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Why should we care about health research?
The Canadian Institutes for Health Research (CIHR) will use new government money for health research. Many activists and front-line community and hospital-based workers aren't happy about spending new money on something other than services. Services for women - both in communities and in institutions - have been cut with what seems like every new budget announcement at just about every government level.
Should the careers of researchers be advanced at the expense of important front-line services?
The answer: Of course not. But, we do need both to improve women's health.
We need to take part in the development of the CIHR and work to end to the cuts to front-line services, getting new dollars into them from all levels of government.
But we also need to argue for more and better research in women's health.
The women's health movement has worked hard to put women's health on the agenda of health providers and health researchers. The momentum created by such programs as the Centres of Excellence for Women's Health risks being lost through this new restructuring if we don't speak out for it now.
What are the CIHR?
As reported earlier in Network (Spring 1999) health research in this country is about to be transformed with the Canadian Institutes of Health Research (CIHR). Announced by Health Minister Allan Rock early last year, the federal government plans to put in more research dollars to alter the way health research is organized in Canada.
Rock has announced that by 2002, the health research budget will be double what it was last year. This is after years of concern about the lack of funds for health research that is publically controlled and accountable.
Many Canadians do not know that much of what is done in Canada in the name of "health research" is testing for medical drugs and devices, funded in part or whole by pharmaceutical companies and carried out by contract researchers.
Rock's announcement shows the government responding to a wake-up call to the strong need for research funded by and accountable to the Canadian public.
The wake-up call came in the form of the tainted blood scandal, a new and growing understanding of what really determines our health, experiences like that of Dr. Nancy Oliveri at the Hospital for Sick Children, and a beginning at recognizing the variety of needs in a diverse population.
These new research dollars mark an effort to retain home-grown minds in our country, keep them from trotting off to join our free-enterprise neighbours to the south - the so-called "brain drain."
While many feel that the notion of a "brain drain" is grossly exaggerated (what about the "brain gain" from new immigrants?), few would argue that health research in Canada is not under-funded.
The Vision
When all pieces of this new organization are fully in place some time this spring, the CIHR is supposed to transform how research is funded and carried out in Canada.
The CIHR vision includes bringing the four "pillars" of health research and their associated researchers together. The four pillars of research are 1) biomedical 2) population health 3) applied clinical and 4) health services and health systems.
Although it is unclear where research on issues such as health promotion or alternative health will occur, this shift to a more inclusive model is good news.
CIHR Institutes
All the individual CIHR institutes will be governed by an appointed Governing Council with each institute headed by a Scientific Director. This Governing Council will oversee the work of 10-15 "virtual" health institutes across the country.
The decision about which institutes to fund will be made by the Minister of Health and the Governing Council of the CIHR. Their decision will be based on recommendations from an interim governing council of the CIHR. They received 170 proposals on which to base their recommendations.
For-Profit Interests
Clarity is lacking around the issue of commercial interests in the CIHR - there is also a need for clear conflict of interest guidelines in any public appointments related to the CIHR.
Concerns about for-profits extend not just to industry-sponsored researchers or representatives from industry, but to those voluntary and community groups who take their money.
As women have often noted, those who define the research question define the answer. If selling a product is a goal, would developing that product get priority over preventing an illness?
Would the other "pillars of health research" - like population health - take a back seat? Will this work against our understanding of the real determinants of health? Will researchers have the freedom to report negative findings? Will the knowledge created by the CIHR be patented or would it be held in the public domain?
The role of the pharamaceutical industry specifically at the Governing Council has also been questioned. This issue is currently being debated in the Senate as it reviews the legislation.
Out with the Old
In addition to providing new dollars for health research, this move will gradually eliminate the existing Medical Research Council - the major Canadian funding body for medical research - and other national health funding bodies will eventually be rolled into the larger CIHR.
Supporting Women's Health Research
In the fall of last year, a working group of researchers and activists from across Canada, calling themselves the Working Group on the CIHR, Gender and Women's Health Research, joined together to prepare and submit a proposal for a women's health research institute within the CIHR.
They await the Minister's announcement find out which institutes made the grade.
A women's health research institute would help make sure that gaps in women's health research are addressed. It will also make sure that research looks into the context of women's lives as well as their biological make-up.
For example, what is the cost of violence against women to the health care system? How can we put a stop to violence against women?
We need creative and humane solutions to look at the effects of health care restructuring and increased home care on women's already overburdened workload and on their health.
The Working Group's proposal further recommended that the CIHR should take sex and gender into account in all their institutes. This means, for example, that all health research must take look at sex differences where this is appropriate.
Write a Letter
The Working Group is asking people to write letters of support. Please send yours to both the Minister of Health, Allan Rock and the Prime Minister's Office in support of a Women's Health Research Institute.
For more information on the proposal or the Working Group, contact:
Working Group on the CIHR, Gender and Women's Health Research coordinator:
Amanda Kobler
Tel: (604) 875-2345 ext. 6871
E-mail: akobler@cw.bc.ca
Web site: www.cwhn.ca/cihr
Consider a few of the reasons why we need more research in women's health:
More women believe they will die of breast cancer than of the true #1 killer of women -heart disease.
Recent research has shown that women's symptoms of heart attack are somewhat different from men's, and that the perception that women don't get heart attacks means that women and their providers don't respond as quickly to warning signs. Treatment decisions for women with cardiac disease are often based on research that has been conducted only on men.
We need more and better information about diagnosis and treatment issues specific to women and heart disease.
It is more difficult for women to quit smoking and more young women than men are taking up the habit.
Why? While money is needed for smoking cessation programs specific to women, the best programs will only be designed when we fully understand what makes it so difficult for women to quit.
Are women at increased risk of breast cancer if they take hormone therapy?
For some time, clinicians have advised women that the link between hormone replacement therapy and breast cancer is tenuous enough that this should not deter them from taking hormones for difficult menopausal symptoms and to prevent osteoporosis and heart disease. However, two very recent studies on hormone replacement therapy have, in fact, found that women are at increased risk of breast cancer if they take both estrogen and progestin, particularly if for more than five years. We are now back to square one in determining the best advice to give to women.
The quality of the work we are able to do as front-line and community workers, clinicians and counsellors, is dependent on more and better women's health research.