At the end of February, the Minister for Indigenous Health Ken Wyatt chaired a roundtable of about 30 stakeholders in Darwin, including Aboriginal medical services and representatives of the WA, NT, SA and Queensland governments, to lay down a roadmap to end rheumatic heart disease.

Prof Jonathan Carapetis and Kenya McAdams, who was diagnosed with RHD and had to undergo surgery to repair damaged heart valves.

He also announced that the Federal Government had allocated $23.6m over the next four years for a Rheumatic Fever Strategy, which would also address the underlying social and cultural determinants that contribute to RHD, including poor housing.

A $5.4b national agreement, which funded states and territories to provide remote housing, is due to end on 30 June 2018 and Minister Wyatt said the Commonwealth had begun discussions about future funding arrangements.

With significant funds in the kitty, long-time workers in the area such as Telethon Kids Institute chief Prof Jonathan Carapetis, believe the time is ripe for decisive action that can make the disease history.

Jonathan said the foundation of a strategy was already in train.

Evidence mounts

“Telethon Kids is into the fourth year of the five-year End RHD project which is bringing the research and economic and policy framework together with the view that by early 2020 we will have a detailed, costed plan for eliminating RHD as a public health priority in Australia,” he said.

“What the Minister managed to do was to get a wide range of stakeholders around the table, all unified in their position that this disease is shameful and tragic in such as country as ours, and to elicit their commitment to get rid of it.”

“The Minister recognised that of any disease, RHD was the epitome of what needs to be tackled to Close the Gap. It is the single biggest cause of differential of burden in cardiovascular disease between indigenous and non-indigenous people. It is almost exclusively born of social determinants, so to get rid of it, we must tackle those determinants.”

“That was the other aspect about the meeting that was particularly pleasing – people didn’t see this as just a dread disease but something that characterises what we are trying to do with Closing the Gap.”

“It gives us something tangible to aim for because Closing the Gap is overwhelming in its scope – tackling life expectancy differentials is extremely hard.”

A unified approach

It is believed that Minister Wyatt will be taking the RHD strategy to COAG, which would ensure that the state and federal governments were on the same page.

While there have been national partnership agreements for individual control programs in the past, there has not been a unified approach on a uniform, national strategy.

In our story on the WA sustainable health review (see P21), Health Minister Roger Cook said the WA government was in constructive talks with the federal government on national commissioning models in the Kimberley.

And it was the Kimberley Aboriginal Medical Service at the roundtable that said it was important not to lose momentum on the RHD disease front.

“Their view is that regardless of what happens nationally, it doesn’t stop their commitment to eliminate RHD in the Kimberley. I thought that was a really positive statement. People can act now,” Jonathan said.

“Researchers have heaps of information on this disease – we know the things that are most likely to work, and we have the evaluation capacity to see if it is working. We can assist.”

Community leadership

“But one thing that was made very clear at the roundtable was that whatever happens, it has to be focused at the community level. We can’t do this with a top-down approach. We have to empower local communities to say ‘we want to get rid of this disease’ and the local Aboriginal leadership to take ownership of it. The focus has to be on all aspects of prevention and control. There is no silver bullet.”

Finding demonstration communities will be the next task.

“These demonstration communities will need resources and support to ensure they are buttressed but local people will be directing priorities. Essential is the need for local community workers who are trained and employed on a genuine career path,” Jonathan said.

“These people will be working with families to help them improve their physical environment and housing and to identify and manage sore throats and skin infections – the health problems we know lead to RHD. There is a lot that needs to happen but it must happen on the ground in local communities.”

Deadly shame

Jonathan said RHD claimed the lives of between 50 and 150 people a year, almost all at far too young and age and almost all were Aboriginal or Torres Strait Islanders.

“And that’s not acceptable in the 21st century,” he said.

“But at this moment, I have never been more optimistic about defeating RHD and I have worked in this field for a long time. We have a group of individuals and organisations around the country serious about doing something.”

“I am also confident that we have a pretty good idea what needs to be done. What we’ve needed is the third step to bring people together and get political will. With Minister Wyatt’s leadership, I am quite optimistic that we are taking that third step.”

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