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Over the past 20 years, there have been a number of reports
on supporting and developing northern health research.1-5
These all reached similar conclusions, calling for increased
infrastructure and capacity for health research, involvement of
northerners, and recognition of various knowledge bases present
in the North. Such consultations continue as little progress has
been made towards redressing the north-south disparity in health
research.
Despite low resource allocations to the North, northern residents
and community organizations have taken significant initiatives
towards the development of health research. In this commentary,
we present a model for the development of northern health
research based on our experiences in establishing the Institute for
Circumpolar Health Research (ICHR) in the Northwest Territories.
It is hoped that the lessons we have learned will inform decision-
makers and encourage them to make strategic investments to sup-
port further health research capacity and institutional development
within the North.
Originally incorporated under the NWT Societies Act in 2005 as
the Arctic Health Research Network Northwest Territories (AHRN
NT), AHRN NT changed its name to ICHR in 2009 to reflect more
accurately its mandate to conduct research, facilitate research, and
engage in research training, knowledge synthesis and dissemina-
tion. In the short span of three and a half years, the Institute has
obtained $4.7 million in grants and contracts to support various
research activities.
Factors that have enabled the development of a health research
institute in the North include leadership, a vision for health
research, and the engagement of key partners and stakeholders.
Challenges arise in the development of appropriate governance and
policy for health research.
Leadership and partnerships
The ICHR board of directors adopted as its vision statement, “Build-
ing on the strengths and knowledge of all cultures to achieve health”. We
have stayed away from governance models where board members
are composed of representatives of stakeholder organizations, as it
increases the potential for conflicts of interest when board members
have mixed mandates and feel the need to advance the interests of
the “parent” organization rather than those of the Institute. Instead
the Institute board consists of individuals who bring various per-
spectives and experiences to ensure that the Director upholds the
vision and mandate of the Institute.
On a project-by-project basis, ICHR enlists a broad base of part-
ners, who do not play a role in the governance of the Institute.
These partners are engaged because the research area has particular
relevance to their organization. Partners to date have included
Indigenous governments, policy-makers, health care providers, and
community organizations. The partners provide guidance on
research priorities and are involved in project implementation and
interpretation of research findings. Such a partnership model
thrives within a northern culture of consensus and close-knit com-
munities and organizations.
The partnership approach of ICHR enhances evidence-based
practice in support of policy development, clinical decision-making
and health system design by incorporating the inputs of various
partners. The output of the research is a synthesis of various knowl-
edge sources and perspectives. Relevance is built in at an early stage,
as are economic and political considerations that will influence the
course and outcome of a research project.
COMMENTARY
Author Affiliations
1. Scientific and Executive Director, Institute for Circumpolar Health Research,
Yellowknife, NT; Assistant Professor, Dalla Lana School of Public Health, University
of Toronto, Toronto, ON
2. Professor and TransCanada Pipelines Chair, Dalla Lana School of Public Health,
University of Toronto; Chair, International Scientific Advisory Council, Institute for
Circumpolar Health Research, Yellowknife, NT
Correspondence: Ms. Susan Chatwood, Executive and Scientific Director, Institute
for Circumpolar Health Research, P.O. Box 11050, Yellowknife, NT X1A 2T9, Tel: 867-
873-9337, Fax: 867-873-9338, E-mail: susan.chatwood@ichr.ca
Conflict of Interest: None to declare.
A New Approach to Health Research in Canada’s North
Susan Chatwood, BScN, MSc,1Kue Young, MD, FRCPC, DPhil2
ABSTRACT
Over the past four years, despite low resource allocations to the North, northern residents and community organizations have taken significant initiatives
towards the development of health research. In this commentary, we present a model for the development of northern health research based on our
experiences in establishing the Institute for Circumpolar Health Research (ICHR) in the Northwest Territories. It is hoped that the lessons we have learned
will inform decision-makers and encourage them to make strategic investments to support further health research capacity and institutional
development within the North. Factors that have enabled the development of a health research institute in the North include leadership, a vision for
health research, and the engagement of key partners and stakeholders. Challenges arise in the development of appropriate governance and policy for
health research. There is an urgency to target resources to support the development of policies and governance for health research in northern
jurisdictions. Both academic and community-based research need to be strengthened.
Key words: Research; health policy; arctic regions; public health
La traduction du résumé se trouve à la fin de l’article. Can J Public Health 2010;101(1):25-27.
© Canadian Public Health Association, 2010. All rights reserved. CANADIAN JOURNAL OF PUBLIC HEALTH • JANUARY/FEBRUARY 2010 25
Research program
The Institute board, staff, and advisors have identified five research
themes for development. These themes were selected for their
strategic advantage because of the physical location in the North
and likelihood for long-term sustainability. They also reflect cur-
rent capacity and the availability of northern-based researchers to
serve as group leaders.
Research Themes
• Developing youth-driven community-based participatory methods
• Improving health systems performance
• Monitoring changing population health status
• Understanding socio-economic determinants of health
• Assessing the impacts of health research.
The Institute appoints senior research fellows from universities
across Canada and also in other circumpolar countries who will
participate in these research programs and mentor our northern-
based researchers. Representatives of northern communities, gov-
ernments, and health care institutions will also participate in
program design and partner on individual projects. The Institute
director will also draw upon the strategic advice of an internation-
al scientific advisory council.
Governance and policies
Historically, northern-based researchers have often conducted
research as independent scholars or consultants or within NGOs as
there are not any university structures to work from. They are
dependent on guidelines provided by funding agencies, govern-
ment regulations and community organizations. As a result, poli-
cies that oversee northern-based health research are fragmented
and usually vary from project to project.
Generally, research funds are disbursed to and administered by
universities and affiliated research institutes, which have long-
established policies and structures to ensure accountability and
quality. Thus it is not surprising that territorial institutions without
university affiliation do not meet criteria to access these funds for
health research.
Some northern institutions have taken small first steps. For
example, Yukon College has acquired the status to be eligible for
receiving and administering SSHRC funds. Memorial University of
Newfoundland has established a tenure track position in health
research at the Labrador Institute located in Goose Bay. Two senior
staff members of the Institute for Circumpolar Health Research
have recently received off-campus, status-only faculty appointment
at the Dalla Lana School of Public Health, University of Toronto.
Such small steps are essential to building northern-based research
capacity. The day when a northern-based researcher can apply for
and be successful in receiving a tri-council research grant will be a
tangible marker of advances in capacity building for health research
in the North.
Barriers exist within our northern institutions to support and
promote excellence in academic and community-based research.
Foremost is the lack of policies similar to those which uphold
health research practices in university structures. ICHR has devel-
oped memorandums of understanding with university researchers
on a project-by-project basis. While this process meets the imme-
diate needs for health research in the territories, it does not pro-
mote long-term sustainable health research in the North.
Ultimately, a formal affiliation agreement with a university will
allow the Institute to build its research programs, hold tri-council
grants, supervise northern-based graduate students and offer
graduate-level courses in the North.
Further work is also required to develop policies and frameworks
to support community-based research. Research funding targeted at
community-based initiatives is becoming more common and in
many instances university partnerships are not required. However,
in many cases community-based organizations struggle with meet-
ing requirements laid down by licensing bodies and funding agen-
cies, creating additional challenges for already under-resourced
research partners.
Ethical oversight
In the northern territories, all research – including health research
– is governed by a scientist’s act. This act ensures a process of
regional consultation and an obligation to register and report back
on research activities. Health Research Ethics Boards (HREB) also
play a role in overseeing research practice. In the North there are
few functional HREBs, and these are highly variable in their struc-
ture and capabilities. There are immediate needs to coordinate,
streamline, and enhance the capacity for health research ethics
review in the territories. These efforts must occur in tandem with
the development of health research institutes.
Policies and procedures related to ethical review that have been
designed for university-based researchers have the unintended
illogical result that community organizations that apply for
research funding often have to demonstrate community relevance
and provide evidence of community consultation and community
approval.
Northern consultations
The federal government has developed a national science and tech-
nology strategy.6While this document offers clear and strategic
directions for research, the underdevelopment of health research
in the North prevented northerners and their institutions from con-
tributing to, benefiting from, or responding to such strategies.
To their credit, national research agencies have not neglected the
North – witness the parade of northern consultations that have
passed through the North in recent years. But northern input is
often sought after strategies have been set and resources have
already been allocated. Northerners have resorted to political chan-
nels to evoke timely change or access resources for research pro-
grams, a practice that is neither strategic nor beneficial as advances
for the North are made in a reactive rather than proactive manner.
So, while northern consultations are required to enable national
organizations to better serve northern jurisdictions, it must be
stressed that the consulting organizations need also to explore their
own policies and governance structures to determine why northern
stakeholders engaged in health research are not at the table from
the outset.
Research funding
A quick scan of the millions of dollars in funding allocations of the
tri-council bodies (CIHR, SSHRC and NSERC), the Network of Cen-
tres of Excellence, Canada Research Chairs and the Canada Foun-
dation for Innovation programs reveals the complete lack of a
primary grant holder from the northern territories. In 2007,
BUILDING HEALTH RESEARCH CAPACITY
26 REVUE CANADIENNE DE SANTÉ PUBLIQUE • VOL. 101, NO. 1
of $6.3 billion spent on health research systems in Canada,7none
flowed directly to a territorial jurisdiction. Thus, while all the
national programs are well positioned strategically to support excel-
lence in northern health research, they currently fail to address
immediate capacity needs in the North itself.
As a northern-based entity, ICHR has by necessity sought alter-
native mechanisms and methods to fund and support its health
research activities. Due to good timing and visionary partners who
have demonstrated a true commitment to northern-based research
capacity, ICHR was able to access some stable funds for three- to
five-year periods. These supporters include the federal International
Polar Year (IPY) program, the CIHR Team in Circumpolar Health
Research led by the University of Toronto’s Dalla Lana School of
Public Health, and the Government of the Northwest Territories
through the Tri Territorial Health Access Fund. Most recently, ICHR
was the only health research organization in the North to receive
funding from the Arctic Research Infrastructure Fund, which
enables it to develop research space in close proximity to the
regional health and social services authority in Yellowknife.
In each of these instances, it was the leadership within the fund-
ing agency who recognized the barriers and struggles for northern
access to research funds. Adjustments were made so that alloca-
tions can be made to northern organizations engaged in health
research. The federal IPY program in particular moved the agenda
forward for northern-based health research and made special efforts
to support both academic and community-based researchers.
As a young organization, ICHR had to be constantly alert to
funding opportunities and respond in a timely fashion. To sustain
a small research institute, approximately $1.5 million in contracts
and grants are required each year to cover the indirect costs of
research and core operations. Since 2005, such costs have been
recovered from a total of 22 contribution agreements and grants.
The time dedicated to the administration of these grants has been
substantial and detracts from the research mandate of the Institute.
Each grant is associated with its own proposal writing, contract
negotiation, periodic reporting, and financial audits. Northern-
based researchers are at a clear disadvantage to their provincial and
university-based colleagues as they lack institutional support for
such functions. Immediate solutions are required to rectify this sit-
uation, as current practices are not conducive to advancing a sci-
ence agenda based in the North.
Research impacts
Inspired by the assessment undertaken by the Canadian Academy
of Health Sciences,8ICHR recognizes the need to measure and mon-
itor the impact of research and returns on investment in the North,
including advancing knowledge, informing decision-making and
gains in health outcomes.
Specific attention will be required to measure capacity building for
health research, as we move academic research into northern juris-
dictions. Measures of capacity need to capture activities in a broad
cross-section of organizations which do not necessarily have
research mandates. In evaluating the impact of research, a distinc-
tion needs to be made between conducting research and facilitat-
ing research. In facilitating research, northern stakeholders
contribute to proposal development, serve on steering committees,
and assist with data access and dissemination. It is important to rec-
ognize when a project is led or directed by a northern stakeholder.
As comparable frameworks are developed and put in place,
northern-based academic and community research activities can
then be compared nationally and internationally. ICHR is well posi-
tioned to create and adapt impact models and measures for the
northern research environment.
CONCLUSIONS
The interaction of various factors has contributed to the establish-
ment of the Institute for Circumpolar Health Research in the North-
west Territories. Committed individuals in the North have
demonstrated the ability to set a vision and mandate for northern-
based health research, bring together partners, and develop teams
to support research programs that have relevance regionally,
nationally and internationally. There is an urgency to target
resources to support the development of policies and governance
for health research in northern jurisdictions. Both academic and
community-based research need to be strengthened.
REFERENCES
1. Government of the Northwest Territories and Science Institute of the North-
west Territories. Yellowknife, NT: Health Research North of 60 Workshop.
Final Report, 1989.
2. Canadian Institutes of Health Research, Institute of Aboriginal Peoples’ Health
and the Institute of Nutrition, Metabolism and Diabetes. Ottawa, ON: Health
Research Needs North of 60: Northern Town Hall Meetings, September 2001,
2002.
3. Graham J, Fortier E, submitted by the Institute on Governance (IOG) to the
Natural Sciences and Engineering Research Council (NSERC), the Social Sci-
ences and Humanities Council(SSHRC), the Canadian Institutes of Health
Research (CIHR), and the Planning Committee for the Dialogue on Northern
Research. From Opportunity to Action. A Progress Report on Canada’s Renew-
al of Northern Research. Ottawa: Government of Canada, 2004.
4. Council of Canadian Academies. Vision for the Canadian Arctic Research Ini-
tiative (CARI): Assessing the Opportunities. Report of the International Expert
Panel on Science Priorities for the Canadian Arctic Research Initiative. 2008.
5. Beaulieu JM, Bennett J, Bigras S. Beacons of the North. Research Infrastructure
in Canada’s Arctic and Subarctic. Ottawa: Canadian Polar Commission, 2008.
6. Industry Canada. Mobilizing Science and Technology to Canada’s Advantage.
2007.
7. Statistics Canada. Science Innovation, Electronic Information Division. 2008.
8. Canadian Academy of Health Sciences. Panel on Return on Investment in
Health Research. Making an Impact: A Preferred Framework and Indicators to
Measure Returns on Investment in Health Research. 2009.
Received: July 25, 2009
Accepted: November 18, 2009
RÉSUMÉ
Au cours des quatre dernières années, malgré le manque de ressources
attribuées aux régions nordiques, les résidents et les organismes
communautaires du Nord ont lancé d’importantes initiatives pour
développer la recherche en santé. Dans ce commentaire, nous présentons
un modèle pour le développement de la recherche en santé nordique
d’après notre expérience de l’établissement de l’Institute for Circumpolar
Health Research (ICHR) dans les Territoires du Nord-Ouest. Nous
espérons que les leçons de cette expérience seront utiles aux décideurs et
les inciteront à faire des investissements stratégiques pour rehausser la
capacité de recherche en santé et le développement institutionnel dans le
Nord. Les facteurs qui ont permis la création d’un établissement de
recherche en santé dans le Nord sont le leadership, une vision de la
recherche en santé et la mobilisation des partenaires clés et des parties
prenantes. L’élaboration de structures décisionnelles et de politiques
adaptées à la recherche en santé présente des défis. Il est urgent de cibler
les ressources qui appuieront l’élaboration de ces politiques et de ces
structures dans les territoires nordiques. Il faut renforcer à la fois la
recherche universitaire et la recherche communautaire.
Mots clés : recherche; politique sanitaire; arctique; santé publique
BUILDING HEALTH RESEARCH CAPACITY
CANADIAN JOURNAL OF PUBLIC HEALTH • JANUARY/FEBRUARY 2010 27
