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Section II: Analysis Of Program Activities By Strategic Outcome

Note on Information Sources

The information presented in this Departmental Performance Report is drawn from a variety of sources. CIHR's Electronic Information System (EIS) provides data on the number and value of project awards under the various funding programs.

A second source is the results of a survey of funded and non-funded researchers conducted for CIHR by EKOS Research Associates in February and March 2005. Both surveys involved structured telephone interviews. A total of 1,676 interviews were completed with respondents coming from a broad range of disciplines and located across the country. This survey provides valuable information on the perspectives of researchers; a key stakeholder group, towards CIHR's many activities. Further information on this survey can be found at http://www.cihr-irsc.gc.ca/e/31683.html.

A third source is the results of program evaluation studies conducted on CIHR's Institutes and programs. More information, including methodology and detailed results for these evaluations, can be found at http://www.cihr-irsc.gc.ca/e/31683.html.

A fourth source is the International Review Panel Report, published in June 2006. The report can be found at: http://www.cihr-irsc.gc.ca/e/documents/irp_2000-2005_e.pdf.

Organization of Performance and Results Information

The following sections are organized by each of CIHR's three Strategic Outcomes. First, an overview of the Strategic Outcome and its indicators is presented, along with some macro-level performance data. Then, each Program Activity under the Strategic Outcome is presented with an assessment its performance based on a comparison of planned and actual spending, activities, and outputs. Finally, each Strategic Outcome section concludes with a summary of relevant risks and challenges.

CIHR continues to make modifications to the set of performance indicators used to monitor its various program activities and sub-activities. In some cases the indicators used differ from those identified in the 2007-2008 RPP due to the availability of performance data or concerns that the data was not reliable. However, the indicators used in this report are consistent with those used in the DPR for 2006-2007. A crosswalk table comparing these indicators to the indicators used in the 2007-2008 RPP is provided under Section III: Supplementary Information.

As outlined in Section 1.3, CIHR is committed to measuring and reporting on performance and work is underway to improve both the indicators and the data available to report against the strategic outcomes and program activities in the PAA.

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Strategic Outcome 1.0: Outstanding Research

CIHR's Strategic Outcome 1.0 ensures that:

Enabling the conduct of outstanding research is the largest part of CIHR's core business. Throughout 2007-2008, CIHR continued to ensure that the best health research across all disciplines was supported in order to create health knowledge responding to opportunities and federal government priorities.

Summary of Results

Three measurement indicators are used to monitor CIHR's performance against this strategic outcome:

1. Canadian ranking in health research expenditures compared to international levels;
2. Number of publications resulting from CIHR-supported research and their impact; and
3. Rating the quality of results of CIHR-funded research.

One of the key enabling inputs for health research is the amount available for investment. CIHR therefore monitors international trends regarding the level of investment in research in general and health research in particular. The number of publications resulting from CIHR-funded research is also an indicator of the overall productivity of Canadian researchers. Finally, rating the quality of results of CIHR-funded research is an indicator of the quality of the outputs of investment in research. It is important to note that CIHR is not the only organization that contributes to the achievement of this strategic outcome. Support for health researchers is also provided through other Canadian provincial and federal granting agencies for example: FRSQ, SSHRC and NSERC. Therefore, CIHR does not claim direct attribution for the results.

1. Canadian ranking in health research expenditures compared to international levels

The Canadian government is the second-largest funder of general research and development (R&D) in Canada, behind the business sector. Since the end of the 1990s, federal expenditures have increased steadily, mostly through the funding of the higher-education system and via the federal granting Tri-Agencies (CIHR, SSHRC and NSERC) as well as the National Research Council, the Department of National Defence, the Canada Foundation for Innovation (CFI) and Genome Canada, etc. However, total government funding for R&D in Canada still trails the United States and other Organizations for Economic Co-operation and Development (OECD) countries.³ OECD data indicate that Canada currently ranks 12^th out of 30 countries in terms of the share of Gross Domestic Product (GDP) invested in overall R&D.⁴ Federal Government investment in Health-related R&D (as a % of GDP) between 2000 and 2006 continues to rank Canada in the top five OECD countries (Figure 2).

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3. "Science and technology Policy Documents", Science and Technology Data - 2004 available at http://strategis.ic.gc.ca/epic/site/rti-rti.nsf/en/te04319e.html

4. See OECD, Main Science and Technology Indicators, 2006 http://www.oecd.org/dataoecd/49/45/24236156.pdf.

Figure 2:  Health-related R&D in government budget as a percentage of GDP, 2006

Source: OECD, R&D database, May 2007

2. Number of publications resulting from CIHR-supported research and their impact

Publications are a key output measure of the productivity of researchers and a primary method by which the outcomes of research are translated into results for Canadians. There are two key factors: the overall number of publications, and the measure of the impact that they have. At this time, CIHR is not able to report on the impacts of publications stemming from CIHR-related research. However, CIHR's Impact Assessment Team is currently working on identifying ways in which to capture such data.

As shown in Figure 3, the number of Canadian health research publications increased steadily from 1997 to 2005, peaking at about 17,000 publications in 2005⁵. The increased funding available during the first four years of CIHR's existence (2000 to 2004) corresponds with a detectable increase in research output starting in 2003-2004 (most grants are three-to-four years in length and require approximately one year before results are published). The Canadian share of total health publications produced by the G-8 nations, which had been stable at about 4% between 1992 and 2000, started to rise in 2003 and exceeded 4.75% in 2005. It is projected that this rate may stabilize around the 4.75% level for 2006.

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5. There may be a slight underestimation as the data excludes certain publications in psychology and health sciences

Figure 3: Number of Canadian Publications in Health Research and World Share⁶

Source: Observatoire des sciences et des technologies (OST)

As shown in Figure 4 Canada's rate of scientific production in health research is strong compared to the United States and is comparable to that of the United Kingdom⁷. This indicates that Canada may be considered to be a global leader in the production of health-related research publications as compared with some of the leading producers of health R&D research (see also Figure 2).

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6. '2006p' in this graph represents 'projected rate in 2006'

7. These figures cover the majority of health research publications, but omit certain relevant publications in psychology and health services.

Figure 4: Per Capita Output of Publications in Health Research for Select Countries, 2006

Source: Observatoire des sciences et des technologies, OECD, 2006 CIA World Fact Book.

3. Rating the quality of results of CIHR-funded research

A useful measure of the quality of research funded by CIHR is the degree to which resulting publications are cited (and in theory found useful). The citation impact for a group of researchers is the number of citations per paper that a group has received over a certain time period. A relative citation impact (RCI) can be calculated for any group of researchers and compared to an appropriate baseline. By this definition the RCI for the world is always 1.00 for any field and therefore if the RCI for Canadian researchers is greater than 1.00 then they are performing above the world average in that field.

As illustrated in Figure 5, the average relative citation factor for Canadian publications is approximately 1.1 when compared to the world average. This again, provides some indication that Canada's health research is favorably received, however, many other factors may contribute to variations on this measure such as: the types and substantive domains of research; the duration of the research (long-term vs. short-term R&D); and the overall "popularity" of various areas of research.

Figure 5: Average Relative Citation Factor (ARC) in Health Research, 2006⁸

Source: Observatoire des sciences et des technologies (OST)

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8. Only includes countries with at least 4,000 publications in health research in 2006 (excludes publications in psychology and health sciences).

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Performance at the Program Activity Level of the MRRS

The following sections present the results achieved in 2007-2008 within each of the Program Activities that contribute to Strategic Outcome 1.0 - Outstanding Research.

Program Activity 1.1: Fund Health Research

CIHR supports the development of new knowledge through health research across all disciplines that are relevant to health. CIHR provides grants for both investigator-initiated research (also known as open research, due to the fact that researchers can choose the field of research they want to focus on) and strategic research (priority areas determined by CIHR's 13 Institutes) through competitions in conjunction with many partners.

Financial Resources ($M)

Planned Spending	Authorities	Actual Spending
$493.5	$535.7	$539.5

Human Resources

Planned	Actual	Difference
230	204	-26

Expected Results Effective and efficient funding programs that enable ethical health research creating health knowledge that responds to opportunities and priorities.	Indicators Level of activity: number and dollar value of investments. Success of CIHR-funded research programs, including results, awareness and satisfaction levels Extent to which Institutes have influenced the research, policy and/or practice agendas in their communities.
Link to Priority Priority #1: Research - Advance health knowledge, through excellent and ethical research, across disciplines, sectors and geography

Program Activity 1.1 Performance Status: Successfully Met

The following presents a 2007-2008 performance summary of the key sub-activities that support the performance status of Program Activity 1.1 - Fund Health Research.

As outlined in more detail in the sections below, CIHR has successfully met the expected results for this program activity. This performance rating is based on assessment of planned and actual spending, activities and outputs. CIHR has supported the creation of new knowledge by making significant investments in health research across all disciplines that are relevant to health. Although there is limited data this year to support an evidence-based assessment of the success of the research programs, the level of application pressure for all of CIHR programs indicates that they are filling a need in the research community. The Institutes continue to influence the research agendas in their communities by funding a series of strategic initiatives in targeted areas.

A. Open Operating Grants Program (OGP)
The OGP represents CIHR's single largest investment. In 2007-2008, CIHR invested $380.2M, which represents 41% of CIHR's total investment in grants and awards research. This open research support program encourages Canadian health researchers to pursue their very best ideas, define and pursue the mode of research best suited to advance those ideas, and pursue the opportunities most likely to advance the impact of their work. Applications are accepted in all areas relevant to health and to CIHR's mandate and are funded according to their excellence as determined by peer review. The health research capacity that this program helps to maintain is available to be mobilized when a national emergency (such as SARS) threatens the health of all Canadians. As it is impossible to predict future health crises, it is necessary to maintain research capacity in all of the main fields of health, which this program does.

In the 2007-2008 competition year, 3,626 applications were received (2,384 of these were deemed fundable) and 816 new projects were approved which means that only the top 23% of applications were approved for funding. The average project that is funded lasts 3-5 years so that in any given year the program funds approximately 3,500 new and ongoing projects. On average a new project receives $119,000⁹ per year. The number of projects supported by the OGP, together with program expenditures for the period 2000-2001 to 2007-2008 are shown in Figure 6 below.

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9. Includes OGP grants in which the first year of payment is 2007-2008

Figure 6: Number of Projects Supported and Expenditures of the OGP

Source: CIHR Funding Database

Although more health research funding has become available to Canadian researchers, it has not necessarily become more accessible. Figure 7 shows the trends in the number of fundable¹⁰ applications to the OGP that were not funded, compared to the number funded, over the period of 2000-2001 to 2007-2008. As seen in Figure 7 approximately 1,500 high quality applications were left unfunded in the 2007-2008 Competition Year. Despite increases to the CIHR budget the funding rate for this program (which is the percentage of fundable applications that have been funded) has dropped significantly. In 2000-2001 CIHR was able to fund 58% of applications that were rated as worthy of funding through an expert review process, as of the 2007-2008 Competition Year, the funding rate has fallen to 34%. This is a slight increase over the 2006-2007 Competition Year (32%) and reflects a decrease in overall applications submitted to CIHR. This decrease may indicate a leveling-off of the application pressure to the OGP due to CIHR's communication of its intent to fund between 800 and 900 new grants per year in the OGP. This has established a reasonable expectation within the research community as to the level of support available and the competitiveness of this program. The high application pressure to the OGP program can be seen as measure of success since it is highly competitive and filling the needs of the research community.

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10. CIHR has a rating scale of 0-4.9 for the peer review of funding applications, and only applications rated 3.5 and above are eligible for funding.

Figure 7: Fundable Applications to the Open Operating Grants Program

Source: CIHR Funding Database
Note: CIHR has a rating scale of 0-4.9 for peer review of funding applications, only applications rated 3.5 or higher are eligible for funding.

A study by the Council of Canadian Academies in 2006 found that in the health and life sciences, Canada is strong, relative to other countries, in a number of areas which happen to coincide with the areas that CIHR has been targeting. These include: cancer research and control; neuroscience; circulatory and respiratory health; infectious diseases and immunity; as well as emerging disciplinary fields such as: aboriginal health; aging; gender; and health. Much of the funding for these areas comes from the OGP.

The OGP was evaluated in 2004. Since the evaluation was completed, progress has been made in implementing the study recommendations. For example, the Research Reporting System was developed in 2007-2008 and will be implemented in 2008-2009 for the OGP competition; a new electronic newsletter targeted to researchers has been developed that identifies new developments regarding research funding; work is underway to improve the rating scale and criteria used by peer-review committees; and the success of entry-level applicants is being monitored.

Evidence that the OGP program is meeting expected results includes:

1. The high application pressure to the OGP which has stimulated a large number of applications from many researchers in all areas of health research.
2. Canada is strong in the health and life sciences relative to other countries in many areas being funded by CIHR in the judgment of both the Canadian Academy of Sciences and the Science, Technology and Innovation Council of Canada.
3. The competitiveness of the program ensures that only the very best research is funded.

B. Team Grants
CIHR contributes funding to several team-related programs as part of its strategy to strengthen the research environment and enable outstanding research. In 2007-2008 a total of 26 teams were funded for up to five years through the open Team Grants competition. The average amount of funding per team in 2007-2008 was $739K. CIHR invested $19.2M in 2007-2008 on the open Team Grant program. CIHR has found that many of the teams who have been successful under this "open" competition process are from research areas where there is already a strong research capacity and infrastructure. As a result, this program is not adequately supporting research areas that are under-developed. An evaluation of the Team Grants, as well as other team type programs is scheduled for 2008-2009.

C. Institute Strategic Initiatives
CIHR's broad-based approach brings together researchers across disciplinary and geographic boundaries through its 13 Institutes, each of which strategically addresses an area of health research that is of importance to Canadians. The total expenditures of the Institute Strategic Initiatives that fall under this program activity were $31.7M in 2007-2008. In deciding how to allocate these funds, the Scientific Directors of each of CIHR's 13 institutes and the Institute Advisory Boards are guided by the strategic plan of each Institute, as well as CIHR's overall strategic plan (referred to as Blueprint) and discussions with other Institutes and external partners and decisions by CIHR's Research and Knowledge Translation Committee (RKTC).¹¹ Researchers are invited to submit research proposals to address the research priorities identified by the Institutes, which are then reviewed through CIHR's expert peer review process.

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11. Established in 2007 (prior to 2006-2007 this committee was called the Research Planning and Priorities Committee).

Table 4: Key Strategic Research Themes Funded by the Institutes in 2007-2008

Institute	Key strategic research themes funded in 2007-2008
Aboriginal Peoples' Health	- Aboriginal Health Determinants - Chronic Disease and Indigenous Peoples - Health Services and Aboriginal Peoples
Aging	- Mobility in Aging - Cognitive Impairment in Aging - Longitudinal Research Platform for Healthy and Successful Aging
Cancer Research	- Access to Quality Cancer Care - Colorectal Cancer Screening
Circulatory and Respiratory Health	- Cardiovascular Complications of Diabetes - Clinical Imaging - Clinical Research Initiative
Gender and Health	- Boys and Men's Health - Gender, Mental Health and Addictions
Genetics	- Genes to Genomic Medicine - Health Services for Genetic Diseases - Genetics and Ethical, Legal and Social Issues
Health Services and Policy Research	- Access to Appropriate Care across the Continuum - Drug Policy (Quality, Safety, and Financing) - Health Information
Human Development, Child and Youth Health	- Indoor Air and Asthma / Allergy - Child Health Indicators
Infection and Immunity	- HIV/AIDS - Emerging Infections and Microbial Resistance - Pandemic Influenza Preparedness - Vaccines of the 21st Century
Musculoskeletal Health and Arthritis	- Physical Activity, Mobility and Health - Tissue Injury, Repair Replacement - Pain, Disability Chronic Diseases
Neurosciences, Mental Health and Addiction	- Co-morbidity and Co-occurrence of Brain Disorders with other Health Problems - Research in Addiction - Mental Health in the Workforce
Nutrition, Metabolism and Diabetes	- Obesity and Healthy Body Weight - Intervention Research on Healthy Living and Chronic Disease Prevention
Population and Public Health	- Global Health - Impacts of the Social, Physical and Built Environments on Health - Understanding and Promoting Equity in Health

The IRP concluded that "The Institutes have all achieved considerable progress in developing and implementing an agenda to coordinate and develop their research area... Despite resource constraints, these Institutes have operated extremely effectively. Each has developed a specific set of strategic initiatives as well as provided leadership through training initiatives, mentoring and workshops."¹²

D. Large Strategic Initiatives
CIHR's Strategic Plan, Blueprint, calls upon the organization to develop national research platforms and initiatives. CIHR's Governing Council has identified a number of partnered, long-term strategic initiatives to pursue in order to address Canada's health research priorities. This program funds large scale and long-term projects that cut across several health-related fields and that are too big for one Institute to fund alone. The topic areas are chosen by CIHR from its research priorities on the basis of their potential for significant impact. As planned in the approved CIHR 5-Year Evaluation Schedule, an evaluation of CIHR's Large Strategic Initiatives is scheduled for 2010-2011. A description of CIHR's Clinical Research Initiative is provided as an example of one of CIHR's eight Large Strategic Initiatives:

The Clinical Research Initiative (CRI) is CIHR's response to a clear need and opportunity to strengthen Canadian clinical research to accelerate the translation of clinical research discoveries into improved and cost-effective approaches to maintaining health and treating illness, and to provide evidence for sound health policies and an efficient health-care system. In 2007-2008 there was a total CIHR investment of over $14.3M towards the various programs offered through the CRI Initiative. One of the key programs launched in 2007-2008 is the CIHR/CFI Regional/National Clinical Research Initiatives with a major focus on building the excellence, national capacity and critical mass required to allow Canada to become an international leader in clinical research that leads to a better health-care system, improved health and a stronger economy. Under the CRI, through which funding starts in 2008-2009 the CFI and CIHR challenged institutions and their investigators to consider non-traditional models and/or combinations of traditional/non-traditional models to best meet the overall objective of enhancing clinical research through multidisciplinary and collaborative approaches. Integral components of the proposals included multidisciplinary research teams focused on high impact, clinically relevant health problems, training programs in clinical research, formal knowledge translation programs and a strong underlying ethics framework.

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12. CIHR Year 5 International Review Panel Report 2000-2005, June 2006, p. 11. (http://www.cihr-irsc.gc.ca/e/31464.html)

Benefits to Canadians Vulnerable Populations - Children Poor children gain more weight Dr. Lisa Oliver of Simon Fraser University produced new evidence that where you live has an impact on weight gain. Her study tracked children over an eight-year period and determined that while most kids had roughly the same body mass index (BMI) in their early years, by age 11 those living in Canada's poorest neighbourhoods had gained more weight than those living in middle-income areas. The study provides important information for policymakers, suggesting that the prevention efforts aimed at kids five to eight years of age will produce the greatest impact. Breastfed babies ace IQ tests A CIHR-funded study that tracked 14,000 children over more than six years has concluded that breastfeeding can boost a child's IQ. In this study, led by McGill University's Dr. Michael S. Kramer, a control group of mothers received ordinary maternity and pediatric care while an experimental group was encouraged to breastfeed their babies over a long time. The mothers were of similar age, health and social-economic status. When teachers and pediatricians assessed cognitive abilities, the breastfed children scored higher. Child abuse can alter biology Childhood abuse can trigger genetic changes, according to a study that compared the brains of abused people who committed suicide with the brains of those who died suddenly but were not abused. Researchers in the CIHR-funded project found that the 13 suicide victims' brains showed changes in the methylation, the chemical coating around a gene that activates it, which they described as "aberrant regulation of the protein synthesis machinery." McGill University's Dr. Moshe Szyf, who led the study, says that knowing these "epigenetic" differences can exist in the biological makeup of those who are neglected or abused as children will help to detect those most at risk and, potentially, help prevent suicides. The results of the study were published in an open-access Public Library of Science journal.

E. Randomized Control Trials (RCT) Program
The RCT Program supports RCTs that provide rigorous evidence on the efficacy and effectiveness of interventions in health and health services which make it well aligned to government priorities. The open program funded over 74 trials in 2007-2008 at a cost of $32.3M.

The RCT Program is seen to be very effective due to its strong applied focus and the numerous high impact Canadian trials that have been funded. However, the trials are longer, lasting up to ten years and more costly than open operating grants. The current average total investment for the duration of a new grant is $1.6M¹³. The high cost and long duration of RCTs make them difficult for CIHR to fund. The performance of this program can be improved by ensuring a more sustainable level of funding. CIHR is committed to increasing its funding for this program in 2008-2009. Increases will come from internal reallocations and future budgetary increases consistent with CIHR's five year investment plan.

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13. Includes OGP grants in which the first year of payment is 2007-2008. Figures are to date as of May 2008 and are subject to change

F. HIV/AIDS Research Initiative
CIHR's HIV/AIDS Research Initiative is responsible for the management and oversight of the research components of the two major Government of Canada initiatives in HIV/AIDS, namely: the Federal Initiative to Address HIV/AIDS in Canada (FI); and the Canadian HIV Vaccine Initiative (CHVI). Through support via the FI (a partnership between the Public Health Agency of Canada (PHAC), Health Canada (HC), Correctional Service Canada, and CIHR) CIHR funds research in the areas of: biomedical/clinical; health services and population health; community-based; and the Canadian HIV Trials Network. Through the new CHVI, a partnership between the Government of Canada (PHAC, HC, Industry Canada, the Canadian International Development Agency, and CIHR) and the Bill & Melinda Gates Foundation, CIHR funds research to accelerate the development of an HIV vaccine and address critical research gaps.  With this combined funding, and further support from CIHR, HIV/AIDS related research expenditures totalled approximately $37.1M in 2007-2008.

While research is a long-term endeavour, many of the funded projects have already demonstrated tangible outcomes. The HIV/AIDS Research Initiative is undertaking an evaluation of its HIV/AIDS Community Based Research Program (CBR) Program, which will be completed in spring 2009. The Canadian HIV Trials Network (CTN) was recently independently evaluated and the network scored highly in all areas reviewed. The evaluation noted that the CTN has played a key role in Canada's response to the HIV/AIDS epidemic and further funding will help ensure continued Canadian strength and expertise in conducting important and high quality clinical trials in HIV.

Benefits to Canadians - HIV/AIDS Discoveries Male circumcision Researchers estimate that HIV infection rates in sub-Saharan Africa could be reduced by up to two-thirds if male circumcision becomes standard practice. An international team of researchers, including Dr. Stephen Moses from the University of Manitoba, conducted a large study in Kisumu, Kenya, where 18% of the men and 25% of the women are HIV positive. Dr. Moses found that circumcised men in that community were 53% less likely to contract the deadly virus than uncircumcised men. The project, co-funded by CIHR, confirms the findings of several previous studies. The findings of these studies have collectively resulted in the World Health Organization developing recommendations regarding male circumcision. Natural gene can shut down HIV Researchers at the University of Alberta have found a naturally occurring gene that can block HIV and prevent the onset of AIDS. Dr. Stephen Barr, a molecular virologist, says his team has identified a gene called TRIM22 that blocks HIV infection in a cell culture by preventing the virus from assembling. While antiretroviral drugs can interfere with HIV's ability to reproduce copies of itself, they can't eradicate the virus - something TRIM22 potentially could do naturally. The next challenge is to find why TRIM22 does not work in people infected with HIV and learn how to switch it on. Protein protection from killer diseases A Canada-U.S. research team has discovered a key protein that has the ability to protect against killer immune diseases, like HIV. HIV kills so-called "central memory" cells that play an important role in helping the immune system fend off viruses. The newly discovered protein, FOX03a, helps retain memory cells. The protein was identified by studying a group of men infected with HIV but who do not show any symptoms. According to lead researcher Dr. Rafick-Pierre Sékaly of the Université de Montréal, the discovery of FOX03a will also help scientists develop therapies for cancer, rheumatoid arthritis and hepatitis. Results of the CIHR-supported research were featured in an advance online edition of Nature Medicine.

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Risks and Challenges - Strategic Outcome 1.0

When delivering results in 2007-2008 related to Strategic Outcome 1.0 - Outstanding Research, CIHR proactively managed the following risks:

Risk # 1: Managing complexity of long-term investment mechanisms: There is a risk that funding via an annual appropriation may make it difficult for CIHR to provide longer term funding mechanisms that vary throughout the lifecycle of a research project. This may limit CIHR's ability to initiate new programs that meet the temporal needs of the researcher community.

Impact: Research takes time and a sustained investment. It is also subject to considerable uncertainty. A large portion of CIHR's budget is committed to grants and awards that extend over three to five years. In many cases small levels of investment in the first years of a project results in larger commitments in the third and fourth years although the actual spending profile itself is often not predictable. Not managing the complexity of these funding mechanisms results in limited flexibility for new investments which could reduce CIHR's ability to address specific health challenges as they arise.

Mitigation: To mitigate this risk CIHR is in the process of implementing a five year investment roadmap for the grants and awards budget which is supported by more sophisticated investment modelling processes. This allows the organization to better forecast the future impacts of funding decisions and to implement concepts of "steady-state" dynamics to ensure relative stability of investments over time.

Risk # 2: Ensuring organizational capacity to address Strategic Priorities: There is a risk that CIHR may not have the agility and flexibility required to quickly address strategic priorities in targeted areas.

Impact: There is an increasing requirement to ensure that health research knowledge is developed in targeted areas to address specific issues and concerns and respond to government priorities. This typically occurs because there is a gap in the current knowledge base and/or a requirement to strengthen and expand the existing knowledge base to respond to a significant health challenge. If CIHR does not have the organizational capacity to respond to priorities it could result in specific health challenges not being addressed.

Mitigation: The Institute structure and the Advisory Boards that support them allows CIHR to mitigate this risk by keeping abreast of the critical health challenges that need to be addressed and the research capacity that exists in Canada to address these challenges. Each Institute is led by a Scientific Director who plays a leadership role in his/her area of expertise and attempts to anticipate future requirements through the development of strategic plans.

Risk # 3: Ability to recruit peer reviewers: There is a risk that CIHR may be unable to continue to recruit highly qualified peer reviewers to evaluate research proposals.

Impact: The peer review process is a critical component of the delivery of CIHR programs. This process ensures fairness and transparency, good value for money, and that the best and brightest researchers are funded. The inability to recruit new peer reviewers results in fatigue for the reviewers that remain, reliance on less experienced reviewers, inferior reviews and delays in the overall peer review process.

Mitigation: To mitigate this risk CIHR has established a central group to coordinate the peer review process including the recruitment of peer reviewers. This group is also in the process of identifying ways to streamline and improve the peer review processes to reduce the burden on peer reviewers.

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Strategic Outcome 2.0: Outstanding Researchers in Innovative Environments

Strategic Outcome 2.0 focuses on building a:

Developing a community of outstanding health researchers is another part of CIHR's core business. The main instruments used by CIHR to develop health research capacity in Canada are training and salary awards, Institute-led partnerships and ethical research standards.

Summary of Results

CIHR uses several indicators to monitor long-term trends in this area, two such indicators being:

1. Percent of PhD graduates in Canada planning postdoctoral studies in health; and
2. Quality and availability of adequate resources for research (e.g., infrastructure, hardware and software).

Indicators at the strategic outcome level are general societal indicators. CIHR contributes to the development of highly qualified personnel (HQP) through direct investments in people via training and salary awards and indirectly through grants as many trainees are involved in CIHR Operating grants.

1. Percent of PhD graduates in Canada planning postdoctoral studies in health

The percentage of PhD graduates planning postdoctoral work is a key indicator of both the likelihood of PhD training encouraging individuals to continue in health research, as well as the potential demand for CIHR postdoctoral fellowship awards. According to the 2005 Survey of Earned Doctorates, 56% of all graduates planned to enter the labor force after graduation, while 34% were planning to undertake a postdoctoral fellowship.¹⁴ However, for those graduating in the life sciences, approximately 64% were planning on continuing their training or study through a postdoctoral fellowship or other arrangement. These data support the concept that the majority of PhD graduates in areas of health/medical research are motivated to continue conducting research in their field after they have completed their academic training. The findings also validate CIHR's increased emphasis on encouraging students and trainees to complete their graduate degrees through fellowships, scholarships, grants and awards.

2. Quality and availability of adequate resources for research

The 2005 survey of CIHR-funded researchers found that 70% agreed that the environmental capacity (e.g., infrastructure, hardware and software) to sustain researchers in conducting their research, is reasonably adequate or optimal, with 8% saying that their research environment is to a large extent optimal. As Figure 8 demonstrates, researchers connected to CIHR Institutes clearly identify capacity building as an area of high need; ranging from 88% for the Institute of Health Services and Policy Research (IHSPR) to 70% for the Institute of Genetics (IG).

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14. Data taken from Gluszynski, Tomasz and Valerie Peters, Survey of Earned Doctorates: A Profile of Doctoral Degree Recipients, Statistics Canada and Human Resources Development Canada, 2005, p. 14.

Figure 8: Need for Institutes to Develop Capacity - Funded Researchers

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Performance at the Program Activity Level of the MRRS

The following sections present the results achieved in 2007-2008 within each of the Program Activities that contribute to Strategic Outcome 2.0 - Outstanding Researchers in Innovative Environments.

Program Activity 2.1: Fund Health Researchers and Trainees

One of CIHR's core objectives is to provide leadership in building capacity within Canada's health research community. This is done through the training and development of researchers, and by fostering the development and ongoing support of scientific careers in health research. In addition to providing trainees and independent investigators with salary support, CIHR is committed to helping them develop the skills they require to succeed in the modern research environment.

Financial Resources ($M)

Planned Spending	Authorities	Actual Spending
$203.6	$208.5	$202.3

Human Resources

Planned	Actual	Difference
95	84	-11

 

Expected Results Effective and efficient funding programs that ensure a supply of highly trained health researchers and trainees are available to conduct outstanding research.	Indicators Level of activity: number and dollar value of investments. Success of CIHR-funded salary and training programs, including results, awareness and satisfaction levels.
Link to Priority Priority #2: Researchers - Develop and sustain Canada's health researchers in vibrant, innovative and stable research environments.

Program Activity 2.1 Performance Status: Successfully Met

The following presents a 2007-2008 performance summary of the key sub-activities that support the performance status of Program Activity 2.1 - Fund Health Researchers and Trainees.

As outlined in more detail in the sections below, CIHR has successfully met the expected results for this program activity of ensuring that a supply of highly qualified personnel (HQP) is available to conduct outstanding research. This performance rating is based primarily on an assessment of planned and actual spending, activities and outputs. CIHR has made significant investments in supporting health researchers and has increased the research capacity within all disciplines that are relevant to health. Although there is limited data this year to support an evidence-based assessment of the success of these programs anecdotal evidence such as the level of application pressure indicates that they are filling a need in the research community. Furthermore significant budget increases through Budget 2007 to the Canada Research Chairs Program and the Canada Graduate Scholarships Program indicate the continued success and relevance of these programs in supporting Canada's health researchers. The Institutes continue to build capacity in their communities by funding a series of strategic training and salary awards in targeted areas.

A key instrument used by CIHR to develop health research capacity in Canada is training and salary awards. CIHR supports training and salary in two streams: open training and salary support, which is not targeted; and strategic training and salary support, which is targeted to priority research areas identified by the 13 Institutes. Other activities include CIHR's participation in the Canada Research Chairs and Canada Graduate Scholarships programs.

A. Training Awards
CIHR's training awards support more than 2,400 individuals, including undergraduates, masters and doctoral students, and postdoctoral fellows. Expenditures incurred for the training support programs in 2007-2008 were $51.9M.

The open training programs have three main components:

• Doctoral Research Awards (DRAs);
• Strategic Training Initiative in Health Research (STIHR); and
• Fellowships

The STIHR program was evaluated in 2007-2008 to provide evidence on program performance, to facilitate corporate decision-making around program renewal and funding decisions, and to fulfill reporting requirements to central agencies. Based on the key findings, it was recommended that CIHR review and revise the level of funding for the open STIHR program. CIHR plans to address this observation by better aligning its STIHR program to strategic priority areas rather than open research. The final report is expected to be publicly available by September 2008.

A recent evaluation of the STIHR program concluded that it has performed as well as programs like the Canada Graduate Scholarships, the Doctoral Research Awards, and CIHR Fellowship awards in terms of trainees' disciplinary background; early scholarly productivity; and perceptions of the training environment and trainee experience. Additionally, the program appeared to be increasing the number of research training opportunities for health systems and services and clinical trainees.

Figure 9 shows the number of people in health research across Canada who were supported by various CIHR awards programs in 2007-2008.

Figure 9: Research Capacity Building Support in 2007-2008

Source: CIHR Funding Database

B. Salary Support Programs
Under the Salary Support Programs, approximately 60 New Investigators start their funding each year through the open competition. In a few years the programs should reach a steady state, where a total of approximately 300 new investigators will be supported at any given time. This funding enables them to focus a minimum of 75% of their time on research (rather than teaching, administration or clinical work).

As seen in Figure 10, expenditures incurred for the CIHR Salary Support Programs declined in 2007-2008 to approximately $30.7M as compared to approximately $32M in 2006-2007. This trend is expected to continue in the 2008-2009 fiscal year, due to the termination of the Investigator, Senior Investigator and Distinguished Investigator programs. Salary awards are also being terminated early due to the uptake of Canada Research Chairs by recipients of CIHR salary awards (as per CIHR regulations, an individual may not hold a CIHR salary award and a Canada Research Chair concurrently).

Figure 10: Expenditures in Training and Salary Support

Source: CIHR Funding Database
Note: Salary Award figures exclude the Canada Research Chairs

C. Strategic Training and Salary Support Programs - Role of CIHR's 13 Institutes
A key role of CIHR's Institutes is building capacity through training and salary support in strategic health research areas identified by the Institutes in consultation with stakeholders from government, health-care organization, patient groups, and industry. The Strategic Training and Salary Support Programs provide support and special recognition primarily to students who are pursuing a master's or PhD degree, or for highly qualified candidates at the postdoctoral or post-health professional degree stages. The 13 Institutes provide training support through a number of mechanisms, including:

• Strategic Training Initiative in Health Research (STIHR);
• Priority Announcements; and
• CADRE Program of targeted post-doctoral fellowships.

In addition to those mentioned above the Institutes build capacity through their own strategic initiatives. One such example includes the following:

As one of its first initiatives, the CIHR-Institute of Aboriginal Peoples' Health (IAPH) established the Aboriginal Capacity and Developmental Research Environments (ACADRE) centres to develop a network of supportive research environments across Canada to facilitate the development of Aboriginal capacity in health research.  The centres are dedicated to improving First Nations, Inuit and Métis peoples' health through community-based and scientifically excellent research.  The performance of these centres was seen as successful as all ACADREs made marked progress towards achieving the program's overall goals. With the aim to sustain and ensure momentum of the ACADRE centres, CIHR-IAPH launched a new initiative and funding commenced in the fall of 2007 for the second phase of the program with the Network Environments for Aboriginal Health Research (NEAHR). The federal government demonstrated support for this program in early 2008 when Parliamentary Secretary Steven Fletcher announced an investment in the NEAHR program of $15.8M over the next three years.

D. Canada Research Chairs (CRC)
The Canada Research Chairs Program invested approximately $315M in 2007-2008 to attract and retain some of the world's most accomplished and promising minds. CIHR expenditures for the CRC Program have grown significantly over the past few years, from $72.9M in 2005-2006 to approximately $86.5M in 2007-2008. CIHR planned spending and expenditures for the CRC Program have increased each year since 2005-2006 due to incremental increases received by CIHR for the Program. CIHR lapsed significant funds for the CRC Program in each fiscal year (2005-2006 through 2007-2008) due to difficulties encountered by the universities in filling the Chairs.

As of November 2007, there were a total of 1,851 active Chairs. More than 2,000 researchers have held CRCs since the beginning of the program. Therefore, the program has met its goal of supporting 2,000 chairholders by the end of 2008, in spite of lapsing funds over the last three years. The fifth-year evaluation of the program concluded that the CRC Program has helped to create a research environment that is conducive to the long-term retention and attraction of top researchers. Chairholders reported significant increases in research productivity and number of HQP being trained at the graduate level since receiving their Chair awards compared to other researchers over the same time period. Also, they reported research impacts such as patents, inventions and potential health treatments which can be at least partly attributable to the CRC Program.

E. Canada Graduate Scholarships (CGS)
The CGS Program provides financial support to develop future researchers at both the master's and doctoral levels, providing them with an opportunity to gain research experience. In 2007-2008 CIHR invested $13.9M in the CGS Program. In its 2007 Budget, the Federal Government announced new funding for CIHR's CGS Program to enable CIHR to fund an additional 400 scholarships on an ongoing basis by the time the program is fully implemented in 2009-2010.

The CGS Program is currently undergoing a joint evaluation with SSHRC and NSERC. CIHR is the lead on this Tri-agency evaluation for which the final report will be ready in late 2008.

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Program Activity 2.2: Fund Research Resources, Collaboration and other Grants to Strengthen the Health Research Community

CIHR is strengthening the health research community's ability to conduct research by supporting research-enabling activities and resources. This includes supporting large teams of researchers from across disciplines in resolving some of the most complex health problems facing Canadians, engaging in collaborative activities such as networking and providing and maintaining state-of-the-art tools such as new equipment, databases and other specialized resources to conduct research.

Financial Resources ($M)

Planned Spending	Authorities	Actual Spending
$70.0	$69.7	$68.0

Human Resources

Planned	Actual	Difference
33	29	-4

 

Expected Results Effective and efficient partnerships and funding programs that lead to a dynamic research environment and outstanding research.	Indicators Level of activity: number and dollar value of investments. Success of CIHR-funded research resources and collaboration programs, including results, awareness and satisfaction levels.
Link to Priority Priority #2 - Researchers - Develop and sustain Canada's health researchers in vibrant, innovative and stable research environments.

Program Activity 2.2 Performance Status: Successfully Met

The following presents a 2007-2008 performance summary of the key sub-activities that support the performance status of Program Activity 2.2 - Fund Research Resources, Collaboration and other Grants to Strengthen the Health Research Community.

As outlined in more detail in the sections below, CIHR has successfully met the expected results for this program activity of effective and efficient partnerships and funding programs that lead to a dynamic research environment and outstanding research. This performance rating is based primarily on an assessment of planned and actual spending, activities and outputs. In 2007-2008 CIHR strengthened the health research community's ability to conduct research by providing funds to acquire the necessary resources required to conduct research. The Institutes played a key role by funding various team grants within their respective research communities.

A. Institute-strategic Team Grants
The majority of expenses under this program activity arise from New Emerging Team grants (NETs) and Interdisciplinary Capacity Enhancement team grants (ICEs) funded through the institutes and other CIHR strategic initiatives. In 2007-2008 CIHR funded 124 NETs representing approximately $30.1M and 45 ICEs representing approximately $7.4M.

An evaluation of all of CIHR's Team-Type Programs (numbering approximately ten) is being initiated in 2008-2009 and is expected to report in 2010 on the relative success and limitations of those programs.

In this context, an additional benefit is that some of the work of this evaluation will result in contributions to the development of tools for measuring knowledge translation and capacity enhancement in the CIHR and Canadian Research environment. The design of the Team-Type programs will be examined in the light of Team science and what is needed to establish increasingly productive and innovative teams (or team-type funding programs). This could be an exceptional opportunity for management to review CIHR's Team-Type Programs and to align their requirements and funding with known factors of Team science success.

B. Research Resources and Collaboration Program (RRC)
The RRC Program is made up of a number of sub-programs, all with the goal of strengthening the health research community's ability to conduct research. CIHR expenditures for the RRC Program totalled approximately $6.8M in 2007-2008. The decline in expenditures is due primarily to the fact that the Research Resource Grant program has not been re-launched since 2005.

Benefits to Canadians - Advances in Neuroscience Adult neural stem cells In 1992 Dr. Samuel Weiss at the University of Calgary discovered neural stem cells in the brains of adult mammals. Dr. Weiss made this discovery quite unexpectedly, while looking at how to use growth factors to protect the brain. Since then his research has focused on understanding how neural stem cells work and how they can be used to heal neural tissue and help people recover from brain and spinal cord injuries or diseases. In recognition of this work, Dr. Weiss received a 2008 Gairdner International Award, Canada's most prestigious award for medical research. Neuroscience: Dr. Peter St. George-Hyslop at the University of Toronto has done pioneering research into the causes and consequences of Alzheimer's and other neurodegenerative diseases. This research has paved the way for the development of new treatments for these diseases. For example, in 2006, Dr. St George-Hyslop and his colleagues found a sugar-like substance known as scyllo-cyclohexanehexol, which stops the build-up of toxic plaque in mice with Alzheimer's disease, essentially curing the disease. Dr. St. George-Hyslop won a 2008 Killam Prize for this work.

C. Regional Partnerships Program (RPP)
This program helps build partnerships and is designed to enable researchers in less populous and less economically prosperous regions of Canada. The program provided 94 grants and 50 awards to researchers and trainees (combined amount of new and ongoing grants and awards) in 2007-2008. The total CIHR funds paid out in the fiscal year 2007-2008 totaled $4.4M. The CIHR funding for grants and awards is matched by partners to a ratio of 1:1. An evaluation of the RPP in 2005 recommended a redesign to ensure that activities would better meet expected results. This redesign has since taken place with extensive input from key stakeholders. The RPP is the sole CIHR program focused on the development of health research capacity in lower resourced regions. It is very positively rated by participating researchers, Advisory Committee members, and other stakeholders.

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Program Activity 2.3: Develop and Support a Strong Health Research Community Through National and International Alliances and Priority Setting

CIHR is developing strong national and international partnerships through its 13 Institutes to advance strategic health research priorities and leverage funding and expertise for research. These partners include health policy makers at provincial, federal, and international levels of government, the private sector and voluntary health organizations from Canada and abroad.

Financial Resources ($M)

Planned Spending	Authorities	Actual Spending
$28.1	$28.2	$24.0

Human Resources

Planned	Actual	Difference
13	12	-1

Expected Results National and international health research agendas as well as strong alliances and partnerships are formulated and implemented.	Indicators Level of activity: number and dollar value of investments. Success of CIHR-funded partnership research programs, including results, awareness and satisfaction levels.
Link to Priority Priority #2 - Researchers - Develop and sustain Canada's health researchers in vibrant, innovative and stable research environments.

Program Activity 2.3 Performance Status: Successfully Met

The following presents a 2007-2008 performance summary of the key sub-activities that support the performance status of Program Activity 2.3 - Develop and Support a Strong Health Research Community through National and International Alliances and Priority Setting.

As outlined in more detail in the sections below, CIHR has successfully met the expected results for this program activity of implementing and formulating national and international health research agendas as well as strong alliances and partnerships. This performance rating is based primarily on an assessment of planned and actual spending, activities and outputs. In 2007-2008 CIHR continued to collaborate with hundreds of its partners including the Tri-agencies, non-profit, national and international organizations and has leveraged significant funding to maximize its investment in health research and to facilitate the knowledge exchange and translation of research results. Although there is limited data this year to support an evidence-based assessment of the success of these programs the number of partnerships and the amount of funding leveraged by these partnerships substantiate the rating of 'successfully met'. The Institutes play a crucial role in creating and building partnerships across all disciplines of health research.

A. Institute Support Grants (ISG)
The Institute Support Grants (ISG) Program provides $1.0M to each of CIHR's 13 Institutes for its operational, strategic and development activities. A management review of the ISG Program undertaken in 2007-2008 concluded that alternative models would not meet the required elements of the virtual Institute model and demonstrated that the ISG Program is deemed to be the most appropriate, efficient and cost effective funding mechanism for the Institutes.

B. Small Health Organizations Partnership Program (SHOPP)
This program increases the research funding capacity of health charities and non-profit organizations. The program provides nearly 60 awards (combined amount of new and existing awards in 2007-2008) to trainees. The total CIHR funds paid out in 2007-2008 totalled over $800K. The findings of the 2007 evaluation of SHOPP indicated that the program is having a significant positive impact on the research community.

C. Human Frontier Science Program (HFSP)
This program provides grants to support intercontinental collaboration in basic research at the frontier of human knowledge of biology. It also emphasizes support for young researchers by offering post-doctoral fellowships that support outstanding candidates. A recent expert panel review of the HFSP showed it is meeting its objectives of promoting interdisciplinary and new collaborations, and is filling a unique niche in international research funding.

Benefits to Canadians - Aboriginal Peoples Inuit obesity in step with Euro-Canadian rates The proportion of overweight and obese people among the Inuit of Canada, Greenland, and Alaska is similar to that of overweight and obese people among Canadians of European origin, according to a study that used data culled from four surveys. The study, led by CIHR-funded researcher Dr. Kue Young of the University of Toronto, found that 36.6% of Inuit men and 32.5% of Inuit women were overweight while 15.8% of the men and 25.5% of the women were obese. As levels of obesity increased, various measures of how the body is functioning - such as lipid, glucose, and insulin levels and blood pressure - also increased. At each level of obesity, however, the Inuit had lower blood pressure and lipid levels than Euro-Canadians. Results of the study were published in the American Journal of Public Health. Dr. Young is a principal investigator on a CIHR team looking into chronic disease prevention in circumpolar countries. CIHR sets guidelines for Aboriginal studies Researchers should understand and respect Aboriginal world views, according to a new set of ethics guidelines developed by CIHR through consultation with Canada's First Nation, Inuit and Métis communities. The guidelines strive to balance the pursuit of scientific excellence with respect for Aboriginal values and traditions and stress that research projects should lead to benefits to the participating Aboriginal community and/or its members. As well, benefit-sharing with a community should be interpreted from the community's perspective. Ultimately, the goal is to improve on the profound disparity in health for Aboriginal communities through research that is ethically and culturally competent. The complete guidelines can be viewed at: http://www.cihr-irsc.gc.ca/e/29134.html. Researchers tackle tooth decay epidemic among Aboriginal children Cree children in Eeyou Istchee, the James Bay Cree region, are near the end of a major CIHR-funded five-year trial to battle an epidemic of tooth decay among young children in Aboriginal communities across Canada. Dr. Rosamund Harrison at the University of British Columbia and Dr. Jacques Véronneau of McGill University, are working with the Cree Board of Health in Quebec to provide one-on-one counselling, starting when women are pregnant. The program could become part of routine care for other First Nations children in Canada. Dental decay rates for First Nations and Inuit people of all ages are three to five times as high as in the non-Aboriginal Canadian population. The problem often starts in early childhood with tooth decay affecting about 72% of First Nations and Inuit children two to five years of age.

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Program Activity 2.4: Inform Research, Clinical Practice and Public Policy on Ethical, Legal and Social Issues (ELSI) Related to Health and Health Research

CIHR funds research on ethical, legal and social issues (ELSI) related to health and health research and strives to build capacity in Canada in the field of research ethics. The ELSI program is related to all other CIHR programs, as its legislation requires that it promote or fund research that "meets the highest international scientific standards of excellence and ethics".

Financial Resources ($M)

Planned Spending	Authorities	Actual Spending
$6.3	$6.3	$2.2

Human Resources

Planned	Actual	Difference
3	3	0

Expected Results Uptake and application of ethics knowledge as an integral part of decision-making in health practice, research and policy.	Indicators Level of activity: number and dollar value of investments. Success of CIHR ELSI activities, including results, awareness and satisfaction levels.
Link to Priority Priority #2 - Researchers - Develop and sustain Canada's health researchers in vibrant, innovative and stable research environments.

Program Activity 2.4 Performance Status: Not Met

The following presents a 2007-2008 performance summary of the key sub-activities that support the performance status of Program Activity 2.4 - Inform research, Clinical Practice and Public Policy on Ethical, Legal and Social Issues (ELSI) Related to Health and Health Research.

As outlined in more detail in the sections below, CIHR has not met the expected results for this program activity of increasing the uptake and application of ethics knowledge as an integral part of decision-making in health practice, research and policy. This performance rating is based on an assessment of planned and actual spending, activities and outputs. In 2007-2008 due to the underutilization of the funding for this program activity, a management decision was made to reduce the planned spending amount and reallocate these funds to other programs. CIHR had over estimated the capacity of the health research community to undertake studies into health research ethics. As a result, the actual spending for this activity was significantly less than then planned amount identified in CIHR's 2007-2008 Report on Plans and Priorities. As a result the decreased investment, the reach of the program was less than anticipated. It should be noted, however, that this change in planned spending does not change CIHR's commitment to ensure that all CIHR funded research is conducted in an ethical manner.

A. Ethical, Legal and Social Issues (ELSI)
The standards for ethics research developed and administered under this program are recognized as the gold standard in Canada and have been incorporated into the rules of all major institutions. In 2007-2008, CIHR invested approximately $1.8M to support ELSI-related grants and awards. Notwithstanding these efforts, a portion of the allocated funding has been consistently underutilized. CIHR intends to continue its efforts at building receptor capacity to conduct research into ethics and is confident that over time this issue will be addressed.

Despite these challenges, the ELSI Program has had some great accomplishments in 2007-2008, including the publication of Guidelines for Health Research Involving Aboriginal People, developed by CIHR at a time when no government agency had a clear mandate in this highly sensitive area. The guidelines can be found on CIHR's website at the following address: http://www.cihr-irsc.gc.ca/e/29339.html.

Benefits to Canadians - Environment and Health Once-common contaminants linked to lymphoma Exposure to two environmental contaminants – once widely used but now banned or strictly controlled – increases the risk of non-Hodgkin lymphoma, a major Canadian study suggests. Dr. John Spinelli, senior scientist at the BC Cancer Agency, led the study in which almost 900 British Columbians – half with non-Hodgkin lymphoma– provided blood samples. Those with non-Hodgkin lymphoma showed much higher levels of organochlorine pesticides and polychlorinated biphenyls (PCBs). Incidence of non-Hodgkin lymphoma increased steadily over the past three decades but recently levelled off. Formerly found in flame retardants, hydraulic fluid, lubricants, and added to pesticides, paints, and carbonless paper, PCBs now can be used only to insulate existing electrical equipment. Most organochlorine pesticides are banned in Canada. Results of the study, partly funded by CIHR, were published in International Journal of Cancer. Does pollution hit women harder? Are women more susceptible to the effects of pollutants? There is growing evidence that more women than men are developing and dying from chronic obstructive pulmonary disease (COPD) - a long-term illness usually caused by smoking. Given the decline in women's smoking rates, some researchers suspect exposure to pollutants may be contributing to the apparent rise in COPD among women. A review of 73 recent articles on occupational and environmental exposure to pollutants turned up no definitive answer, according to a December, 2007 report by Dr. Susan M. Kennedy in the Proceedings of the American Thoracic Society, largely because few articles included "gender-stratified" results. Dr. Kennedy, a professor at the University of British Columbia's School of Environmental Health, led the review for a COPD conference workshop. Participants identified the need for research focusing on gender differences in exposure to pollutants at home, on the job and in everyday life. Industry, not traffic, increases air pollution risk of Parkinson's The Ontario Medical Association estimates that 1,900 Ontarians die prematurely each year from ambient air pollution exposure, and that the economic costs of these and other health effects total more than $1 billion per year. A CIHR-funded study is the first in North America to draw a link between Parkinson's disease and manganese air pollution, and suggests that industry-generated emissions of the pollutant pose a greater health risk than traffic-generated manganese. "This study of 110,000 people over three years supports the theory that exposure to manganese adds to the natural loss of neurons attributable to the aging process," says Dr. Murray Finkelstein at the University of Toronto, one of the study's authors. The results appear in a recent issue of Environmental Research.

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Risks and Challenges - Strategic Outcome 2.0

In delivering results in 2007-2008 related to Strategic Outcome 2.0, Outstanding Researchers in Innovative Environments, CIHR proactively managed the following risks:

Risk # 1: Canada's potential future research personnel shortage: There is a risk that Canada may face shortages in research personnel in the future.

Impact: Given the increasing demand for high-quality researchers around the world at a time of increasing rates of retirement among senior researchers, a shortage of personnel conducting research on new health products and services could place Canadian economic competitiveness at risk. This issue was identified in a 2007 Conference Board of Canada report card that assessed Canada's socio-economic performance. The report noted that: "Canada has a shortage of the skilled people who are essential for innovation. We have 7.2 researchers per 1,000 employees, compared with 16.5 per 1,000 in top-ranked Finland. Canada ranks 12th among the 17 comparator countries in the proportion of graduates with science and technology degrees"¹⁵. The impact of not adequately addressing this challenge is that Canada may lack the intellectual capital to conduct the research needed to support improvements in the health of Canadians and the health-care system.

Mitigation: This risk is being mitigated by making research capacity development a priority and funding both individual awards and strategic health research training programs to address capacity gaps. The expanded Canada Graduate Scholarships program, the new Vanier Scholarships and the Canada Research Chairs program will help attract and retain researchers.

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15. Conference Board of Canada, How Canada Performs: A Report Card on Canada, June 2007, available at: http://www.conferenceboard.ca/documents.asp?rnext=2047

Risk # 2: Ensuring alignment of programming with other granting agencies: There is a risk that CIHR's programming overlaps with programs already in place in other granting organizations.

Impact: This could result in over-investing in certain areas with limited resources available in other areas of need.

Mitigation: To mitigate this risk, CIHR makes a concerted effort to work with other federal funding agencies - the Natural Sciences and Engineering Research Council (NSERC) and the Social Sciences and Humanities Research Council (SSHRC) to create inter-agency mechanisms that foster a more comprehensive approach to the overall management of research support. CIHR has established mechanisms for ongoing planning and exchange, the harmonization of policies and practices, and the collaborative delivery of programs.

Risk # 3: Effectiveness of partner selection and engagement: There is a risk that CIHR's approach to selecting and working with partners is ineffective and does not yield the types of partnerships required to have an impact on health research.

Impact: This could result in inconsistent and multiple contacts with the same partners, a large number of partner relationships to manage, missed opportunities and potentially partners choosing to stop working with CIHR.

Mitigation: To mitigate this risk CIHR has established a Partnership and Citizen Engagement Branch to ensure the consistent, coordinated and effective management of partnerships and citizen engagement activities across CIHR. CIHR is also in the process of developing a partnership strategy for CIHR which clearly outlines what the organization is trying to achieve through its partnerships. This strategy will identify the types of partnerships CIHR should be engaging with from all sectors, the key stakeholders CIHR should be engaging with and the anticipated outcomes of these relationships.

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Strategic Outcome 3.0: Transforming Health Research into Action

Strategic Outcome 3.0 focuses on ensuring that:

A key part of CIHR's mandate, knowledge translation (KT) is a dynamic and iterative process that includes synthesis, dissemination, exchange and the ethically sound application of knowledge to improve the health of Canadians, provide more effective health services and products and strengthen the health care system. This is accomplished through the funding of KT research and activities; facilitation and management of partnerships that can accelerate KT; and the development of measurement, analysis and evaluation policies, frameworks and tools to assess the outcomes and impacts of CIHR-funded research. CIHR's KT strategy aims to accelerate the transformation of research results into health benefits for Canadians and an improved health-care system. CIHR also plays a role in helping to move promising new research breakthroughs toward potential commercial applications. Throughout 2007-2008, CIHR worked towards fulfilling the knowledge translation part of its mandate through targeted funding opportunities, the development of policies to facilitate KT and by expanding CIHR's messaging about KT within and outside of the organization.

Summary of Results
Several key strategic outcome indicators are used to monitor CIHR's progress in this area, including the following:

1. Extent to which CIHR-funded researchers are integrating KT targets into their work; and
2. Number of patents, spin-off companies and licenses for intellectual property generated from CIHR-funded research.

1. Extent to which CIHR-funded researchers are integrating KT targets into their work.

CIHR's policy on Access to Research Outputs took effect January 1, 2008 and applies to all grants funded after that date. Grant recipients must now make every effort to ensure that their peer-reviewed research articles are freely available as soon as possible after publication. Open access enables authors to reach a much broader audience, which has the potential to expedite awareness of and facilitate the use of research findings by policy makers, health care administrators, clinicians, and the public, by greatly increasing ease of access to research. CIHR funds several programs that require knowledge users within the health system decision makers as project team members, such as the Partnerships for Health System Improvement initiative. In 2007-2008, CIHR invested approximately $1.7M in this program, an amount that was matched at least one to one through partner contributions. KT plans are required and assessed as part of the application process to ensure that project findings are disseminated and applied to improve health-care in Canada. The Knowledge to Action and Knowledge Synthesis funding opportunities (discussed in more detail in section 3.1) also require knowledge users as part of the research team. These integrated KT funding opportunities require a collaborative or participatory approach to research that is action oriented and is solutions and impact-focused. Health research is adopted into practice by engaging the knowledge-user partner in defining the research question and in interpreting and applying the findings.

2. Number of patents, spin-off companies and licenses for intellectual property generated from CIHR-funded research

Health research leads to new products, companies and jobs. Data available for the past 10 years shows that 187 spin-off companies have been created by CIHR funded researchers, the majority of which are still active. Figure 11 illustrates the total number of health patents that have been issued each year, and how many of those patents are held by CIHR-funded researchers. The drop in the number of patents from 2006 to 2007 is of concern and requires further analysis to determine its causes and ramifications. CIHR is currently developing a KT Advisory Committee on Commercialization with the view of convening expert advice on how to best deploy our available resources in this area.

Figure 11: Number of Health Related Patents by Year

Source: US Patent Office Database

Figure 12 summarizes the grants and awards expenditures made by CIHR under Strategic Outcome 3.0 - Transforming Health Research into Action. Expenditures have grown substantially over the last six years, from $32M in 2000-2001 to $134M in 2007-2008. In 2007-2008 CIHR was allotted $73.5M for the Centres of Excellence for Commercialization and Research (CECR) program (see section 3.2). The Institutes have strongly supported KT research through their strategic initiatives.

Figure 12: CIHR Investments in the Knowledge Translation Mandate (transforming Health Research into Action

*In 2007-2008, $73.5M was funded through the Centres of Excellence for Commercialization and Research (CECR) program.
Source: CIHR Funding Database
Note: Includes the Networks of Centres of Excellence Program.

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Performance at the Program Activity Level of the MRRS

The following sections present the results achieved in 2007-2008 within each of the Program Activities that contribute to Strategic Outcome 3.0 - Transforming Health Research into Action

Program Activity 3.1: Support Activities on Knowledge Translation, Exchange, Use and Strategies to Strengthen the Health System

A key part of CIHR's mandate, knowledge translation (KT) is about moving knowledge into action: turning the knowledge gained through health research into improved health for Canadians, more effective services and products, and a strengthened health system. CIHR's KT Strategy is designed to further expand and increase its ongoing efforts in this area. The strategy is a multi-year plan based on Blueprint that identifies planned activities in the following four areas: supporting research on KT concepts and processes; contributing to building networks of researchers and knowledge-users; improving the capability to support KT research focused on the synthesis of knowledge at CIHR and with partners; and supporting and recognizing KT excellence.

Financial Resources ($M)

Planned Spending	Authorities	Actual Spending
$40.7	$41.9	$39.8

Human Resources

Planned	Actual	Difference
19	17	-2

Expected Results Effective dissemination, exchange, synthesis and application of research results take place to create new knowledge, strengthen Canadian capacity and networks and, together with our partners, enable effective research and application of health research results.	Indicators Level of activity: number and dollar value of investments. Success of CIHR-funded research programs, including results, awareness and satisfaction levels.
Link to Priority Priority #3: Knowledge Translation - Catalyze health innovation in order to strengthen health and the health-care system and contribute to the growth of Canada's economy

Program Activity 3.1 Performance Status: Successfully Met

The following presents a 2007-2008 performance summary of the key sub-activities that support the performance status of Program Activity 3.1 - Support Activities on Knowledge Translation, Exchange, Use and Strategies to Strengthen the Health System.

As outlined in more detail in the sections below, CIHR has successfully met the expected results for this program activity of the effective dissemination, exchange, synthesis and application of research results to create new knowledge, strengthen Canadian capacity and networks and, with partners, enable effective research and application of health research results. This performance rating is based primarily on an assessment of planned and actual spending, activities and outputs. The expected results have been achieved through increased funding for the Networks of Centres of Excellence program and increased focus on building and strengthening teams of researchers engaged in KT. The Institutes play an instrumental role in helping to achieve CIHR's KT mandate. CIHR's knowledge translation sub-programs are all relatively new (2-3 years old) and therefore an evidence-based assessment of their performance is not yet available. However, increasing application pressure indicates progress in building capacity in this area. CIHR is committed to significantly increasing its expenditures in knowledge translation activities.

A. Networks of Centres of Excellence (NCEs)
The NCE Program is a joint program with the three federal research councils in collaboration with Industry Canada. The NCEs are unique partnerships among universities, industry, government and not-for-profit organizations resulting in the transfer of knowledge and exploitation of leading-edge research results with economic or societal benefits to Canadians. During the period of 2001-2007, the program produced: 27,000 refereed publications; filed 720 Patents and issued 240; 140 Copyrights over 3,100 graduate students trained; 400 licenses granted or in negotiation; and 58 spin-off companies (over 120 spin-offs since the beginning of the program).

The report released in 2006 by the Council of Canadian Academies, The State of Science and Technology in Canada which can be found at this link: http://www.scienceadvice.ca/documents/The_State_of_Science_and_Technology_in_Canada.pdf, ranked the NCE Program as second for its support to commercialization, thanks to the partnerships it has nurtured with outside organizations and for its support in creating spin-off companies. The survey also included a summary of international reports on S&T that indicated the NCE Program's collaborations and networking efforts also have gained international recognition. In 2007-2008, an international advisory committee reviewed the NCE Program. The international review was favourable. Full details of the NCE's International Advisory Committee report can be found at the following address: http://www.nce.gc.ca/pubs/reports/2007/nce-iacreport/nce-iac-content_e.htm.

As well in 2007, the NCE program was evaluated under the guidance of an interagency steering committee. This evaluation was also favourable and a copy of the report, along with an NCE management response can be found at: http://www.nce.gc.ca/pubs/reports/2007/evaluation/NCEEvaluationReport2007-eng.pdf.

B. Knowledge to Action
This program aims to build and strengthen teams of researchers and knowledge users engaged in KT at the community, regional, provincial or federal level. Applications received for this initiative jumped from 30 in 2005 to 54 in 2007. Twelve of these 54 applications were funded in 2007-2008, representing an investment of approximately $2.2M over the next two years. Partners to date that have supported this initiative include Canada Health Infoway and the Mental Health Commission of Canada.

C. Knowledge Synthesis
This program supports teams of researchers and health knowledge users to produce knowledge syntheses and scoping reviews that respond to the information needs of knowledge users in all areas of health. When first launched in 2005, 16 applications were received with 8 projects funded. In 2007, 41 applications were received with 22 projects funded, representing nearly $2.0M in expenditures in fiscal year 2007-2008. CIHR also successfully negotiated a Tri-Council partnership focusing on syntheses on complex interactions between the environment and one or more other sectors - particularly health, energy and natural resources, and information and communications technology. In addition CIHR forged partnerships with the Atlantic Advisory Committee on Health Human Resources, the Canadian Patient Safety Institute, the Canadian Stroke Network, Health Canada, the Mental Health Commission of Canada and the Western & Northern Health Human Resource Planning Forum.

D. The KT Award
Since 2003 CIHR has been raising awareness and celebrating KT excellence through the annual regional and national KT awards. These awards are granted to an individual, team or organization that has made an outstanding contribution to increasing the application of research findings, improving the health of Canadians or strengthening the health system. Each year CIHR gives out one national and one regional KT Award.

Benefits to Canadians - Reducing Injuries in the Workplace Manufacturing poor mental health? A major CIHR initiative to investigate the impact of the workplace on mental health found that workers employed in manufacturing were most likely to report psychological problems. Using Statistics Canada survey data representing more than 77,000 workers in 139 occupations and 95 industries, researchers found that high-stress occupations commonly considered to have the potential to produce mental distress - police work and firefighting for example - appeared less likely to do so. Among those more likely to report mental health challenges were machine operators in the fabric, fur and leather products industries, labourers, food, beverage and tobacco wholesale distributors, electrical equipment and component manufacturers, and auto mechanics. In an interview with the National Post, CIHR-funded scientist Dr. Alain Marchand of the Université de Montréal suggested that cutbacks in many manufacturing industries have created anxiety among workers. The study was published in the International Journal of Law and Psychiatry. University invention reduces forces on people's backs Lower-back pain is the leading cause of workplace disability and the cause of nearly one-third of all lost-work claims in Ontario according to the Institute for Work and Health. Two university professors are hitting the market with a new Personal Lift Assistive Device that workers wear to reduce the forces on the back. The ultimate goal is to get people back to work faster after a back injury, and hopefully reduce their risks of future back injuries. With financial support from CIHR's Proof of Principle (POP) program, Dr. Mohammad Abdoli of Ryerson University and Dr. Joan Stevenson of Queen's University have proven its effectiveness in the laboratory and are now demonstrating its effectiveness and user acceptability in industry. CIHR's POP program funds business development activities and market research to speed prototype development of commercially-promising research.

Role of CIHR's 13 Institutes in Achieving KT
CIHR's Institutes play an instrumental role in helping to achieve CIHR's KT mandate as they are centrally located within the researcher, partner and knowledge user communities. KT research is supported across the mandates of all 13 Institutes and in 2007-2008, 192 grants and awards totalling $9.5M were funded across the 13 institutes. More than half of these grants and awards were funded through two institutes: the Institute of Health Services and Policy Research and the Institute of Population and Public Health. The KT activities undertaken by the Institutes address their specific strategic priorities.

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Program Activity 3.2: Support National Efforts to Capture the Economic Value for Canada of Health Research Advances made at Canadian Institutions

Commercialization is an integral part of CIHR's mandate and is part of the knowledge translation process. CIHR provides various funding programs in support of the implementation of its commercialization and innovation strategy, which focuses on four areas: research, talent, capital and linkages. More information on the strategy can be found at: http://www.cihr-irsc.gc.ca/e/30162.html.

Financial Resources ($M)

Planned Spending	Authorities	Actual Spending
$27.3	$103.4	$98.3

Human Resources

Planned	Actual	Difference
13	12	1

Expected Results Implement strategies to enable the effective development and commercialization of health research that will lead to a better quality of life for Canadians through improvements in the Canadian health system, products and economy. As well, plan, launch and manage competitions and programs for grant funds to create and transfer new knowledge, strengthen Canadian capacity and networks and undertake effective commercialization of health research.

Indicators Level of activity: number and dollar value of investments. Success of CIHR-funded research programs, including results, awareness and satisfaction levels. Number and nature of patents, spin-off companies and licences for intellectual property (IP) generated from CIHR-funded research.

Link to Priority Priority #3: Knowledge Translation- Catalyze health innovation in order to strengthen health and the health-care system and contribute to the growth of Canada's economy.

Program Activity 3.2 Performance Status: Exceeded Expectations

The following presents a 2007-2008 performance summary of the key sub-activities that support the performance status of Program Activity 3.2 - Support National Efforts to Capture the Economic Value for Canada of Health Research Advances made at Canadian Institutions.

As outlined in more detail in the sections below, CIHR has exceeded expectations in meeting the expected results for this program activity of implementing strategies to enable the effective development and commercialization of health research that will lead to a better quality of life for Canadians through improvements in the Canadian health system, products and economy. This performance rating is based primarily on an assessment of planned and actual spending, activities and outputs. Through an unplanned $163M increase from Budget 2007 CIHR was able to establish and launch the new Centres for Excellence for Commercialization and Research (CECR) program in collaboration with the other two granting councils SSHRC and NSERC. This innovative program has invested in research and commercialization centres capable of achieving global leadership in Canada. Other successes in CIHR's commercialization programs further support this rating as detailed below.

A. Centres of Excellence for Commercialization and Research (CECR)
The 2007 Federal Budget announced that as part of the S&T Strategy, approximately $163M in funding would be made available in 2007-2008 for the CECR Program, to be split among the three granting councils - CIHR, NSERC and SSHRC. CIHR was granted $73.5M towards the CECR Program. Through the CECR Program, the Federal Government is able to support research and commercialization centres capable of achieving global leadership for Canada and translating knowledge into significant commercial advantage. The first CECR competition was launched in June of 2007. In 2007-2008 the Tri-councils committed the $163M in support of a total of eleven Centres of Excellence for Commercialization and Research, 9 of which focus on health.

B. CIHR/Rx&D Collaborative Research Program
The CIHR/Rx&D Collaborative Research Program promotes peer-reviewed research and enhances the training and development of health research personnel and opportunities in Canada. This was successfully completed in February 2007 with the launch of the Clinical Research Initiative (CRI) collaborative program with the CFI. In 2007-2008, The CIHR/Rx&D Collaborative Research Program committed over $4.4M towards 199 new and ongoing grants and awards. Private industry contributed over $6M¹⁶ in support of these same grants and awards. CIHR and its partner organizations have invested over $156M¹⁷ between 2000 and 2008 for research funded under this Program, over $45M of which was contributed by CIHR.

C. Proof of Principle (PoP)
CIHR identified a critical gap in funding at the early stage of commercialization, between the traditional role of granting agencies in supporting discovery research, and the demonstration of "proof of principle" for an innovation, at which stage private-sector investment becomes interested. CIHR filled that gap with its PoP Program. To date, over 250 projects have been funded and over $31M in CIHR commitments have been made through the PoP program. Over the first four years of competition funding, 76% of funded projects resulted in a new patent being filed after receiving PoP funding (113 projects), 26% of funded PoP projects had intellectual property licenses (38 projects), and 14% of funded PoP projects contributed to new company formation (21 projects).

D. CIHR's Small and Medium-Size Enterprise (SME) Program
This program is designed for SMEs who are not members of Rx&D. The program supports a wide range of grants and awards, with fixed funding matches between CIHR's and the company's contribution to the costs of a research grant or award. Eligible applicants may participate within and/or outside the Clinical Research Initiative. In 2007-2008 CIHR invested a total of $4.5M in funding through the SME Program. This included funding for Fellowships, New Investigators, Research Chairs and Operating Grants. In addition, a total of $6M¹⁸ was contributed by SME partners in support of these applications over the same period.

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16. Partner contributions are likely understated as the figures do not include "in-kind" partner contributions and some partner funds that are not administered by CIHR.

17. Partner contributions are likely understated as the figures do not include "in-kind" partner contributions and some partner funds that are not administered by CIHR.

18. Partner contributions are likely understated as the figures do not include "in-kind" partner contributions and some partner funds that are not administered by CIHR.

In 2007-08 CIHR provided approximately $13.7M in funding through its Commercialization programs focused on building successful commercialization activities within Canada's health research community (see Figure 13). CIHR contributed to creating the environment, the talent and the programs necessary for Canada to reap the economic benefits of health research: high-quality jobs; internationally-competitive biotechnology firms; increased direct foreign investment and increased productivity.

Figure 13: Commercialization Program Expenditures, 2000-2001 to 2007-2008

Source: CIHR Funding Database

Benefits to Canadians - Vulnerable Populations: Seniors Study links antipsychotics to dementia deaths A CIHR-supported study has linked the use antipsychotic drugs by older adults who have dementia with an increased risk of death. The Institute of Clinical Evaluative Services (ICES) tracked Ontario residents 66 years of age and older with dementia for 180 days after they started taking the drugs. The six-year study found slightly higher death rates among seniors who took either older typical (also called conventional) antipsychotics or newer atypical antipsychotics. Dr. Sudeep Gill, ICES Adjunct Scientist, said the severity of the outcome and the study's relatively short follow-up time means even slight mortality increases are significant, especially given that for many elderly dementia patients "these medications may not be very beneficial." Bilingual bonus: a delay in dementia Researchers with Toronto's Rotman Research Institute have found evidence that bilingualism may yield an additional benefit: delaying the onset dementia for four years. The researchers studied diagnostic records of 184 patients with cognitive complaints between 2002 and 2005. The investigators found that the onset of dementia symptoms was 71.4 years for monolingual patients and 75.5 for the bilingual. "There are no pharmacological interventions that are this dramatic," said CIHR-supported researcher Dr. Morris Freedman. Canadian Stroke Network What began as an idea and partnership between the Canadian Stroke Network and the Heart and Stroke Foundation has become a movement, driven by health-care professionals, families and people who have personally experienced a stroke - and borne of a few simple facts: The level and quality of stroke care provided in Canada varies dramatically from one part of the country to another; Stroke is largely preventable and treatable. New research, drug therapy and rehabilitation practice can save lives and dramatically reduce disability; The cost of stroke is huge; it costs the health-care system $3 billion a year in direct costs alone; and the impact on families and society is immeasurable. Seed funding from the Canadian Stroke Network (CSN) in 2005 led to the founding of NoNO Inc., which has raised an additional $88.5M to commercialize a new drug that protects brain cells from damage in the event of a stroke. Phase 1 human trials have begun with this promising new drug developed by CSN researchers that could spare thousands of Canadians the debilitating effects of a stroke.

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Risks and Challenges - Strategic Outcome 3.0

When delivering results in 2007-2008 related to Strategic Outcome 3.0 - Transforming Health Research into Action, CIHR proactively managed the following risks:

Risk # 1: Adequate Knowledge Translation: There is a risk that CIHR may not be able to support the creation and synthesis of knowledge and results to deliver on the knowledge translation portion of its mandate.

Impact: This could result in the inability to demonstrate impact, possible reductions in future funding levels and a lost opportunity to translate the results of the new knowledge created by CIHR funding into new products or medical services for the benefit of Canadians.

Mitigation: This risk is being mitigated in two ways. The first is the establishment of specific KT programs that require researchers to synthesize and disseminate their results. The second is the establishment of the infrastructure within CIHR to act as a convenor and to carry out the synthesis and dissemination of specific research results. CIHR is in the process of implementing a research reporting system which will allow the organization to access reports on the results of CIHR funded research. In addition, a "Knowledge to Action" strategy is being developed which outlines the roles of both CIHR and its partners in knowledge translation activities, including the appropriate translation of final grant reports.

Risk # 2: Effective reporting of results: There is a risk that CIHR may be unable to evaluate and report on the results of CIHR's funded-research inputs, outputs and impacts.

Impact: The linkages between health research inputs, outputs and impacts are difficult to trace when knowledge develops incrementally over time and through multiple channels. Attribution of credit for research impacts can also be complex, as impacts often result from a number of research projects carried out or funded either collaboratively or independently in the same and/or different countries. In addition, the application of research findings is influenced by a variety of contextual factors. This challenge could result in the inability to report on results, possible reductions in future funding levels and extensive public scrutiny.

Mitigation: To mitigate this risk CIHR has developed, and is in the process of implementing, an impact framework which provides guidance to CIHR and its partners on how to report on results in a consistent way to demonstrate impact.

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