Experts say Australia appears 'willing to tolerate' rheumatic heart disease

Global health leaders sign 2040 declaration to end rheumatic heart disease In Short: An ambitious plan to eradicate rheumatic heart disease (RHD) will be endorsed by public health experts in Perth today. The "Perth Declaration" says the world already knows how to prevent and treat the disease, but what's needed is political will. What's next? Australia has a national plan to end RHD by 2031, but experts say only a small part of the required funding has been committed. In the lead-up to running her first marathon in 2019, Cecilia Johns received some "shocking" news. She had volunteered herself for a heart check-up after conducting screenings for children at the health service where she worked. She was floored by what she saw on the echocardiogram screen. "I saw my own [heart] valve not working properly … and then heard the valve regurgitating," she said. At 29 years old, she was fit and healthy but was diagnosed with rheumatic heart disease (RHD) despite showing no symptoms of it or its predecessor, acute rheumatic fever (ARF). She suspected it may have started with childhood tonsillitis and sores from eczema — which can lead to ARF — but that possibility was never raised during her regular health check-ups. Ms Johns is one of almost 12,000 people living with RHD or who have a history of ARF in Australia. First Nations people account for four in five cases and die from RHD at more than five times the rate of non-Indigenous Australians. The highest rates of ARF are among First Nations children aged 5 to 14. Australia condemned for 'disease of poor conditions' The fact First Nations Australians have among the highest rates in the world came in for sharp criticism at a global conference of public health experts in Perth this week. "[Australia's] health system is universal, well-funded and world-class, so the usual explanation, resources, is not available here," World Health Federation head Jagat Narula told delegates. "This is not a disease of poor countries, it is a disease of poor conditions. "Poor conditions can persist inside a rich country for as long as a society is willing to tolerate them." RHD is permanent damage to the heart valve caused by one or more episodes of ARF, which itself arises from an untreated bacterial infection, group A streptococcus. Both conditions are preventable. The disease is closely linked to overcrowded housing and poor hygiene. Without access to clean water or washing machines, skin and throat infections can spread quickly. Aunty Vicki Wade, associate professor at Menzies School of Health research, said some Indigenous communities were living in "Third World conditions" when it came to health, housing and education services. "This disease typifies Australia's failure to look after one of the oldest living cultures in the world," the senior Noongar woman said. "It's heartbreaking when you go out to community and a three-year-old gets onto the couch, and you pick up [they have] rheumatic heart disease … [they've] got no muscle and got to have an injection every 28 days." Garry Jennings, the Australian Heart Foundation's chief medical advisor, said ARF was easily treated with benzathine penicillin. "We need to get up into the communities, do better screening, better surveillance," he said. "We need to make sure that everybody that's picked up the risk of developing serious rheumatic heart disease is treated in their earliest stages and gets the penicillin they need." Professor Narula told delegates Australia had so far only committed a small proportion of the $689 million required to fund the national plan to end RHD by 2031, known as the Endgame Strategy. The federal government told the ABC it was investing $95.8 million to prevent and treat RHD. This funding was announced in 2021, to be spent over six years. It had made alternative PBS medicines available during the ongoing shortage and worked with Aboriginal health services to provide eligible medications direct to patients, Assistant Indigenous Health Minister Rebecca White said in a statement. "Preventing rheumatic heart disease also means addressing the broader factors that affect people's health, including housing, sanitation and living conditions," she said. Workforce, medication and testing challenges in the Pacific Like Indigenous Australians, Māori and Pasifika peoples are also diagnosed with ARF and RHD at high rates compared to their peers. Māori peoples are roughly 26 times more likely to be hospitalised for their first case of ARF compared to non-Māori peoples. It is believed 1 to 3 per cent of people in the Pacific Islands have RHD, although data collection is difficult because reporting systems are not always in place. Joshua Agnew, a general paediatrician in Tauranga, Aotearoa/New Zealand, said global action was needed to bring these rates down. "Every [Pacific] nation is different, but workforce remains a challenge and equitable access to medications and [testing] remains a challenge," he said. Delegates at the World Congress on Rheumatic Heart Disease will today launch the so-called Perth Declaration, a global plan to eliminate ARF and RHD by 2040. It calls on governments to commit long-term funding, invest in housing, water and environmental health, support Indigenous community-controlled organisations, secure antibiotic supply, support vaccine development and register and follow every person diagnosed. Aunty Vicki said it would not be achieved unless governments worked in partnership with First Nations communities. "We've got the blueprint, we've got the Endgame Strategy," she said. "Unless that is taken seriously and some money is put behind it … and we look at housing, education and how Aboriginal people are treated in these communities, I don't feel like we're going to make that deadline." [Image text:] O O CISSY JOHNS