diseases, Health Services for Genetic Diseases) and build on strengths (Genomics, Proteomics, Integration of Physical and Applied Sciences into Health Research and Clinical Genomic Research). The annual New PI meeting organized by the Institute is a brilliant idea to achieve its goals and foster partnerships with other Institutes. The fact that this initiative has been reproduced by other Institutes is a proof of relevance of this initiative. Also, an IG support to PIs working in IG mandate is provided on a competitive basis and designed to fill program gaps (e.g. clinical investigator awards, one year bridging operating grants with a high success rate).

Status of Open and Targeted Competition Systems in This Area of Health Research

The review team appreciates that the strengths/weaknesses are being addressed by a targeted competition system of RFAs in a very effective manner. At least 2 RFAs are launched in various priorities particularly Health Services, Clinical Research, Proteomics, Bioinformatics, Ethical Legal and Social Issues (GELS). The review team also appreciates that the issue of KT and public awareness is a major concern of the IG which is also covered by RFAs. Several initiatives in this field deserve particular mention and interest e.g. "be a gene researcher for a week", "Geee! In Genome" traveling museum exhibit. Owing to the quality of IG, excellence of science and relevance of genetics in medicine and public health, the review team recommends to increase the budget of this Institute.

The peer review system seems to be fair and effective. The review team recommends that the Institute populates the panel with more senior reviewers as role models for the more junior panel members.

Status of Training Systems in This Area of Health Research

The training system of younger researchers is very good. Considering that the number of physician scientists is slowly declining, the clinical investigatorship award, MD/PhD awards, and genomic medicine/human development program are regarded as an opportunity to attract the best young clinical scientists, foster clinical research in genetics and retain and recruit bright investigators to Canada.

Status of the Institute of Genetics (IG)

The Institute of Genetics is highly productive and competitive at the international level. Its output in terms of gene discovery and understanding of disease mechanisms is outstanding.

Institute of Health Services and Policy Research (IHSPR)

Mission

The stated mission of the Institute is "to support innovative research, capacity-building and knowledge translation initiatives geared towards improving the way health care services are organized, regulated, managed, financed, paid for, used and delivered, in the overarching interest of improving the health and quality of life of all Canadians." Its focus includes health workforce planning, management of the health care workplace, timely access to quality care for all, managing for quality and safety, understanding and responding to public expectations, sustainable funding and ethical resource allocation; governance and accountability; managing and adapting to change; linking care across place, time, and settings; and linking public health to health services.

The Institute grew out of the earlier National Health Research and Development Program, and has brought considerable vitality to CIHR. Many of its innovations - such as systematic research reviews, building interdisciplinary teams, outreach to users of research, building relationships with communities and funding partnerships, emphasis on knowledge translation, privacy sensitive research environments - have stimulated CIHR-wide action and enhanced CIHR's standing with important constituencies. In turn IHSPR has benefited enormously from nurturing by CIHR central staff.

Accomplishments

The key accomplishments the review committee found were:

• Significant impact developing a new cadre of young investigators and capacity building in health services, health systems, and health policy research by supporting a nurturing research environment, and supporting research at all levels (trainees through established investigators). These efforts include building interdisciplinary teams, influencing evolution of team funding tools, building teams in emerging priority areas, Interdisciplinary Capacity Enhancement (ICE), and establishing summer Institutes.
• Fostered the creation of the Canadian Association of Health Services and Policy Research.
• Developed innovative process such as the Listening for Direction I and II workshops to ensure that the Institute research priorities are responsive to the needs of decision-makers.
• Rapid responses including research useful in responding to SARS crisis, establishing Wait Times Benchmarks (assembling evidence based on clinical implications of waiting times for different procedures and conditions such as hip replacement, cardiac surgery, and others), and meeting research needs of the Romanow Commission and the Kirby Senate Committee on Canadian Health System Reform.
• Provided direct support to national policy experts and other Institutes as Theme 3 experts.
• Creation of the Healthcare Policy Journal.
• Innovative partnerships with decision-makers and with the Canadian Health Services Research Foundation.
• Developed research systematic review process that has been vital to decision-makers and posted research syntheses on the website accessible to all.
• Supported the basic science development of health services research through a highly successful RFA for research advancing theories, methods, and measures of health services research.

Key Strengths

• Strong leadership by Scientific Director;
• Interdisciplinary focus;
• Capacity building in health services research;
• Responsiveness to decision-makers;
• Theme 3 support to CIHR and individual Institutes.

Key Weaknesses Imposed by External Constraints

• The Institute and its investigators are limited by the lack of health care information from several provinces and lack of comparable data on health services across provinces where they exist;
• Tension between supporting Theme 3 research within other Institutes and maintaining strategic initiatives of IHSPR;
• Started from a lower base of support; took time and effort to compete for funding tools originally designed for biomedical research (e.g. such as the Equipments and Maintenance grants and the Team grants);
• Canada Research Chairs are less likely to go to health services investigators because their departmental "homes" are generally less well integrated and weaker within university hierarchies;
• Inadequate attention to primary care research;
• Inability to link health services data across time and place;
• Inadequate attention to variations in health services, case-mix adjusted.

Balance Between Open and Targeted Competition Systems

• Initiated the move from 80/20 to 100/0 decision on distribution of open competition funding which has resulted in a more equitable distribution of open competition funding.

Specific and General Recommendations

• Stabilize health services research capacity by filling the gap in salary funding between new investigators and Canada Research Chairs;
• Catalyze the development of a national health system database (e.g. 5% sample) designed on models working in Manitoba and British Columbia that would capture health care utilization including primary care, specialty care, inpatient care, pharmaceutical use, and other services, expenditures, and clinical data across services and over time;
• Catalyze development of academic centers/units for health services research; consideration should be given to establishing strong academic units, centers or schools to help attract researchers and obtain Research Chairs;
• The IHSPR and IPPH are both individual Institutes and two of the four pillars that are supposed to be integrated into each of the 13 Institutes. Thus, these two Institutes have "double duty" to serve across Institutes and strengthen their individual strategic agendas. Additional resources at the CIHR level to guide the work of the integration of pillars within each of the Institutes would relieve some of this burden;
• Permit carry-over of unspent grant money;
• Build the base for primary care knowledge generation;
• Institute staff need to have permanent positions without risk of geographic displacement when Scientific Directors change, and Scientific Director terms need to be extended;
• Participate in discussions of impact of privacy policy on research capabilities, particularly use of existing databases;
• More emphasis on tracking and reporting on research products and impact.

Summary

The review team was very impressed with the agenda and strategic planning that the IHSPR has undertaken in a very short time. We support their efforts with the very highest levels of enthusiasm. We are impressed with its accomplishments to date and look forward to its future.

The review panel suggests the following four opportunities for the future of the Institute:

1. Creation of a national health services database; and work on making provincial health system data comparable;
2. Cross provincial analysis of variations in provision of care and health outcomes, controlling for case-mix, learning from innovations in provinces that can generally apply;
3. Support research on integration of care including primary care, community care, tertiary care, pharmacy, and social sector;
4. Forecast need for health professionals (primary care, specialty care, nurses, others).

The overall impression of this Institute by the review team is to retain status quo in administrative structures while providing added resources to enhance the ability of the Center to foster Theme 3 and contributing to Theme 3 foci in other Institutes.

Institute of Human Development, Child and Youth Health (IHDCYH)

Breadth of Research in This Area

Mandate of Institute: To support research to enhance maternal, child, and youth health and to address causes, prevention, screening, diagnosis, treatment, short- and long-term support needs, and palliation for a wide range of health concerns associated with reproduction, early development, childhood, and adolescence (note: this mandate is extremely broad and achieving success across this breadth demands collaboration with other Institutes).

Status of This Area of Research in Canada

The overall status in this area is good. Canada is an international leader in many important areas of this field such as developmental origins of health and disease, developmental neuroscience, child development, the social determinants of child health and life course epidemiology.

A great deal of multidisciplinary research is already being done in this field, largely due to the efforts of, initially, the Canadian Institutes For Advanced Research (Fraser Mustard) and now provincial groups as well as IHDCYH. However, the challenge faced with this abundance of broad multidisciplinary research will be to maintain and increase the depth of the research being done and to ensure that the new knowledge created underpins provincial and federal policy-making not just in health, but in education and other portfolios. How this is done challenges traditional linkages (e.g. CIHR to health). The Institute has identified new strategic areas to further strengthen the research landscape in the area (see comments on gaps in research below), although the lack of population data in establishing priorities was noted.

Some provinces (BC, Manitoba, Quebec) are more advanced than others and these are also the provinces which have powerful large population databases which support this research area. There is a need for better population data across all Canada, not just in this area but across all health, demographic and risk factor groups and to enhance pillars two, three and four.

Transformative Features of This Health Research Area

The Institute has encouraged collaboration across disciplines and has provided funding for research in pillars three and four which previously had little opportunity for CIHR funding. A new peer review Child Health committee has been effective in addressing gaps and allows researchers the security of having their applications properly reviewed. Both basic and social scientists appeared to be excited about the opportunities for their research from these new collaborations.

IHDCYH has launched innovative initiatives such as the New Investigator program in partnership with the SickKids Foundation and the Start-Up Grants for new PIs. The Institute has developed partnership with some outside Canadian and international partners as well as with other CIHR Institutes (e.g. the RFAs on obesity and asthma). Proposed RFAs with the CIHR's Institute of Aboriginal Peoples' Health and the Inuit and Aboriginal Health Agency continue this novel approach.

The RFA in asthma and air quality incorporates innovative ways to integrate knowledge translation with relevant end-user, policy and community groups (for example regulatory agencies) co-funding the RFA and hence having a stake in using the results. The RFA in partnership with the Canadian Paediatrics Society is an excellent example of KT research, investigating whether paediatricians use treatment guidelines and why or why not.

Status of Open and Targeted Competition Systems in This Area of Health Research

IHDCYH currently participates in the open competition through its new Investigator Program for child health research and its start-up grants for new PIs. These grants both fund applications above 3.5, but below the funding cut-off, providing additional opportunities for new investigators in this field. In addition, the Institute has created a new peer review panel, the Children's Health committee, to ensure the fair evaluation of the applications in this area as well as the allotment of CIHR funds to this research.

Status of Training Systems in This Area of Health Research

Training in this area of health research was deemed to be acceptable. The Institute was concerned about support for clinician scientists with a conflict between clinical time, paid by the province, and research time, paid by the federal government. This causes conflict as it does not allow CIHR to buy time for clinicians to do research as it would for teaching staff for example. More emphasis should be put on the training of mid-career researchers at CIHR. The possibility of training and support for multidisciplinary collaborations should be considered.

Status of the Institute of Human Development, Child and Youth Health (IHDCYH) including recommendations

The Institute is doing well in terms of the CIHR mandate across all four pillars with evidence of increasing collaboration across disciplines, which was obviously exciting for many younger scientists we interviewed. The Institute should be encouraged to maintain this momentum. The relative neglect of birth defects research and prevention, given the outstanding fetal alcohol research going on in Canada, was noted. Similarly, child, adolescent and parental mental health was also neglected; linkages with other Institutes programs (IAPH, IG, IPPH, INMHA) is recommended to ensure that such important priorities are researched. Some of the younger basic scientists mentioned that underfunded collaborative grants do not adequately support them as PIs (reminiscent of the undervaluing of biostatisticians in the past!). The transition to a new Director was obviously difficult and raises generic issues for CIHR concerning the handover to new teams and the need for support for the new staff and some corporate memory to be maintained.

Working with other Institutes and external agencies (Provincial health and other bureaucracies such as education, disability and family services) should be encouraged. Sharing and enhancing KT models and activities could be fruitful, as there appears to be considerable confusion across pillars as to what KT is. The ethics agenda appears limited to some aspects of cohort studies with little other successful activities, in spite of significant ethical issues around reproduction, early life decisions and genetic screening. This may relate to the small ethics research capacity in Canada. Ways to enhance this via CIHR and others should be encouraged. This Institute, along with Public Health should, with others outside CIHR, champion the collection, linkage and analysis and protect the privacy of, population data nationally, along the lines of the excellent models which already exist in Manitoba, BC and Quebec. Such data enable epidemiological analyses, objective priority setting, elucidation of causal pathways and the evaluation of clinical and population care, with scientific rigour and lack of bias.

Institute of Infection and Immunity (III)

Breadth of Research in This Area

Mandate of Institute: To support research to enhance immune-mediated health and to reduce the burden of infectious disease, immune-mediated disease, and allergy through prevention strategies, screening, diagnosis, treatment, support systems, and palliation.

Status of This Area of Health Research in Canada

The research in Infection and Immunity in Canada is very well developed. There is a large, mature group of seasoned investigators who appear to have embraced the CIHR model. There is very considerable strength in pillar one in particular and good bridging between this basic science and clinical epidemiology. The Scientific Director clearly leads by example and has the confidence of much of the community. This is an example where Knowledge Transfer has worked very well and has provided rapid responses to a range of public health requirements.

Important limitations in this area of research include the challenges associated with succession, particularly given the strength of the current Scientific Director. More clarity about the ownership of panels and resourcing of those panels is required and there is clearly a problem identified by this group about how resources for strategic and open competitions are agreed. There are also questions about the process of establishing new panels as this group had requested several new panels be developed and received no response in the context of more than 20 other new panels being established. Clarity on process here should be important.

Finally, there is not yet a significant issue in the area of autoimmunity that has wide and important health care impact.

Transformative Features in This Health Research Area

They have been, in particular, the major projects in response to infectious diseases that have important public health implications. Work on food and water purity, SARS, avian flu and prion-mediated disease are all excellent examples of how the research strengths of this Institute and its related community can have a profound impact on the health care system in Canada. It would appear that the health care system may now be dependent on this Institute's leadership to make crucial decisions about its response to a range of infectious pathogens and, in this context, those decisions are likely to be much more soundly based on evidence.

There has been year-on-year growth in the number of investigators and grants funded in this area and the Institute has identified a series of strategic priorities that are both acute and more long-standing.

The Institute has made significant strides in integrating ethical issues in the important scientific challenges presented in areas such as SARS, water safety and HIV prevention and treatment. Its Institute Advisory Board (IAB) has included expertise from the bioethics community and should be a model that can be replicated. It is clear that here, as elsewhere, the Research Ethics Board (REB) system is potentially disabling to clinical research.

The central funding for training that is provided to the Institute has been of benefit. The consolidation of programs for training into larger thematic training schemes is viewed to be a significant new benefit as it allows one strong training scheme often to replace several small, less substantial and effective programs (e.g. HepC).

Recommendations

Convergence of leadership provided both for the Institute and for the open competition system. This could achieve the necessary accountability and would leave the constituency largely responsible for taking decisions about allocation of funds between programs. It is clear that processes are not in place to deliberate equitably and effectively between a range of strategic opportunities presented to CIHR, including those associated with major public health challenges. We believe that, in a number of areas including allocation of resources to strategic versus open competitions and in such issues as the establishment of new panels, the lack of a transparent and agreed process will be limiting. This has clearly led to some disillusionment in the scientific community about the role of strategic research. This could be quickly rectified. On balance, however, this Institute has been very successful and should take a larger role in the deliberations about Infection and Immunity funding across the whole of CIHR.

Institute of Musculoskeletal Health and Arthritis (IMHA)

Breadth of Research in This Area

Mandate of Institute: IMHA's vision is to sustain health and enhance quality of life by eradicating the pain, suffering and disability caused by arthritis, musculoskeletal, oral and skin conditions.

Status of This Area of Health Research in Canada

Overall Impression:

• The overall impression of this Institute is good.

Key Strengths:

• Success in partnering with other organizations and industry;
• Integration of representatives from the research community;
• Excellence;
• Having an administrative model where the Assistant Director is based in Ottawa (maintains corporate history when the Scientific Director changes);
• New programs developed: (1) that increase research in health services; (2) across pillars; (3) that embrace diverse research communities;
• KT mechanism established (oral health prevention);
• Well defined short- and long-term strategic plan which identifies approaches to meet goals.

Key Weaknesses:

• Turnover of Scientific Directors and members of their IABs;
• Communication across Institutes and with the research community (e.g., complexity of CIHR website);
• The peer review committees with small research communities have difficulties recruiting and assigning reviewers due to many conflicts of interest and "burn-out";
• Not enough activities in all pillars;
• Lack of clarity of the relationships across funding programs.

Recommendations for Future Strategy in This Health Research Area:

• Better definition of goals;
• CIHR should develop metrics for assessing;
• Accomplishments and achieving goals;
• Assessing quality of science;
• Demographics;
• Clarify relationships to other funding sources;
• Improve KT to community;
• Improve the review process;
• Expand the capacity for training and career pathways.

Transformative Features of This Health Research Area

There has been considerable progress towards broadening the discipline base, particularly in the areas of skin, oral health and rehabilitation and a very considerable effort into integrating research across four pillars. Knowledge Transfer integration and action has been high, although the metrics for KT are not clearly defined. Ethics needs further development.

Status of Open and Targeted Competition Systems in This Area of Health Research

Only minor changes are needed here, but concern was expressed about the problems with the peer review process which is clearly under strain.

Status of the Institute of Musculoskeletal Health and Arthritis (IMHA)

Overall, the performance of this Institute has been high. There are clearly opportunities for the future in expanding knowledge translation and expanding partnerships with industry and other organizations. The training programs could continue to expand and capacity in some of the specialty areas also needs further work. The Ethics program also could be further developed. In general, however, the impression of this Institute is very good.

Institute of Neurosciences, Mental Health and Addiction (INMHA)

Breadth of Research in This Area

Mandate of Institute: To support research to enhance mental health, neurological health, vision, hearing, and cognitive functioning and to reduce the burden of related disorders through prevention strategies, screening, diagnosis, treatment, support systems, and palliation.

Status of This Area of Health Research in Canada

Overall Impression:

• The overall impression of the review team is excellent.

Key Strengths:

• Integration of research across pillars and content areas (e.g., neuroethics);
• Delivery across diverse societal and cultural groups;
• Excellence and quantity of research productivity;
• Commercialization of scientific discovery.

Key Weaknesses:

• Inability to fully realize strategic opportunities due to: (1) insufficent funds (imbalance between research capacity and resources); (2) young investigators pool; (3) dropout of mid-career scientists; (4) potential fragmentation of integrated programs.
• Lack of coordination with other canadian funding programs.

Recommendations for Future Strategy in This Health Research Area:

• Increased funding to meet needs of a large, diverse and productive research community;
• Improved alignment and integration with partnership, with CFI and other programs;
• Involve consumers and professional groups;
• Improved reporting documentation of research and translational accomplishments (document return on investment).

Future Opportunities:

• Expand integration beween biomedical research, clinical health services and population health programs;
• Outreach and interaction with international community;
• Partnerships with industry;
• Involvement with consumer community.

Transformative Features of This Health Research Area

There has been considerable progress in broadening the discipline base and ensuring integration across the pillars. The strategic research priorities have been clearly laid out and the performance in delivering these have been high. KT has been thoroughly integrated and acted upon in many settings and Ethics has remained a strong feature of the program.

Status of Open and Targeted Competition Systems in This Area of Health Research

This is an example where self-affiliated researchers have an allegiance with the Institute, perhaps in part because the Scientific Director has maintained good communication with these researchers. The open competition appears to require no modification although there is a need for a system for setting priorities for funding.

Status of Training Systems in This Area of Health Research

The training in this area is a very good model for integration across pillars and Institutes and on the whole, no changes are recommended. The training systems are diverse within this Institute and appear to be robust.

Status of the Institute of Neurosciences, Mental Health and Addiction (INMHA)

Overall, the Review Panel was very impressed by the performance of this Institute; it was clearly capable of responding effectively and the Scientific Director has done an outstanding job in creating programs, meeting the mandate of the Institute and working across disciplines. Opportunities exist in the future for alignment with other programs including those with Canada Foundation for Innovation (CFI) and increased involvement with consumers and professional organizations. Improved reporting of research and translational accomplishments need to be a future objective. This is the largest area of biomedical research in Canada including in the open competitions and appears to be operating in an extremely coherent way, in part because the Institute has taken some responsibility for activities within the open competitions.

Institute of Nutrition, Metabolism and Diabetes (INMD)

Breadth of Research in This Area

Mandate of Institute: Focuses on enhancing health, as it pertains to diet, digestion, excretion, and metabolism; and to address causes, prevention, screening, diagnosis, treatment, support systems, and palliation for a wide range of conditions and problems associated with hormone, digestive system, kidney and liver function.

SD and IAB have made the decision to create a single strategic research priority: Excellence, Innovation and Advancement in the Study of Obesity and Healthy Body Weight.

Status of This Area of Health Research in Canada

This is not a particularly advanced research area in Canada, with some exceptions such as the Quebec cohort study and the Laval University satiety study. For this reason, the decision that the Institute would focus primarily on obesity appears to be sensible. The leadership of this Institute is strong with a highly effective Scientific Director, a strong IAB and good peer reviewers. Strategic initiatives have been adequately funded to date.

Transformative Features and Weaknesses of This Health Research Area

A major focus on interdisciplinary research has led to 61% of the projects in this category. The Institute has a strategic initiative that will help build capacity in one major area.

There are several aspects on the Institute that need to be further developed. There has been no serious relationship with pharma and biotech companies in this fertile area for external relationships and leverage has been less than optimal. Funding of new investigators appears to be inadequate and there has been no attention paid to the ethics related to the stigma issue of obesity. Importantly, there is no serious fundamental basic research in this area of merit as yet and this is a serious limitation.

Status of Open and Targeted Competition Systems in This Area of Health Research

The open competitions have not been able to fund all high scoring qualifying grants while the strategic competition is adequately funded. This raises questions about how this balance was struck, particularly in the light of weak basic science in this area.

Status of Training Systems in This Area of Health Research

Minor changes are needed. Training approaches appear appropriate to the varied audiences involved in this program. Young Investigators need more support particularly in the start-up phase.

Future Opportunities

A continued focus on this area of strength is wholly appropriate and there needs to be expansion into other priority areas within the mandate and expansion of KT as funded research matures. Ethics needs to be further developed. The major question for this Institute is whether the singular focus on obesity can and should be maintained now into the future. More effort also has to be made in evaluation of the research that is already funded. The lack of support for pillar 1 investigators is probably inappropriate given the importance of this field in better understanding of disease pathogenesis.

Institute of Population and Public Health (IPPH)

Mission

The stated mission of the Institute is "to support research into the complex interactions (biological, social, cultural, environmental) which determine the health of individuals, communities and global populations; and the application of that knowledge to improve the health of both populations and individuals, through strategic partnerships with population and public health stakeholders, and innovative research funding programs." Its focus on population is critical for informed health policy. Decision-making for health requires knowledge about the extent and distribution of risks in populations rather than in individuals, because policy-making must take into account the frequency of problems in populations and subpopulations as well as the magnitude of the contribution of each one to ill health.

While Canada has had some very strong population health programs in individual provinces and universities, there are no national or provincial academic structures dedicated to public or population health. There are few universities in which the basic public health disciplines are taught, few people trained at the doctoral level in public health. Therefore, there is no unified advocacy group for public health or population sciences. Canada, however, has been an intellectual leader in the area of Population Health. Starting with the Lalonde report and continuing with Population Health and Human Development Programs developed at the Canadian Institute for Advanced Research, Canada has led the international community in advancing ideas related to Population Health. This Institute represents one of the first national efforts to institutionalize this important sector of research.

The IPPH has made an important contribution to expanding public health and population-based research by means of its programs, building capacity in investigators trained in public health, and by its collaborations with other Institutes and government agencies, and has elevated population health issues to a higher level of interest and immediacy.

Accomplishments

The key accomplishments the review committee found were:

• In a short time, the IPPH has had a significant impact on capacity building in population sciences, and on articulation of population health principles that are being integrated into the programs of other research Institutes;
• Created seven interdisciplinary centres, three of which are located in underserved regions of Canada;
• Supports the research of important cohort studies on health during the life course, namely the Canadian Lifelong Health Initiative that will tell us much about development and aging;
• Delineated deficiencies in the public health systems of Canada prior to SARS and deficiencies in as well as potentials for use of databases in population-based health and health services;
• Provides Canadian scientific leadership to a global health collaborative initiative with scientists in developing countries.

Key Strengths

• Strong leadership by its Director;
• Interdisciplinary focus;
• Good linkages to the Health Services Institute, and Public Health Agency and universities;
• Has begun to develop important linkages between public health practice and scholarship in universities.

Key Weaknesses

• Can fund innovation only on a small scale;
• Cannot go to scale in program projects, e.g. linking biology with population sciences;
• Unable to fund adequately cross-cutting initiatives in health disparities, due to lack of a unity of focus across a myriad of interest groups, and lack of data within and across provinces;
• Absence of cohort studies and funding limit studies of gene/environment interactions, a major priority in population sciences;
• Needs to make a greater distinction between population health focused on aggregations at the individual level (e.g. social determinants of health) and public health with a population focus (e.g. societal determinants of health);
• Interactions between social and population sciences are good, but the IPPH would welcome more input and interaction with biological sciences.

Balance Between Open and Targeted Competition Systems

• The review group believed that the balance was appropriate, but noted that with the level of available funding, larger multidisciplinary projects were unlikely to be funded, and yet are crucial in the population sciences.
• The Institute has little "ownership" of research funded in the Open Competition system, and no ability to shape research priorities beyond the strategic funding initiatives.

Ethical Concerns

• While ethical issues were not part of the discussion, the issue of regulations on privacy of health and other population records was. Population sciences have the potential to link medical and social and economic data and study the social and environmental determinants of ill health. Yet concerns were raised that unless careful planning were done, privacy regulations might make it impossible to carry out many important population-based studies of risks to health.

Specific and General Recommendations

• IPPH needs the capacity to fund large grants that support interdisciplinary work and to take on large scale studies and program projects integrating biology, epidemiology and social sciences to address population health issues.
• In the area of training, there appears to be a high demand for its training programs, but consideration should be given to establishing schools of public health or other formal training incorporating all the disciplines relevant to rigorous training in population and public health, and public health practice.
• Capacity to respond to new challenges is limited. The available resources are well used, but limit opportunities, and consideration should be given to increasing resources for this Institute.
• A concern raised was that while there was support for new investigators, and through panels for outstanding senior investigators, there was a potential gap in mid-career support that needs to be considered.
• There is a need to increase communication with other agencies about the mandate and programs of the CIHR in general, and the IPPH. Consideration should be given to the CIHR creating a professional communications program to make the contributions better known to policy-makers and the public.
• Canada has some of the richest data on population health in the world, yet access to provincial health data is highly restricted and unavailable to many competent researchers in population, health policy and health services. A major effort should be made to make these databases available for study and research through a central mechanism and at reasonable price. Further, it should be possible to link databases for public health, health care outcomes, adverse effects and costs to create useful linked databases for the nation. There is value on the CIHR directing greater attention to developing appropriate metrics for health that will allow databases to be amenable to uniform study and evaluation. Much knowledge paid for by the public of Canada is not being used to the maximum to create knowledge, best practices and cost savings.
• Greater attention should be given to evaluation of research funded in the Open Competition and strategic initiatives, and to communicating the results of the research electronically to interested audiences.

Summary

The review team was very impressed with the agenda and strategic planning that the IPPH has undertaken in a very short time. They are making excellent progress in accomplishing their primary aims. While many other Institutes benefit from the long-term support of previous Medical Research Council (MRC) collaborations, the IPPH has started to build with only the basic building blocks for an Institute. We support their efforts with the very highest levels of enthusiasm. Additionally, the IPPH has made excellent use of collaborations with other agencies and programs. Their work with the Public Health Agency holds great promise for integrating research and practice activities for Population and Public Health across Canada. Similarly, they seem to have solid relationships with investigators funded through the open competitions of CIHR. Canada has taken a bold leadership role in the conceptual development of identifying determinants of population health. The IPPH is in many ways the incarnation of this idea. We are impressed with its accomplishments to date and look forward to its future.