The Burden of Disease
A Global Picture
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The past 60 years have seen a momentous decline in the prevalence of ARF and RHD throughout industrialised nations. This has primarily come about from an improvement in socioeconomic conditions (meaning that general living standards are better) and easier access to health care [1]. Nevertheless, the developing world and Indigenous populations in many developed countries are yet to share in experiencing this disease decline. There are at least 15.6 million people suffering from RHD in the world right now [2]. In addition to this, 1.9 million people are living with a history of at least one episode of ARF, there are 470,000 new cases of ARF diagnosed each year and 230,000 annual deaths from RHD [2]. The experience of the globe's poorest people is truly overshadowing the success achieved within industrialised nations, as RHD is the most common paediatric heart disease in the world [3].
References
[1] Colquhoun SM, Condon JR, Steer AC, Li SQ, Guthridge S, Carapetis JR. Disparity in Mortality From Rheumatic Heart Disease in Indigenous Australians. J Am Heart Assoc. 2015;4(7):1-9.
[2] National Health and Medical Research Council. A guide to the development, implementation and evaluation of clinical practice guidelines [Internet]. National Health and Medical Research Council [cited 2017 Feb 14]. Available from: https://www.nhmrc.gov.au/_files_nhmrc/publications/attachments/cp30.pdf.
[3] Carapetis JR, Brown A, Wilson NJ, Edwards, KN. An Australian guideline for rheumatic fever and rheumatic heart disease: an abridged outline. Med J Aust. 2007;186(11):581-6.
[4] Parnaby MG, Carapetis, JR. Rheumatic fever in Indigenous Australian children. J Paediatr Child Health. 2010;46:527-33.
[5] Australian Institute of Health and Welfare. Rheumatic heart disease and acute rheumatic fever in Australia: 1996-2012 [Internet]. 2013 [cited 2017 Feb 14]; AIHW cat. no. CVD 60. Available from: http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129542747.
[6] Closing the Gap on Indigenous Disadvantage: The Challenge for Australia [Internet]. Department of Social Services [cited 2017 Feb 14]. Available from: https://www.dss.gov.au/sites/default/files/documents/05_2012/closing_the_gap.pdf.
[7] White H, Walsh W, Brown A, Riddell T, Tonkin A, Jeremy R, et al. Rheumatic Heart Disease in Indigenous Populations. Heart Lung Circ. 2010;19(5):273-81.
[8] Aboriginal and Torres Strait Social Justice Commissioner. Social Justice Report – 2nd Report, 1994. Canberra: Australian Government Publishing Services (AGPS); 1995.
The Burden on Indigenous Australians
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In Australia, ARF and RHD are almost exclusively restricted to Indigenous people living in rural and remote areas of far north Queensland (QLD), the Torres Strait, Northern Territory (NT) and the Kimberley and Pilbara regions of Western Australia (WA) [4]. While estimating the national burden of disease is difficult because the collected data is state or territory-specific, NT provides a good snapshot of the current situation because the most data is recorded in this region and it has the highest proportion of Indigenous people in the population (30.4%) [5].
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Despite comprising just over 30% of the population, 98% of ARF cases in NT between 2005 and 2010 involved Indigenous Australians [4]. Of all Aboriginal people living in NT, 2% have RHD including 3% of young adults [5]. As both Figure 1 and Figure 2 below demonstrate, the number of cases and deaths per 100,000 people is astronomically higher among Indigenous people across all age groups, even within the youngest age interval. Given that RHD is typically regarded as a disease present among older generations, these statistics relating to the Indigenous youth are extremely alarming.
Figure 1. Rheumatic heart disease prevalence rates in the Northern Territory, by age and Indigenous status, 2010. Obtained from the Australian Institute of Health and Welfare [5].
Figure 2. Rheumatic heart disease death rates, underlying cause, by Indigenous status and age, 2004-2007. Obtained from the Australian Institute of Health and Welfare [5].
Other things you need to know:
Why is it important to address this national and global health issue?
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ARF and RHD are completely preventable diseases and are therefore important to understand and investigate [5]. Indigenous Australians are already significantly disadvantaged with respect to life expectancy, child mortality, access to childhood education, educational achievement and employment outcomes [6]. The burden of additional health problems merely serves to widen this gap. For example, if ARF and RHD were eliminated from the Indigenous population, more children would be able to attend school, improve their chances of employment and sustain a standard of living compatible with a higher life expectancy.
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However this health issue is not limited to Australia. The Maori people of New Zealand, for instance, suffer dismally higher prevalence and incidence rates of ARF and RHD compared to their colonisers of European descent [7]. Addressing such an issue in Australia would provide a platform to effect culturally-appropriate change among equally as disadvantaged groups around the world. Further, these approaches could be applied to other neglected diseases that are also completely preventable such as a range of tropical infections.
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As an aside, health problems arising from RHD remain in both Indigenous and non-Indigenous elderly populations due to the higher rates of ARF across the entire population when that generation was younger [5]. This results in a significant number of people who need medical procedures. between 2009 and 2010 alone, approximately 1,200 people in Australia over 15 years of age required a heart valve procedure to be performed [5].
Posted 14th February, 2017
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"There should be no mistake that the state of Indigenous health in this country is an abuse of human rights. A decent standard of health and life expectancy equivalent to other Australians is not a favour asked by our peoples. It is our right - simply because we too are human." - Aboriginal and Torres Strait Islander Justice Commissioner, Social Justice Report [8]
Note: Individual images used in the info-graphic above were sourced from Google Images: https://images.google.com/?gws_rd=ssl