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12 Dec 2016

CAPTION: AMA President Dr Michael Gannon (R) with NACCHO Chair Matthew Cooke and Labor Member for Lingiari Warren Snowden at the launch of the 2016 AMA Report Card on Indigenous Health in Darwin on 25 November.


Focussing attention on the damage and distress being caused by rheumatic heart disease (RHD), the peak medical group has urged all governments to sign up to a goal of preventing all new infections in Indigenous Australia by 2031.

Nearly 6000 Australians, almost all of them Indigenous, were living with RHD or its precursor, acute rheumatic fever (ARF), last year, and the infection kills Indigenous people at 20 times the rate of other Australians – and up to 55 times in the Northern Territory.

AMA President Dr Michael Gannon said RHD was a “disease of poverty”, and it was shocking that it was killing and harming so many people in one of the wealthiest countries in the world.

“RHD is a disease of poverty, and it is preventable,” Dr Gannon said. “Yet…Australia has one of the highest rates of RHD in the world.”

He said the fact that it was almost exclusively localised to Indigenous communities “speak[s] volumes about the fundamental underlying causes of RHD, particularly in remote areas – poverty, housing, education and inadequate primary health care”.

“The lack of action is…symptomatic of a national failure. RHD must be eradicated – it must no longer occur in Australia.”

The disease begins with infection by Group A Streptococcal (Strep A) bacteria, which is often associated with overcrowded and unhygienic housing, and can show up with seemingly innocuous symptoms such as a sore throat or impetigo.

As the immune system responds to the Strep A infection, people develop acute rheumatic fever, which can result in damage to the valves of the heart – RHD. This is particularly the case where there are multiple episodes of ARF.

Those with RHD or at risk of ARF can be treated with penicillin tablets or regular injections of Benzathine Penicillin G (BPG), though the regime is onerous. Patients require 13 BPG shots a year, usually for a decade or until the age of 21 or, in the most severe cases of RHD, until 40 or older.

Those with the disease can suffer strokes, and often have open heart surgery multiple times to repair and replace damaged heart valves.

The AMA said ensuring adherence to such treatment was difficult, particularly in the remote areas where many cases occurred. A study in the Northern Territory found that less than half of patients enrolled in a control program in 2013 received their required doses.

While urging action to improve the management of RHD, the AMA’s 2016 Report Card on Indigenous Health hasput the focus on prevention.

“RHD is an entirely preventable public health problem. [It] is not an intractable issue,” the Report Card said. “Its devastating impact can be halted within existing medical knowledge.”

It has recommended that governments commit to preventing any new cases of RHD by 2031, including the goal that by 2025 no child will die of ARF or its complications.

The AMA said achieving such a target would make an “important and necessary” contribution to close the gap in life expectancy gap between Indigenous Australians and the rest of the community.

Three activities were critical: preventing Strep A infection, detecting and treating such infections early, and using BPG shots to prevent re-infection.

The country was at a “unique juncture” to deliver on such a commitment, the medical organisation said, not least because the NHMRC-funded End Rheumatic Heart Disease Centre of Research Excellence was due in 2020 to deliver a report which would form the basis of a comprehensive strategy to end RHD as a public health problem.

But it has already identified some key steps, most importantly improvements in Indigenous living conditions.

“The Strep A bacterium thrives and spreads in overcrowded conditions,” the AMA said. “Conversely, dramatic falls in the rates of ARF/RHD have been observed as social and environmental conditions improve. Improving overcrowded and unhygienic conditions is key to stopping new cases of RHD.”

In its Report Card, the AMA called for action to:

  • make RHD a notifiable disease and create a national register;
  • ensure Indigenous community partnership and engagement;
  • adopt a broad, multisectoral approach;
  • closely target prevention efforts; and
  • support research into a Strep A vaccine.

“The necessary knowledge to address RHD has been around for many decades, but action to date has been totally inadequate,” Dr Gannon said.

The AMA is a foundation member of the END RHD Coalition, a nationally-funded research collaboration established to identify ways to tackle the disease.

It includes the Australian Heart Foundation, the National Aboriginal Community Controlled Health Organisation, RHD Australia and the Centre for Research Excellence to End RHD.

Federal Labor welcomed the release of the AMA Report Card and called on the Turnbull Government to commit to tackling RHD.

Adrian Rollins




Published: 12 Dec 2016