Health research and indigenous health

Short abstract

In 2002 Australia, Canada, and New Zealand signed a tripartite memorandum of understanding on health research for indigenous health for the purpose of sharing expertise on the “purchase” of health research. Later this year the agreement will be augmented at a meeting to be held in Townsville, Australia

Health research has much to contribute to improving health and research outcomes for indigenous populations. Although indigenous approaches to knowledge and learning may challenge Western orthodoxy, there is growing evidence of the value of investing in specific research projects and in capacity building for researchers of indigenous origin. Indigenous researchers are important contributors, but mainstream research can make substantive contributions if the requirements for responsiveness to the needs and expectations of indigenous populations are carefully implemented. In a policy environment three conditions—clear direction, dedicated funding, and processes governed by indigenous people—are needed to identify and enhance the quality, relevance, and responsiveness of grant applications by all researchers.

In 2002 Australia, Canada, and New Zealand signed a tripartite memorandum of understanding on health research for indigenous health. All three countries fund research centrally through contestable grant rounds; they have considerable indigenous populations, whose health outcomes are poorer than those in non-indigenous populations; and they have developing sectors of indigenous researchers alongside Western oriented researchers. The purpose of this agreement is to share expertise on the “purchase” (funding) of health research and to develop policy for collaborative research between the three countries, including sponsoring placements of individuals, funding international research projects, and supporting other collaborative research relationships. In November 2003, this agreement will be developed at a meeting to be held in Townsville, Australia.

Australia

In Australia the National Health and Medical Research Council (www.health.gov.au/nhmrc) has as its main objective to “advise the Australian community on the achievement and maintenance of the highest practicable standards of individual and public health, and to foster research in the interests of improving those standards.”¹ The council currently fosters this objective through three primary programmes—advice (Health Advice Committee), ethics (Australian Health Ethics Committee), and research (Research Committee). The council has been active in relation to the health of Aboriginal and Torres Strait Islanders, and a recommendation in May 2000 that “for the next five years the Commonwealth ensure the National Health and Medical Research Council allocate at least five percent of total annual research funding for Indigenous health research” has served as a catalyst for further developments.² Although there have been no legislative changes to the 1992 National Health and Medical Research Council Act, activity in and funding of indigenous health research have increased across strategic and ongoing peer reviewed programme and project grant schemes. In these grant schemes the criteria for Aboriginal and Torres Strait Islander health research are applied through the work of the indigenous health research panel to assess the extent to which these grants contribute to sustainable, transferable health developments in partnership with local and other indigenous communities. In the past year more than 5% of project grants funding was allocated to the area of indigenous health. Capacity building activities to support and enhance the development of indigenous researchers have been furthered through postgraduate indigenous health scholarships, priority indigenous health postdoctoral fellowships, and the awarding of a sizeable population health capacity building grant in the area of indigenous health research.

Figure 1.

The National Aboriginal Community Controlled Health Organisations are aiming to reduce health disparities

Credit: TAIT SCHMAAL/NEWSPIX

As we begin the 2003-6 triennium the National Health and Medical Research Council has agreed to allocate at least 5% of research funding to the area of indigenous health and has considerably increased representation on the council and its principal committees. In previous years the council had a single indigenous representative; now, the council and each of the three principal committees are to have two indigenous representatives, bringing to eight the number of people with expertise in this area who are directly involved in the council's core business. A broader Indigenous Health Forum will provide further advice directly to the council, and an Indigenous Health Research Subcommittee will advise the research committee about specific activities in relation to funding allocations from the medical research endowment account.

These developments have been shaped by two processes of consultation with indigenous communities conducted during 2000-3. In October 2002 the council endorsed the NHMRC Roadmap for action.³,⁴ This document was the result of national consultation with indigenous communities, researchers, and health policy makers about the role and priorities for research in relation to indigenous health. In June 2003 the council endorsed Values and Ethics: Guidelines for Ethical Conduct in Aboriginal and Torres Strait Islander Health Research.⁵,⁶ These ethical guidelines replace and build on the 1991 interim guidelines on ethical matters in Aboriginal and Torres Strait Islander health research.⁷

Canada

In Canada, the Institute of Aboriginal Peoples' Health was established in June 2000, along with 12 other Canadian Institutes of Health Research (www.cihrirsc.gc.ca). All 13 institutes are located in academic institutions as part of a virtual network across Canada that works in collaboration with the corporate headquarters in Ottawa. The scientific director of the Institute of Aboriginal Peoples' Health, who is currently located at the University of Toronto, receives strategic planning advice and support from a 16 member advisory board.

The institute is pursuing ambitious goals to improve the health and wellbeing of aboriginal people in every part of Canada by stimulating aboriginal health research, creating new knowledge, forming research partnerships with organisations in Canada and abroad, and respectfully involving aboriginal communities in every project it undertakes. Its role is to advance a national research agenda in the area of aboriginal health and promote innovative research to improve the health of aboriginal people in Canada. The institute accomplishes its task by supporting and promoting research that has a positive impact on the mental, physical, emotional, and spiritual health of aboriginal people at all life stages.

Figure 2.

The formation of Canada's Inuit-led territory of Nunavut in 1999 heralded initiatives to improve the health and wellbeing of aboriginal people in every part of Canada

Credit: SHAUN BEST/AP

The institute strives to improve the health of First Nations, Inuit, and Métis people by supporting innovative research programmes based on scientific excellence and aboriginal community collaboration. It has a lead role in building research capacity in these communities, and supports partnerships and alliances between aboriginal communities and non-aboriginal health research organisations and institutes. The core values which guide the institute include:

• Presenting health research results to aboriginal people in a way that is accessible, appropriate, and easily understood

• Including aboriginal people in all health research activities

• Sharing new knowledge with all research partners

• Conducting all activities and business in a transparent manner

A particular priority of the institute, relevant to the tripartite agreement, is international research recognising and exploring the commonalities in health concerns among indigenous populations worldwide.

To meet all these objectives, the Institute of Aboriginal Peoples' Health helped set up a network of research environments institutes to address national and regional research needs. The network falls under the umbrella of ACADRE, the Aboriginal Capacity and Developmental Research Environments programme.⁸ The network has eight centres across the country, all based at academic centres and each has a volunteer advisory board, with a majority membership from aboriginal people drawn from each region. Although investigators are encouraged to submit proposals focused on the aboriginal community to the open competitions run by the Canadian Institutes of Health Research, it is through these centres that much of the health research of aboriginal populations is beginning to be organised.

New Zealand

In New Zealand, the Health Research Council (www.hrc.govt.nz) has, since its formation in 1991, had a legislative requirement to purchase research for the Maori population. It has a statutory committee on Maori health, which is empowered to review and fund research applications; two of the 10 members of the governing board are Maori, and a further member is a kaumatua (cultural elder); the secretariat has a Maori research manager. The government has identified a modest, dedicated fund for Maori development research (research under Maori control which seeks to support health and development outcomes for Maori) to augment the “public good health research” budget. Progress has been carefully guided by a number of senior Maori health specialists who have been board members, notably the late Professor Eru Pomare, the late Hohua Tutangaehe, and the late Dr Erihapeti Murchie. A strategic plan and guidelines for researchers have been developed.⁹,¹⁰

After a reasonable lead-in time, this investment is showing results. Funding research in a new area can increase the risk of not achieving the desired objectives, yet New Zealand's policies are showing strong results. Ten Maori PhDs have graduated from the Health Research Council's career development award programme (which now invests $1m a year); four Maori health research centres have received developmental funding, and one of these has recently secured ongoing programme funding, in open competition in the council's most competitive year to date.

Many challenges remain. Arguably the Maori research sector is too small to operate independent peer review—the backbone of the Health Research Council's internationally recognised assessment process. Maori trainees are keenly sought by the public sector and other research sectors in New Zealand, making retention within health research problematic. Methodologies for and approaches to research on Maori health are still in the developmental phase, and no definitive text on Maori health research exists, although some are in development. Because Maori research priorities are so numerous, expectations on research and researchers quickly become daunting.

Ultimately Maori researchers will demand a dedicated purchase agency, where Maori methodologies and world views are orthodox, where Maori assessment processes (including meeting Maori ethical standards) are fundamental, and where collective, culturally based prioritisation and assessment processes prevail. Until then New Zealand's Health Research Council will continue its leadership role in partnership with Maori, and increasingly in partnership with both the Australian National Health and Medical Research Council and the Canadian Institutes of Health Research.

Figure 3.

Maori health services have moved on since a special Maori nursing scheme was established early in the 1900s

Credit: ARCHIVES NEW ZEALAND

Summary points

Australia, Canada, and New Zealand are taking similar approaches to purchasing health research for the improvement of indigenous health

Australia's National Health and Medical Research Council will allocate at least 5% of research funding to indigenous health

In Canada, the network of institutes set up by the Institute of Aboriginal Peoples' Health is organising much of the health research of aboriginal populations

New Zealand's Health Research Council has been purchasing research for the Maori population since 1991