Action Plan: Building a healthier future for First Nations, Inuit, and Métis Peoples

Progress by commitment

1. Increase its capacity to interact with Indigenous communities in a culturally appropriate manner, through the creation of a dedicated team assigned to work directly with Indigenous Peoples, researchers, and communities

   The selection process for the new Institute of Indigenous People's Health (IIPH) Scientific Director (SD) started with the establishment of an Advisory Circle grounded in Indigenous ways of knowing, being and doing. The post was advertised through an open competition.

   CIHR and its Institutes have built and strengthened internal capacity related to Indigenous (First Nations, Inuit and Métis) engagement best practices. For example, the Institute of Infection and Immunity (III) consulted resources and local communities for recommendations related to Elder engagement.

2. Ensure that the Federal Government is made aware that the membership of CIHR's Governing Council should reflect the diversity of Indigenous Peoples in Canada

   CIHR continues to work with other federal government departments to encourage the inclusion of representatives of the Indigenous community.

   The Institute of Nutrition, Metabolism and Diabetes recruited new Indigenous members for the Institute Advisory Board (IAB) and the III has been seeking Indigenous research representative(s) for the III IAB.

   The CIHR Indigenous Health Research (IHR) team continued to support building IHR capacity across the organization to enable meaningful engagements with Indigenous Peoples, researchers and communities.

3. Accept the definition of "Indigenous health research" as drafted by the Institute of Indigenous Peoples' Health in consultation with Indigenous stakeholders

   The definition of IHR continues to be used in funding opportunities specific to IHR or with an IHR pool or potential for IHR. It is also used as a basis to determine a project relevancy to IHR.

4. Develop, in collaboration with the newly appointed Institute Advisory Board on Indigenous Peoples' Health, performance indicators to validate CIHR investments in Indigenous health research

   The CIHR Performance and Results Unit in collaboration with respective Branches has ensured reliable indicators were in place to validate IHR investments and for ongoing performance monitoring of IHR endeavors.

5. Increase its investments in Indigenous health research to a minimum of 4.6% (proportional to Canada's Indigenous population) of CIHR's annual budget

   In 2022-23, the estimated IHR investments reached 4.7% of CIHR's total Grants and Awards annual expenditures.

6. Seek to grow these investments as research capacity and additional financial resources allow

   The 13 Institutes of CIHR contribute to IHR priorities. The CIHR HIV/AIDS and STBBI Research Initiative Strategic Plan 2022-2027 was launched on April 28, 2022, which will support research and knowledge mobilization approaches of Indigenous Peoples by prioritizing Indigenous-led research, fostering self-determination, and enabling distinction-based approaches.

   In June 2022, the CIHR Institute of Circulatory and Respiratory Health has launched the Strategic Plan 2022–2025, Partnerships for Better Health with a Foundational Theme on Strengthening Indigenous Health Research to champion research led by Indigenous Peoples and culturally safe engagement with Indigenous communities.

7. Continue working with the Reference Group on Indigenous Health Research to implement iterative peer review processes for applications relevant to Indigenous health, so as to ensure better success rates for Indigenous-focused investigator-initiated grant applications

   A set of guiding principles for the appropriate review of Indigenous research was developed in July 2022 by Reference Group Members (i.e. ensuring a greater understanding of community in academic research; maintaining ongoing and reciprocal engagements, decolonizing research to ensure is it meaningful, and developing relationships).

   In October 2022, the Reference Group made recommendations on ways to make the letters of support process more accessible and efficient. Continued discussions were held about Indigenous ways of addressing conflict of interest in peer review through a perspective focused on community reconciliation.

   In March 2023, the first in-person meeting of the Reference Group was held in Yellowknife, Northwest Territories, with a focus on unique challenges for research conducted in the North.

8. Create, with the advice of the Institute Advisory Board on Indigenous Peoples' Health, impactful strategic initiatives aimed at improving the health of Indigenous Peoples

   The Operating Grant: Diabetes, Psychosocial Health, Prevention and Self-Management was launched in June 2022. The Indigenous Youth and Young Adults (YYA) Type 2 Diabetes (T2D) Prevention and Self-Management Funding Pool funded two applications for a total investment of $1.9M.

   The CIHR HIV/AIDS and STBBI Research Initiative sponsored the 9th International Indigenous Pre-Conference on HIV and AIDS. This event was hosted in Montreal from July 26 to July 28, 2022 by four Indigenous organizations: Communities, Alliances & Networks, the International Indigenous Working Group on HIV & AIDS, the International Indigenous HIV & AIDS Community and the Southern Quebec Inuit Association.

   The Team Grant: Food Security and Climate Change in the Canadian North FO supports Indigenous-led community-driven projects relevant to food security and climate change in the Canadian North. In September 2022, 1 new team grant was successfully funded for a total investment of $1.5M over 4 years.

   In September 2022, the First Nations Information Governance Centre was successfully awarded the First Nations Biobanking and Genomic Research Grant funding opportunity, for 1 year. Tailored to the distinct needs of First Nations, the purpose of this funding opportunity is to build knowledge and capacity for informed First Nations decision-making and governance on biobanking and genomic research.

   In December 2022, the Nuu-chah-nulth Tribal Council, in partnership with First Nations Health Authority, university-based researchers from Simon Fraser University's Faculty of Health Sciences and the University of Alberta, as well as Indigenous leaders and communities, received a $16M Indigenous Healthy Life Trajectories Initiative (I-HeLTI) Cohort Grant to carry out a long-term study on improving health and wellness for children.

   The Catalyst Grant: Towards Pan-Canadian Standards for Children and Youth Mental Health Services FO led by the Institute of Neurosciences, Mental Health and Addiction, in partnership with Health Canada, funded 3 IHR-relevant applications for a total investment of $598K.

   In October 2022, 3 Healthy Cities Implementation Science Team Grants received development grants (up to $25K for one year) from the Urban Indigenous Health thematic area. At the full application stage, the Alberta First Nations Information Governance Centre was successful and received $3M from CIHR over 6 years as well as supplementary funding from Australia's National Health and Medical Research Council.

9. Hold annual meetings between the President of CIHR and leaders of the Assembly of First Nations, Inuit Tapiriit Kanatami, and the Métis National Council to discuss Indigenous health research priorities

   In June 2022, ITK became a CIHR Eligible Institutions authorized to administer grant and award funds.

   In November 2022, a Ministerial announcement for the Inuit Research Network took place at the ITK office.

10. Work with other federal research councils to develop strategies to strengthen Indigenous research capacity development through training and mentoring along the entire career continuum from undergraduate to postdoctoral levels

    The Tri-Agency Working Group on Administrative Barriers to Indigenous Community-led Research has progressed in its collaborative efforts between the Social Sciences and Humanities Research Council, the Natural Sciences and Engineering Research Council of Canada and the CIHR.

    The Tri-Agency Working Group on Indigenous Citizenship and Membership was formed and held its inaugural meeting in January 2023. The deliverables of the Working Group are: the implementation of an engagement plan; a "What We Heard" report summarizing key elements of the engagement; a policy outlining respectful ways to citizenship and membership and a supporting lexicon.

Purpose

This public report provides an update on progress made in 2021-22 in terms of the CIHR Action Plan: Building a healthier future for First Nations, Inuit and Métis Peoples (the Action Plan).

Background

Since the launch of the Action Plan in November 2016 and the CIHR Strategic Plan 2021-2031 (the Strategic Plan) in February 2021, CIHR aims to further strengthen Indigenous health research (IHR) in Canada. Within the Strategic Plan, CIHR envisions to achieve the best health for all throughout 5 Priority areas. This includes a dedicated priority, Priority C: Accelerating the Self-Determination of Indigenous Peoples in Health Research, to guide all priority areas in a distinctions-based approach to respect and uphold the right of First Nations, Inuit and Métis Peoples. Priority C confirms continued and enhanced support for IHR initiatives by embedding both the Institute of Indigenous People's Health (IIPH) Strategic Plan as well as the Action Plan. The IIPH Strategic Plan 2019-2024 is currently under review.

In June 2022, guided by colleagues from the IHR community, IIPH appointed Dr. Margo Greenwood as the IIPH interim Scientific Director. On December 1, 2022, Prime Minister Justin Trudeau appointed Dr. Greenwood to the Senate. CIHR remains committed to advancing Indigenous self-determination in health research and embedding Indigenous ways of knowing, learning and healing in our research programs. Information on the selection process for the next Scientific Director of IIPH will be shared in the coming months.

CIHR and IIPH are proud to share the progress made towards the commitments to IHR in this report, which focuses on key action areas: COVID-19 and IHR; Governance and Strategic Leadership; Community-Based Health Research; and Community and Partner Engagement.

COVID-19 and IHR

From June to October 2021, several COVID-19 funding opportunities were launched with an IHR specific pool or with IHR relevant funded applications. A few of them are highlighted below.

• the Operating Grant : COVID-19 Vaccine Confidence supports research that will inform effective strategies to improve COVID-19 vaccine confidence and in turn, uptake. 3 successful applications relevant to Indigenous Peoples have been funded.
• the Operating Grant: Emerging COVID-19 Research Gaps & Priorities is part of the Government of Canada's continued response to address the health challenges of the COVID-19 pandemic. 7 successful applications relevant to IHR have been funded.
• the Operating Grant: Addressing the Wider Health Impacts of COVID-19 funded 5 IHR grants. This funding will enable rapid and timely research responding to current and next phase wider impacts of the COVID-19 pandemic in Canada and globally.
• the Operating Grant: Indigenous COVID-19 Rapid Research Funding Opportunity (Indigenous Peoples and COVID-19 Rapid Research Operating and Knowledge Mobilization Grants Funding Opportunity) funded 15 successful applications. This opportunity will support strengths-based, solutions-focused research and knowledge mobilization that is led by Indigenous Peoples and communities.

On October 26-28, 2021, CIHR and the IIPH hosted a 3-day Virtual Knowledge Mobilization Forum on Indigenous Peoples and COVID-19. A joint session on Indigenous Peoples and COVID-19 in Canada, Australia (National Health and Medical Research Council - NHMRC), and New Zealand (Health Research Council - HRC) also took place during the forum. The report from the forum can be found on the IIPH webpage.

On January 18, 2022, CIHR hosted the Supporting the Healthy Development of Young Children Facing Health Equity Barriers in Communities in the COVID-19 Era and Beyond Best Brains Exchange (BBE) event, in collaboration with Public Health Agency of Canada (PHAC) and CIHR's Institute of Human Development, Child and Youth Health (IHDCYH). The BBE focused on identifying opportunities to improve community-level interventions and capacity-building through innovative service delivery and multisectoral partnerships, and the better integration of new research and evidence-based practices in community settings, including Indigenous communities lived experiences.

Governance and Strategic Leadership

Along with colleagues from the Social Sciences and Humanities Research Council (SSHRC), the Natural Sciences and Engineering Research Council of Canada (NSERC), and the Canadian Foundation for Innovation, CIHR supports the Canada Research Coordinating Committee's work to advance understanding of reconciliation, including the Strengthening Indigenous Research Capacity strategic plan. In February 2022, the first progress report on the implementation of the interagency strategic plan on Indigenous research and research training was released.

In March 2022, an open call was launched by CIHR, SSHRC and NSERC for Knowledge Keepers (e.g., Elders, Kitchi Anishnaabe, Grandparents) to join the membership of the Reference Group for the Appropriate Review of Indigenous Research. This Reference Group developed a set of principles to guide their work and recommendations for the appropriate review of Indigenous research.

It is a priority for CIHR to increase its capacity to interact with Indigenous communities in a culturally appropriate manner. This year, CIHR increased Indigenous employment representation and continued distinction-based training for staff to promote a culturally safe workplace to advance reconciliation with Indigenous Peoples through the Canada School of Public Service and dedicated opportunities. With these efforts and its strategic plan strategies, CIHR recognizes the unique rights, interests and circumstances of First Nations, Inuit and Métis Peoples as a central priority for achieving health equity in Canada.

Community-Based Health Research

For CIHR, impactful strategic initiatives developed by and with Indigenous Peoples are a high priority to ensure its investment in IHR reaches a minimum of 4.6% of CIHR's Grants and Awards annual budget^{Footnote 1} (proportional to Canada's Indigenous population in 2016). To calculate the percentage of investments in IHR, IHR-relevant grants and awards investments are compared against the overall CIHR grants and awards budget^{Footnote 2}. In the 2021-2022 fiscal year, CIHR increased its investment to 4.8% of CIHR's total Grants and Awards budget, which represents a total investment of over $62M in IHR funding. This consists of 144 new individual projects funded in IHR. CIHR invested a total of $11.4M in IHR COVID-19 relevant projects beginning in fiscal year 2021-22, including 43 successful grants through 7 different COVID-19 competitions and the fall Project Grant competition. Since the adoption of the Action Plan, it is the first time the goal of 4.6% is reached^{Footnote 3}.

The Network Environments for Indigenous Health Research (NEIHR), now in its third year of operations, is funding 9 NEIHR Centres and a National Coordinating Centre (NCC) to conduct health research, build capacity and enhance knowledge mobilization focused on the priorities and values of First Nations, Inuit and Métis communities. In June 2021, CIHR and IIPH co-developed and released NEIHR profiles featuring research from each NEIHR Centre. Also in June 2021, the first annual NEIHR Council was organized by the NCC and supported by the NEIHR Centres.

Ongoing engagements with Inuit Tapiriit Kanatami (ITK) led to the launch of the Inuit Research Network (IRN) Grant in August 2021, a funding that aligns with the principles articulated in the National Inuit Strategy on Research (NISR). The purpose of the IRN grant is to support the development and begin implementation of an Inuit research network that will strengthen long-term capacity for Inuit-led research and knowledge mobilization across all disciplines, with an emphasis on improving Inuit health and well-being through research, within and beyond Inuit Nunangat.

As part of the multiphase Indigenous Gender and Wellness Initiative, the Indigenous Gender and Wellness Team Grant (Phase 3) was launched in November 2021. A total of 15 teams were funded, in partnership with CIHR's Institute of Gender and Health, the CIHR HIV/AIDS and Sexually Transmitted and Blood-Borne Infections (STBBI) Research initiative, IIPH and CIHR's Institute of Population and Public Health (IPPH). The objective is to provide funding for Indigenous-led teams to implement their ideas through research and action-oriented, community-based participatory projects that will improve wellness for Indigenous Peoples from a gendered perspective.

In 2021-2022, other funding opportunities were launched with an IHR specific pool or with IHR relevant funded applications. Select examples include:

• IIPH, along with IPPH and Institute of Cancer Research (ICR), supported an Indigenous funding pool in the Team Grant: GACD Primary and Secondary Prevention of Cancer competition, where CIHR successfully funded 1 IHR application.
• In May 2021, IIPH and ICR partnered with the Canadian Cancer Society (CCS) and other partners to launch the Phase 1: CCS/CIHR Action Grants: Proof-of-Concept Interventions in Primary Cancer Prevention, where 3 IHR applications were funded.
• The Healthy Cities Implementation Science Team Grants launched in May 2021 in partnership with the PHAC and the National Health and Medical Research Council funded 3 applications who received a development grant (up to $25K for 1 year) from the Urban Indigenous Health thematic area.

To strengthen accessibility to research funding, the following funding included sessions to help complete an application.

• In February 2022, CIHR's Institute of Nutrition, Metabolism and Diabetes and IIPH, in collaboration with CIHR's Institute of Circulatory and Respiratory Health, and IHDCYH, held a virtual Strengthening Workshop for applicant teams who were successful at the letter of intent stage for the Team Grant : Diabetes Prevention and Treatment in Indigenous Communities: Resilience and Wellness to prepare for the full application stage. The team grants will support Indigenous-led and community-driven research to define and integrate models of resilience and wellness into diabetes prevention and treatment approaches.
• In February 2022, the HIV/AIDS and STBBI Initiative held an interactive webinar for applicants to the community-based research funding opportunities (Catalyst and Operating). The webinar included guidance from Indigenous and non-Indigenous successful grantees, insights from Indigenous and non-Indigenous peer reviewers, and information from the AHA Centre and REACH Nexus.

On April 7, 2021, CIHR hosted the Visioning the Future of Public Health in Canada BBE, in collaboration with the Office of the Chief Public Health Officer of Canada (CPHO) and PHAC. There was significant emphasis throughout the event on Indigenous health, the disproportionate impact of COVID-19 on Indigenous communities, and ongoing/recommended future actions to address this. The BBE provided key evidence and guided commissioned work to inform the development of the 2021 Chief Public Health Officer Annual Report, and the accompanying report entitled Visioning the Future: First Nations, Inuit, & Métis Population and Public Health.

Community and Partner Engagement

Ongoing engagement with the First Nations Information Governance Centre led to successfully co-developing and launching the First Nations Biobanking and Genomic Research Grant funding opportunity, in March 2022. Tailored to the distinct needs of First Nations, the purpose of this funding opportunity is to build knowledge and capacity for informed First Nations decision-making and governance on biobanking and genomic research, including the development of appropriate protocols to guide this work and associated knowledge mobilization efforts.

At the international level, CIHR and IIPH have continued their collaboration with the Tripartite Agreement partners of the NHMRC of Australia and the HRC of New Zealand as they work to renew the Memorandum of Understanding between the 3 agencies.

Building on the established relationship and commitments included in the ITK-CIHR Joint Work Plan 2021-2025, ITK and CIHR's Presidents prepared a joint statement for World Tuberculosis Day on March 24th, 2022. The statement reiterated the importance of Inuit-led research and included a summary of the Tuberculosis roundtable co-led in February 2020.

Conclusion

In this period of great change, CIHR reaffirms its commitment to IHR by continuing to engage and to build trusting relationships with First Nations, Inuit and Métis communities. This will lay the foundations to advance CIHR's Strategic Plan and its 10-year vision in a culturally appropriate and meaningful way for the IHR environment.

Michael J. Strong, MD, FRCP, FCAHS, FAAN
President, CIHR

Aanii, Greetings, Hello,

Over the past few months, many aspects of our lives have changed. The Canadian Institutes of Health Research (CIHR) and the Institute of Indigenous Peoples' Health (IIPH) have faced challenges due to the COVID-19 pandemic. We have had to redirect our capacity and resources to play a significant role in the whole-of-Canada response to COVID-19 while continuing to build on our ongoing engagements with Indigenous communities.

This has, in turn, caused us to delay the presentation of the 2019-2020 Progress Update - Action Plan: Building a healthier future for First Nations, Inuit and Métis Peoples until Fall 2020. Rest assured that we continue to focus on strengthening governance and leadership, increasing community-based research, and ensuring an appropriate research response regarding COVID-19 in Indigenous communities. As co-champions of the Action Plan, we look forward to reaffirming our commitment to Indigenous Health Research (IHR) through the Fall update and to building on the progress accomplished to date.

Miigwetch, merci, thank you for your dedication to the health and well-being of the First Nations, Inuit and Métis Peoples as we move forward through this health crisis.

Dr. Tammy J. Clifford
Vice-President, Research Programs
Canadian Institutes of Health Research

Aanii, Tanshi, Ullukkut, Bonjour, Hello,

The Canadian Institutes of Health Research (CIHR) and CIHR's Institute of Indigenous Peoples' Health (CIHR-IIPH) are proud to share the progress made in 2020-2021 towards the commitments articulated in the Action Plan: Building a healthier future for First Nations, Inuit and Métis Peoples (the Action Plan). The COVID-19 pandemic has forced each and every one of us, including communities, organizations and institutions, to work differently and find solutions for many unforeseen situations. The progress described below is possible because of the strength and resilience of First Nations, Inuit, Métis and Urban Indigenous communities, and their ongoing work to advance health and well-being during this pandemic.

The launch of the CIHR Strategic Plan 2021-2031 (the Strategic Plan) in February 2021, represents an important milestone for CIHR and the Indigenous health research (IHR) community. The Strategic Plan, informed by engagement with Indigenous partners and communities, includes a dedicated top-level priority (Priority C) focused on accelerating self-determination of Indigenous Peoples in health research as well as strategies throughout the Strategic Plan to respect and uphold the rights of First Nations, Inuit and Métis Peoples. Priority C confirms continued and enhanced support for IHR initiatives by embedding both the Institute of Indigenous Peoples' Health Strategic Plan 2019-2024 as well as the Action Plan within the Strategic Plan. Priority C also contains three (3) supporting strategies, which includes advancing the health and well-being of First Nations, Inuit and Métis Peoples, accelerating the implementation of the Action Plan and removing barriers to Indigenous-led research. By listening attentively to and working with First Nations, Inuit and Métis Peoples, CIHR is embracing a distinctions-based and culturally safe approach to strengthening IHR and knowledge mobilization. To achieve equitable health outcomes, CIHR's ten (10) year vision for Priority C is to have Indigenous communities lead health research that focuses on resilience, wellness and Indigenous Ways of Knowing.

COVID-19 and IHR

Over the past year, CIHR has been central to Canada's research response to COVID-19. This has included funding opportunities and engagements relevant to Indigenous communities' experiences with COVID-19, some of which are highlighted below.

Launched in April 2020, the Operating Grant: COVID-19 May 2020 Rapid Research Funding Opportunity, funded five (5) grants relevant to IHR. This funding was to enable rapid and timely research focused on slowing and stopping the spread of SARS-CoV-2. Research projects funded through this call were encouraged to amplify existing national and international networks in order to leverage efforts and increase timeliness, efficiency, and impact of response.

Also launched in April 2020, as part of the COVID-19 and Mental Health (CMH) Initiative, the Operating Grant: Knowledge Synthesis: COVID-19 in Mental Health and Substance Use, resulted in three (3) successful research projects in IHR. These grants were provided to enable the development of rapid and timely knowledge syntheses and related knowledge mobilization plans to address evidence gaps and build the evidence base as part of the mental health and substance use response to COVID-19.

CIHR-IIPH had representation on the board for the CanCOVID Network, and on the Leadership Group for the Government of Canada COVID-19 Immunity Task Force. The CanCOVID Network is an initiative committed to giving a line of sight on existing and emerging COVID-19 science and research to help inform policy and practices at the national level. The Task Force is charged with leading a Canada-wide strategy focused on the mobilization of rapid and reliable knowledge to inform public health policy makers.

Launched in June 2020, the Operating Grant: COVID-19 Mental Health & Substance Use Service Needs and Delivery of the CMH Initiative funded three (3) grants in the research area Understanding Rapid System Transformations and one (1) grant in the research area Developing Innovative Adaptations of Services and/or Delivery for research projects involving First Nations, Inuit and/or Métis Peoples.

CIHR hosted a virtual Best Brains Exchange (BBE) in July 2020, in partnership with the Public Health Agency of Canada, to better understand the intersectional COVID-19 impacts on the health and well-being of priority groups in Canada. The BBE informed the Chief Public Health Officer's (CPHO) 2020 Annual Report on COVID-19, From risk to resilience: An equity approach to COVID-19, including the design of protective strategies moving forward. A complementary report, What we heard: Indigenous Peoples and COVID-19 has also been made available to reflect the content of Indigenous engagement sessions and describe fifteen (15) directions and challenges faced by Indigenous Peoples during the COVID-19 pandemic.

For the Indigenous COVID-19 Knowledge Synthesis, Evaluation and Assessment Grants Rapid Research launched in September 2020, thirteen (13) IHR grants were awarded. This number includes five (5) Knowledge Synthesis Grants and eight (8) Evaluation and Assessment Grants which are representing a CIHR investment of over $2M. This funding opportunity was aimed at supporting strengths-based, solutions-focused research that is bold, innovative, Indigenous community-led, and that addresses the immediate, intermediate, and/or long-term consequences of COVID-19 and/or informs future preparedness.

Governance and strategic leadership

Appointments to the Tri-agency Reference Group for the Appropriate Review of Indigenous Research (Reference Group) were announced in September 2020. Comprised of eighteen (18) individuals with a deep cultural understanding of Indigenous research and Indigenous Knowledges, the Reference Group members will provide advice to the Tri-agency, CIHR, Social Sciences and Humanities Research Council (SSHRC) and Natural Sciences and Engineering Research Council (NSERC), on ethically and culturally safe peer review approaches and practices for research conducted by and with First Nations, Inuit and Métis Peoples.

To advance community-based research and access to research funding for Indigenous Peoples, individuals affiliated with Indigenous non-governmental organizations in Canada with a research or knowledge translation mandate are now also eligible to apply to the CIHR Project Grant competition as Nominated Principal Applicants. The updated eligibility criteria was first implemented in the Fall 2020 Project Grant competition and will apply to other strategic funding opportunities within CIHR. In recognition that the Canadian Common CV is a barrier for some groups, CIHR has developed a new Applicant Profile CV for Indigenous organizations and non-academic or international participants. It was piloted in several COVID-19 competitions and has been implemented in the Spring 2021 Project Grant competition. CIHR intends to implement this CV option more broadly and will continue to survey knowledge users and Indigenous applicants to evaluate the utility of this new tool and its use for other programs.

In January 2021, the Canada Research Coordinating Committee (CRCC) opened an Expression of Interest for First Nations, Inuit and Métis Peoples to participate in an Indigenous Leadership Circle in Research (Leadership Circle). The Leadership Circle will advise the Tri-agency and the Canadian Foundation for Innovation in implementing the CRCC Strategic Plan: Setting New Directions to Support Indigenous Research and Research Training in Canada 2019-2022 [ PDF (19 MB) - external link ]. The CRCC also published a progress report [ PDF (6 MB) - external link ] outlining priorities and actions taken in fiscal year 2019–2020 to mobilize Canadian research for the benefit of all Canadians, including improved research outcomes for the benefit of Indigenous communities.

CIHR employees continue to participate in training to increase organizational capacity to interact with Indigenous Peoples and communities in a meaningful and culturally safe manner. This year's mandatory training included distinctions-based courses (First Nations, Inuit and/or Métis) through the Canada School of Public Service. These courses, developed with First Nations, Inuit and Métis Peoples, present the history and contemporary realities, and recognize the diversity of Indigenous Peoples across the country.

Community-Based Health Research

CIHR continues to identify opportunities to ensure its investment in IHR reaches a minimum of 4.6% of CIHR's Grants and Awards annual budget. For CIHR, impactful strategic initiatives developed by and with Indigenous Peoples is a high priority. In the 2020-2021 fiscal year, investment in IHR increased to 4.1% (amounting to 4.5% when considering that a portion of CIHR's budget was reprofiled from 2020-21 and made available for use in 2021-22 to continue to address emerging priorities and gaps in COVID-19 research). This represents an increase of $18.9M since 2019-20, for a total investment of $64M. 56% of the total $18.9M increase in IHR investment was dedicated to COVID-19 projects and for additional funding to support students, trainees and research support personnel funded through CIHR research grants, and students and postdoctoral researchers who are paid through scholarships and fellowships, to lessen the impact due to COVID-19.

Across CIHR and all thirteen (13) Institutes, impactful strategic research initiatives were developed to contribute significantly to the health and wellbeing of First Nations, Inuit, Métis and Urban Indigenous communities. In the past year, CIHR has contributed funding and included IHR considerations in various areas of focus for Indigenous communities to advance IHR.

The Indigenous Healthy Life Trajectories Initiative Cohort Research Study (I-HeLTI) Cohort research study was launched in November 2020. This funding opportunity is open to the three (3) Indigenous-led teams funded through the previous Team Grant: Indigenous Component of Healthy Life Trajectories (I-HeLTI). In the fall, CIHR held a series of three (3) virtual strengthening workshops with the I-HeLTI Team Grant recipients to come together in anticipation of the Cohort Study application and discuss a wide range of topics, such as team networking, collaboration models and Indigenous data sovereignty.

As part of the Indigenous Gender and Wellness Initiative, which is a $7M investment, the Indigenous Gender and Wellness Team Grants (Phase 3) was launched in November 2020. This third phase will provide funding for Indigenous-led teams to implement their ideas through research and action-oriented, community-based participatory projects that will improve wellness for Indigenous Peoples from a gendered perspective.

In the same month, the Diabetes Prevention and Treatment in Indigenous Communities: Resilience and Wellness Team Grants was also launched. It will help define and integrate models of resilience and wellness into diabetes prevention and treatment approaches among First Nations, Inuit and Métis Peoples and support Indigenous-led and community-driven efforts to reverse the upward trajectory of diabetes in Indigenous communities.

The Network Environments for Indigenous Health Research (NEIHR) Program, now entering its second year of operations, has established a national network of Indigenous-led centres to conduct research, build capacity and enhance knowledge mobilization focused on the priorities and values of First Nations, Inuit and Métis communities.

The Catalyst Grants: Cannabis and Mental Health funded two (2) grants, under the Integrated Cannabis Research Strategy, that will support research focused on First Nations, Inuit and Métis Peoples' approaches to cannabis and mental health, and the Health Effects of Vaping Catalyst Grant funded one (1) grant focused on youth, including those from Indigenous/Métis communities.

The Strategy for Patient-Oriented Research (SPOR) SUPPORT Unit in Yukon (Phase I), was launched in January 2021 with a total of $5.25M awarded to support patient-oriented research (based on community priorities) in Yukon over five (5) years. As a component of the SPOR Capacity Development Initiative, the SPOR National Training Entity (NTE) was funded and launched in March 2021. The SPOR NTE involves significant engagement of, and relevance to, Indigenous Peoples in the context of patient-oriented research training and capacity development.

Community and partner engagement

In October 2020, the partnership between CIHR and Inuit Tapiriit Kanatami (ITK) was announced. CIHR and ITK acknowledged the importance of Inuit-led health research and improving the health and wellbeing of Inuit at a national level, in accordance with the National Inuit Strategy on Research [ PDF (4.3 MB) - external link ].

At the international level, CIHR-IIPH continues to have regular virtual meetings with the Tripartite Agreement partners of the National Health and Medical Research Council of Australia and the Health Research Council of New Zealand to further the shared commitment to improving the health of Indigenous Peoples through research and capacity-building. Since 2019, IIPH has been an active member of the International Research Advisory Board for the Health Research Council (New Zealand). Following a successful joint workshop in New Zealand in December 2019, planning is underway for the next International Indigenous Capacity Building Workshop.

As co-champions of the Action Plan, we reaffirm our commitments to continue engaging with First Nations, Inuit and Métis Peoples, including Urban Indigenous communities, to advance and strengthen IHR. We look forward to building on the progress accomplished to date to achieve the vision of equitable health outcomes outlined in the CIHR Strategic Plan through strengths-based and Indigenous-led research.

Miigwetch, maarsii, nakurmiik, merci, thank you,

Dr. Tammy Clifford
Vice-President, Research Programs
Canadian Institutes of Health Research

Aanii, Tanshi, Ullukkut, Bonjour, Hello,

As announced in June 2020, the 2019-2020 Progress Update: Action Plan: Building a healthier future for First Nations, Inuit and Métis Peoples (Action Plan) is being provided later than usual this year due to COVID-19 impacts. The Canadian Institutes of Health Research and the Institute of Indigenous Peoples' Health (CIHR-IIPH) are proud to highlight the progress accomplished over the past year, while recognizing that much remains to be done. We are also happy to share that, following the retirement of Michel Perron, Dr. Tammy Clifford, Vice-President, Research Programs at CIHR has been appointed to lead the Action Plan.

We would like to take this opportunity to thank all the Indigenous researchers, communities and organizations from across the country for their work, leadership and collaboration with CIHR in the whole-of-Canada response to COVID-19. This pandemic has laid bare issues of health equity, while at the same time revealing the strength and resilience of First Nations, Inuit and Métis Peoples, including Urban Indigenous communities. This has driven CIHR to continue to work towards advancing Indigenous health research (IHR) and addressing the health challenges of COVID-19 in Indigenous communities. The Indigenous Peoples and COVID-19 Knowledge Synthesis, Evaluation and Assessment Grants Rapid Research Funding Opportunity will support strengths-based, solutions-focused research that is bold, innovative, Indigenous community-led, and that addresses the consequences of COVID-19 and/or informs future preparedness. Other examples of CIHR contributions can be found on the COVID-19: Indigenous Health Research webpage.

Governance and strategic leadership

Over the past year we have made good strides towards implementing strategies identified in the IIPH Strategic Plan 2019-2024 launched in June 2019. From strengthening community-based research through competitive grant funds flowing directly to Indigenous organizations, to building capacity through network grants devoted to this purpose, we are working to honour the vision of Elders, Knowledge Keepers, Indigenous communities and organizations across the country and to advance the health, wellbeing, strength and resilience of First Nations, Inuit and Métis Peoples.

In Spring 2019, a Working Group composed of CIHR, Social Sciences and Humanities Research Council (SSHRC) and Natural Sciences and Engineering Research Council (NSERC) representatives met to advance the Reference Group for the Appropriate Review of Indigenous Research (Reference Group). This Reference Group is meant to provide guidance to these federal granting agencies on culturally appropriate review of Indigenous research, as well as approaches and practices for research conducted by, with and at the direction of First Nations, Inuit and Métis Peoples. An expression of interest for the Reference Group was launched in early 2020.

CIHR is committed to engage with leaders of the Assembly of First Nations (AFN), Inuit Tapiriit Kanatami (ITK), and the Métis National Council (MNC) to discuss IHR priorities. In October 2019, CIHR President, Dr. Michael J. Strong met with MNC leadership, to learn more about Métis-specific health research priorities. In March 2020, health opportunities and ongoing engagement were discussed with representatives from both organizations to continue building the relationship. The CIHR-IIPH Scientific Director also met with the Health Director of AFN in October 2019 to discuss research priorities and engagement between both organizations. In addition, through regular meetings, CIHR and ITK have continued to build on the relationship established between our Presidents.

One of the key commitments of the Action Plan is for CIHR to increase our capacity to interact with Indigenous communities in a meaningful and culturally safe manner. To follow up on a previous Progress Update, new training was undertaken by CIHR staff to help build capacity and cultural safety within the organization. These opportunities focus on topics including reconciliation, Indigenous Peoples' rights and history, as well as the importance of cultural safety and respectful relationships. These courses are a small but important step to increase CIHR's organizational understanding and respect for First Nations, Inuit and Métis rights and contexts.

Community-Based Health Research

CIHR continues to identify opportunities to ensure its investment in IHR reaches a minimum of 4.6% of CIHR's Grants and Awards annual budget. Across the organization and all thirteen (13) Institutes, delivering impactful strategic initiatives developed by and with Indigenous Peoples is a high priority. In the 2019-2020 fiscal year, investment in IHR increased to 4.0%. Between 2018-19 and 2019-20, this represents an additional $11M, for a total of over $45M.

An exemplar investment across all thirteen (13) CIHR Institutes, under the scientific leadership of CIHR-IIPH and the CIHR Institute of Circulatory and Respiratory Health (ICRH), is the Network Environments for Indigenous Health Research (NEIHR) Program, which is a 16-year, $100.8 million investment. In March 2020, nine (9) NEIHR centres across the country and the NEIHR Coordinating Centre (NCC) received their funding. This national network of centres is addressing needs in capacity development, research and knowledge translation focused on the priorities and values of First Nations, Inuit and Métis communities. Collectively, the following NEIHR centres and the NCC will work together as a consortium of Indigenous-led research centres across Canada: NEIHR - British Columbia, NEIHR – Alberta, NEIHR - Saskatchewan, NEIHR – Manitoba, NEIHR – Ontario, NEIHR – Quebec, NEIHR - Atlantic Region, NEIHR - The Yukon or the Northwest Territories, NEIHR – Nunavut and NEIHR - Consortium NEIHR Grant.

For the Indigenous Healthy Life Trajectories Initiative (I-HeLTI), jointly developed by CIHR-IIPH and the CIHR Institute of Human Development, Child and Youth Health, three (3) teams were successful in obtaining grants in December 2019. The purpose of these grants are to build infrastructure and capacity in Indigenous communities to conduct cohort intervention research. Their research will follow a Developmental Origins of Health and Disease (DOHaD) life trajectory approach from pre-conception to early childhood. Each team received funding of just over $1 million for two (2) years. In keeping with the CIHR-IIPH Strategic Plan commitment to increase funding to Indigenous organizations, the funded applications were awarded to the following Indigenous organizations:

• Nuu-Chah-Nulth Tribal Council (with Simon Fraser University): Hishuk-ish tsawalk (everything is one, everything is connected): Using two-eyed seeing to optimize healthy early life trajectories for Indigenous Peoples;
• Alberta First Nations Information Governance Center: Restoring the Healthy Family System in Indigenous Communities: A Collaborative Research Partnership in Alberta to Address the Gap in Indigenous Health Outcomes; and
• First Nations Health and Social Secretariat of Manitoba: Supporting the trajectories of our spirit: Living Cree Pimatisiwin and Blackfoot Kiipaataapiisiinii (Our spiritual way of life).

The next phase of I-HeLTI will provide an opportunity for the three (3) teams to work together to undertake a joint cohort research program specific to Indigenous populations in Canada with an I-HeLTI Collaborating Centre to support the governance and management of the cohort.

As part of the Indigenous Gender and Wellness Initiative, the CIHR Institute of Gender and Health, CIHR Institute of Population and Public Health, CIHR-IIPH and the CIHR HIV/AIDS and STBBI Research Initiative launched the Indigenous Gender and Wellness Development Grants in June 2019. Thirty-eight (38) Development Grants were awarded to support teams to continue sharing their ideas, developing relationships and planning for the following phase of funding. The Development Grants were open to participants of the Idea Fair and Learning Circle also held in June 2019.

In September 2019, the Inuit Research Network Development Grant was launched to support the development and planning phase of an Inuit Research Network aligned with the activities and priorities outlined in the National Inuit Strategy on Research [ PDF (1.2 MB) - external link ].

In October 2019, CIHR launched the second phase of the jurisdictionally-based funding of the SPOR SUPPORT Units. The SPOR SUPPORT Units Phase II funding opportunity increases the acknowledgement and requirement of engaging with Indigenous Peoples and communities throughout all of the components.

As a component of the SPOR Capacity Development Initiative, the Patient-Oriented Research Awards – Transition to Leadership Stream funding opportunity funded five Indigenous trainees in March 2020 to support trainees transition into independent patient-oriented research careers. Another component of this initiative, the SPOR National Training Entity (NTE), involves significant engagement of, and relevance to, Indigenous Peoples in the context of patient-oriented research training and capacity development.

In February 2020, ITK and CIHR co-hosted a roundtable on research to support tuberculosis elimination across Inuit Nunangat. In total, forty-six (46) participants attended the event, which included members from the Inuit Public Health Task Group, ITK, CIHR, including CIHR-IIPH, CIHR-ICRH and CIHR-Institute of Infection and Immunity, and the two (2) other national funding agencies, SSHRC and NSERC.

Community and partner engagement

In the development of the CIHR Strategic Plan 2021-2031, CIHR has undertaken a significant engagement process to solicit the views of a diverse set of interested individuals and groups, including Indigenous community members and organizations. CIHR engaged with Indigenous communities through the CIHR-IIPH, additional in-person Indigenous communityengagements sessions, the CIHR Strategic Plan Consensus-Building Workshops and the National Health Research Summit. Through this collaborative dialogue, First Nations, Inuit and Métis perspectives were provided to identify priorities and recommendations for the next CIHR Strategic Plan.

In September 2019, AFN, ITK and MNC participated in a meeting organized by the CIHR Institute of Neurosciences, Mental Health and Addiction to share their perspectives on developing a common research agenda to promote best health outcomes for individuals, families and communities impacted by Post-Traumatic Stress (PTS). The PTS Knowledge Gaps Consensus Workshop was then held in Ottawa in January 2020 to bring together a diverse group of people with lived and living experience. At this workshop, participants benefited from Indigenous knowledges and perspectives, including ways of knowing, being and healing, to inform PTS research and knowledge translation opportunities at CIHR.

As part of the Tripartite Agreement signed in 2002, CIHR-IIPH, Australia's National Health and Medical Research Council, and New Zealand's Health Research Council worked together to hold an International Indigenous Health Research Capacity-Building, Strengthening and Mentoring Workshop in Auckland, New Zealand in December 2019. This workshop promoted collaboration and capacity building with a mentorship focus for Indigenous trainees and scholars from all three (3) countries.

Through the Canadian Research Coordinating Committee, CIHR, SSHRC and NSERC published in January 2020 the Strategic Plan: Setting new directions to support Indigenous research and research training in Canada 2019–2022 [ PDF (15.4 MB) - external link ]. Four (4) strategic directions are identified in the plan to guide the development of new models for Indigenous research based on ideas and experiences provided by Indigenous organizations, groups and communities. A key mechanism is to remove the barriers and challenges that Indigenous organizations and researchers face regarding access to agency funding. This has contributed to discussions to explore options to broaden institutional eligibility for Indigenous organizations to become eligible to administer grant funds and to expand applicant eligibility criteria in support of Indigenous-led research. In June 2019, CIHR updated its Research Projects and Personnel Support Grant Program's Terms and Conditions (T&Cs) to allow individuals affiliated with Indigenous-led organizations to apply for funding if the organization type is listed within the T&Cs as an eligible recipient organization.

Strengthening IHR relies on strong collaboration with First Nations, Inuit and Métis Peoples, including Urban Indigenous Peoples, from across the country and with Indigenous Peoples internationally. As co-champions of the Action Plan, we reaffirm our commitment to continue working together on advancing IHR and achieving common goals.

Miigwetch, maarsii, nakurmiik, merci, thank you,

Dr. Tammy Clifford
Vice-President, Research Programs
Canadian Institutes of Health Research

Since its inception in 2000, CIHR has recognized the importance of Indigenous health research, and Indigenous Peoples' engagement in this process. With leadership provided by the Institute of Indigenous Peoples' Health (IIPH) and support from its other 12 institutes, CIHR has made significant progress to support the health and wellness of First Nations, Inuit and Métis Peoples. In November 2016, CIHR released the “Action Plan: Building a healthier future for First Nations, Inuit and Metis peoples” (the Action Plan). The Action Plan describes 10 commitments to strengthen Indigenous health research in Canada, building on work that was already underway. In the last two years, we have had the opportunity to make meaningful progress by working with Indigenous communities and other partners to address gaps in Indigenous Health Research (IHR) in Canada.

We are pleased to present this year's update on the Action Plan. Activities over the last year focused on strengthening governance and leadership, increasing community-based research, and continuing to build meaningful relationships with communities and partners.

Governance/strategic leadership:

Adopted in 2017, CIHR's definition of Indigenous Health Research (IHR) emphasizes research by and with Indigenous Peoples. To prioritize Indigenous Peoples leading their own research and to ensure appropriate engagements, we also developed a definition of culturally safe involvement. It defines research environments as socially, spiritually, emotionally and physically safe, which requires understanding the root causes of health inequities among Indigenous Peoples, including the impact of colonization.

In 2018, the IIPH IAB was reconstituted and now counts among its members two Elders, who will provide guidance and cultural and spiritual support to IIPH in the development of its activities. Other CIHR IABs also increased Indigenous representation, including the Institute of Gender and Health and the Institute of Population and Public Health. The CIHR Indigenous Health Research Support Unit is now fully staffed at CIHR and it increases CIHR's capacity to support and interact meaningfully with Indigenous Peoples, researchers and communities.

Consistent with the CIHR Health Research Roadmap II and the CIHR Action Plan: Building a healthier future for First Nations, Inuit, and Métis Peoples, IIPH committed to support more community-based participatory research and to build capacity within Indigenous communities in a culturally safe way. In order to achieve that, and with guidance from its Institute Advisory Board (IAB), Indigenous communities, Elders and Knowledge Holders, IIPH has developed a new strategic plan, released on June 27^th, that maps out four strategic directions for the next 5 years:

• To support First Nations, Inuit and Métis Peoples and communities to drive Indigenous health research and knowledge translation.
• To contribute to the process of improving First Nations, Inuit and Métis health using multiple Indigenous and non-Indigenous research paradigms simultaneously to support research and innovation.
• To advance research beyond acknowledged notions of health equity and give primacy to wellness, strength and resilience of First Nations, Inuit and Métis Peoples at the individual, group and structural levels.
• To encourage and champion Indigenous community-based health research networks across Canada to develop capacity for First Nations, Inuit and Métis health research and knowledge translation.

IIPH and its partners will strive to improve the health of Indigenous Peoples by recognizing Indigenous knowledges and being respectful of Indigenous values, cultures and ways of knowing.

In January 2019, consistent with the Action Plan commitment, CIHR's President, Dr. Michael J. Strong, met with Inuit Tapiriit Kanatami's (ITK) President, Natan Obed. This meeting was held to discuss how CIHR could support ITK in the implementation of their National Inuit Strategy on Research (NISR), which was released in March 2018. The presidents agreed to meet on a regular basis to assess progress towards the commitments made. CIHR's President subsequently participated in the ITK Executive Training Program, an experiential learning opportunity on the realities and priorities of Inuit, on the land in Inuit Nunangat. CIHR was also invited to participate in the NISR Roundtable in February 2019.

The relationship built with the Indigenous communities in recent years will continue to be an invaluable source of strength to address gaps in Indigenous health research together. Efforts to build and maintain engagement with the leadership of the Assembly of First Nations, ITK, and the Métis National Council to discuss IHR priorities will continue.

Community-Based Health Research:

The IHR investment estimate has been updated

In 2016/17, CIHR revalidated its investments for IHR to develop a baseline of 2.1% of the total annual budget (based on fiscal years 2014/15 to 2016/17). In 2017/18, CIHR increased its investment in IHR to 3% of its total annual budget. For the 2018/19 fiscal year, investment in IHR increased again to 3.1%. It represents an additional $3M invested in IHR in 2018/19, for a total of over $34M. CIHR will continue to implement key actions to ensure its investment in IHR increases to a minimum of 4.6% of its annual budget. Creating impactful strategic initiatives developed by and with Indigenous Peoples is a priority across the organization and all 13 institutes.

In December 2018, CIHR launched the second component of the Network Environments for Indigenous Health Research (NEIHR) – a $100.8M, 16-year capacity building investment – which is supported financially by all 13 CIHR Institutes. The purpose of the NEIHR Program is to establish a national network of centres focused on capacity development, research and knowledge translation (KT) centered on First Nations, Inuit and Métis. The network of centres is intended to provide supportive research environments for Indigenous health research driven by and grounded in, Indigenous communities in Canada. It will also ensure continued growth, broad regional development and national collaborations.

In addition to the NEIHRs, CIHR continues to invest in initiatives that address Indigenous specific health needs. For example, CIHR has recently launched the Pathways Implementation Research Teams Component 3 request for applications which focus on equitable reach, access and sustainability of interventions in four priority areas: mental wellness, diabetes/obesity, tuberculosis, and oral health.

CIHR also launched the Team Grants for the Indigenous Healthy Life Trajectories Initiative. These grants will support four (4) teams to build infrastructure and capacity along the continuum of care and prevention from pre-conception to pregnancy, infancy and early childhood with a life trajectory perspective relevant to the following research areas: a Developmental Origins of Health and Disease (DOHaD) life trajectory approach, a focus on the prevention of Non-Communicable diseases (NCD) and an intervention cohort design. The funded research teams will collaborate to develop the partnerships, and leverage the necessary expertise and resources to establish an Indigenous-driven I-HeLTI Intervention Cohort.

In March 2019, IIPH launched the Indigenous Research Chairs in Nursing. This initiative will support nurses of both Indigenous and non-indigenous ancestry to conduct research in Indigenous Health Nursing, thus furthering the development of knowledge and best and wise practices in the area of nursing practice, education, research and administration. The Chairs will undertake research to understand social, economic and cultural determinants of health and Indigenous holistic health practices to improve the health of Indigenous Peoples.

CIHR's Science Council recently endorsed the SPOR Capacity Development Initiative. The first component of this initiative is the Patient-Oriented Research Awards – Transition to Leadership Stream. This funding opportunity will include an Indigenous Peoples' Health Pool to supports trainees transitioning into independent patient-oriented research careers.

Other initiatives launched during the last year include Indigenous components in their funding opportunities. The Food security and Climate Change in the Canadian North under the scientific leadership of the Institute of Nutrition, Metabolism and Diabetes, will support research that will provide a deeper understanding of food security and climate change in the Canadian North, with a particular focus on Indigenous populations. There is an Indigenous component in the Transitions in Care – Best and Wise Practices Grants, to support groups of researchers and knowledge users to identify best and wise practices in the areas of transitions in care, led by the Institute of Circulatory and Respiratory Health. The Institute of Gender and Health launched the Indigenous Gender and Wellness Travel Awards to bring interested First Nations, Inuit and Métis Peoples, researchers, organizations, Indigenous community members, and other allies of Indigenous Peoples to attend an Idea Fair and Learning Circle on "Indigenous Gender and Wellness". The event, held on June 18-20, 2019 in Montreal, on the traditional unceded territory of the Kanien'keha:ka (Mohawk) people, provided an opportunity for Indigenous Peoples and allies to meet each other and share their ideas and goals. The Cannabis Research in Priority Areas funding opportunity was launched in March 2019 by the Institute of Neurosciences, Mental Health and Addiction (INMHA). Its purpose is to explore in more detail the potential therapeutic benefits and harms associated with cannabis use on Indigenous Peoples' health. Additional funding opportunities are planned under CIHR's Integrated Cannabis Research Strategy, including research to evaluate policies related to the legalization and regulation of cannabis that may impact the health of Indigenous Peoples.

Community and partner engagement:

In June 2018, at Lethbridge, Alberta, CIHR and the First Nations Health and Social Secretariat of Manitoba (FNHSSM) Nanaandawewigamig PEKE, co-hosted the 4th Pathways Annual Gathering (PAG) in partnership with the Alberta First Nations Information Governance Centre. The gathering took place on the traditional territories of the Blackfoot and the people of Treaty 7 under the theme: “Land-based learning and healing”. The PAGs have contributed to defining new ways to improve the health of Indigenous Peoples through networking, teambuilding and sharing of cross learnings in the field of Implementation Science.

To continue this important work and support the evolution of CIHR investments in Indigenous health research beyond the Pathways Initiative, CIHR has decided to bring together community members, researchers, knowledge holders and community organizations with a new model in the coming years. More details will be communicated in the coming months on the NEIHR Webpage.

The SPOR Summit - Mapping the Progress of Patient-Oriented Research in Canada held November 13-15, 2018 in Ottawa brought together over 340 attendees. SPOR provided numerous travel awards to enable patient engagement, including for participants from Indigenous communities. The Summit provided an opportunity to participate in panel discussions, plenary and poster sessions to share knowledge and experiences, highlight early successes and share lessons learned. Throughout the event, Indigenous perspectives and approaches were highlighted, and participants were honoured by the wisdom and knowledge of Elders Sophie Pierre, Jack Robinson, and Margaret Lavalee.

IIPH participated in a roundtable meeting in November 2019, hosted by the INMHA, which brought together experts and leaders within the post-traumatic stress (PTS) community. A key outcome of this roundtable was the need to focus research on inter-generational stress experienced by Indigenous communities. IIPH will be engaged in the development of a national research strategy on PTS, which will include health research needs of Indigenous communities. Also, IIPH, INMHA and other CIHR representatives participated in the National Conference on Post-Traumatic Stress Disorder on April 9-10, 2019.

At the international level, IIPH delivered two presentations on ‘Indigenous health issues in Canada' at the Union World Conference on Lung Health and provided financial support to a conference workshop titled Ethnicity and health: Building intercultural solutions for equitable tuberculosis care with Indigenous Peoples – locally and in the Americas. The working relationship with the National Health and Medical Research Council of Australia and Health Research Council of New Zealand continues to grow by means of the international commitment renewed in December 2017. Through this collaboration, supporting emerging researchers will be pursued as a main priority to generate positive outcomes for Indigenous Peoples and the research community.

To support Indigenous research and coordinate efforts among the granting agencies, CIHR is working with the Social Sciences and Humanities Research Council and the Natural Sciences and Engineering Research Council through the Canadian Research Coordinating Committee (CRCC) on identifying opportunities for common approaches and procedures. Through this work, CRCC held a Strengthening Indigenous Research Capacity National Dialogue in March 2019 where key themes were discussed, and where recipients of tri-agency funded Indigenous Research Capacity and Reconciliation-Connection Grants were gathered. Progress towards increased coordination of research-related programs and policies for all priority areas, including Indigenous research, are outlined in the newly released CRCC Progress Report.

As stated in the previous progress report update in June 2018, strengthening Indigenous health research relies on strong collaboration with First Nations, Inuit and Métis Peoples from across the country, and with Indigenous Peoples internationally. With this annual progress update, we are reaffirming our commitment to IHR as co-champions of the Action Plan. We look forward to building on the progress accomplished to date, and to ongoing engagement with Indigenous communities to guide our efforts.

Miigwetch, merci, thank you,

CIHR Institute of Indigenous Peoples' Health

Michel Perron
Executive Vice-President
Canadian Institutes of Health Research

Since the last public update in June 2017 of the CIHR Action Plan to strengthen Indigenous health research (IHR) in Canada, CIHR has made tangible progress towards its commitments to build a healthier future for First Nations, Inuit and Métis Peoples. CIHR has focused on strategic leadership, peer review, capacity building, and community and partner engagement to help address gaps in Indigenous health research. As co-champions of the Action Plan, we are leading efforts to strengthen IHR as a priority across all of CIHR, including all 13 institutes.

We thank Indigenous communities from across the country for collaborating with CIHR and providing feedback throughout the year to implement its plan successfully. CIHR has greatly benefited from the guidance, knowledge, and approaches of Indigenous Peoples and organizations. The current 4th Pathways Annual Gathering provides an excellent opportunity to reflect on how this important initiative is advancing. CIHR is delighted to present the progress made on our commitments, while recognizing the need to continue to work together to enable true community-led research.

Progress/action since June 2017

Governance/strategic leadership: To reflect current respectful terminology and alignment with other federal departments, CIHR renamed the CIHR Institute of Aboriginal Peoples' Health to the CIHR Institute of Indigenous Peoples' Health (IIPH). Additionally, to respond to the need for improved Indigenous leadership in governance at CIHR, we are pleased that Dr. Mark S. Dockstator, President of the First Nations University of Canada, has been appointed to CIHR's Governing Council. We also look forward to working with the newly reconstituted IIPH Institute Advisory Board which will help guide IIPH in the development of its emerging strategic plan, and validate the criteria by which CIHR is counting its investments in Indigenous health research. The advisory board is a valuable resource for IIPH, the institutes and CIHR as a whole. Complementing the work of the advisory board, which has seats reserved for delegates from the Assembly of First Nations, Inuit Tapiriit Kanatami and the Métis National Council, CIHR upholds its commitment to meet with senior leadership from Indigenous organizations and has had initial discussions with the National Association of Friendship Centres, and more recently, the Native Women's Association of Canada. We believe this ongoing dialogue will help ensure our investments align with Indigenous priorities

Funding/peer review: As part of its Action Plan, CIHR adopted a new definition of IHR that put emphasis on research by and with Indigenous Peoples. As a result of the new definition, CIHR revalidated its estimates in funding for IHR and calculated a new baseline estimate (based on the previous three years) of ~2%. In 2017/18, CIHR increased its investment in Indigenous health research to 3% of its total budget. We are confident that this will continue to grow towards our commitment of 4.6% investment in IHR through some key actions. The first is launching the Network Environments for Indigenous Health Research (NEIHR) – an $89M, 15-year capacity building investment – which is being supported financially by all 13 institutes. Second is a careful and ongoing review of potential administrative barriers that currently disadvantage true community-led research, including institutional eligibility. Third, we are continuing our commitment to iterative peer review for IHR which allows for promising applications to receive feedback from the peer review panel and resubmit in order to strengthen their applications. Iterative review has been implemented in the last three rounds of the Project Grant competition (including current competition in progress) and some of our priority-driven initiatives. We are now formalizing the terms of reference and selection process for the Reference Group on Appropriate Review Practices for Indigenous Health Research, which will include Elders.

Community and partner engagement: Over the past year, the IIPH have conducted community engagements with Indigenous Peoples from across the country to help inform its emerging strategic plan. Some of the key messages heard from the community include the importance of self-determination in research, including priority setting; the need for strength-based approaches; and the need to ensure ceremony and Indigenous knowledges are respected and an important part of any research initiative.

Complementing the community engagements, CIHR has held or participated in key engagements with Indigenous communities and research partners. For example, in 2017 CIHR and the Native Women's Association of Canada co-hosted the third Pathways Annual Gathering in Whitehorse, Yukon. Under the theme of gender inclusivity as a foundation for building healthy communities, this gathering brought 120 researchers, community partners, Indigenous organizations, and local Indigenous representatives together to discuss progress of Pathways research teams. This builds upon the partnership CIHR had with the National Association of Friendship Centres to co-host the second Pathways Annual Gathering in 2016, and continues with this year's partnership with the First Nations Health and Social Secretariat of Manitoba to co-host the current Pathways Annual Gathering.

Additionally, to raise awareness of opportunities for Alberta First Nations to participate in federally funded research activities and to share Canada's federal research funding agencies' efforts to support and promote culturally appropriate research, CIHR, the Natural Sciences and Engineering Research Council (NSERC) and the Social Sciences and Humanities Research Council (SSHRC) provided an orientation session for ~70 community/academic representatives associated with the Alberta First Nations Information Governance Centre. CIHR continues to collaborate with SSHRC and NSERC through the Canadian Research Coordinating Committee to advance understanding of reconciliation. Understanding the need for both domestic and international partnerships, CIHR was delighted to renew an international commitment in December 2017 with the National Health and Medical Research Council of Australia and Health Research Council of New Zealand to collaborate on Indigenous health research priorities.

Finally, at the 2018 Indigenous Health Conference in May, CIHR's IIPH and Ethics office organized two important events – a plenary session raising awareness to existing challenges in IHR; and a workshop on research ethics with First Nations, Inuit and Métis Peoples integrating perspectives from the Truth and Reconciliation of Canada report; the United Nations Declaration on the Rights of Indigenous Peoples, and the 2017 Fundamental Science Review report. Increasing funding for IHR is not enough – we must continue to ensure that any research involving Indigenous Peoples is conducted in an ethical and appropriate manner.

Emerging initiatives: In addition to the NEIHRs, CIHR continues to invest in initiatives that address Indigenous health inequities. For example, CIHR has recently launched the Pathways Component 3 Implementation Research Teams request for applications which focus on equitable reach, access and sustainability of interventions in four priority areas: mental wellness, diabetes/obesity, tuberculosis, and oral health. CIHR also awarded development grants and held a strengthening workshop for the Indigenous component of the Healthy Life Trajectories Initiative. The development grants were targeted to communities, which represents an important paradigm shift to ensure Indigenous Peoples are at the forefront of research. CIHR also announced the launch of Development and Engagement Grants and Team Grants in Food Security and Climate Change in the Canadian North. The Development and Engagement Grants will bring together Indigenous organizations, communities, researchers and others, to work together to develop projects and proposals that address food security and climate change. The Team Grants will bring together multidisciplinary teams of researchers, knowledge users and/or partners to work together to address food security and climate change in the North. Other emerging initiatives include Indigenous Gender and Wellness Travel Awards and grants for the Transitions in Care initiative – Best and Wise Practices.

As we have outlined, strengthening Indigenous health research relies on strong collaboration with First Nations, Inuit and Métis Peoples from across the country and internationally. We remain committed to working with Indigenous communities and other partners to achieve our shared goals.

Miigwetch, merci, thank you,

Michel Perron
Executive Vice-President
External Affairs and Business Development
Canadian Institutes of Health Research

In November 2016, CIHR announced 10 commitments to strengthen Indigenous health research in Canada, building on work that was already underway.

Over the past months, CIHR has worked closely with the First Nations, Inuit and Métis communities to address gaps in Indigenous health research, and will continue to do so in the future. CIHR is grateful for the advice and guidance of its partners in the Indigenous health research community such as the Assembly of First Nations, Inuit Tapiriit Kanatami, the Métis National Council, the Native Women's Association of Canada, and the National Association of Friendship Centres, among others.

The successful implementation of our 10-point plan to strengthen Indigenous health research is being co-led by Dr. Carrie Bourassa, the Scientific Director of the CIHR Institute of Aboriginal Peoples' Health and CIHR Executive Vice-President Michel Perron.

Today, on National Aboriginal Day, we are pleased to present the progress we've made on our commitments, while recognizing that much remains to be done.

Progress by commitment

1. Increase its capacity to interact with Indigenous communities in a culturally appropriate manner, through the creation of a dedicated team assigned to work directly with Indigenous Peoples, researchers and communities.

   CIHR has established a dedicated Indigenous Health Research Support Office. This team is responsible for supporting initiatives such as Pathways to Health Equity for Aboriginal Peoples, a major program of research focused on suicide prevention, diabetes/obesity, tuberculosis and oral health; supporting the iterative peer review process, which is designed to ensure higher success rates for applications with an Indigenous health focus; and supporting the development of policies and resources to strengthen Indigenous health research generally across CIHR.

   We know that delivering on these 10 commitments will require a concerted effort on the part of the whole organization, and to that end, we have made cultural competency and cultural humility classes available to staff, with more training opportunities to follow in the future. To build on what is being taught in these classes, last week's employee recognition event, held during National Public Service Week, had an Indigenous theme, including Elders, a smudging ceremony, and traditional dancing and food.

2. Ensure that the Federal Government is made aware that the membership of CIHR's Governing Council should reflect the diversity of Canada's Indigenous Peoples.

   We recognize that Indigenous voices must be heard around the management table, and that is why we are working with our government partners to encourage the inclusion of representatives of the Indigenous community on Governing Council and other committees. As a first step, we have ensured that at least half of the membership of theInstitutes Advisory Board for Indigenous Peoples' Health is made up of representatives from the First Nations, Inuit and Métis communities, with three seats reserved for representatives of the national Indigenous organizations.

3. Accept the definition of “Indigenous health research” as drafted by the Institute of Aboriginal Peoples' Health in consultation with Indigenous stakeholders.

   The words we use matter, and, as a sign of respect, it is important that, when discussing Indigenous health research, we use the vocabulary favoured by First Nations, Inuit and Métis communities. We wish to thank the Indigenous stakeholders who helped our Institute of Aboriginal Peoples' Health draft a new, more encompassing and culturally sensitive definition of “Indigenous health research.”

4. Develop, in collaboration with the newly appointed Institutes Advisory Board on Indigenous Peoples' Health, performance indicators to validate CIHR investments in Indigenous health research.

   With a new definition of Indigenous health research now in place, CIHR is working closely with its Institutes Advisory Board on Indigenous Peoples' Health to refine its performance indicators. This will support our goal of being open and transparent when reporting on our progress on investing in Indigenous health research.

   CIHR has also been collaborating with the Social Sciences and Humanities Research Council (SSHRC) and Natural Sciences and Engineering Research Council (NSERC) in order to standardize the practice for collecting data on applicants' and other stakeholders' identities (including Indigenous identity), with the goal of gaining a better sense of participation rates across applicant and stakeholder groups.

5. Increase its investments in Indigenous health research to a minimum of 4.6% (proportional to Canada's Indigenous population) of CIHR's annual budget.

   CIHR continues to take steps to ensure its investment in Indigenous health research totals 4.6% of its annual budget. For our recent Project Grant competition, all 38 applications for Indigenous health research projects went through our iterative peer review process where at least two of the reviewers had expertise in Indigenous health and wellness and who provided their written reviews through a mentorship lens.

   This resulted in 22 of the 38 Indigenous health research projects being awarded funding, with an additional 12 projects receiving one-year bridge grants, for a total investment of $16.5M.

   This topic will be discussed in detail at the next meeting of the Institutes Advisory Board on Indigenous Peoples' Health.

6. Seek to grow these investments as research capacity and additional financial resources allow.

   CIHR launched the refresh of the Indigenous Mentorship Network Program on December 13, 2016, with an $8M investment over five years, enough to fund eight teams, including seven regional nodes (in British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Quebec and Atlantic Canada) plus an international/coordinating node. The goal of this program is to break down the barriers hindering participation of First Nations, Inuit and Métis trainees and new investigators in health research. CIHR has also begun discussions with partners around collaborative and innovative strategies to support capacity for Indigenous health research across the spectrum, from entry level (high school) to post-doctoral, including building capacity for communities to engage in research.

   In May, CIHR's Institute of Aboriginal Peoples' Health hosted a national gathering of graduate students in Indigenous health attended by 20 students and a new investigators meeting. At these two events, the interest in supporting scholarship using an Indigenous research paradigm was evident. In September 2017, CIHR will be supporting Indigenous new investigators, as well as Elder/youth pairs, to attend the third annual Pathways Annual Gathering, an event that brings together community members, researchers, national Indigenous organizations and CIHR staff to encourage respect for and inclusion of Indigenous Ways of Knowing in CIHR's Indigenous health research projects, and support networking and community building.

7. Continue working with the Reference Group on Indigenous Health Research to implement iterative peer review processes for applications relevant to Indigenous health, so as to ensure better success rates for Indigenous-focused investigator-initiated grant applications.

   CIHR continues to work with the external Reference Group on Appropriate Review Practices for Indigenous Health Research to develop an iterative peer review process. This process was used for the first time in the most recent Project Grant competition, with all Indigenous health-related applications being sent to a separate face-to-face committee where at least half of reviewers had expertise in Indigenous health and wellness and provided their written reviews through a mentorship lens.

8. Create, with the advice of the Institutes Advisory Board on Indigenous Peoples' Health, impactful strategic initiatives aimed at improving the health of Indigenous Peoples.

   CIHR continues to look for ways to integrate Indigenous health research into its funding opportunities, and has recently earmarked funds for Indigenous components in funding opportunities for the microbiome, HIV/AIDS, maternal, reproductive and child and youth health, and improved immunization coverage, among others. The CIHR Institute of Aboriginal Peoples' Health will be working with its community to identify other opportunities for investment.

9. Hold annual meetings between the President of CIHR and leaders of the Assembly of First Nations, Inuit Tapiriit Kanatami, and the Métis National Council to discuss Indigenous health research priorities.

   We are committed to strengthening our relationship with the Indigenous community, including the national Indigenous organizations, and have made significant strides in building positive and collaborative relationships. For example, we have been working closely with Inuit Tapiriit Kanatami (ITK) on one of their biggest health priorities – suicide prevention. In Iqaluit in March 2017, CIHR and ITK cohosted an important international symposium on suicide prevention. CIHR is also pleased to have become a member of a Health Portfolio Table which will strengthen our ability to engage with the Métis National Council. And to make certain that we listen and hear from the community about its needs, the national Indigenous organizations will once again be participating in our third annual Pathways Gathering in September.

10. Work with other federal research councils to develop strategies to strengthen Indigenous research capacity development through training and mentoring along the entire career continuum from undergraduate to postdoctoral levels.

    CIHR staff have joined a Tri-Agency working group convened by SSHRC to identify areas of collaboration for Indigenous research between SSHRC, CIHR and NSERC. This group will focus on strategies for capacity building, investments for improved management of Indigenous data, and administrative efficiencies to support Indigenous community-based research. CIHR is also exploring opportunities to leverage investment funds with the other Tri-Agencies to achieve the greatest impact when it comes to supporting Indigenous research.

The activities above represent the first steps CIHR is taking as an organization to strengthen Indigenous health research. The Truth and Reconciliation's health-related Calls to Action were clear: there is a pressing need for governments to close gaps in health outcomes experienced by Indigenous Peoples, recognize the value of traditional healing practices and increase the number of Indigenous Peoples working in the health care field, among other urgently needed actions. CIHR is committed to doing its part to work towards reconciliation through research.

In the spirit of openness and transparency, we will be reporting on our progress towards our 10 commitments regularly, so please check back often.