"Canadian health research is entering a brilliant new era - one where biomedical researchers work with sociologists - where clinicians collaborate with economists. I encourage you to enter this new era by participating."¹

1.Purpose

Earlier this year, Simon Fraser University decided to explore the opportunities for expanded research and teaching in health-related fields. A consultant was engaged to assist the University in evaluating its prospects for launching a comprehensive Health Initiative. Dr. Stuart MacLeod has visited Simon Fraser University on two separate occasions and has provided assistance to begin the assessment stage of the process.

The first stage of the review process requires Simon Fraser University to conduct an extensive self-study of its current health-related research and teaching and to explore the interests of faculty members, Departments, and Faculties in expansion of health programming. What follows is an overview of our interests, expertise, and strengths in health-related areas. As will become evident over the course of this report, "health-related" research has been broadly defined by the survey respondents. The broad interpretation of "health-related" research may well be one of the key characterizing features of a Health Initiative at Simon Fraser University and eventually could be one of our greatest strengths.

2.Context for the Health Initiative

External Funding Context

In recent months a number of new funding opportunities have been introduced that reinforce the timeliness of a Health Initiative for Simon Fraser University. Foremost among these was the October 1999 announcement by Prime Minister Jean Chrétien of new federal funding to the three major research councils: Social Sciences and Humanities Research Council (SSHRC), Natural Science and Engineering Research Council (NSERC) and Medical Research Council (MRC). This pronouncement is consistent with the "1999 federal budget which indicated an increase of almost 100% in allocations to health sciences, social sciences and health services delivery research and basic biomedical sciences over the next four years. New funding in areas such as health information, the study of health transitions, and the study of targeted initiatives in health disciplines such as nursing are also anticipated".²

Similarly encouraging was the announcement by the Canadian Federal Government to launch the "Twenty-First Century Chairs". These prestigious appointments will be made across the country and will be awarded to Universities on the basis of their historical success rates with the major granting councils. It is anticipated that Simon Fraser University may be awarded between 30-45 of these appointments which carry with them salary, benefits and research funding for an extended period. Simon Fraser University could choose to direct several of the Chairs to strategic initiatives, one or more of which could be in the Health area.

The federal government has also further expanded its investment in health research through the creation of the Canadian Institutes of Health Research (CIHR). This new entity will replace the Medical Research Council of Canada which has been the premier federal agency responsible for funding basic biomedical health research in Canada. According to the September 1999 working paper of the CIHR Programs Sub-Committee, the CIHR will deliver a broad range of crucial health research funding and support activities. In an overview of its mission, it is stated that the CIHR "program design will broaden the reach and scope of health research, integrate the work of researchers across the different sectors, address gaps in the current funding programs, promote knowledge gain through interdisciplinary approaches and partnerships, translate research findings into information and knowledge for a wide range of user groups, and promote applied clinical research to inform evidence-based practice and decision making".³ Of particular interest and potential opportunity for Simon Fraser University is the identification of considerable funding for the creation of new Chairs in health areas and financial support for faculty members who change fields or research concentration into health-related research areas. The CIHR also intends to offer "career research awards" which would provide salary support and operating grant support over the course of faculty members' careers at an institution. When coupled with the research grant support traditionally available from the MRC, the new CIHR could have significant financial import for the SFU Health Initiative. Given the potential of the CIHR as a major supporter of health related research at Simon Fraser University, it may be prudent for the Health Initiative to be formalized in a manner that has clear linkages to one or more of the institutes that will comprise the CIHR.

Other evidence of increasing opportunities in the health area is the recent program to support eight to twelve new Chairs/Professorships by the Canadian Health Services Research Foundation (CHSRF).⁴ Four to six of the chairs are targeted to the areas of health policy and politics, linking health and social domains, innovative methodologies, dissemination and uptake of health issues, and health services in general. The other Chairs/Professorships are directed to the area of Nursing. Valued at between $130,000 to $170,000 annually for a three-year period, these Chairs represent a significant investment in the promotion of applied health research. While Simon Fraser University was not in a position to take advantage of these opportunities at this time, it is hoped that we will be poised to make successful application for similar Chair/Professorships in the future.

All this demonstrates that there is an extremely favorable national funding environment in which to launch a new Health Initiative at Simon Fraser University. Provincially, however, the funding environment has been less supportive. Since 1992, the provincial government has increasingly eroded its support for the B.C. Health Research Foundation (BCHRF). In 1998 representatives from BC universities, teaching hospitals, community health organization, the biotechnology industry and major funding agencies formed a Coalition for Health Research in British Columbia in order to take proactive steps to oppose the provincial government funding priorities in the health area. The Coalition continues to argue for increased priority for health research within the province and is currently developing a long-term strategy to this end. At present, however, the "priority for the Ministry of Health in British Columbia remains on utilization of services and 'system efficiency' rather than on biomedical or biotechnology research".⁵

Health-Related Programming at B.C. Post-secondary Institutions

With the exception of the University of British Columbia, universities in B.C. do not have extensive programming and research in health related areas. Most, however, are looking to expand their current health-related activities. The Technical University of British Columbia currently has no formalized programming in health related areas. Royal Roads University possesses an on-line Executive Program entitled "Creative Leadership in Health Care" but this appears to be a relatively generic management and leadership program that has been adapted to the health care industry. The University of Northern British Columbia has a broader base in the health area offering a Masters of Science in Community Health Care, a Bachelor of Science in Nursing, and a Bachelor and Masters of Social Work. The First Nations program at UNBC contains courses on First Nations Health and Healing which introduces students to a holistic vision of health care. The University of Victoria also offers a Bachelor of Science in Nursing and a Bachelor and Masters of Social Work. In addition, they offer an undergraduate degree in Health Information Science, the focus of which is to provide students with the skills to improve health care delivery systems. Planning is currently underway to extend this program to the graduate level. The University of Victoria is also home to the Centre for Environmental Health which investigates induced mutation, disease and genome research in humans and is an active participant in the Human Genome Project. Recently the University of Victoria has expanded its Health Informatics research.

Not surprisingly, given its Medical Faculty and adjacent Hospital, the University of British Columbia offers the most comprehensive programming in the health field within British Columbia. Aside from the usual academic departments in areas such as Anatomy, Cardiology, Biochemistry, Genetics, Medicine and Obstetrics & Gynaecology, health related topics are in evidence throughout the curriculum. UBC also has a significant number of health centres and institutes covering a range of health issues from both medical and policy perspectives and orientations. Examples are the Brain Research Centre (BRC), the Canadian Genetic Diseases Network (CGDN), the Institute of Health Promotion Research (IHPR), and the Centre for Health Services and Policy Research (CHSPR).

Outside the B.C. university sector, the Open Learning Agency (OLA) offers a large number of certificate programs, refresher programs, and continuing education in health related subjects. In addition, the OLA offers a Bachelor of Science in Nursing and three Bachelors degrees in Health Sciences with specialization in one of respiratory therapy, physiotherapy, or psychiatric nursing. One program of particular interest offered through the continuing education branch of the OLA is entitled Health and Human Services. It brings together a group of health-related courses such as "Health Policy", "Issues in Health Care", "Cultural Diversity in Health Care", "Health and Healing", and "Health Promotion, Prevention and Healing". Another significant player in Health Sciences education in the province is the British Columbia Institute of Technology (BCIT). BCIT offers a number of certificates, diplomas, and undergraduate level degrees in Health Sciences areas. The majority of the programming at BCIT is concentrated in the medical and nursing areas.⁶ Other health-related programs are also in evidence at some of BC's colleges although these, like programs at OLA and BCIT, represent educational opportunities within the province rather than research opportunities.

3.SFU Mission and Health Programming

On September 25, 1998, President Blaney wrote the following in his "President's Agenda":

"We will welcome and seize grand challenges, nurture our spirit of adventure, and strengthen our support for bold initiatives. This must and will be agenda item number one."

In this same document, the President added:

"We will build on our strengths, and continue to be an institution which is integral and essential to the development of British Columbia and British Columbians."

While the final form of the Health Initiative is yet to be defined, it will build on the strengths of our existing expertise and respond in an innovative way to nationally and provincially defined health research needs.

Interest in an interdisciplinary approach to health research and education is not new to Simon Fraser University. In June 1991, a Task Force on Applied Health Programs was established with the responsibility to advise the University on program directions and strategies for developing new programming in Health Services. Three years later, in May 1994, the Task Force tabled a comprehensive report before the Vice President, Academic, recommending the development of a new unit for the delivery of a Health Studies Program with five areas of focus: Human Growth and Development; Health as Health Promotion/Disease Prevention; Health, Society and Social Policy; Socio-Cultural Aspects of Health and Healing; and Community Health Services Management. While the Senate Committee for Academic Planning supported the general direction of the report and recommended the establishment of an Applied Health Programs Planning Committee, a decision was made in June 1995 not to proceed. At that time there appeared to be neither an obvious champion to lead the programming initiative nor a stable funding source to ensure successful implementation and continuation of health programming at SFU. Despite the fact that a formalized program did not come to fruition at that time, interest in expanded health programming has continued to be present. In May 1996, the report of the Presidential Committee on University Planning (PCUP)⁷ stated that "there [is] considerable opportunity in interdisciplinary subject areas at both the undergraduate and graduate levels, such as … health related programs … and such opportunities should be actively pursued …". Three years later the opportunity has arisen to follow up with these recommendations to expand in health-related programming at Simon Fraser University.

4.Overview of Current SFU Programming and Future Programming Potential

Presently there is considerable health research and programs at Simon Fraser University. What does not exist, however, is a unifying focus, centre or institute to coordinate health research and programming.

Kinesiology, Molecular Biology and Biochemistry, and Gerontology have the most visible health-related research and teaching programs at the departmental level. In addition, SFU is home to the Mental Health, Law and Policy Institute affiliated with the department of Psychology. This Institute has established an international reputation for its graduate level instruction. Outside department-based credit instruction, Simon Fraser University offers the Physician's Executive Management Program and Medical Writing and Editing Program in Continuing Studies.

The dispersed nature of current health-related research and educational programming makes summarizing our current level of activity in this area a challenging exercise. A fuller view of our current activity is revealed in the self-studies contributed by individual faculty members and Departments. These documents are briefly summarized in sections 6 and 7 below. Complete departmental responses are provided in Appendix D. Individual self-study documents are overviewed in various sections of this report. Appendix E provides a description of faculty members' interest in the Health Initiative and a profile of their current and intended health-related research activity.⁸

Future programming will likely be more interdisciplinary than at present with new program development being structured around integrated models of health that combine basic, applied and social sciences. The strong graduate programs in the Departments of Molecular Biology and Biochemistry, Kinesiology, Gerontology, Psychology, and Sociology & Anthropology may represent the most logical areas to promote graduate level health-related programming as part of the Health Initiative for Simon Fraser University. While it is not possible to forecast the range of potential new programming that will arise out of the Health Initiative it is envisioned that initial new programming, particularly with respect to joint majors, will proceed most naturally in cognate areas such as: Kinesiology/Molecular Biology and Biochemistry, Biological Sciences/Kinesiology, Physics/Kinesiology, Kinesiology/Gerontology, Molecular Biology and Biochemistry/Business Administration, and Engineering/Kinesiology. Several new programs might also take shape under the new Health Initiative, such as a graduate program in Biostatistics, and a Health Psychology Program at both graduate and undergraduate levels. Other programs would be strengthened, in particular the health, science and society focus within the Sociology and Anthropology graduate program, diversity issues in health care and health care systems which fall within programming in the Women's Studies Department, and further expansion of the Executive Management Development Program for Physicians in Business Administration and Continuing Studies. A feasibility study is also underway to explore expanding the writing program to include the area of Health Communication.

At present, there are no plans to actively pursue professional health programs such as Nursing, Pharmacy, or Medicine. Other post-secondary institutions within British Columbia have already targeted these areas and it seems more appropriate for Simon Fraser University to focus its health related activity in interdisciplinary intersections of the basic, applied and social sciences.

Encouraging internal collaborations across traditional disciplinary boundaries within Simon Fraser University should be one of the top priorities of the Health Initiative. The diverse expertise and the complementarity of research interests across disciplines is not sufficiently known within the SFU community and mechanisms that would facilitate the joining of these interests and expertise should be explored and implemented. While it is premature to identify formal thematic lines for these internal research bridges, there are five research areas that may have significant potential for Simon Fraser University based on the expertise of our current faculty. Clearly the categories that follow overlap and are broadly defined. It is hoped that the breadth of these categories will be inclusive of all faculty currently working in health-related areas. Further discussions with the university community will be held before solidifying our areas of research focus. For working purposes, then, the following five categories have been identified:

Disease and Society - encompassing disease discovery, cause determination and prevention, treatment, education and communication, evaluation and understanding;

Biopsychosocial Approaches to Health - strengthening the linkages between traditional medical research and psychology, law and the social sciences;

Basic Science, Biotechnology, and Health - incorporating cellular, genome, and other organic research, activity and health, rehabilitation and occupational therapies as well as economic, social, ethical and legal considerations;

Lifecycle Health - including reproductive health, child development, aging and gerontology, health policy, and alternative health treatment perspectives;

and,

World Health and Well-Being - combining cross-cultural perspectives on health issues, medical anthropology, physical and social geographies of health, environmental toxicology, health policy, health economics, and nutrition, poverty and social welfare.

5.Overview of SFU Health-Related Research Activities

Simon Fraser University has an extensive number of informal and formal arrangements, collaborative agreements and partnerships with both the public and private sector in health-related areas. Although not all of these arrangements represent funding commitments for researchers at Simon Fraser University, they remain an integral part of the infrastructure and network that supports research in health-related subject areas.

The following examples illustrate the breadth of arrangements, partnerships, networks and funding agencies that facilitate and support the health-related research currently underway at SFU: Medical Research Council of Canada (MRC), Natural Science and Engineering Research Council (NSERC), Social Sciences and Humanities Research Council (SSHRC), Heart and Stroke Foundation, B.C. Health Research Foundation, BC Centre for Excellence in Women's Health, Health Canada, National Cancer Institute of Canada, National Institutes of Health (NIH), BC Cancer Agency, St. Paul's Hospital, BC Children's Hospital, AIDS Vancouver, Vancouver Hospital and Health Sciences Centre, McCreary Centre Society for Adolescent Health, Down Syndrome Research Society, DisAbled Women's Network (DAWN), Workers Compensation Board (WCB), the Vancouver Health Collective, Status of Women Canada, Canadian Bacterial Diseases Network of Centres of Excellence (CBDN), Secwepemec Cultural Education Society, Canadian Diabetes Association, National Health Research and Development Program (NHRDP), and Protein Engineering Network of Centres of Excellence (PENCE).

In the area of funded research, Simon Fraser University faculty members annually attract an average of $ 3.4 million in external health-related research funding each fiscal year. A complete inventory of the external grants and contracts held by Simon Fraser Faculty members over the period 1995/96 through 1998/99 is provided in Appendix A. This inventory identifies only those external funding sources channeled through Simon Fraser University. Funding support for collaborative projects funneled through other partners is not captured.

Since it is not possible to mention all the major collaborative research activities in which SFU faculty members participate, we have chosen to highlight several partnerships that are currently underway or in the development stages in order to demonstrate the breadth of our current activity.

• The Living Laboratory, opened in November 1997, is a "full-scale simulation residence for the study of effective environmental and product design for older persons and disabled adults". The Living Laboratory is a joint venture of the Gerontology Research Centre (under the direction of Dr. Gloria Gutman) at Simon Fraser University and the Technology Centre of the British Columbia Institute of Technology.
• In a significant collaboration with the Scripps Research Institute and the Henry F. Jackson Foundation for Military Research, Dr. Jamie Scott is working to develop a vaccine against AIDS. This high-profile collaboration has attracted extensive funding from both MRC and NIH (US).
• In conjunction with the Down Syndrome Research Society, a new Down Syndrome Research Building will be built within the Lower Mainland in the near future. The new privately funded research building will benefit considerably from the expertise of Drs. Dan Weeks and Hal Weinberg who have international reputations in Down Syndrome research.
• A significant new initiative in active rehabilitation has recently begun at the Geraldine & Tong Louie Human Performance Centre at the Harbour Centre campus. This initiative is connected to the Workers Compensation Board (WCB) and the Insurance Corporation of British Columbia (ICBC).
• An affiliation between the Women's Studies Department at Simon Fraser University and the Centre for Women's Health Studies and Promotion at Ben-Gurion University of the Negev is currently under negotiation.
• In partnership with the BC Children's Hospital, the Statistics group at Simon Fraser University is exploring ways to secure permanent funding for the position of Director of the Statistics Consulting Service. It is envisioned that the Director would spend a portion of his/her working week at the Children's Hospital, fostering collaborative research projects between researchers affiliated with the hospital and those at Simon Fraser University.
• Finally, there is a proposed partnership between Providence Health Care, Simon Fraser University and the Vancouver/Richmond Health Board to develop a Centre for Excellence in Health and Aging. The Centre "is envisioned as a vehicle for fostering collaborative work between hospitals, universities and community service providers who share an interest and expertise in the health needs of the elderly. The goal is to help older adults achieve wellness, cope with chronic illness, maintain function and improve quality of life. Activities would include research, evaluation, application/dissemination of knowledge, and education/training to address the broad health needs of the elderly."⁹

  Simon Fraser University researchers have also been extremely successful in commercializing the marketable products of their health-related research. At the time of writing this report, seven such "spin-off" companies were active in the pharmaceutical and medical device industries.

  • Applied Brain Behaviour Systems Limited (A.B.B.S.) was formed in the 1980's by Dr. Hal Weinberg of SFU's School of Kinesiology. This firm is a research and development group that develops and implements methodologies for the evaluation , prediction, training, rehabilitation and improvement of human cognitive function and motor abilities. A.B.B.S. combines the expertise of neuroscientistis, computer software experts and specialized technicians to conduct basic and applied brain research. They also excel in the application of neurophysiological assessment techniques for legal, medical, human factors and industrial problems. A.B.B.S. is affiliated with The Geraldine and Tong Louie Human Performance and Rehabilitation Centre at SFU.
  • Andrew Engineering Inc. was founded in 1988 by Dr. Andrew Rawicz of SFU's School of Engineering Science. This company commercializes biomedical devices including: skin colour tester, dental colour matching device, a "receptive field" (an artificial retina for robotic applications an ultimately for a prosthetic eye), a prosthetic lens, and a soaker injection needle (a hypodermic needle with many holes in the sides instead of a single hole at the end so that drugs can be injected more effectively over a large area - important for anesthetics and the treatment of muscular dystrophy).
  • De Novo Enzyme Corporation was incorporated in 1995 by Dr. Thor Borgford and co-workers from SFU's Department of Molecular Biology and Biochemistry. The company is developing enzyme systems and applying recombinant DNA technology to the treatment of various human diseases, including HIV, cancer, viral and parasitic infections, using a re-engineered derivative of a naturally produced toxin which only becomes active by infected cells.
  • Welichem Technology Corporation was founded in 1995 by Dr. John Webster, Dr. Jianxiong Li, and Dr. Genhui Chem of SFU's Department of Biological Sciences. They are developing novel anti-cancer agents with high selectivity and novel antibiotics against drug-resistant bacteria derived from natural sources.
  • PhageScreen Inc. was founded in 1996 by Dr. Jamie Scott of SFU's Department of Molecular Biology and Biochemistry. This is a contract research organizations designed to assist in the discovery of lead peptides for diagnostics, therapeutics, vaccines, and preventatives, as well as other research applications. The lead peptides discovered can function as: receptor targeting molecules (including agonists and antagonists); peptide mimetics of proteins, carbohydrates, nucleic acids and other target molecules.
  • NeuroStream Technologies Inc. was founded in 1997 by Dr. Andy Hoffer of SFU's School of Kinesiology. The company is developing and will commercialize a suite of nerve stimulus products (nerve cuffs).
  • Chirologix Pharamceuticals Inc. was founded in 1998 by Dr. Saul Wolfe and co-workers of SFU's Department of Chemistry. The company is based on research into the mechanism of drug resistance in bacteria.

    As the above overview suggests, the diversity of health-related research and partnerships involving SFU researchers as well as the success in marketing the products of their research, are perhaps two of the greatest assets upon which to build a Health Initiative for Simon Fraser University.

     

    6.Summary of Departmental Responses

    The following twelve units wrote summary reports of their interest in the Health Initiative: Physics, Biological Sciences, Chemistry, Molecular Biology and Biochemistry, Mathematics & Statistics, Kinesiology, Gerontology, Psychology, Sociology & Anthropology, Women's Studies, Business Administration, and Continuing Studies. Faculty members from other disciplines have also expressed interest in the Health Initiative and many of them have responded with individual questionnaires. The full reports from responding Departments are presented in Appendix D.

    Interestingly, through the Departmental reports, a set of guiding principles emerges regarding the possible shape of the Health Initiative. The reports also provide a list of convincing arguments for the benefits researchers and educators at Simon Fraser University could reap from this initiative. One identified feature is the desire for a multi-disciplinary facility that would join researchers together from various disciplines at Simon Fraser University. Such inter-disciplinary collaboration, it is believed, would increase the competitive advantage of SFU researchers with funding agencies such as the CIHR which support integrated basic, applied and social science research projects. A unifying structure - in the form of a centre or institute - would coordinate research activities and simultaneously increase the profile of health-related research currently underway at Simon Fraser University. It is also believed that such a centre would provide more structure and support to individual efforts and would improve the possibility of obtaining infrastructure grants - an imperative for SFU if it wants to become a significant player in advanced health-related research. Individual efforts currently do not have sufficient departmental support or resources given competing research agendas and administrative priorities within any single Department. In addition to supporting current individual efforts, a unified structure should also develop methods to initiate new collaborative research projects and assist in providing them with necessary support and infrastructure. A centrally organized Health Initiative would also facilitate more holistic approaches to research projects and enable researchers to follow the research enterprise through from initial conception to application in the field.

    Locating research and teaching in health in the same facility could also lead to multi-faceted approaches to graduate programming; to equip the next generation of researchers with the skills necessary to tackle complex research problems more holistically and with a broader methodological capability. Additionally, the improved profile of a single entity for health-related research should attract an increased number of external partnerships which would lead to increased co-operative education opportunities and new research-based learning opportunities