In 2018, The Australian Burden of Disease Study: impact and causes of illness and death in Aboriginal and Torres Strait Islander people found that Indigenous Australians as a whole lost almost 240,000 years of healthy life due to ill-health and premature death.
This figure is the equivalent to 289 years for every 1,000 people.
When outlining the major issues, one of the five noted was cardiovascular diseases, such as coronary heart disease (CHD) and rheumatic heart disease (RHD).
It is an issue that Heart Foundation National Manager Population Health & Wellbeing, Le Smith knows all too well. Especially its effect on younger First Nation populations.
“Heart disease’s significant impact on First Nations peoples at an earlier age compared to the broader Australian population is attributed to a complex interplay of social, cultural, economic, historic and political factors,” Ms Smith said.
“These factors collectively contribute to health inequities, with the social determinants of health playing a crucial role.”
RHD is mainly considered a third-world disease. However, Australia has some of the highest rates in the world. The Telethon Kids Institute estimates that 3-5 per cent of Aboriginal people living in remote and rural areas have the condition.
The disease typically begins as an infection of the throat or skin by group A streptococcus, which untreated can lead to acute rheumatic fever (ARF). When rheumatic fever affects the heart it can cause inflammation and damage to the heart valves. Children aged between 5 and 14 years are most likely to get rheumatic fever.
According to data released in March 2024 from the Australian Institute of Health and Welfare (AIHW), at December 2022, 10,349 people were living with a diagnosis of ARF and/or RHD.
Of these, 8,448 (82%) were First Nations people. The AIHW report shows 5,424 First Nations people were living with RHD at December 2022.
The data was drawn from jurisdictional registers across New South Wales, Queensland, Western Australia, South Australia, and the Northern Territory.
RHD can be life threatening if not properly treated or managed, and there is a high risk of complications and impact on quality of life.
| “Rheumatic heart disease disproportionately affects First Nations communities,” Ms Smith said.
“Tragically, RHD often occurs at a young age, and so its impact on First Nations communities across Australia demonstrates a form of disadvantage faced by younger First Nations people with an RHD diagnosis.”
“People with RHD must have frequent and painful penicillin injections over many years to save their heart valves, and may miss education while sick.” |
Heart Foundation National Manager Population Health & Wellbeing, Le Smith. |
There has been some process in recent years towards reducing this trend. AIHW data shows that the incidence rate among First Nations people who were newly diagnosed with RHD increased from 2015 to 2018, then decreased over the last 5 years.
More broadly, between 2006 and 2018, the age-standardised death rate for cardiovascular disease among Indigenous Australians fell from 323 to 229 per 100,000, while the cancer death rate rose from 205 to 235 per 100,000 (AIHW 2020).
This marks the first time cancers have overtaken cardiovascular diseases as the most common group of diseases causing deaths among both Indigenous and non-Indigenous Australians.
But this decreased figure is still higher than the rates seen in non-indigenous communities.
“RHD is 100% preventable,” said Ms Smith, “and the Heart Foundation, alongside community-controlled health organisations and other stakeholders, are advocating strongly for additional investment to implement solutions and end RHD.”
“The Heart Foundation’s long-term goal is to lead, advocate and partner in efforts that contribute towards closing the gap in heart health, whilst supporting and acknowledging the importance of First Nations leadership in the design and implementation of community-based solutions.”
When it comes to the need to build consensus and effective partnerships to close the gap, Ms Smith is acutely aware of the role the Heart Foundation must play.
“As Australia’s leading charity in cardiovascular health, the Heart Foundation acknowledges the responsibility it holds to improve heart health where such significant disparities exist, and this must be done in co-design and collaboration with those communities impacted,” she said.
“Forming partnerships with community leaders and elders, community-controlled health organisations and relevant stakeholders working with communities, is critical to achieving improved health outcomes for First Nations peoples.”
“The Heart Foundation strongly supports First Nations sovereignty and self-determination. Working from a strength-based approach, with cultural understanding and curiosity, the Heart Foundation aims to build community trust and respect to further strengthen efforts and address disparities in First Nations heart health.”
At present, the National Aboriginal Community Controlled Health Organisation (NACCHO) is leading the implementation of Australia’s Rheumatic Fever Strategy. The Heart Foundation and other expert health organisations continue to work in partnership with NACCHO and other community-controlled health organisations to enhance and support efforts where needed.
In addition, the Heart Foundation is in the process of developing a First Nations Heart Health Strategy. Led by their First Nations Heart Health team, the key building block according to Ms Smith is building strong relationships across First Nations communities, stakeholders and relevant organisations to deliver programs and activities that support improvements in cardiovascular health for First Nations peoples.
“By continuing to foster and build strong relationships in their work, the Heart Foundation aims to ensure that First Nations peoples receive high-quality, culturally-appropriate and respectful care and support tailored and relevant to the communities they serve.”
