Promoting equitable global health research: a policy analysis of the Canadian funding landscape

Decolonising global health research: Shifting power for transformative change

Recent debates on decolonizing global health have spurred interest in addressing the power asymmetries and knowledge hierarchies that sustain colonial ideas and relationships in global health research. This paper applies three intersecting dimensions of colonialism (colonialism within global health; colonisation of global health; and colonialism through global health) to develop a broader and more structural understanding of the policies and actions needed to decolonise global health research. It argues that existing guidelines and checklists designed to make global health research more equitable do not adequately address the underlying power asymmetries and biases that prevail across the global health research ecosystem. Beyond encouraging fairer partnerships within individual research projects, this paper calls for more emphasis on shifting the balance of decision-making power, redistributing resources, and holding research funders and other power-holders accountable to the places and peoples involved in and impacted by global health research.

Barriers to sustainable health research leadership in the Global South: Time for a Grand Bargain on localization of research leadership?

BACKGROUND

Strong Global South (GS) health research leadership, itself both dependent on and a requisite for strong health research systems, is essential to generate locally relevant research and ensure that evidence is translated into policy and practice. Strong GS health research systems and leadership are important for health development and in turn for strong health systems. However, many GS countries struggle to produce research and to improve performance on widely used research metrics measuring productivity and reflecting leadership. Drawing on literature from a rapid review, this viewpoint paper considers the barriers to GS health research leadership and proposes strategies to address these challenges.

FINDINGS

GS researchers and institutions face numerous barriers that undermine health research leadership potential. Barriers internal to the GS include researcher-level barriers such as insufficient mentorship, limited financial incentives and time constraints. Institutional barriers include limited availability of resources, restrictive and poorly developed research infrastructures, weak collaboration and obstructive policies and procedures. Structural barriers include political will, politicization of research and political instability. External barriers relate to the nature and extent of Global North (GN) activities and systems and include allocation and distribution of funding and resources, characteristics and focus of GN-GS research collaborations, and publication and information dissemination challenges.

CONCLUSIONS

Strengthening GS health research leadership requires acknowledgement of the many barriers, and adoption of mitigating measures by a range of actors at the institutional, national, regional and global levels. Particularly important are leadership capacity development integrating researcher, institutional and systems initiatives; new GN-GS partnership models emphasizing capacity exchange and shared leadership; supporting GS research communities to set, own and drive their research agendas; addressing biases against GS researchers; ensuring that GS institutions address their internal challenges; enhancing South-South collaborations; diversifying research funding flow to the GS; and learning from models that work. The time has come for a firm commitment to improving localization of research leadership, supported by adequate funding flow, to ensure strong and sustainable research systems and leadership in and from the GS. Just as the humanitarian donor and aid community adopted the Grand Bargain commitment to improve funding flow through local and national responders in times of crisis, we strongly urge the global health research community to adopt a Grand Bargain for research leadership.

Transforming Canada's role in global cancer control

Cancer has not been an explicit priority of Canada's international health and development agenda, but it is key to realising the country's Sustainable Development Goal commitments. Multiple converging political, health, and social forces could now drive support for a more integrated Canadian approach to global cancer control. Success will depend on the extent to which Canadian leaders and institutions can build consensus as a community and agree to work together. Collaboration should include agreement on the framing and prioritisation of the core issues, building a broad coalition base, aligning with priorities of international partners, and on a governance structure that reflects the principles of equity, diversity, and inclusion. This Series paper will discuss global cancer control within Canada's global health agenda, how Canada can address its history of colonisation and present-day disparities in its global work, and the challenges and opportunities of creating a Canadian global cancer control network.

Informing 'good' global health research partnerships: A scoping review of guiding principles

Background: Several sets of principles have been proposed to guide global health research partnerships and mitigate inequities inadvertently caused by them. The existence of multiple sets of principles poses a challenge for those seeking to critically engage with and develop their practice. Which of these is best to use, and why? To what extent, if any, is there agreement across proposed principles?

Objective: The objectives of this review were to: (1) identify and consolidate existing documents and principles to guide global health research partnerships; (2) identify areas of overlapping consensus, if any, regarding which principles are fundamental in these partnerships; (3) identify any lack of consensus in the literature on core principles to support these partnerships.

Methods: A scoping review was conducted to gather documents outlining ‘principles’ of good global health research partnerships. A broad search of academic databases to gather peerreviewed literature was conducted, complemented by a hand-search of key global health funding institutions for grey literature guidelines.

Results: Our search yielded nine sets of principles designed to guide and support global health research partnerships. No single principle recurred across all documents reviewed. Most frequently cited were concerns with mutual benefits between partners (n = 6) and equity (n = 4). Despite a lack of consistency in the inclusion and definition of principles, all sources highlighted principles that identified attention to fairness, equity, or justice as an integral part of good global health research partnerships.

Conclusions: Lack of consensus regarding how principles are defined suggests a need for further discussion on what global health researchers mean by ‘core’ principles. Research partnerships should seek to interpret the practical meanings and requirements of these principles through international consultation. Finally, a need exists for tools to assist with implementation of these principles to ensure their application in research practice.

Mining, Colonial Legacies, and Neoliberalism: A Political Ecology of Health Knowledge : Minerıa, legados coloniales y neoliberalismo: una ecologıa polıtica del conocimiento en salud

Scholarship on the health impacts of resource extraction displays prominent gaps and apparent corporate and neocolonial footprints that raise questions about how science is produced. We analyze production of knowledge, on the health impacts of mining, carried out in relation to the Canadian International Resources and Development Institute (CIRDI), a university-based organization with substantial extractive industry involvement and links to Canada’s mining-dominated foreign policy. We use a “political ecology of knowledge” framework to situate CIRDI in the context of neoliberal capitalism, neocolonial sustainable development discourses, and mining industry corporate social responsibility techniques. We then document the interactions of specific health disciplinary conventions and knowledges within CIRDI-related research and advocacy efforts involving a major Canadian global health organization. This analysis illustrates both accommodation and resistance to large-scale political economic structures and the need to directly confront the global North governments and sectors pushing extractive-led neoliberal development globally.

Resumen

La investigación sobre los impactos en la salud de la extracción de recursos naturales delata brechas importantes y huellas corporativas y neocoloniales, que plantean dudas acerca de cómo se produce la ciencia. Analizamos la producción de conocimiento sobre los impactos en la salud de la minería en relación con el Instituto Canadiense de Desarrollo y Recursos Internacionales (CIRDI, siglas en inglés), una organización universitaria que cuenta con participación sustancial de la industria extractiva y tiene vínculos con la política exterior de Canadá, la cual es dominada por intereses mineros. Utilizamos un marco de "ecología política del conocimiento" para situar a CIRDI en el contexto del capitalismo neoliberal, los discursos neocoloniales de desarrollo sostenible y las técnicas de responsabilidad social corporativa de la industria minera. Luego, documentamos las interacciones entre los conocimientos y convenciones disciplinarias de salud dentro de los esfuerzos de investigación y promoción relacionados con CIRDI que involucran a una importante organización canadiense de salud global. Este análisis muestra tanto la complacencia como la resistencia a las estructuras políticas económicas a gran escala, y la necesidad de confrontar directamente a los gobiernos y sectores del Norte global que manejan el desarrollo neoliberal impulsado por la extracción a nivel mundial.

The politest form of racism: sexual and reproductive health and rights paradigm in Canada

The Canadian national identity is often understood as what it is not; American. Inundation with American history, news, and culture around race and racism imbues Canadians with a false impression of egalitarianism, resulting in a lack of critical national reflection. While this is true in instances, the cruel reality of inequity, injustice and racism is rampant within the Canadian sexual and reproductive health and rights realm. Indeed, the inequitable health outcomes for Black, Indigenous and people of color (BIPOC) are rooted in policy, research, health promotion and patient care. Built by colonial settlers, many of the systems currently in place have yet to embark on the necessary process of addressing the colonial, racist, and ableist structures perpetuating inequities in health outcomes. The mere fact that Canada sees itself as better than America in terms of race relations is an excuse to overlook its decades of racial and cultural discrimination against Indigenous and Black people. While this commentary may not be ground-breaking for BIPOC communities who have remained vocal about these issues at a grassroots level for decades, there exists a gap in the Canadian literature in exploring these difficult and often underlying dynamics of racism. In this commentary series, the authors aim to promote strategies addressing systemic racism and incorporating a reproductive justice framework in an attempt to reduce health inequities among Indigenous, Black and racialized communities in Canada.

Using a rapid environmental scan methodology to map country-level global health research expertise in Canada

Background

Many countries are currently rethinking their global health research funding priorities. When resources are limited, it is important to understand and use information about existing research strengths to inform research strategies and investments and to drive impact. This study describes a method to rapidly assess a country’s global health research expertise and applies this method in the Canadian context.

Methods

We developed a three-pronged rapid environmental scan to evaluate Canadian global health research expertise that focused on research funding inputs, research activities and research outputs. We assessed research funding inputs from Canada’s national health research funding agency and identified the 30 Canadian universities that received the most global health research funding. We systematically searched university websites and secondary databases to identify research activities, including research centres, research chairs and research training programmes. To evaluate research outputs, we searched PubMed to identify global health research publications by Canadian university-affiliated researchers. We used these three perspectives to develop a more nuanced understanding of Canadian strengths in global health research from different perspectives.

Results

Canada’s main global health research funder, the Canadian Institutes of Health Research, invested a total of $314 M from 2000 to 2016 on global health research grants. This investment has contributed to Canada’s wealth of global health research expertise, including 12 training programmes, 27 Canada Research Chairs, 6 research centres and 30 WHO Collaborating Centres across 27 universities. Research activities were concentrated in Canada’s biggest cities and most commonly focused on health equity and globalisation issues. Canadian-affiliated researchers have contributed to a research output of 822 unique publications on PubMed. There is an opportunity to build global health expertise in regions not already concentrated with research activity, focusing on transnational risks and neglected conditions research.

Conclusions

Our three-pronged approach allowed us to rapidly identify clear geographic and substantive areas of strength in Canadian global health research, including urban regions and research focused on health equity and globalisation topics. This information can be used to support research policy directives, including to inform a Canadian global health research strategy, and to allow relevant academic institutions and funding organisations to make more strategic decisions regarding their future investments.

Systematic analysis of global health research funding in Canada, 2000-2016

OBJECTIVES

Considering recent shifts in global funding landscapes, this study analyzes Canada's long-term global health research funding trends in the hope of informing a new Canadian global health research strategy. Examining past investments can help prioritize limited future resources to either build on Canada's existing strengths or fill gaps where needed, while simultaneously informing the investments of research funders in other countries.

METHODS

Administrative data were analyzed covering all 1584 global health research grants awarded by the Canadian Institutes of Health Research (CIHR) to 927 unique principal investigators from 2000 to 2016, totalling C$341 million. Existing metadata associated with each grant was supplemented by additional qualitative coding. Descriptive time-series analyses of global health research grant data were conducted using various measures related to each grant's recipient (e.g., province, university, sex, distribution) and subject matter (e.g., research theme, area, focus).

RESULTS

CIHR's total annual global health research funding increased sharply from $3.6 million in FY2000/2001 to $30.3 million in FY2015/2016, with the largest share of research funding now focused on health equity-representing nearly 50% of CIHR's global health research funding. Past grants have concentrated on infectious disease and public health research. One third of CIHR's global health grant funding went to 20 principal investigators. Only 42.2% of global health research funding came from CIHR's open investigator-driven competitions, with the rest coming from strategic priority-driven competitions.

CONCLUSION

Global health research has seen steady increases in funding from CIHR's open competitions when preceded by investment in strategic competitions, which suggests the level of a national research funding agency's strategic investments in global health research may determine the size of the field in their country. The greatest concentration of past investment lies in health equity research, followed by infectious disease research. Future analyses of research funding would benefit from an internationally accepted keyword classification scheme and more granular administrative data.

Canada's global health role: supporting equity and global citizenship as a middle power

Canada's history of nation building, combined with its status as a so-called middle power in international affairs, has been translated into an approach to global health that is focused on equity and global citizenship. Canada has often aspired to be a socially progressive force abroad, using alliance building and collective action to exert influence beyond that expected from a country with moderate financial and military resources. Conversely, when Canada has primarily used economic self-interest to define its global role, the country's perceived leadership in global health has diminished. Current Prime Minister Justin Trudeau's Liberal federal government has signalled a return to progressive values, driven by appreciation for diversity, equality, and Canada's responsibility to be a good global citizen. However, poor coordination of efforts, limited funding, and the unaddressed legacy of Canada's colonisation of Indigenous peoples weaken the potential for Canadians to make meaningful contributions to improvement of global health equity. Amid increased nationalism and uncertainty towards multilateral commitments by some major powers in the world, the Canadian federal government has a clear opportunity to convert its commitments to equity and global citizenship into stronger leadership on the global stage. Such leadership will require the translation of aspirational messages about health equity and inclusion into concrete action at home and internationally.