Thursday the 29th of September marks World Heart Day, which aims to promote awareness about cardiovascular disease (CVD) such as heart disease and stroke. This international day of celebration also encourages individuals to make changes to control and prevent the disease.
In Australia, CVD is one of the leading causes of death: in 2019, it was the underlying cause of 25% of deaths in the nation. In fact, coronary heart disease is the number one killer of Australian men.
In Australia, CVD accounts for almost 13% of the total burden of disease. In 2018, Australians were estimated to have lost 646,000 disability-adjusted life years (Also known as DALYs, meaning years of healthy life lost due to disease or injury) due to CVD.
CVD poses a significant risk to the health of all Australians, but Aboriginal and Torres Strait Islander peoples are at a much higher risk of developing CVD and other preventable cardiac conditions such as Rheumatic Heart Disease (RHD).
RHD is the permanent damage to the heart muscle or valves that results from contracting Acute Rheumatic Fever (ARF), an autoimmune response to an infection in the upper respiratory tract caused by streptococcus A infections. Complications are common for the condition and include atrial fibrillation, endocarditis, heart failure and stroke.
The condition is often life-long, and treatment consists of penicillin injections every 3 to 4 weeks, lasting a minimum of 10 years. This treatment works to prevent future ARF infections and further damage to the heart valves.
94% of ARF cases occur in Indigenous Australians, with the highest risk category being children aged between 5 and 14 years. Similarly, 81% of people diagnosed with RHD in 2018 were Indigenous, and nearly 40% were under the age of 25. The DALYs lost by Indigenous communities are 6.6 times higher than that of non-Indigenous Australians, highlighting a significant disparity in health outcomes between the two groups.
A recent report by NITV’s The Point focusing on the community of Doomadgee in Far North Queensland shed some light on the devastating effects of RHD, which has taken the lives of several young people in recent years.
This trend is similarly reflected in CVDs (2.6 times higher for men, and 3.2 times higher for women compared to non-Indigenous populations) as well as coronary heart disease (3.1 times higher than non-Indigenous populations).
Both RHD and ARF are closely related to risk factors such as poverty, overcrowded housing, and decreased access to healthcare. These risk factors are frequently present in rural and remote Indigenous communities due to poor resources and funding.
To address the health disparities that cause this preventable disease and the health burden that it creates, the Australian Government has introduced the Rheumatic Fever Strategy (RFS). The strategy, proposed in 2021, was in collaboration with the Aboriginal Community Controlled sector to develop a new service delivery model for the prevention and treatment of ARF and RHD.
Further funding has been pledged by both the Queensland and Federal government to strengthen the response to ARF through vaccine development, healthcare worker training, upgrading Aboriginal community-controlled healthcare organisations and increased housing and healthcare services.
The Doomadgee Aboriginal Shire is leading a Queensland-first Closing the Gap pilot program to address housing shortages in high-risk communities, placing them at the heart of decision-making of housing, health and early childhood projects.
Currently, research is underway for a vaccine for Strep A to protect individuals against ARF, preventing them from developing consequent RHD. The Australian Strep A Vaccine Initiative (ASAVI) was formed in 2019 in response to the World Health Organization (WHO) setting the development of Strep A vaccines as a priority. Currently, the Telethon Kids Institute and the Murdoch Children’s Research Institute, through ASAVI, are working on fast-tracking the development of the vaccine and intend to begin clinical trials in 2023.
Significant work remains to Close the Gap in heart health between Indigenous and non-Indigenous populations this World Heart Day, but actions that focus on addressing the social determinants of health that create these inequalities, such as housing and healthcare access, is a step in the right direction.
