CCS Health Equity Research Grants – Advancing a more accessible and inclusive cancer care system
Highlights of the program
The purpose of this funding program is to support research projects that seek to advance cancer-related health equity. Projects must be collaborative, co-created by people both affected by cancer and by structural marginalization, and designed to address the systemic, structural, and institutional factors that sustain health disparities in Canada. Applications should take a social determinants of health perspective in identifying and defining both the health equity need and the community of focus, taking care to consider the intersectionalities of such communities.
Background & Context @(Model.HeadingTag)>
Health inequalities (or disparities) are prevalent in Canada (see 1). Health inequities are defined as health inequalities that are due to avoidable (unfair or unjust) differences in health outcomes that result from systemic, structural, and institutionalized injustices based on, for example, race, gender, or sexual orientation. For First Nations, Inuit and Métis Peoples, this includes health outcomes that result from the effects of colonialism. Achieving health equity involves addressing these systemic, structural and institutionalized injustices, many of which are rooted in racism (and other ‘isms’, including sexism, ageism, ableism, heterosexism, classism, etc.), discrimination, exclusion and oppression.
The Government of Canada describes determinants of health as the broad range of personal, social, economic and environmental factors that determine individual and population health. These include:
- Income and social status
- Employment and working conditions
- Education and literacy
- Childhood experiences
- Physical environments
- Social supports and coping skills
- Healthy behaviours
- Access to health services
- Biology and genetic endowment
- Race / Racism
Social determinants of health refer to the non-medical factors that affect a person’s health. They include the social and economic factors that a person experiences that can influence health, such as income, education and employment. Experiences of racism, discrimination, exclusion and oppression are important social determinants of health for certain groups such as First Nations, Inuit and Métis Peoples, LGBTQ2S+ and Black people living in Canada. There is no one ‘accepted’ standard or exhaustive list of social determinants of health (2, 3, 4).
The cancer control continuum begins with prevention and proceeds through screening and early detection, diagnosis, treatment, psychosocial and palliative care, recovery and survivorship, and end-of-life care. As they pertain to cancer, specific health disparities (many of which are inequities), documented in both the US (see 5) and Canada (see 6, 7, 8, 9, 10), highlight that there is significant work to be done. For example: screening is lower in trans communities
- Cancer screening is lower in trans communities
- Homeless people have higher cancer rates than the general population
- First Nations, Inuit and Métis Peoples are more likely to be diagnosed with late-stage cancers
- Black women with endometrial cancer have a poorer prognosis compared with white women (US data) (11)
Through the lens of a social determinants of health framework (see above, including, for First Nations, Inuit and Métis Peoples, the First Nations holistic policy and planning model (12) or similar justified framework), this research funding program will support research projects that seek to advance cancer-related health equity by addressing modifiable factors that sustain health disparities. By enhancing health equity in specific populations, the health of Canada’s population as a whole, will be improved.
Program description @(Model.HeadingTag)>
Research teams will employ collaborative methods to co-design, co-implement and co-evaluate carefully considered approaches to address specific health inequities relevant to cancer prevention, detection, treatment, and/or survivorship. Applications must address a clear health equity need and be focused on a defined group (with consideration of sub-groups) that is mindful of intersecting determinants of health. For example, First Nations, Inuit and Métis, Black, and other minoritized or racialized groups are not homogenous, and intersect with other determinants of health including gender, sexual orientation, geographical location, education, other ethnicities, and economic status. Therefore, teams should make efforts to address, and be cognizant of, the limitations with respect to application of study results to a specific population.
Proposed projects should ideally address the systemic, structural and/or institutional practices that promote health inequity, but may also pursue provider-level (e.g. point-of-care) and individual (with caution - to avoid assigning blame or perpetuating harms but where supported by team members and other advisors as appropriate) approaches/interventions where relevant. Implications and intended outcomes, as well as dissemination and mobilization of the proposed research must be clearly articulated, with risks and alternative/mitigating approaches described.
Research teams will be comprised of relevant partners as integral members of the team from the outset:
- A Principal Investigator who meets the eligibility criteria, and who brings with them an authentic, demonstrated commitment to health equity research. Researchers that have not traditionally worked in cancer, but are focused on health equity research (e.g. social scientists, arts-based researchers, community-engaged researchers) are encouraged to apply. For applications involving First Nations, Inuit and Métis Peoples, the Principal Investigator or co-Principal Investigator must self-identify as Indigenous or engage (an) Indigenous Elder(s) or Knowledge Keeper(s) to provide evidence of meaningful and culturally safe engagement with Indigenous communities.
- A team (Principal Investigator, Co-Principal Investigator(s), Co-Applicant(s), People affected by cancer, Implementers and Decision-makers, Additional Authors and Collaborators) whose clear focus is on health equity, and who collectively bring the appropriate experience and expertise to bear towards achieving the research objectives. Health equity training may be required for some members of the research team (e.g. trainees) and should be described where needed.
- People affected by cancer are people both affected by structural marginalization and at risk of cancer, patients, survivors, and/or caregivers. These individuals must be integrally involved in co-creating all aspects of the research plan from the outset, beginning with the identification of a research issue of importance and relevance, through to dissemination of results. The characteristics and intersections of sub-populations should be carefully considered to ensure fair representation. Teams may consult the CIHR Strategy for Patient-Oriented Research – Patient Engagement Framework for guidance on meaningful engagement.
- Implementers and decision-makers include professionals (healthcare, community-based, administrators, policy makers) who may be involved in implementing the proposed approaches to enhance health equity. These individuals must be integrally involved in the project from the outset and must demonstrate their commitment to the proposed work.
- A detailed Terms of Reference (that can evolve over the project) for all members of the team will be required as part of the application process and regular check-ins by CCS staff throughout the duration of funding will confirm appropriate engagement of stakeholders.
We encourage inquiries about project scope and eligibility of team members. Please contact firstname.lastname@example.org.
CCS is committed to equity, diversity and inclusivity and First Nations, Inuit and Métis Peoples rights, and strives to promote inclusive excellence in its research programs. We welcome and encourage eligible applicants of diverse backgrounds to apply for our funding opportunities.
Authentic Team Building
Recognizing that team building in an authentic, collaborative way takes time, newly formed teams may submit applications that comprise the team building and issue identification process (for up to 1 year of funding), with a subsequent application (in a future competition*) for the (cancer-related health equity) research itself. Applications framed in this way will need to provide a well-justified rationale and detailed plan for the team building activities and requested budgets should reflect the work proposed. Members of the team will need to be identified at the application stage. *Note that teams utilizing this approach will be subject to the same evaluation criteria as other applicants in a future competition
- Funding will be available for up to $300k per grant over 3 years (max $150k/yr).
- Up to $3M may be awarded in this funding envelope.
- Budgets awarded will not exceed $300,000 over 2 or 3 years per grant. Funding will be provided to support the direct costs of research, including supplies, expenses, wages, stakeholder/partner engagement (where eligible) (including remuneration and ceremonial items for feasting and gift-giving for First Nations, Inuit and Métis Peoples), and equipment associated with the proposed work. Equipment requests of up to $10,000 can be included within the proposed budget but must be appropriately justified. For this competition, team building expenses and community-based researcher salaries (prorated to the work specific to the project) are eligible expenses. Review CCS’s Financial Administration policy for details of eligible and non-eligible expenses. Indirect costs are not eligible.
- Grants will be renewable upon submission of a full application to a subsequent competition (where offered).
Additional information @(Model.HeadingTag)>
Involvement of CCS mission staff
Interested applicants may also approach CCS mission leaders (in information, support, advocacy and/or CCPS) to explore mutually beneficial opportunities to leverage the following CCS mission priority areas:
- Tobacco/vaping initiation/cessation for at risk populations
- Cancer risk and alcohol use
- Cancer risk and physical inactivity for at risk populations
- Cancer risk and nutrition for at risk populations
- Cancer risk and sun/UVR protection for at risk populations
- First Nations, Inuit & Metis (FNIM) and cancer prevention
- Mental health and cancer
- Virtual care for underserved populations
- Cancer data in underserved populations
- Access to treatment
- Access to cancer information and cancer community supports for patients and caregivers from underserved populations (priority communities) including:
- Cancer survivors
- Advanced cancers
- Adolescents and young adults with cancer (AYA)
- Older adults
- Black and racialized patients
- Financial and geographic barriers
The peer review committee will be composed of diverse scientific reviewers and patient/survivor/caregiver reviewers who will collectively evaluate applications to this research funding program (see review criteria below for more information). The peer review committee will be comprised of relevant and appropriate individuals with the expertise necessary to evaluate the full applications submitted.
Please review the application guide prior to submitting your abstract. An abstract registration stage is mandatory to confirm project eligibility and inform the composition of the review panel. A maximum of one application per Principal Investigator is permitted in this competition (applicants may be listed as Co-PIs on multiple applications).
Abstract registration includes:
- Applicant details (Principal Investigator (PI), Co-PIs, Co-Applicants, Additional Authors, People affected by cancer, Implementers/Decision-makers, and Collaborators)
- A scientific abstract that describes the rationale, overall aims/objectives, methods, and anticipated outcomes of the project.
- A relevance statement that clearly explains the rationale for the population of focus (including sub-groups and intersectionality of determinants) and the chosen approach to advance cancer-related health equity. Meaningful, integral involvement of relevant representatives in identifying the proposed topic, study design and methods, evaluation/analysis and dissemination plans must be evident. Implications and proposed methods for achieving outcomes should be described.
- Suggested reviewers
- Research tracking information
Please consult the abstract registration guide for additional details. Abstracts will be reviewed for inclusion of relevant team members, a collaborative approach to project development, and a health equity focus (addressing a clear need in a well-defined population) using a social determinants of health framework.
Eligible abstract registrations will be invited to submit a full application. Substantive changes that significantly alter the team composition and/or overall goals and aims of the proposal relative to the Abstract Registration are not permitted. Any questions should be directed to email@example.com as soon as they are known
Please review the application guide prior to submitting your application. When preparing the full application, the following additional information is required:
- Public summary
- A detailed proposal (up to 5 pages) including overall goal and aims of the project, supporting evidence/rationale, guiding theoretical framework, study design, methods, and evaluation/analysis (including alternative approaches should initial plans fail) and how risks (including potential harms to communities) will be mitigated. Details of data ownership (e.g. OCAP® Principles for First Nations) should be described. Details of the team members including how all team members have been and will be integrated into the work proposed must be included. Briefly describe how patient/survivor/caregiver and implementer/decision-maker stakeholders were recruited to the team, including whether relationships preceded the funding opportunity announcement. Inclusion of accessibility, equity, diversity and inclusion principles in the composition of the research team must be evident. A description of the research environment where the work will take place is also required. An additional 2 pages of figures/tables/charts and associated legends are permitted.
- A description of how sex and/or gender and/or dimensions of diversity/determinants of health and their intersectionalities have been factored into the study design. While this section is called out in the application here, it should represent a fundamental component of the research proposal given the nature of this competition.
- Terms of reference for all team members.
- A description of products or programs anticipated to result from this research, including details of ownership and a clear dissemination (and implementation) plan. Include dissemination methodology/tactics to stakeholder communities.
- A detailed budget and justification providing rationale for the requested consumables, personnel (including team members, where eligible), and equipment associated with the research project. Consult SPOR guidance, CCS policy or contact CCS for additional information on remuneration eligibility.
There are three key areas being evaluated in this competition by scientific and patient/survivor/caregiver reviewers. Relevant criteria is weighted within each reviewer type rating scale. Note that for applications seeking to conduct team building activities and identify a cancer-related health equity issue only at this time, review criteria will be adapted accordingly.
Strategy & Approach:
- How has the research project been developed? Has there been evident engagement of people affected by cancer (as well as implementer/decision-maker) representatives from the outset - in identifying the inequity(ies) to be addressed, defining the methodologies to be used, and in dissemination and mobilization plans? Is co-creation evident?
- Is there use of a social determinants of health framework (or similar) to guide the proposed research? Have relevant dimensions of diversity/determinants of health and their intersectionalities been appropriately included in the development of the proposal?
- Is the research plan appropriately tailored to the community(ies) of focus, and will the research employ adequate methods to facilitate accurate interpretations of findings, with consideration for potential harms? Is data collection planned at multiple levels (beyond individual level – i.e. institutional, governmental) to ensure analysis is framed within the appropriate context and addresses systemic, structural and institutionalized injustices?
- Is ownership of data and other products resulting from this research (programs, processes, tools, etc.) explained and justified appropriately? For research involving First Nations, Inuit, and Métis Peoples, have the Principles of OCAP®, or other locally relevant data governance principles been followed?
- Is the budget and term requested appropriate for the work proposed? Is the overall approach feasible within the timeline and budget provided? Is remuneration for team members affected by cancer in accordance with CCS policy?
Relevance & Impact:
- At what level is the proposed research targeted (systemic, structural, institutional, provider-level or individual) and how likely is it to have the intended impact?
- Has the team adequately demonstrated the need for the proposed research? Have risks and alternative strategies been proposed? Is there any potential for unintended negative consequences?
- Specific communities have been appropriately engaged - project will not exacerbate inequities or cause harm and/or mitigating strategies, as well as benefits, have been described
- Knowledge dissemination and mobilization: how will results be shared with the relevant communities? Who will share the results, and if positive, what are the intended next steps (e.g. pursuit of policy change)?
Research Team & Environment:
- Do the researchers on the team possess the necessary experience and expertise to engage in health equity research? For example, has a commitment to health equity or health justice work been demonstrated through prior experience?
- Are members of the team who are affected by cancer appropriate and reflective of the community of focus for the proposed research? Has the team identified any gaps and will they work to address this? Has the team acknowledged any limitations with respect to application of study results to a specific population?
- Are implementer/decision-maker team members appropriate and have they demonstrated their commitment to ‘actioning’ relevant activities as part of this research?
- Have accessibility, equity, diversity and inclusion principles and Indigenous rights (where relevant) in team composition been included?
- Does the team, as a whole, possess the capacity to carry out the proposed project? Is any expertise missing?
- Are the Terms of Reference clear and appropriate? Have team power dynamics been thoughtfully considered and addressed?
- Is the environment in which the research will take place appropriate?
All grant recipients must submit annual progress reports and statements of account throughout the grant (and 2 years post-grant for progress reports). Principal Investigators will be emailed instructions about completing the report in our online system (EGrAMS). Submission of these reports is mandatory. Failure to submit the required reports will result in the future installments of a grant being withheld.
CCS staff will conduct regular check-ins throughout the duration of funding that will include ensuring appropriate engagement of identified stakeholders.
Successful teams will participate in annual meetings to share learnings and outcomes with each other and relevant stakeholders, including CCS staff. The meetings may be designed as in-person or virtual events, to be determined. Additional information will be shared closer to the meeting date.
How to apply @(Model.HeadingTag)>
Consult CCS eligibility and requirements. Review CCS requirements for Principal Investigators, their teams, and Host Institutions.