FormalPara Key Points

  • Indigenous and Tribal peoples share a wealth of knowledge and understanding of health and wellbeing, together with an imperative to lead Indigenous health research.

  • Improving the health and wellbeing of Indigenous peoples in Australia, Aotearoa New Zealand, and Canada is the goal driving the continued partnership between three medical research funding agencies.

  • In addition to initiatives at the international level, Australia has created many positive opportunities to accomplish the intentions of the Tripartite Agreement and to broaden the scope of international collaborations among Indigenous health researchers.

This chapter explores the benefits, challenges, and outcomes of international Indigenous and Tribal peoples’ health research collaborations and the future of these collaborations in the context of the Tripartite Agreement on International Indigenous Health between Australia, Canada, and Aotearoa New Zealand. Our goal is to provide broad brushstrokes that raise awareness of the context and potential for international Indigenous health collaborations.

Conversations with three Indigenous health research leaders inform the content of this chapter.

  • Gail Garvey AM, a proud Kamilaroi woman, a National Health and Medical Research Council (NHMRC) Research Leadership Fellow, and Professor of Indigenous Health Research in the Faculty of Medicine at the University of Queensland.

  • Sam Faulkner, a Torres Strait Islander and Aboriginal woman from the Wuthuthi and Yadhaigana peoples, Cape York Peninsula and Badu and Moa Islands, and NHMRC Director of Aboriginal and Torres Strait Islander Health Advice.

  • Dan McAullay, a Noongar man from the south-west of Western Australia, and Dean of Kurongkurl Katitjin and Director of Aboriginal Research at Edith Cowan University. He was a member of the review panel for the first International Collaborative Indigenous Health Research Partnership (ICIHRP) program.

The Tripartite Agreement

The Tripartite Agreement is a three-country international Indigenous health agreement between the Canadian Institutes of Health Research (CIHR), the Health Research Council of New Zealand (HRC NZ), and the National Health and Medical Research Council (NHRMC) Australia. Signed in 2002, the Agreement made a commitment to improving Indigenous peoples’ health by supporting research activities and actions that further understanding of Indigenous cultures, health, research experiences, and approaches to health and wellness. Central to developing and undertaking activities is respecting and harnessing the expertise, culture, and values of Aboriginal and Torres Strait Islander, Māori, First Nations, Inuit, and Métis peoples. The Agreement is renewed every five years and, at the time of writing, is in the process of being renewed for another five-year period.

The four key intentions of the current Tripartite Agreement are to:

  1. 1.

    Strengthen the capacity and capability of Indigenous health and medical researchers.

  2. 2.

    Use international research initiatives and calls for research to encourage international collaboration on health and research issues of relevance to Indigenous populations.

  3. 3.

    Agree on research priorities of mutual and shared national priority and refresh these during each five-year term.

  4. 4.

    Support actions that further our understanding of Indigenous peoples’ cultures, health or research experiences, and approaches to health and wellness.

Operationalizing the Tripartite Agreement at the International Level

While the idea of bringing together three agencies and countries with a shared goal has been positive, operationalizing the Agreement’s intentions is an ongoing challenge at the funding level, given the different ways each agency operates, its maturity bases, and its resourcing and priorities.

Initially, the Agreement sought to fund international research projects between the three countries (Australia, Canada, and Aotearoa New Zealand). The International Collaborative Indigenous Health Research Partnership (ICIHRP) program was created to support international networking and linkages between Indigenous health researchers. In the first year of the program, ICIHRP focused on the theme of “resilience,” with one successful project that investigated the role of resilience in Indigenous communities in response to sexually transmissible infections and blood-borne viruses.

In 2009, ICIHRP funded a limited number of research projects including (1) health literacy among cardiovascular disease patients, their families, and healthcare providers; (2) reducing chronic dental disease in early childhood; and (3) the impact of professional health education in mitigating disparities in chronic disease care.

The ICIHRP grant scheme proved difficult to administer, as projects could only be funded if they were fundable in all three countries. Owing to each country’s medical research funding and assessment criteria, only a handful of project applications were successful.

The second iteration of the Tripartite Agreement (2007–2011) directed funding to short-term researcher exchanges to strengthen the Indigenous health research workforce, from early researchers and beyond. Participating Indigenous researchers found these highly valuable, providing international networking opportunities, furthering interest in their field of research, and identifying potential mentors and job opportunities in the country of exchange after the program. The exchanges were a great investment in people. The short-term exchange and financial support are available to Australian NHMRC Investigator Grant recipients who identify as Aboriginal and/or Torres Strait Islander descent to facilitate and strengthen international collaborations. The NHMRC, CIHR, and HRC NZ have also held mentoring and capacity-building workshops that provide face-to-face opportunities for networking between Indigenous health researchers.

In 2019, HRC NZ collaborated with the NHMRC and CIHR to host the International Indigenous Health Research Workshop in Auckland, which brought together 56 Indigenous health researchers to share experiences, present research, and develop collaborative activities. Early-career, mid-career, and established researchers from Māori, Aboriginal and Torres Strait Islander, First Nations, Inuit, and Métis backgrounds were overwhelmingly positive about the event [1].

Australian Initiatives and Intentions

In alignment with the Tripartite Agreement, Indigenous Australian researchers are implementing opportunities to enable international collaborations and share ideas and practical knowledge, leading to a range of health research initiatives. These encapsulate the intentions and influence of the Agreement, and represent movements beyond its operational scope, speaking to new pathways for international collaborations.

Strengthening the Capacity of Indigenous Health and Medical Researchers: Indigenous Researcher Networks

Australia has looked to CIHR’s model of researcher networks to develop Indigenous capacity in health research, including Aboriginal Capacity and Developmental Research Environments (ACADRE) and the Network Environments for Aboriginal Health Research (NEAHR) [2]. The aim of building capacity has come to fruition in OCHRe (Our Collaborations in Health Research), a national network for Aboriginal and Torres Strait Islander researchers. Funded by the NHMRC and co-led by Gail Garvey AM (University of Queensland), Alex Brown (ANU), Janine Mohamed (Lowitja Institute), and Sandra Eades AO (University of Melbourne), the network is “one of the largest cohorts of Aboriginal and Torres Strait Islander researchers ever assembled in Australia” [3]. Its vision is to create a culturally resilient and all-encompassing network of Indigenous researchers spanning Australia and sovereign Indigenous Nations, and to grow the next generation of research leaders. OCHRe’s early activities include professional development sessions, dissemination of information about events, employment and scholarship opportunities, and webinars about current issues of importance, such as the recent Voice to Parliament webinar. This network will cultivate distinctive competencies at the intersection of culture, science, and health research, ultimately leading to advancements in the health and wellbeing of Indigenous communities.

Encouraging International Collaboration: Healthy Cities Implementation Science Team Grant Scheme

Recently, the NHMRC partnered with the CIHR on the Healthy Cities Implementation Science Team Grant Scheme to support population health research studies focused on evidence-based interventions across multiple urban sites in both countries [4]. This grant opportunity builds on successful collaborations between the two countries. For example, Professor Garvey and her team, in collaboration with Ms Lea Bill and her colleagues in Canada, successfully secured funding for projects focused on supporting healthy lifestyle choices to promote the mental health and wellbeing of Indigenous youth aging out of care in urban settings. The Canadian component includes extending the Australian wellbeing measure for Indigenous youth for the Canadian context (What Matters 2 Youth) [5].

Establishing National Research Priorities: Climate Change and Health

Canada identified climate change as a health priority long before it was recognized in Australia. Between 2000 and 2018, the NHMRC invested approximately $20 million in research on the health implications of environmental change but received few grant applications [6]. This prompted the development of the Healthy Environments and Lives (HEAL) National Research Network in 2021. HEAL is an NHMRC special initiative located in Australia that aims to support environmental change and health research with AUD$10 million over five years. The NHMRC describes the funding as bringing together “Aboriginal and Torres Strait Islander wisdom, public health, epidemiology, sustainable development, and innovative data science and communication methods to address environmental change and its impacts on health across all Australian states and territories” [6].

Challenges and Opportunities: Moving Forward with International Collaboration

With any international collaborations there are challenges, which vary from the complex to the day-to-day. As discussed above, a singular complexity of international collaboration lies in research funding agency resources and funding to develop and assess grant schemes across borders. Other challenges include scheduling online meetings and phone calls between countries spanning multiple time zones. On this point, however, researchers note the significant and rapid improvements in technology, especially videoconferencing software, that emerged during the COVID-19 pandemic. International collaborations work best when there is a champion driver to provide leadership through these challenges.

The intentions of the Tripartite Agreement remain strong as the three agencies move toward signing its next iteration. Ensuring that the three key funding agencies build an intent to collaborate internationally into their own funding streams is a priority. This will make it easier to fund the international components of research studies, allow for the involvement of international investigators, and allow for the transfer of international data. While Indigenous communities share histories and health outcomes, current priorities for Indigenous communities may differ between the three countries and between other nations with Indigenous populations. Therefore, finding and negotiating topics that are of common, current interest to collaborating researchers, such as is the case with cancer research, are of great significance.

Desktop research, such as systematic reviews and meta-analyses that bring together findings from multiple countries, can help establish common interests and represent another form of international collaboration. Such reviews highlight not only similar histories and outcomes but reveal which interventions might be transferable and offer opportunities to learn from interventions that have been less successful. Building on the Tripartite Agreement, the CIHR, HRC, and NHMRC came together with the Cochrane Collaboration in 2015 to prepare a series of special collections about three important topic areas for Indigenous health, namely diabetes, fetal alcohol spectrum disorders, and suicide prevention. Sam Faulkner and Professor Davina Ghersi from NHMRC Research Policy and Translation, who co-edited the collections, note that these collections can “raise awareness of the need for better and more relevant research in these areas” by highlighting the areas that may be lacking [7]. For example, most Cochrane reviews about suicide prevention focused on pharmacological interventions and didn’t evaluate non-drug interventions alone, or community interventions, or studies of Indigenous populations. Bringing reviews together in this way offers pertinent avenues for research. Another example is the Care for Child Development (CCD) program led by Dan McAullay and Natalie Strobel at Edith Cowan University. CCD aims to provide community-based interventions to enhance Indigenous mothers’ capacity to engage, communicate, and meet their child’s neurodevelopmental requirements during the 24 months following childbirth. It builds on a systematic review of the effectiveness of the CCD program across 19 countries.

Finally, while the Tripartite Agreement exists between Australia, Canada, and Aotearoa New Zealand, working and sharing with other Indigenous peoples around the world is essential, and there is a potential need for a much larger global research collaboration network. International agreements are a way to share knowledge and learn from other countries and researchers, which may have similar problems and be able to share solutions.