Measuring Nova Scotia s Results in Health Research

Collins Management Consulting & Research Ltd. Measuring Nova Scotia s Results in Health Research 2009 Update Report

Health Research 2009 Update Report Prepared on behalf of the Nova Scotia Health Research Foundation Prepared by: 106 Crichton Avenue Dartmouth, Nova Scotia, B3A 3R5 T: 902.461.9606 F: 902.461.9716 E: bcollins@collinsmgmt.ca W: www.collinsmgmt.ca November 3, 2009

Health Research: 2009 Update i EXECUTIVE SUMMARY TABLE OF CONTENTS Health Research Spending in NS...ES-1 Impacts of Health Research Funding...ES-2 1. INTRODUCTION... 1 1.1 PURPOSE OF THIS REPORT...1 1.2 OVERVIEW OF THE REPORT...1 2. HEALTH RESEARCH FUNDING AND ITS IMPACTS... 3 2.1 OVERVIEW OF HEALTH RESEARCH SPENDING IN NOVA SCOTIA...3 2.2 GROSS DOMESTIC EXPENDITURES ON R&D IN NOVA SCOTIA...4 2.3 PROVINCIAL SHARE OF CIHR FUNDING...7 Perspectives on CIHR Funding Levels...7 Changes in the Number of CIHR Grants and Awards...11 Grants and Awards by CIHR Research Themes...12 Grants and Awards by CIHR Institute...15 2.4 OTHER FEDERAL HEALTH RESEARCH FUNDING...17 2.5 OTHER MAJOR SOURCES OF HEALTH RESEARCH FUNDING...19 Canadian Cancer Society Funding to Nova Scotia...19 Pharmaceutical R& D Investment n Nova Scotia...20 2.6 THE ECONOMIC IMPACTS OF HEALTH RESEARCH SPENDING IN NOVA SCOTIA...22 Method and Assumptions...22 Health Research Funding Data...23 Estimated Economic Impacts...25 Impacts of Health Research Spending in the Context of the Nova Scotia Economy...27 2.7 LEVERAGING NSHRF RESEARCH FUNDING IN NOVA SCOTIA...27 2.8 OTHER BENEFITS OF HEALTH RESEARCH SPENDING...29 3. MEASURING THE QUALITY OF NOVA SCOTIA S HEALTH RESEARCH... 30 3.1 AVERAGE RELATIVE IMPACT FACTOR...30 3.2 INTERPROVINCIAL COLLABORATION...32 4. PRODUCTIVITY IN HEALTH RESEARCH... 34 4.1 GROWTH IN HEALTH RESEARCH PUBLICATIONS...34 4.2 TRENDS IN HEALTH RESEARCH SPECIALIZATION...36 5. SUMMARY... 39 Collins Management Consulting & Research Ltd

Health Research: 2009 Update ii TABLE OF FIGURES Figure 1: Inflation Impacts on NSHRF Annual Grant, 2000-01 to 2008-09, $M... 3 Figure 2: Annual Changes in Gross Domestic Spending on Research & Development in the Natural Sciences in NS, 1995 2006, $M... 5 Figure 3: Percentage Distribution of GERD (Natural Sciences) by Funding Sector, Canada and Nova Scotia, 1995-2006 Average... 6 Figure 4: CIHR Expenditures by Province, 2000-01 to 2008-09, $M... 7 Figure 5: Growth in CIHR Funding (Grants and Awards), Selected Provinces and Canada, 2000=100... 9 Figure 6: Provincial Funding Indices for CIHR Expenditures, 2000-01 to 2008-09... 10 Figure 7: Growth in the Number of CIHR Grants and Awards, All Provinces, 2000=100... 12 Figure 8: Shares of Total CIHR National Funding Awarded in Nova Scotia by CIHR Research Theme, 2000-01 to 2008-09, Projects and $M... 13 Table 1: Average Project Funding by CIHR Research Themes, NS & Canada, 2000-01 to 2008-09, $.. 14 Figure 9: Nova Scotia Funding Index for CIHR Research Themes, 2000-01 to 2008-09... 15 Figure 10: Average Funding Index for CIHR Institutes for NS, 2000-01 to 2008-09... 16 Figure 11: Tri-council Funding Indices for Nova Scotia, 2000-01 to 2008-09... 17 Table 2: Nova Scotia Share of Tri-Council Project Funding, 2000-01 to 2008-09... 18 Figure 12: Canadian Cancer Society Funding Indices for Selected Provinces, 2000-01 to 2008-09... 20 Figure 13: Pharmaceutical Industry R&D Funding Indices for Selected Provinces, 1995 to 2006... 21 Table 3: Health Research Funding by Funding Organization, 2001-02 to 2008-09... 24 Table 4: NSHRF Funding by Program, 2001-02 to 2008-09... 25 Table 5: Economic Impacts on Nova Scotia of Health Research Spending, 2001-02 to 2008-09... 26 Table 6: NSHRF Matching Program Leveraging Results, 2000-01 to 2008-09... 28 Figure 14: Comparison of the Quality of Health Research Publications, 1996-2007... 31 Figure 15: Interprovincial Collaboration by Province, Average %, 1994-2007... 32 Figure 16: Growth in Medical Sciences Research Articles by NS Health Researchers, 1985-2007... 34 Figure 17: Health Research Articles Published Per 1,000 Population, 1996-2007... 35 Figure 18: Published Health Research Articles by Field, Nova Scotia, 1996-2007... 36 Figure 19: Health Research Specialization Index by Province, 1999-2004... 37 Collins Management Consulting & Research Ltd

Health Research: 2009 Update ES-1 EXECUTIVE SUMMARY This report supports the Nova Scotia Health Research Foundation (NSHRF) in one of its three key strategic directions: demonstrating and communicating the impacts of health research. In 2007, NSHRF identified the following four major benefits of investing in health research in Nova Scotia: Healthier Nova Scotians - health research leads to a better understanding of disease and its treatments, and this information helps improve the overall health of Nova Scotians; Better, more cost-effective and more efficient health care; A stronger economy offering more jobs and more opportunities; A destination for world-class talent. The report presents the findings of an analysis of health research spending over the eight fiscal years from 2001-02 to 2008-09 using a variety of published data sources and related indicators of health research funding success. HEALTH RESEARCH SPENDING IN NS The federal government is the largest financial contributor to gross domestic expenditures on research and development (GERD) for R&D in Nova Scotia. The Canadian Institutes for Health Research (CIHR) is the dominant federal funding agency for health research. Over the eight years, CIHR funding of $134.5 million in Nova Scotia represented 45.8 per cent of the province s total health research funding. Federal spending as a percentage of total GERD in Nova Scotia has been declining as has the pharmaceutical and other business investment in R&D. During this period, the value of CIHR grants and awards to Nova Scotia researchers grew from $7.7 million to $19.7 million, a 156 per cent increase. In 2008-09, the province experienced a 4.5 per cent decline in CIHR funding of close to $1 million. Nova Scotia s share of CIHR funding over the past decade peaked at 2.59 per cent in 2002-03 and declined to 2.21 per cent in 2008-09. Population health (a CIHR research theme) is an area of strength for Nova Scotia, along with CIHR Institute areas of: gender and health; aboriginal peoples health; aging; neurosciences, mental health & addiction; and population & public health. NSHRF ranked second among Nova Scotia contributors to health research funding, contributing $34.7 million (11.8 per cent of total funding) during the period. Inflation has decreased the impact of NSHRF funding: NSHRF had $1.2 million less funds available in 2008-09 to support Nova Scotia health research than if inflation-adjusted funding were available. Inflation has eroded funding by an annual average of 2.6 per cent or more than 20 per cent in total since 2000, the year NSHRF was established. Business spending on R&D in the natural sciences (which includes health) accounts for a smaller share of total funding in Nova Scotia (1.5 percent) than nationally (2.0 per cent in 2006).

Health Research: 2009 Update ES-2 IMPACTS OF HEALTH RESEARCH FUNDING This report focuses on the early impacts of health research funding, including the ability of health researchers to provide new information. The study estimates the economic impacts of health research spending over the past eight years. CREATION OF NEW HEALTH INFORMATION The analysis found that Nova Scotia health researchers are producing high quality, scientific publications. NS health researchers were the top publishers of medical research papers per capita in Canada from 2004-07 (up from second place in 2007) and NS health researchers are publishing above the national average. ECONOMIC IMPACTS Over the eight years, total economic impacts from health research spending are estimated at: o $243.8 million in household income, including direct household income of $157.3 million ($30.5 million annually); o $321.2 million in Gross Domestic Product ($40.2 million annually); o $27.3 million in provincial government revenues, consisting of taxes on personal incomes and expenditures, and net sales tax revenue on capital goods acquisitions ($3.4 million annually); and o 7,370 person-years of employment (920 annually). LEVERAGING OF NSHRF FUNDING Over the past eight fiscal years, $5.2 million from NSHRF funding programs were able to attract $38.4 million. This amounts to $7.40 in external funding for each NSHRF dollar. OTHER BENEFITS OF HEALTH RESEARCH Intangible benefits of provincial health research funding in Nova Scotia are considerably more difficult to identify and quantify empirically than are the economic benefits related to health research funding itself. These benefits include: jump-starts to careers in health research by providing funding to researchers at an early stage in their careers when they may not have the experience and funding track-record to access national funding programs; opportunities for collaboration with colleagues on a global scale; funds for research that is of particular and unique interest to Nova Scotians; support for important health research infrastructure and state-of-the-art health care and services in Nova Scotia; and attraction of health care professionals and clinicians to the province that subsequently use research to inform their health care practice. The ultimate goal of this funding is to improve the health of Nova Scotians through health research.

Health Research: 2009 Update 1 1. INTRODUCTION 1.1 PURPOSE OF THIS REPORT This report supports the Nova Scotia Health Research Foundation (NSHRF) in one of its three key strategic directions: demonstrating and communicating the impacts of health research. In 2007, NSHRF identified the following four major benefits of investing in health research in Nova Scotia: Healthier Nova Scotians - health research leads to a better understanding of disease and its treatments, and this information helps improve the overall health of Nova Scotians; Better, more cost-effective and more efficient health care; A stronger economy offering more jobs and more opportunities; A destination for world-class talent. In 2007, NSHRF commissioned to undertake an economic analysis of the impacts and performance of Nova Scotia in health research. This current report updates the 2007 study, using a variety of published data sources and related indicators of health research funding success to add two years of data to the previous analysis. These data sources include: Statistics Canada; federal research organizations and granting councils; foundations that fund health research in Canada; and NSHRF. Updated information from Science-Metrix and Observatoire des sciences et des technologies (OST) are included in the analysis. Federal government public funding for health research in Canada is awarded by the federal tricouncil funding agencies: the Canadian Institutes of Health Research (CIHR), the Natural Sciences and Engineering Research Council (NSERC) and the Social Sciences and Humanities Research Council (SSHRC). The NSHRF is the source of health research funding in Nova Scotia. Private for-profit sources include pharmaceutical companies, biotechnology firms, and medical device manufacturers. In addition, private not-for-profit organizations provide health research funding. These Canadian organizations include health research foundations and institutes as well as charities focused on specific illnesses or diseases. Foreign sources comprise another category of health research funding. 1.2 OVERVIEW OF THE REPORT Following this initial chapter, the report examines several dimensions of Nova Scotia s performance in health research using the same report structure as the 2007 report. Chapter 2, Health Research Funding and Its Impacts, has five sections. First, the analysis presents an overview of R&D spending in Nova Scotia, and indicates the contributions from NSHRF. Second, the analysis examines Nova Scotia s share of national health research funding, based mainly on information from the Canadian Institutes of Health Research (CIHR). Third, the chapter provides the results of an

Health Research: 2009 Update 2 economic impact analysis of health research spending in Nova Scotia by federal and provincial research organizations and health foundations. The fourth section of the chapter analyzes the leveraging of health research funding by NSHRF over this same time period. Finally, other benefits of health spending are addressed. Chapter 3, Measuring The Quality of Nova Scotia s Health Research, presents an analysis based on grant success rates for health researchers in Nova Scotia. The analysis examines the performance of Nova Scotia within a national and international context, and shows how the province s health research quality is improving over time. Chapter 4, Productivity in Health Research, considers additional measures related to the performance of health research in Nova Scotia. These measures include changes in the growth of health research publications and trends in health research specialization. Chapter 5, Summary, reviews the findings in this report and draws a series of conclusions related to the performance of health research in Nova Scotia. It should be noted that revisions to the health research data used in the report are ongoing. In particular, aggregate data on research projects funded by the tri-councils and CIHR in particular are adjusted as final project counts, related costs and funding levels are available. This means that the historical data used in this report may vary to some degree from the data that were available at the time of the 2007 report. As the description of the data used in the economic impact analysis indicates, both additional and more accurate data have become available in the past two years, improving the overall value of the analysis presented in this report. Detailed descriptions of the methodologies and other aspects of the analysis, including a description of data sources, are provided in our 2007 report.

Health Research: 2009 Update 3 2. HEALTH RESEARCH FUNDING AND ITS IMPACTS 2.1 OVERVIEW OF HEALTH RESEARCH SPENDING IN NOVA SCOTIA This section provides some context for spending on health research in Nova Scotia, beginning with an overview of NSHRF spending since its inception in 2000-01. Figure 1 illustrates the impact of inflation on funding levels for NSHRF s annual grant from the Nova Scotia government. FIGURE 1: INFLATION IMPACTS ON NSHRF ANNUAL GRANT, 2000-01 TO 2008-09, $M Source: Calculated by Collins Management Consulting from NSHRF, Statistics Canada: Cansim Table 326-0021 The chart illustrates two important concepts: the impact of inflation on NSHRF funding (bottom two lines) and the combined impacts of annual variability and inflation on the spending power of NSHRF s annual grant (top two lines). The lines in Figure 1 should be interpreted as follows: Funding (Current $): the blue line indicates the actual level of NSHRF s annual grant without any adjustment for inflation; Funding (Constant $): the red line shows the inflation-generated erosion in purchasing power of NSHRF s actual grant over the time periods shown. In 2008-09, the inflation adjustment meant that the $5.4 million in funding was only able to purchase $4.5 million due to the impacts of inflation;

Health Research: 2009 Update 4 Consistent Funding With Inflation Adjustment: the green line shows the funding that would be available to NSHRF if its annual grant had remained at $5.0 million annually and an inflation adjustment were made each year; and Actual Funding with Inflation Adjustment: the purple line indicates the funding that would result if the actual funds (blue line) that NSHRF received were adjusted each year to take account of inflation and maintain the spending power of the funds provided. HIGHLIGHTS OF THE ANALYSIS After four years of funding below the initial annual level of $5 million, NSHRF received funding of $6.41 million in 2007-08 and $5.42 million in 2008-09. These adjustments bring the average funding for NSHRF over the past nine years very close to $5 million per year. Although the annual funding for NSHRF has returned close to its initial levels of $5 million, this situation ignores the influence of inflation that has eroded funding levels by an annual average of 2.6 per cent or more than 20 per cent in total over the time period shown in Figure 1. As a result of inflation, there were $1.2 million less funds available in 2008-09 for health research in the province than if consistent levels of funding matched to inflation were available to NSHRF, as shown by the gap between the blue and purple lines in the figure. The gap between current funding and inflation-adjusted funding levels has decreased from 2007, when the gap was estimated at $1.6 million. 2.2 GROSS DOMESTIC EXPENDITURES ON R&D IN NOVA SCOTIA Figure 2 on the following page presents annual in gross domestic expenditures on research and development (GERD) on the natural sciences in Nova Scotia, including engineering, mathematical, life and physical sciences. The figure is meant to be illustrative of R&D spending in the province in terms of trends and sources of funding between 1995-2006. Health research spending falls primarily within natural sciences data although some health research spending is included in the estimates of social sciences GERD. HIGHLIGHTS OF THE ANALYSIS Total GERD in the natural sciences in Nova Scotia over the 12 years totalled approximately $3.84 billion. In the three years since 2003, GERD funding for natural sciences has increased at an annual average of 7.2 per cent, compared to 4.8 per cent annually from 1995 to 2003, inclusive. The federal government is the largest financial contributor to R&D in the province. Federal spending of $1.44 billion in 2006 was 33.3 per cent of GERD spending for that year, and amounted to 37.5 per cent of total funding over the time frame shown in the chart.

Health Research: 2009 Update 5 However, federal spending as a percentage of total GERD funding for the natural sciences in Nova Scotia has been declining. The 2006 federal spending levels in 2006 were the lowest proportionate levels during the entire 1995-2006 period. The higher education sector was the second highest direct contributor to GERD over the 12 years, spending a total of $971 million, or 25.3 per cent of all spending. Funding arrangements between federal and provincial governments to fund this sector make the attribution of funding a complex issue since much of the operational funding to the higher education sector is provided by these governments. Business enterprise R&D spending amounted to $857 million over the 12 years, to the extent that business GERD in Nova Scotia equalled that of higher education spending in 2006. The influence of the Atlantic Innovation Fund (AIF) is likely an important contributor to this change. FIGURE 2: ANNUAL CHANGES IN GROSS DOMESTIC SPENDING ON RESEARCH & DEVELOPMENT IN THE NATURAL SCIENCES IN NS, 1995 2006, $M Source: Statistics Canada, GERD Statistics, Catalogue 88-221-x2008002 Figure 3 on the following page compares the relative share of GERD spending in natural sciences by the same six sectors for Canada and Nova Scotia. The figure shows the proportion of total spending by each sector over the 1995-2006 time frame. Recent changes announced in 2009 in funding levels for the federal tri-councils is not included in the charts presented here due to timeliness of the data available from Statistics Canada.

Health Research: 2009 Update 6 HIGHLIGHTS OF THE ANALYSIS Nova Scotia has a higher proportion of federal government and higher education spending on R&D in the natural sciences than in the country as a whole. Federal spending accounted for 37.5 per cent of Nova Scotia GERD compared to 18.0 per cent of GERD spending at the national level. Business spending on R&D in the natural sciences accounts for a smaller share of total funding in Nova Scotia than nationally. The 27.1 per cent share of business R&D spending on all natural sciences R&D in Nova Scotia in 2006 was about half the 53.4 per cent share that business contributes to GERD at the national level. Nova Scotia receives a significantly smaller proportion of GERD spending in natural sciences by foreign organizations (7.2 per cent) compared to national GERD spending (12.2 per cent). Nova Scotia GERD spending in the natural sciences amounts to about 1.5 per cent of national GERD spending in the natural sciences, well below the province s share of Canada s population (2.9 per cent in 2006). FIGURE 3: PERCENTAGE DISTRIBUTION OF GERD (NATURAL SCIENCES) BY FUNDING SECTOR, CANADA AND NOVA SCOTIA, 1995-2006 AVERAGE Source: Statistics Canada, GERD Statistics, Catalogue 88-221-x2008002

Health Research: 2009 Update 7 2.3 PROVINCIAL SHARE OF CIHR FUNDING This section presents perspectives on health research funded by federal and provincial governments and their agencies in Canada. The major emphasis is on CIHR, the largest source of health research funding in Canada. The analysis of funding levels begins by examining volumes of funding activity and concludes with a review of funding by specific CIHR research themes and institutes. These results include information on other public sources of health research funding, including NSERC and SSHRC. Nova Scotia universities, research institutions, and private corporations also receive financial assistance from the Atlantic Innovation Fund (AIF), launched by the federal government in 2001 and administered by the Atlantic Canada Opportunities Agency (ACOA). PERSPECTIVES ON CIHR FUNDING LEVELS Figure 4 below shows the strong level of growth in CIHR funding by province over the past nine fiscal years, with a modest reversal of this trend in 2008-09. 1 Data in this section have been obtained from the CIHR online research database. FIGURE 4: CIHR EXPENDITURES BY PROVINCE, 2000-01 TO 2008-09, $M Source: Calculated by Collins Management Consulting from CIHR website data: http://www.cihr.gc.ca/ 1 Results exclude expenditures for grants and awards outside Canada and for unknown or N/A locations.

Health Research: 2009 Update 8 HIGHLIGHTS OF THE ANALYSIS During the nine fiscal years beginning in 2000-01, the total value of research grants and awards by CIHR grew from $357.1 million to $890.9 million in 2008-09, a 150 per cent increase. As the figure indicates, CIHR funding declined by 1.6 per cent ($14.1 million) between 2007-08 and 2008-09. The share of CIHR funding awarded to Ontario and Quebec amounted to 71.2 per cent of all CIHR funding in 2008-09, up marginally from its 11-year average of 69.8 per cent of funding. The two provinces received a total of $684.3 million in 2008-09. In the two years following 2000-01, overall growth in total CIHR funding averaged 26.5 per cent per year. In the past three years, this average national rate has declined to 6.7 per cent per year. Over the same two time periods, the Nova Scotia rate of growth averaged 39.6 per cent per year, declining to an average annual rate of 5.1 per cent. Over the past nine years, the value of CIHR grants and awards to Nova Scotia researchers grew from $7.7 million to $19.7 million, a 156 per cent increase. However, in 2008-09, the province experienced a 4.5 per cent decline in CIHR funding of close to $1 million from funding of $19.7 million. Nova Scotia s share of CIHR funding peaked at 2.59 per cent in 2002-03 and retreated to 2.21 per cent in 2008-09, below the nine-year average of 2.36 per cent. Nova Scotia has maintained its national ranking of sixth place among all provinces, based on CIHR expenditures. Figure 5 on the following page compares the growth rates of the value of CIHR grants and awards among selected provinces from 2000-01 to 2008-09, inclusive. The figure indicates an index of funding growth for each jurisdiction, with funding in 2000-01 serving as the base year (with an index of 100). HIGHLIGHTS OF THE ANALYSIS The funding growth index the percentage change since 2000-01 for all four provinces and nationally has flattened in the past several years, and all five indices shown in the table experienced a decline between 2007-08 and 2008-09. Saskatchewan led the four provinces and the country overall in terms of its growth in CIHR funding from 2000-01 to 2008-09, with an index 263.9, representing growth of 163.9 per cent. This growth is somewhat misleading, since Saskatchewan began the period in seventh position among all provinces in 2000-01 in CIHR funding, with a funding level of $3.6 million. In 2008-09 Saskatchewan received $9.6 million, less than half Nova Scotia s CIHR funding of $19.7 million. Nova Scotia s 2008-09 index of 255.8, based on funding of $19.7 million, resulted in second place among the four provinces shown in Figure 5, and exceeded the national index for all provinces of 249.5.

Health Research: 2009 Update 9 FIGURE 5: GROWTH IN CIHR FUNDING (GRANTS AND AWARDS), SELECTED PROVINCES AND CANADA, 2000=100 Source: Calculated by Collins Management Consulting from CIHR website data: http://www.cihr.gc.ca The results presented in Figures 4 and 5 do not consider the population of a province, the notion being that comparing each province s share of CIHR health research funding to its population provides another measure of funding distribution. The report Evaluating British Columbia s Performance in Health Research: Report 1999-2006 applied the concept of a funding index to measure the correlation between CIHR funding levels and population. The CIHR index is defined as the ratio of a province s actual share of CIHR expenditures 2 in a given year to the province s share of the national population in that year. A funding index of 1.0 means a province is attracting CIHR funding to a degree that reflects its share of the national population; a funding index of 1.0 also represents the national average. Figure 6 on the following page presents the CIHR funding index for all provinces over the past nine fiscal years. The indices suggest two comparisons: changes in the index over time, and inter-province comparisons. The results presented in the table clearly show the clustering of provinces based on their funding indices, with the larger provinces at the top of the figure, and smaller provinces below the 1.0 level. 2 Excluding expenditures in Canada and outside Canada.

Health Research: 2009 Update 10 FIGURE 6: PROVINCIAL FUNDING INDICES FOR CIHR EXPENDITURES, 2000-01 TO 2008-09 Source: Calculated by Collins Management Consulting from Statistics Canada & CIHR website: http://www.cihr.gc.ca HIGHLIGHTS OF THE ANALYSIS Ontario and Quebec have a funding index that have consistently been greater than 1.0 over the past nine years, indicating that each province has attracted CIHR funding in excess of its share of the Canadian population. Alberta s funding index has declined over the time shown in the figure as a result of strong provincial population growth of close to 25 per cent over the nine years. The funding indices for Nova Scotia and Manitoba were almost identical during the first six years shown in the table, averaging 0.82 and 0.81, respectively. Since 2005-06, Manitoba s index has declined more sharply than the Nova Scotia index. The Manitoba result is driven by population changes: CIHR funding for Manitoba has not kept pace with the increased growth in the province s population. Two points should be noted about the Nova Scotia funding index. First, the province has been experiencing a slow decline in population. If funding were constant, this decline in population would result in an increased index. Second, the value of CIHR grants and awards to Nova Scotia actually declined between 2007-08 and 2008-09, from $20.6 million to $19.7 million, and this change has been the most influential factor in the decline of the funding index for the province.

Health Research: 2009 Update 11 Most importantly, Nova Scotia s index of 0.79 in 2008-09 represents a capacity gap of 21 points between actual results and parity with the national index of 1.0. If CIHR funds were provided to match Nova Scotia s share of Canada s population, the province would have received approximately $25.0 million in 2008-09, an increase of $5.4 million above actual CIHR funding of $19.7 million for the province in the past year. Finally, as noted in our 2007 report, it is reasonable to argue that health research conducted in Nova Scotia benefits New Brunswick and Prince Edward Island since the health research capacity inherent in the medical school at Dalhousie University and other health research institutions and professions in Nova Scotia support the public health care system in these two provinces. The latest funding index is 0.09 for New Brunswick and 0.21 for Prince Edward Island, reflecting, in part, the lower health research capacity levels in these two provinces. Comparing 2008-09 CIHR funding of $22.2 million for all three Maritime Provinces to its population share of 5.42 per cent results in a 0.46 funding index. Following the above approach, raising the funding index for the Maritime Provinces would result in a total CIHR allocation of $48.3 million in 2008-09 versus the $22.2 million actually awarded, a gap of $26.1 million. Following the above reasoning, Nova Scotia would receive a significant share of this amount as a reflection of its health research infrastructure. CHANGES IN THE NUMBER OF CIHR GRANTS AND AWARDS Figure 7 on the following page provides another perspective on CIHR funding, showing the indexed annual growth in the number of grants and awards (2000=100) between 2000-01 and 2008-09. This section examines the province s performance over the same nine-year period used in the expenditure analysis above. HIGHLIGHTS OF THE ANALYSIS Nova Scotia s rate of growth in CIHR grants and awards lags behind the national average in the number of grants and awards: the province ranked seventh among all provinces in terms of its growth rate. The number of CIHR grants and awards to Nova Scotia increased from 163 to 266 from 2000-01 to 2008-09, a 63.2 per cent increase, while the national growth rate over the same period was 76.9 per cent. The good news is that the province s growth in the number of CIHR grants and awards has increased significantly in the past two years. The growth index remained at 130 on average over most of the time frame in the chart, but has experienced strong growth in the past two fiscal years, going from 138.7 (2006-07) to 149.7 (2007-08) to a level of 163.2 (2008-09). The growth in the average value of CIHR grants and awards has outpaced the national growth rate. Nova Scotia projects increased from $47,208 to $73,995 on average between 2000-01 and 2008-09, a 56.7 per cent increase, while nationally, the average CIHR grant and award increased from $64,990 to $91,682, a 41.1 per cent increase. Most importantly, however, CIHR-funded projects in Nova Scotia remain significantly smaller on average than those funded nationally on average.

Health Research: 2009 Update 12 Although the number of grants and awards to Nova Scotia has increased in the past two years, the average value of these grants and awards has decreased significantly, from $75,809 (2006-07) to $81,773 (2007-08) to an average of $73,995 (2008-09). The average decline in project size in the past two years was 12 per cent, while the number of projects grew by 17.7 per cent over the same time frame. This result reflects the loss of close to $1 million in CIHR funding in the past year. FIGURE 7: GROWTH IN THE NUMBER OF CIHR GRANTS AND AWARDS, ALL PROVINCES, 2000=100 Source: Calculated by Collins Management Consulting from CIHR website data: http://www.cihr.gc.ca/ GRANTS AND AWARDS BY CIHR RESEARCH THEMES CIHR categorizes its grants and awards according to the following four research themes: biomedical research; clinical research; health services research; and population health research. Figure 8 on the following page indicates the distribution of CIHR grants and awards to Nova Scotia relative to Canada over this time for each theme. The figure compares the percentage share of the total number of grants and percentage share of the dollar value of awards, and the expenditure patterns for each research theme.

Health Research: 2009 Update 13 HIGHLIGHTS OF THE ANALYSIS Nova Scotia research projects in population health accounted for 4.3 per cent of the national funding total and 3.8 per cent of all national projects. These proportions are higher than the national share of the three other research themes. The proportion of projects in health systems/services marginally exceeds the province s share of the Canadian population (about 2.8 per cent). This theme accounted for 2.9 per cent of all funding and projects awarded to Nova Scotia researchers. Within Nova Scotia, projects in biomedical research are the most common theme investigated by researchers. If only projects with a specified theme are included in the analysis, the results indicate that 63.6 per cent of all projects and 66.9 per cent of all funding have been in this theme area over the last nine years. It should be noted that CIHR has not assigned a theme for about one in five projects. FIGURE 8: SHARES OF TOTAL CIHR NATIONAL FUNDING AWARDED IN NOVA SCOTIA BY CIHR RESEARCH THEME, 2000-01 TO 2008-09, PROJECTS AND $M Source: Calculated by Collins Management Consulting from CIHR website data: http://www.cihr.gc.ca/ Table 1 on the following page compares the average funding amounts per project over the same time period for Nova Scotia and Canada for each of the four themes, as well as the gap between Nova Scotia and Canada in average project size. As noted above, a significant proportion of projects do not have an assigned theme.

Health Research: 2009 Update 14 HIGHLIGHTS OF THE ANALYSIS The average size of projects at the provincial level exceeds the size of projects undertaken by Canadian researchers in half of the themes shown in Table 1, which represents an improvement from the findings of the 2007 report. The average size of projects in the population health theme exceeds the national average by $10,522. The Nova Scotia average is influenced by the small number of projects relative to the level of CIHR funding awarded for this theme: $19.4 million for 214 projects over the nine years. The average project size increased significantly for Population Health projects in Nova Scotia from 2006-07 to 2008-09, from $93,286 to $111,340. Over the same period, the average project size for projects funded under the Biomedical theme decreased by $9,200 on average, from $84,720 to 75,530. TABLE 1: AVERAGE PROJECT FUNDING BY CIHR RESEARCH THEMES, NS & CANADA, 2000-01 TO 2008-09, $ THEME NOVA SCOTIA ($) CANADA ($) NS GAP ($) Biomedical 72,597 83,181-10,585 Clinical 82,865 96,217-13,352 Health Systems/Services 72,117 70,971 1,146 Social/Cultural/Environmental/Population Health 90,767 80,245 10,522 All Themes 76,314 83,614-7,300 Source: Calculated by Collins Management Consulting from CIHR website data: http://www.cihr.gc.ca/ Figure 9 on the following page compares the funding index of three of the CIHR research themes over the nine fiscal years beginning in 2000-01. The index compares Nova Scotia s share of national funding and divides this proportion by the province s share of Canada s population. HIGHLIGHTS OF THE ANALYSIS The funding index of the CIHR research themes varies a great deal for two of the research themes. This variability likely reflects modest levels of research capacity in these areas in Nova Scotia, given the small number of CIHR funded projects. The index for the population health theme has been greater than 1.0 for eight of the nine years, indicating that Nova Scotia health researchers have been successful in attracting funding for this research area at levels that exceed the amount that would be available if funding were allocated on a per capita basis. Population health is an area of strength for the province. The themes for clinical and health services research showed strong growth from 2004-05 to 2007-08 but have subsequently declined marginally below 1.0 in the past year.

Health Research: 2009 Update 15 The index for the biomedical research theme has remained relatively flat, although the index has been trending down for the past two years. 3 This finding indicates that considerable opportunity exists for additional funding for this theme in Nova Scotia. FIGURE 9: NOVA SCOTIA FUNDING INDEX FOR CIHR RESEARCH THEMES, 2000-01 TO 2008-09 Source: Calculated by Collins Management Consulting from CIHR website data: http://www.cihr.gc.ca/ GRANTS AND AWARDS BY CIHR INSTITUTE CIHR categorizes its grants and awards according to their alignment with its 13 scientific research institutes. CIHR applicants identify the institutes as part of the application process. Similarly to our 2007 report, the findings in Figure 10 are a simplified presentation of the analysis based on funding indices that are averages of the funding for each of the 13 research institutes over the 2000-01 to 2008-09 timeframe. HIGHLIGHTS OF THE ANALYSIS Nova Scotia researchers have attracted research funding above 1.0 in six CIHR institutes, and another three institutes have funding indices close to 1.0. 3 NSERC, as well as SSHRC to a more limited degree, also fund biomedical research. The results shown in Figure 9 include CIHR funding only, and may under-represent the actual level of biomedical research activity in the province.

Health Research: 2009 Update 16 The funding index for the Institute of Gender and Health was the highest among the 13 institutes, although health research in Nova Scotia within this institute is modest: CIHR funded a total of 38 projects valued at approximately $5.8 million over nine years. Nova Scotia accounted for 3.4 per cent of all projects and 6.4 per cent of national funding. The index for the Institute of Aboriginal Peoples Health ranked second compared to third in the 2007 analysis. The institute s index of 1.41 has been buoyed by indices of 1.94 in 2007-08 and 1.71 in 2008-09. Twenty projects were funded, with a total value of $3.7 million, the lowest volume of activity of any institute. This funding amounted to 2.9 per cent of all projects and 4.7 per cent of national funding for this institute. The Institute of Neurosciences, Mental Health and Addiction attracted the greatest volume of funding to Nova Scotia over the nine years: 379 projects were funded with a total value of $27.1 million, nearly one quarter of the total CIHR funding awarded to the province. Nova Scotia s share of this national institute funding amounted to 3.8 per cent of all projects and 3.4 per cent of all funding. The Institute for Cancer Research in Nova Scotia had an average index of 0.38. While researchers were less successful in attracting funding in cancer research in comparison to other institutes, the funding index for cancer research has been steadily increasing: the average index for the past three years is 0.59. FIGURE 10: AVERAGE FUNDING INDEX FOR CIHR INSTITUTES FOR NS, 2000-01 TO 2008-09 Source: Calculated by Collins Management Consulting from CIHR website data: http://www.cihr.gc.ca/

Health Research: 2009 Update 17 2.4 OTHER FEDERAL HEALTH RESEARCH FUNDING CIHR is the dominant funding agency in health research, but other federal and provincial government agencies provide funding for health research. This section documents the financial contribution by the federal Tri-Councils: CIHR, NSERC and SSHRC. Figure 11 indicates the change in the previously defined funding index by the tri-councils. The results are based on the level of funding allocated to health research by the tri-councils over the nine fiscal years shown in the figure. It is worth noting that the data shown in the figure and tables do not reflect policy changes in the tri-councils made in 2009. For example, SSHRC has determined that it will no longer fund health research in the future; CIHR will assume primarily responsibility for supporting health research. FIGURE 11: TRI-COUNCIL FUNDING INDICES FOR NOVA SCOTIA, 2000-01 TO 2008-09 Source: Calculated by Collins Management Consulting from CIHR, NSERC and SSHRC online databases HIGHLIGHTS OF THE ANALYSIS The results in Figure 11 indicate that funding levels for NSERC and CIHR are relatively stable. The figure indicates a great deal of variability in the funding indices for health research funded by SSHRC, particularly in the past two years. The significant increase in the SSHRC index is a result of a substantial increase in health research funding by SSHRC at the national level to $36.4 million in 2007-08, followed by a decline to $12.9 million the following year. The nine-year average level of funding

Health Research: 2009 Update 18 at the national level is $12.7 million. Over the same two years, SSHRC funding for health research in Nova Scotia rose above its nine-year average of $0.37 million, from $0.629 million to $0.999 million in 2008-09. The funding index for NSERC has had a downward slope since 2005-06, indicating that health researchers in the province are not attracting a consistent level of funding from the council. NSERC funding for health research is generally incidental to the council s primary focus: NSERC funding for health research amounted to $2.7 million over the nine years shown in Figure 11. Table 2 indicates the tri-council funding levels to Nova Scotia over the 2000-01 to 2008-09 timeframe. TABLE 2: NOVA SCOTIA SHARE OF TRI-COUNCIL PROJECT FUNDING, 2000-01 TO 2008-09 YEAR CIHR NSERC SSHRC NS $000 % OF CANADA $ NS $000 % OF CANADA $ NS $000 % OF CANADA $ 2000-01 7,695 2.16 90 1.21 237 2.75 2001-02 12,121 2.53 232 3.12 120 1.40 2002-03 14,755 2.59 200 2.42 279 3.90 2003-04 15,126 2.41 299 2.95 266 3.36 2004-05 16,472 2.41 334 2.76 197 2.06 2005-06 17,057 2.31 543 3.80 298 2.76 2006-07 18,481 2.38 433 2.84 305 2.53 2007-08 20,607 2.28 272 1.68 629 1.73 2008-09 19,683 2.21 273 1.49 999 7.77 Total 141,995 2.35 2,676 2.45 3,330 2.92 Source: Calculated by Collins Management Consulting from data obtained by NSHRF from CIHR, NSERC and SSHRC online databases HIGHLIGHTS OF THE ANALYSIS The dominant role of CIHR in funding health research in the province is clear from the table: CIHR accounted for 60.7 per cent of all tri-council funding over the nine years shown in the table. Nova Scotia accounted for less than 3 per cent of the Canadian population during the past nine years. According to the results in the table, Nova Scotia did not achieve a per capita share of CIHR funding over the entire period shown in the table, and in fact, the province s share has been declining since 2002-03. On average, NSERC funding for health research in Nova Scotia over the nine years has been modestly higher than CIHR on a per capita basis. However, the province s share of NSERC funding has declined substantially since 2005-06.

Health Research: 2009 Update 19 In addition to tri-council funding, Nova Scotia health researchers are able to access funding from NSHRF, the Atlantic Innovation Fund (AIF) and the Canada Foundation for Innovation (CFI). The AIF focus is on applied research in the business/industry sector, with an emphasis on the commercialization of research activities. The majority of AIF science-oriented funding to date has been to collaborative projects in the natural sciences area. CFI funds are allocated for health research infrastructure: state-of-the-art equipment, buildings, laboratories and databases required to conduct research. The Nova Scotia Research and Innovation Trust (NSRIT) partners with CFI to provide funds for health research projects. The level of funding for these organizations is described in detail as part of the economic impact analysis in Section 2.6. 2.5 OTHER MAJOR SOURCES OF HEALTH RESEARCH FUNDING As noted in Chapter 1, health research spending is supported by additional organizations outside the public domain. These include private for-profit corporations, private not-for-profit organizations and foreign organizations. CIHR now provides expenditure data on several of the major Canadian not-for-profit health research organizations and foundations. This section examines expenditures in Nova Scotia on health research by two organizations. The economic impact analysis provides information on several additional organizations. CANADIAN CANCER SOCIETY FUNDING TO NOVA SCOTIA The Canadian Cancer Society (CCS) grants its fundraised research dollars through its sister organization, the National Cancer Institute of Canada (NCIC). Figure 12 on the following page compares the growth of NCIC funding for Nova Scotia, Manitoba and Saskatchewan using the funding index approach. HIGHLIGHTS OF THE ANALYSIS Between the 2000-01 and 2008-09 fiscal years, inclusive, the CCS awarded $4.6 million dollars to Nova Scotia health researchers. According to the CCS research database, funds to Nova Scotia researchers increased each year from 2000-01 to 2005-06. Following a slight decline in 2006-07, funds reached a record level of $0.878 million in 2007-08. However, available data for 2008-09 indicate a substantial decline in funds to $0.346 million. This represents a decline of more than 60 per cent in one year. The funding indices for all three provinces have consistently been less than 1.0, indicating that the provinces remain below their per capita funding level.

Health Research: 2009 Update 20 FIGURE 12: CANADIAN CANCER SOCIETY FUNDING INDICES FOR SELECTED PROVINCES, 2000-01 TO 2008-09 Source: NCIC Database http://www.ncic.cancer.ca/ PHARMACEUTICAL R& D INVESTMENT IN NOVA SCOTIA Figure 13 shows annual funding levels by the pharmaceutical industry for Nova Scotia and other selected provinces between 1995 and 2006, the last year for which funding data are available from the industry website. 4 HIGHLIGHTS OF THE ANALYSIS Over the 1995-2006 timeframe, the pharmaceutical industry has invested $8.1 billion in health research in Canada; annual investments at the national level have almost doubled, from $626 million in 1995 to $1,210 million in 2004. However, the annual funding growth rate slowed significantly in 2003, following strong annual increases in 2001 and 2002 of 12.5 per cent and 13.11 per cent, respectively. During this same timeframe, Nova Scotia health researchers received $147.1 million in funding that amounted to 1.8 per cent of total national funding. 4 www.canadapharma.org/industry_publications/fact_sheets/#provincial, information downloaded 22/09/2005.

Health Research: 2009 Update 21 Nova Scotia has experienced a significant decline in funding since 2002 when researchers in the province received $18.6 million. Funding is now below 1995 levels for the province. In 2006, the province received $9.7 million in funding amounting to a loss of close to half 2002 levels. As a result, Nova Scotia s share of total Canadian funding dropped to 0.8 per cent in 2006, well below its per capita level of 3.0, and below its 2003 share of 1.6 per cent. Figure 13 also indicates a decline in the funding indices of Saskatchewan, and for Newfoundland and Labrador in recent years. The figure indicates an upward trend in the funding index for Manitoba since 2003. The funding indices for all four provinces is less than 1.0, indicating that per capita funding is not being attained by these provinces. FIGURE 13: PHARMACEUTICAL INDUSTRY R&D FUNDING INDICES FOR SELECTED PROVINCES, 1995 TO 2006 Source: Pharmaceutical Industry of Canada: www.canadapharma.org/industry_publications/fact_sheets/#provincial

Health Research: 2009 Update 22 2.6 THE ECONOMIC IMPACTS OF HEALTH RESEARCH SPENDING IN NOVA SCOTIA METHOD AND ASSUMPTIONS Economic impact analysis is an analytical tool designed to measure the different kinds of impact that spending in a particular industry sector or a project has on an economy. The analysis traces spending through an economy and measures the cumulative effects of that spending. The applied input-output impact method from the 2007 report is replicated in this update and the definition of economic impact terminology and interpretation of economic impact results are unchanged. The model estimates impacts at different levels of aggregation. The total impact on the economy of an increase in spending is comprised of direct and spinoff impacts. The direct impact of health research spending is the immediate increase in economic activity in the form of additional employment and purchases of local goods and services to meet the requirements of the increase in health research spending. Spinoff impacts consist of indirect and induced impacts. o The indirect impact is the increase in economic activity that occurs from the interindustry transactions when suppliers of goods and services produce outputs to meet the requirements of the initial increase in spending. o The induced impact arises from consumer spending on local goods and services from the increase in household income in the economy generated by the direct and indirect impacts. The key assumptions for conducting the economic impact analysis are as follows: All spending activities on health research arising from the funding awarded by the funding agencies are incremental to the Nova Scotia economy. This means that spending on funded health research activities do not displace or take funds away from other current economic activities. Also, it is assumed that the projects and their related spending activities would not have proceeded in the absence of the funding provided by the funding organizations. All amounts awarded were, or will be, fully spent on health research-related projects. All direct spending arising from awards for health research are allocated to Nova Scotia: no portion of the funding was allocated for spending in other jurisdictions. In addition, the economic impact analysis was conducted from the perspective that there are chiefly three kinds of activity directly supported by the funded research: CONSTRUCTION OF FACILITIES: Research funding from the Canada Foundation for Innovation is limited to the provision of research infrastructure, comprised essentially of building and equipping research facilities. Construction activities typically involve renovations and alterations to existing buildings to accommodate new equipment, and

Health Research: 2009 Update 23 include modifications to floor layouts and upgrading of utilities (e.g., electrical circuits, air-circulation duct work) to meet current building code standards. PURCHASE AND INSTALLATION OF EQUIPMENT: Generally, equipment is purchased directly from suppliers located outside the province through established relations institutions have with vendors. Nova Scotia has very little manufacturing capacity to supply the equipment needs for the conduct of health research in the province. As representatives of the equipment vendors, Nova Scotia businesses may be involved in the installation and testing of equipment to ensure that it is performing to specifications. CONDUCT OF RESEARCH OPERATIONS: The conduct of research comprises the major part of health research spending activity. Except for capacity grants and awards, NSHRF funding is fully allocated to research project operations. HEALTH RESEARCH FUNDING DATA Economic impacts on the Nova Scotia economy arising from the spending of funding for health research provided by public and non-profit organizations are evaluated and presented as the aggregated impacts encompassing the eight years 2001-02 to 2008-09, inclusive, incorporating two more years compared to the 2007 study. In addition to updating the funding amounts, this study has incorporated a number of data revisions, including those to the funding databases of CIHR and other organizations. For example, the most recent online data provides final amounts funded by the Canadian Foundation for Innovation (CFI), and the Nova Scotia Research and Innovation Trust (NSRIT) data now show amounts paid on projects. At least 40 per cent of NSRIT funding is for health research projects. These NSRIT amounts paid are used in the updated database, except for more recent projects where payouts are substantially below the amount approved and in these cases the amount approved is used in the projects database for the analysis in this report. The following points provide observations and identify other data issues that have been addressed in preparing the impact analysis. Several funding organizations have accelerated their funding for health research over the last two years. In addition to increases in the amount of funding provided by organizations, the scale and structure of funding have changed in several respects: o The increase in NSRIT funding reflects in large part NSRIT s source updating which identifies more pre-2007-08 projects jointly funded with CFI. o Genome Canada s two health-related projects are brought into the database and analysis as a result of Genome Canada data on project costs being subsequently made available on their website. o The AIF has stepped up funding for health-related R&D projects; in addition, AIF made a substantial contribution to one of the Genome Canada health research projects. o Indirect Costs, funded under the federal government Indirect Costs program, have been introduced in this study report.

Health Research: 2009 Update 24 Estimates of third party funding have increased but have remained at approximately 20 per cent of the total funding of projects. Nutraceuticals projects are not included in the funding database and impact analysis, as in the previous report, as these are now generally considered manufacturing operations rather than health research projects. Constructing and equipping the Life Sciences Research Institute (LSRI), a major new facility affording an opportunity for cluster development of health research in Halifax, is not included in the database or economic impact analysis due to the present unavailability of the kinds of data required for the impact analysis. Table 3 presents the level of funding by funding organization, ranked in descending order of funding level. TABLE 3: HEALTH RESEARCH FUNDING BY FUNDING ORGANIZATION, 2001-02 TO 2008-09 FUNDING ORGANIZATION $M % Canadian Institutes of Health Research 134.5 45.8 Nova Scotia Health Research Foundation 34.7 11.8 ACOA/Atlantic Innovation Fund 33.3 11.3 Canada Foundation for Innovation 22.5 7.7 Federal Government: Indirect Costs 22.2 7.6 Nova Scotia Research and Innovation Trust 15.9 5.4 National Research Council 8.4 2.9 Genome Canada 6.9 2.3 Non-Profit Organizations 5 9.8 3.3 Social Science and Humanities Research Council 3.1 1.0 Natural Sciences and Engineering Research Council 2.6 0.9 Total 293.9 100.0 Source: Estimated by Collins Management Consulting from online databases of funding organizations HIGHLIGHTS OF THE ANALYSIS CIHR funding dominates the funding contributed over the 2001-02 to 2008-09 period, accounting for 45.8 per cent of all funding. However, as noted earlier, Nova Scotia s share of CIHR funding falls below the national average. The NSHRF ranked second among contributors to health research funding in Nova Scotia. Its contribution of $34.7 million was 11.8 per cent of all funding. The amount of direct funding from all sources over the eight years totalled $293.9 million. 5 Such as the Alzheimer Society, Canadian Cancer Society, Heart and Stroke Foundation and Terry Fox Foundation.

Health Research: 2009 Update 25 An estimated $73.1 million in third party funding was leveraged by the funding amounts shown in Table 3. Specifically in the case of the AIF, CFI and NSRIT and Genome Canada research funding is awarded contingent on participatory funding by third parties, which include universities, hospitals and businesses. The total amount of direct funding for health research in Nova Scotia over the eight years was $366.9 million. This is the amount used in evaluating economic impacts resulting from health research spending in Nova Scotia. AIF funding for health research has more than doubled from the previous report, from $14.5 million over the first six years to $33.3 million over eight years, an increase of $18.8 million in two years. NSRIT provided an estimated $15.9 million for health research over the eight-year analysis timeframe; this estimate includes updated data from previous analysis. NSHRF funding amounts are different in Tables 3 and 4. Table 3 shows the funding provided by NSHRF only, whereas Table 4 includes Matching funding from third-party sources. TABLE 4: NSHRF FUNDING BY PROGRAM, 2001-02 TO 2008-09 NSHRF PROGRAM $ MILLIONS Health Research Grants 15.9 Student Research Awards 11.6 Matching Grants 13.5 Capacity Grants and KT/E 6 Awards 0.8 Research Capacity Awards 1.4 Workshops 0.1 Total 43.5 Source: NSHRF It is useful in analyzing the research-spending impacts that include NSHRF funding to organize NSHRF programs under two broad groupings: project research awards, and capacity grants. Project research grants are comparatively large in amount. Project grants, student research awards, and matching grants are for the conduct of health research. Capacity grants, KT/E awards and research capacity awards are typically smaller in amount and support individuals, teams, universities and institutions to help them develop their research skills or research capacity. ESTIMATED ECONOMIC IMPACTS The Nova Scotia Input-Output Model generated the economic impact results shown in Table 5. These impacts on the Nova Scotia economy result from the spending of $366.9 million on health research in the province. 6 Knowledge Transfer and Exchange

Health Research: 2009 Update 26 The table includes an estimate of annual impacts; these impacts are an average of the total impacts. Care should be taken in the interpretation of this average, since the spending underlying the impact estimates is not evenly distributed across each year and other cumulative effects of the spending may be overlooked in annualizing the estimates. TABLE 5: ECONOMIC IMPACTS ON NOVA SCOTIA OF HEALTH RESEARCH SPENDING, 2001-02 TO 2008-09 ECONOMIC INDICATOR DIRECT INDIRECT INDUCED TOTAL ANNUAL Household Income ($M) 157.3 35.4 51.1 243.8 30.5 Gross Domestic Product ($M) 178.4 54.9 87.9 321.2 40.2 Provincial Government Revenue ($M) 18.0 3.8 5.5 27.3 3.4 Employment (person-years) 5,100 930 1,340 7,370 920 Source: Estimated by Collins Management Consulting from the NS Input-Output Model HIGHLIGHTS OF THE ANALYSIS These economic impacts are the cumulative impacts on the Nova Scotia economy over the full eight-year period. HOUSEHOLD INCOME: Household income is comprised mainly of wages and salaries. In the past two years, the direct household income shown in Table 5 has more than doubled, going from $72.2 million in the previous analysis to $157.3 million over the entire eight years. Indirect household income as doubled as well, going from $17.6 million to $35.4 million. Induced income, however, has declined by half. These results arise from increased spending on health research in Nova Scotia by CIHR, ACOA and other agencies in the past two years as well as improved data sets. GROSS DOMESTIC PRODUCT: In this study, GDP measures the total amount of value added, direct and spinoff, to the Nova Scotia economy for the full eight years as a result of the research spending generated by those projects funded by the organizations listed in Table 4. Household income accounts for the largest component of GDP and business income accounts for most of the balance. Our analysis estimates that total GDP generated by health research spending rose from $150.6 million over the six years examined in the 2007 report to $321.2 million over the eight years examined in this report. This represents an increase of 113 per cent. PROVINCIAL GOVERNMENT REVENUES: The provincial government revenues in Table 5 consist of taxes on personal incomes and expenditures, and net sales tax revenue on capital goods acquisitions. Total revenues increased by 140 per cent since the 2007 report, from $11.4 million to an estimated $27.3 million by the end of 2008-09. EMPLOYMENT: The employment impact is a combination of employment in newly created jobs and employment in existing jobs that was sustained by health research spending activities. Direct employment in health research was estimated at 2,900 personyears in 2007; the eight-year estimate indicates direct employment of 5,100 person-years, an 82 per cent increase.

Health Research: 2009 Update 27 SPINOFF IMPACTS: Spinoff impacts are comprised of indirect and induced impacts shown in Table 5. Indirect impacts arise from the inter-industry transactions set in motion by the direct spending on goods and services in the economy. These indirect impacts generate an additional amount of household income impacts. The spending of the household income created by the combined direct and indirect income impacts generates induced impacts. These induced impacts are larger that the indirect impacts since they are generated from both direct and indirect spending. The indirect and induced spinoffs for each economic indicator in Table 5 have increased significantly since the 2007 report. IMPACTS OF HEALTH RESEARCH SPENDING IN THE CONTEXT OF THE NOVA SCOTIA ECONOMY The impacts of health-related research spending are not large in the context of the Nova Scotia economy. In this analysis, spending on health research operations activities was allocated to that sector of the Nova Scotia Input-Output Model that comprises research and development. In 2005, that sector directly accounted for an estimated 0.7 per cent of GDP and 1.0 per cent of employment of the provincial economy, at $212.2 million and 4,600, respectively. On an annualized basis, the direct impacts of health research-related spending of funds provided by public funding agencies and associated third parties are estimated at 13.9 per cent of employment and 10.5 per cent of GDP of this research and development sector in the province. These impacts are based on health research-related spending that includes both operations and capital expenditures to provide infrastructure for ongoing research activities. 2.7 LEVERAGING NSHRF RESEARCH FUNDING IN NOVA SCOTIA Tables 6-8, which follow, provide details on leveraged health research funding. This leveraging function, also described as matching funding by some organizations, is an important part of the role in health research funding played by the NSHRF. In addition to the direct funding NSHRF provides to health researchers in the province, the organization partners with other funding organizations to increase the amount of funding available for research. At this point, the information in the tables provides only a preliminary perspective on the kinds and level of immediate outcomes this NSHRF funding has produced. Moreover, the process to acquire additional external funds for projects is not simultaneous with NSHRF funding, since it may take some time before researchers know the results of competitions that they applied for subsequent to receiving NSHRF development support. NSHRF has not measured the impacts or incrementality of the projects funded by these programs at this time, although it plans to do so in the future. Partners funds refer to funding obtained from sources that are external to Nova Scotia, either on an international or national basis. The most notable of these external partners is CIHR.

Health Research: 2009 Update 28 TABLE 6: NSHRF MATCHING PROGRAM LEVERAGING RESULTS, 2000-01 TO 2008-09 YEAR MATCHED APPLICATIONS (#) NSHRF ($000) EXTERNAL PARTNERS ($000) TOTAL PROJECT 7 ($000) LEVERAGED $ 8 2000-01 5 186.0 2,228.6 2,414.6 12.0 2001-02 1 91.2 273.7 365.0 3.0 2002-03 28 1,793.3 9,944.0 11,737.3 5.5 2003-04 6 373.5 2,368.0 2,741.5 6.3 2004-05 6 302.1 2,328.3 2,630.4 7.7 2005-06 10 548.1 7,781.8 8,330.0 14.2 2006-07 14 521.0 2,584.8 3,105.8 5.0 2007-08 8 493.1 1,272.5 1,765.6 2.6 2008-09 12 583.3 2,588.5 3,171.8 4.4 Total 90 4,891.7 31,370.2 36,261.9 6.4 Average 10 543.5 3,485.6 4,029.1 6.8 Source: NSHRF HIGHLIGHTS OF THE ANALYSIS Since its inception, NSHRF has contributed about $4.9 million to its Matching Program with resulting support to 90 applications. This support from NSHRF amount attracted an additional $31.3 million to health research in the province through sources such as CIHR. This result means that for every dollar contributed by NSHRF, health research projects and researchers leveraged an additional $6.40. NSHRF s Proposal Development Program provides seed funding for development of a proposal that is subsequently submitted to a national/international organization. As noted, the development process has an inherent delay between the time NSHRF provides funds and a researcher receives funding from national and/or other sources. The analysis found that over the nine years, for every dollar contributed by NSHRF, health research projects and researchers leveraged an additional $44.80 in external funding. NSHRF also provides funding under its Team Development Grant, designed to support Nova Scotia health researchers in the development of a new research team, or to build the capacity of an existing team, to prepare a proposal for submission to a national or international peer reviewed grant competition. For every dollar provided by NSHRF for project team development, these teams of Nova Scotia health researchers were able to secure an additional $1.60 in external funding. 7 This total may under-represent total funding, since only partners external to Nova Scotia are included in the analysis. 8 Leveraging is defined as: Partnership $/NSHRF$

Health Research: 2009 Update 29 Overall, the three programs described in this section were able to attract $38.4 million over the past eight fiscal years from $5.2 million in NSHRF funds. This amounts to $7.40 in external funding for each dollar provided by NSHRF. 2.8 OTHER BENEFITS OF HEALTH RESEARCH SPENDING The primary focus of this chapter is on the estimation of tangible economic (and financial) benefits of health research in Nova Scotia. These benefits - identified in the results of the direct spending by funding agencies, the economic impact analysis and the leveraging analysis - are substantial. Moreover, as the economic impact analysis indicates, the spending on health research leads to spinoff economic impacts on the Nova Scotia economy. Some of the intangible benefits of health research in Nova Scotia are identified below. These benefits are real but considerably more difficult to identify and quantify empirically than are the economic benefits related to health research funding itself. The following list is meant to be illustrative of these intangible benefits. It is neither exhaustive nor definitive. NSHRF funding jump-starts careers in health research by providing funding to researchers at an early stage in their careers when they may not have the experience and funding track-record to access national funding programs such as those offered by CIHR. NSHRF funding helps raise the profile of Nova Scotia health researchers on the national and international scene by giving them access to funding support and the opportunity to collaborate with colleagues on a global scale. NSHRF, in particular, funds research that is of particular and unique interest to Nova Scotians: these research areas may not be of sufficient interest to national funding organizations to attract funding for health researchers in Nova Scotia. Multi-partner funding for health research supports important health research infrastructure, such as the Brain Repair Centre in Halifax. The Centre, internationally recognized as a centre of excellence in health interventions, would not be feasible without a significant investment in research infrastructure by federal and provincial governments. The Centre is building research capacity in this area. Health research funding supports state-of-the-art health care and services in Nova Scotia: research opportunities attract health care professionals and clinicians to the province that subsequently use research to inform their health care practice.

Health Research: 2009 Update 30 3. MEASURING THE QUALITY OF NOVA SCOTIA S HEALTH RESEARCH The analysis for this report examines the quality of health research in Nova Scotia. This information sheds lights on how Nova Scotia compares across Canada and how the province s health research quality is improving over time. As part of that analysis, this section presents two common, high-level measures of research quality: Average Relative Impact Factor, or the relative impact of research as described by a quantitative impact rating of scientific publications reporting research findings; and International Collaborations that reflect the extent to which research activities in a given jurisdiction are operating on the international level. 9 3.1 AVERAGE RELATIVE IMPACT FACTOR 10 METHODOLOGICAL CONSIDERATIONS The average relative impact factor (ARIF) indicator is a proxy for the quality or impact of the journals in which a researcher or research group publishes. The ARIF is based on the number of citations a research paper published in a peer-reviewed journal receives. The two assumptions underlying the ARIF are: A researcher s work has value when it is judged by peers to have merit, and, as a result, is made available in a peer-reviewed journal; and The ARIF normalizes the bibliometric approach underlying the measuring of citations by recognizing that the number of citations varies within different fields of research. The ARIF is an average of impact factors (IF) across fields and subfields of a science discipline and is calculated in three steps: IMPACT FACTOR: Thomson Scientific, a publishing company, annually calculates the impact factor for each journal the company publishes. The IF is the number of citations a journal receives relative to the total number of papers published that year. Articles and papers receive the IF of the journal in which they are published. RELATIVE IMPACT FACTOR (RIF): The IF of each paper is normalized within a scientific field by dividing each paper s IF by the average IF of each paper in that same field. AVERAGE RELATIVE IMPACT FACTOR: The ARIF is the average of the RIFs for all articles published by a particular unit, such as a researcher, research group, or province. An ARIF above 1.0 indicates that papers published by a particular researcher (or province) are cited more often than all other papers in that research field on average in the world. An ARIF below 1.0 indicates that the papers from a particular researcher (or province) are cited less often 9 MSHRF report, p. 17 10 Scientific Positioning of Nova Scotia s Health Research: A Bibliometric Analysis (1985-2004), p.2

Health Research: 2009 Update 31 and have a lower impact than the average, and that a researcher publishes in journals that have a lower impact - and quality - than the world average. Figure 14 compares the ARIF across several jurisdictions, including all Canadian provinces and select international jurisdictions comparable to Nova Scotia. FIGURE 14: COMPARISON OF THE QUALITY OF HEALTH RESEARCH PUBLICATIONS, 1996-2007 Source: Calculated by Collins Management Consulting from Thomson Scientific data HIGHLIGHTS OF THE ANALYSIS The quality of Nova Scotia s output in health research is very high, according to the ARIF analysis undertaken by OST and Science-Metrix using the Thomson Scientific publishing data. Nova Scotia s ARIF of 1.08 places it above the world average of 1.0 for quality of published articles, based on the last years of data. This result ranks the province in seventh position among Canadian provinces. The ARIF for Nova Scotia has remained relatively constant on an annual basis over the past decade. The indices for other provinces have only varied within a narrow band. The province s ARIF is below the performance of the American states, world leaders in the quality of health research publications but above that of Northern Ireland.

Health Research: 2009 Update 32 3.2 INTERPROVINCIAL COLLABORATION Interprovincial collaboration is one indicator of the relative intensity of scientific collaboration between provinces. The rate is calculated by dividing the number of papers with at least one author with address in another province by the province s total number of papers. 11 Figure 15 compares the average interprovincial collaboration rates over the 1994-2007. FIGURE 15: INTERPROVINCIAL COLLABORATION BY PROVINCE, AVERAGE %, 1994-2007 Source: Calculated by OST and Science-Metrix using Thomson Scientific data HIGHLIGHTS OF THE ANALYSIS An average of one third of the publications by Nova Scotia health research over the 1994-2007 period included interprovincial collaboration. Other Atlantic provinces had high interprovincial rates of collaboration as well. This result is most likely related to the small size of the Atlantic provinces, since specialist researchers in these provinces may be more likely to find potential collaborators outside their province than inside. 11 Scientific Positioning of Nova Scotia s Health Research: A Bibliometric Analysis (1985-2004), p.2

Health Research: 2009 Update 33 This collaborative environment is reinforced by the strong collaboration of health researchers in Nova Scotia with researchers in New Brunswick and Prince Edward Island through the Dalhousie University Medical School. The share of publications by Nova Scotia health researchers that involve collaboration with other provinces has been increasing rapidly over the past four years. The province ranked second (to New Brunswick) in terms of average levels of collaboration between 2004-2007, inclusive, with an average rate of 39.6 per cent. During the 1990s, Nova Scotia health researchers collaborated with other Canadian researchers on an average of 129 research publications per year. This level has increased to 257 publications on average during this decade, and 302 publications annually over the past four years.

Health Research: 2009 Update 34 4. PRODUCTIVITY IN HEALTH RESEARCH 4.1 GROWTH IN HEALTH RESEARCH PUBLICATIONS Figure 16 indicates the annual changes in the number of research articles published by Nova Scotia health researchers over the 1985-2007 timeframe. FIGURE 16: GROWTH IN MEDICAL SCIENCES RESEARCH ARTICLES BY NS HEALTH RESEARCHERS, 1985-2007 Source: Calculated by Collins Management Consulting from Thomson Scientific data HIGHLIGHTS OF THE ANALYSIS Between 1985 and 2007, inclusive, Nova Scotia health researchers published 13,135 research papers. According to analysis undertaken by Observatoire des sciences et des technologies (OST) and Science-Metrix, the growth patterns in the level of output for Nova Scotia generally matched Canadian and global output patterns. Overall, the annual volume of Nova Scotia health research reports grew by 83.8 per cent between 1985 and 2007. During the 1990s, Nova Scotia health researchers published an average of 527 research papers annually; since 2000, the annual average has climbed by more than one third to 706 papers.

Health Research: 2009 Update 35 As Figure 16 indicates, the rate of growth in publications increased rapidly during the earlier years of this decade, but has slowed and subsequently declined in the last year. In spite of this modest decline, the average number of articles published by Nova Scotia health researchers averaged 763 articles in the past four years. Figure 17 indicates the number of health research articles per 1,000 persons of population in each province. FIGURE 17: HEALTH RESEARCH ARTICLES PUBLISHED PER 1,000 POPULATION, 1996-2007 Source: Calculated by Collins Management Consulting from Thomson Scientific data 12 HIGHLIGHTS OF THE ANALYSIS On a per capita basis, Nova Scotia has had a very strong performance in publishing over the 1996-2007 timeframe. The province tied Alberta for first place in per capita publishing of medical sciences research, with a publication rate of 0.71 papers per 1000 persons. The province scored well above the national per capita rate of 0.55 papers. Over the past five years, health research publishing growth has exceeded its long-term average, reaching 0.80 articles per 1,000 persons the strongest performance of any Canadian province. This result is driven by growth in the number of published articles, in 12 A change in the dataset and recalculations of the ratios for this figure has resulted in lower average scores than in 2007 although the general interprovincial comparisons have remained similar.

Health Research: 2009 Update 36 comparison to Alberta with 0.77 articles over the same time period which has experienced a decline in the number of annual publications. 4.2 TRENDS IN HEALTH RESEARCH SPECIALIZATION This section presents two additional perspectives on the health research articles published by Nova Scotia health researchers. First, the analysis examines the distribution of articles by four major research fields. Second, the analysis presents the results of a specialization index (SI) analysis using data collected by Thomson Scientific. Figure 18 uses the same data source as Figure 20. It indicates the number of published research articles by Nova Scotia health researchers from 1996-2007, categorized by biomedical research; clinical medicine; social health; and psychology. FIGURE 18: PUBLISHED HEALTH RESEARCH ARTICLES BY FIELD, NOVA SCOTIA, 1996-2007 Source: Calculated by Collins Management Consulting from Science-Metrix/Thomson Scientific data HIGHLIGHTS OF THE ANALYSIS Clinical medicine dominates the number of research publications field among Nova Scotia health researchers, accounting for 4,851 articles over the 1996-2007 timeframe and 61.0 per cent of all articles published in the four fields. Over this time, the number of publications has increased 39.0 per cent.

Health Research: 2009 Update 37 In the past two years, more than 900 articles have been published in the clinical medicine field by Nova Scotia health researchers. Close to 20 per cent of publications in this field were in the areas of neurology and neurosurgery. Growth in biomedical research, which accounted for one quarter of all published articles, has begun to increase after several years of minimal growth in the early years of the 1996-2007 period. Publications increased by 33.6 per cent over the entire 12 years. The number of publications in health and social sciences virtually doubled between 1996 and 2007, although the number of publications remains low in comparison to clinical medicine and biomedical research. There were 55 publications in health and social sciences in 2007. Science-Metrix and OST calculated a Specialization Index (SI) for Nova Scotia health research using the same data discussed throughout this chapter. The SI, like the other indices discussed in this report, is designed to normalize the intensity of research in a particular research area or location, such as a province. The SI is defined as the ratio of papers published in a given research area relative to an entire reference set of published papers for that same area compared to the same ratio for a given research area at the world level. The SI index for Nova Scotia in Figure 19 compares the intensity of Nova Scotia health research to other Canadian provinces in comparison to the specialization in health research globally. FIGURE 19: HEALTH RESEARCH SPECIALIZATION INDEX BY PROVINCE, 1999-2004 Source: Calculated by OST and Science-Metrix from Thomson Scientific data