It’s time to invest in long-term vision and continuity
Nicole Letourneau and Isabelle Malhamé
QUOI Media
Canada invests a lot of money in health research – but are we spending it wisely?
The Canadian Institutes of Health Research (CIHR) alone receives over $1B per year with 95 per cent going directly to grants and awards for heath projects. Much progress has been made in developing the national health research infrastructure, with an increasing emphasis on ensuring research positively impacts people living in Canada. This aligns with CIHR’s stated purpose of translating research into real-world benefits, including improved health, better services and a stronger health care system for Canadians – that’s good news.
In recent years, CIHR has funded several Health Research Training Platforms focused on meeting an expanded definition of excellence that focuses on relationships and training to improve a variety of health outcomes and transform our health systems.
The platforms, embedded in health and social services systems, aim to train future health researchers, clinicians and service providers for optimal impact in real-world settings. It’s a terrific made-in-Canada marriage of research with community partnership.
But a troubling recurrent pattern occurs: these new teams just get off the ground, and then the funding soon ends, before the impacts can be fully realized. Systematically favouring novelty too often results in the widespread and devastating dismantling of fledgling teams.
Integrated health research, knowledge mobilization and training teams need time to achieve and sustain the impacts they are starting to see. Meaningful relationship building and engagement between researchers, health service providers and the public requires time and consistency.
In other words, Canada continues to be a great land for pilot projects – strong on innovation. But we have a sustainability problem. We need to invest in long-term vision and continuity, so that our research dollars can have full impact.
An improved focus on sustainability of impact requires a new way of evaluating and supporting research. We need to provide greater opportunities for existing research, knowledge mobilization and training programs to carry on. Every time a research team has to end for lack of funding, thoughtfully crafted engagement approaches, progressive team-building and steady progress around the programs designed for impact is lost.
Importantly, health disparities and unmet needs faced by certain communities require meaningful, sustained and non-sporadic funding to support collaborative research among health care providers, researchers and community members.
Short-term research horizons also erode public trust that can fundamentally undermine the scientific enterprise in health. The perception that emerges from key community and patient partners when the funding ends before impacts are realized, let along sustained, is that “science is a waste of time.” It can also give the impression that research dollars would be better spent if they were redeployed to clinical practice and health care.
It’s also hard on researchers. Out of frustration, with a system designed to fail, researchers may deliberately step away from doing the science and halt the momentum that may have taken decades to build.
Importantly, we also need to consider how the health of Canadians may be undermined because a team folded too soon. Before we let a research team flounder and ultimately be destroyed for lack of funding, we need to give them opportunities to make the case for sustainability.
A key question when determining the end of funding ought to be: “How many people would be impacted if this research or training stopped?”
Of course, there are risks with prioritizing longer-term horizons for research projects, such as creating a monopoly on funding and prioritizing resources for more established groups. So, a focus on sustainability must also be accompanied by a wider reflection on the development of policies and governance structures built on principles of equity, diversity and inclusion and encourage rotating leadership roles.
We also need to ensure that early career researchers are at the forefront and build career pathways for new leaders and leadership teams, including projects with a long-term horizon.
It’s time to support quality, implementation and sustainability in funding health science. Keeping health research viable over the long-term will help improve the quality of the science – and the health system. Canadians deserve no less.
Dr. Nicole Letourneau is a professor in the Faculty of Nursing and Cumming School of Medicine (Pediatrics, Psychiatry and Community Health Sciences) at the University of Calgary. Dr. Isabelle Malhamé is an obstetric internist and an associate professor in the Departments of Medicine and Obstetrics & Gynaecology of Université de Montréal.
