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Draft Road Map 3: A Strategic Framework for Improving Aboriginal and Torres Strait Islander Health through Research submission

ID: 
19
This submission reflects the views of
Organisation Name: 
Telethon Kids Institute
Personal Details
Specific Questions
Question 1A: Is the proposed objective of Road Map 3 relevant?: 
Agree
Question 1B: Why/why not? Please provide further comments to support your response to Question 1A.: 
Research that seeks to improve the health and wellbeing outcomes of Aboriginal and Torres Strait Islander peoples by working with their priorities is critical because it responds to the ongoing calls from communities for research that works with them. Research that will make a difference is that which community regard as important and addresses the future health and wellbeing of individuals across the life course. As the NHMRC’s Indigenous Research Excellence Criteria recognise, what Indigenous communities want from research is culturally appropriate outputs that are translated into changes to policy and practice that help improve the health and wellbeing of Indigenous people. Paradigm change is a major focus of Indigenous health research. However, to be effective, this needs to be grounded in and driven by the views, priorities and values of the relevant Aboriginal and Torres Strait Islander community(s). Because of this, innovation and creativity in Indigenous health research has a major focus on the methodologies used to engage with the community, facilitate community control over the purpose and direction of the research, and the translation of the research into changes to policy and practice. While the emphasis on integrity is important, the Road Map must acknowledge a track record is not the only indicator of quality research. As is recognised by the NHMRC’s Indigenous Research Excellence Criteria, productive and effective Aboriginal and Torres Strait Islander health research requires a range of skill sets, competencies, knowledge and experience to ensure research excellence. This requires looking at the whole research team in its entirety and giving equal weight to the contribution and role community based partners bring to the research. For example, the involvement of research partners who hold a position of high regard either in terms of their position in a community based organisation (for example, ACCHS) or their seniority within the community. This level of engagement optimises the opportunity for greater investment in the research and creating conditions that will ensure a sustainability of research outcomes.
Question 2A: Are the three priority areas of Road Map 3 accurate?: 
Agree
Question 2B: Why/why not? Please provide further comments to support your response to Question 2A: 
Building the Aboriginal and Torres Strait Islander health and medical research workforce requires a greater recognition of the impediments posed by the way that the track records of those engaged in Indigenous health research is assessed. Far greater recognition needs to be given to the importance accorded by community to translation and dissemination, rather than peer reviewed publications. Furthermore, an inequity exists in the current system because existing grant assessment criteria only indirectly assesses the extra skills and outcomes required to do effective Indigenous health research. Many of these unassessed skills are critical to achieving meaningful community engagement. It is also important to acknowledge that a critical component of improving research excellence and integrity to facilitate improvements in Aboriginal health and wellbeing outcomes requires a focus on the capacity of the mainstream health and medical workforce and non-Aboriginal researchers to engage appropriately with Aboriginal people. The Road Map’s emphasis on meaningful engagement with Aboriginal and Torres Strait Islander communities, and research that is responsive to community priorities, is to be commended. Consideration could also be given to further articulating the importance of appropriate research processes and methodologies that support such engagement with communities and the mainstream service provider workforce, in particular participatory action research. It is also important that the Road Map acknowledge the significant amounts of time and funds that must be invested by researchers in developing and maintaining relationships with the Aboriginal community(s) and to build sufficient trust. This necessitates realistic budgets and timeframes that can accommodate these requirements. While we welcome the focus on the social determinants of health as a high priority research focus. It is also important that this does not support an approach where these issues are conceived in isolation from other research priorities of the Road Map, in particular specific disease research and clinical or biomedical research where these factors do play a critical role. To prevent the focus on specific disease aetiologies from detracting from outcomes the scope of interventions must incorporate the complex and multiple layered context in which people live.
Question 3A: Are there any further priority areas to add? Please provide further details: 
Research on the specific health needs and experiences of Aboriginal sub-populations for example, LGBTQI, prisoners (including juveniles), drug users and children being taken into care. Research that seeks to better understand the impact of cumulative and intergenerational trauma on the health outcomes of many Aboriginal and Torres Strait Islander peoples, families and communities.
Question 4: Is there anything missing from Road Map 3? Please provide further details: 
An emphasis on collaboration as a critical and necessary approach/process in Indigenous health research involving relatively large numbers of researchers and Indigenous community(s). The Road Map could make greater emphasis of the need for collaboration and shared decision making in Indigenous health research, and the importance of team based research where community representatives are considered a vital member of the team. In this regard, the shift in funding emphasis and quanta from team based project grants to individual based Investigator grants poses significant risks to Indigenous researchers and Indigenous health research more broadly and will undoubtedly have a negative impact on the number and extent of research collaboration in Indigenous health research. This has the potential to seriously undermine the progress that is being made by research into improving Indigenous health at a point in time where a critical mass of appropriate Indigenous health research and skilled Indigenous health researchers was beginning to develop.
Question 5: Are there any other comments you would like to make regarding Road Map 3? Please provide details: 
The Road Map emphasises the NHMRC target of 5% of total research funding allocated to Aboriginal and Torres Strait Islander health and medical research. Yet currently this target includes research that only has a 20% component dedicated to Aboriginal and Torres Strait Islander health and medical research. Unfortunately in an increasingly competitive research funding environment this low threshold means research is being funded that is not fully targeted at addressing and benefiting Aboriginal people or conceived according to community priorities. Addressing this situation is a critical factor to realising many of the priorities of Road Map 3. Similarly, the loss of the Indigenous Capacity Building Grants represents a backward step in terms of facilitating the growth of an Aboriginal and Torres Strait Islander health and medical research workforce. Research funding must be directed to work that maximises the opportunities for improving Aboriginal peoples’ health outcomes and not as some small and additional component of the research. To achieve the NHMRC target of 5% of total research funding allocated to Aboriginal and Torres Strait Islander health and medical research it will be imperative that a minimum of 5-6% of the Investigator Grant, Synergy Grant, and Ideas Grant funding is dedicated to Indigenous health research where the overwhelming majority of the research effort is focused on improving the health and wellbeing outcomes of Aboriginal and Torres Strait Islander people. The NHMRC should also give serious consideration to setting up a grant scheme that is capable of supporting the extensive collaboration between relatively large numbers of researchers and Indigenous community(s) that effective Indigenous health research requires. Unless significant changes are made to the way that the track records of those engaged in Indigenous health research are assessed, the shift in funding emphasis and quanta from team based project grants (with a major focus on the proposed project) to individual based investigator grants (with a major focus on individual track record as defined in the bio-medical paradigm) will very likely exacerbate this inequity and significantly undermine the careers of Indigenous and non-Indigenous researchers engaged in the Indigenous health research space and therefore have significant negative effects on Indigenous health research. An initial practical and important step would be to explicitly incorporate and adequately weight the scores for the Indigenous Research Excellence Criteria into the final scores for Investigator and team-based grants. Initial practical and critical steps to achieve this would be to: 1) ensure that the NHMRC’s Track Record Assessment criteria for Indigenous health research and Indigenous health researchers reflect the NHMRC’s Indigenous Research Excellence Criteria; 2) that the scores for the NHMRC’s Indigenous Research Excellence Criteria are explicitly incorporated and adequately weighted into the final scores for Investigator and team based grants; and 3) that Investigator and team based grants with an Indigenous health focus are assessed by separate Indigenous grant review panels composed of suitably experienced researchers.

Page reviewed: 31 July, 2018