Keywords:
Cariovasacular disease, Indigenous Health
Abstract: The choice of rheumatic heart disease (RHD) is telling: the disease is a striking marker of inequality, a novel lens for considering health systems and a feasible target for definitive disease control.
Stemming from childhood group A streptococcal (GAS) infections of the throat, and likely of the skin, RHD is a consequence of repeated episodes of acute rheumatic fever (ARF). In some young people, abnormal immune responses to GAS infection cause pathologic molecular mimicry — resulting in fevers, malaise and symptoms of the skin, synovium, brain and heart.2 The symptoms of ARF resolve, but damage to the heart valves persists and may be amplified with each subsequent GAS infection and ARF recurrence. RHD is characterised by established valve disease, which in turn causes heart failure, arrhythmia, stroke and infective endocarditis and increases cardiovascular risk in the peripartum period.2
In September 2016, the Australian Institute of Health and Welfare (AIHW) published the 3rd Australian Burden of Disease Study focusing on the health of Aboriginal and Torres Strait Islander Australians in 2011.3 The study measures burden in disability adjusted life years (DALYs) to quantify the combined fatal and non-fatal impact of individual diseases. Hidden in this report, covering some 200 specific diseases, are the data which demand action on RHD.