Future Challenges
References
[1] Brennan B. Closing the Gap: Malcolm Turnbull says Indigenous health and wealth progress ‘not enough’ [Internet]. Ultimo, NSW (Australia): Australian Broadcasting Commission; 2017 [cited 2017 Feb 25]. Available from: http://www.abc.net.au/news/2017-02-14/closing-the-gap-malcolm-turnbull-indigenous-progress-not-enough/8268736.
[2] Markbreiter J. RHD Global Status Report 2015-17 [Internet]. World Heart Organisation [cited 2017 Feb 25]. Available from: http://rhdaction.org/sites/default/files/RHD%20Global%20Status%20Report%202015-17.pdf.
[3] Maguire GP, Carapetis JR, Walsh WF, Brown ADH. The future of acute rheumatic fever and rheumatic heart disease in Australia: Can we be optimistic? Med J Aust. 2012;197(3):133-4.
[4] Australian Institute of Health and Welfare. Rheumatic heart disease and acute rheumatic fever in Australia: 1996-2012 [Internet]. 2013 [cited 2017 Feb 9]; AIHW cat. no. CVD 60. Available from: http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=60129542747.
[5] Dickinson H, Gillespie J, Woods M, Moodie R, Duckett S. Federal budget 2016: health experts react [Internet]. The Conversation (Australia); 2016 [cited 2017 Feb 25]. Available from: http://theconversation.com/federal-budget-2016-health-experts-react-58638.
[6] Altman JC, Jordan K. Impact of Climate Change on Indigenous Australians: Submission to the Garnaut Climate Change Review [Internet]. Canberra: Centre for Aboriginal Economic Policy Research; 2008 [cited 2017 Feb 25]. Available from: http://caepr.anu.edu.au/sites/default/files/Publications/topical/Altman_Jordan_Garnaut%20Review.pdf.
[7] Cousins S. Tacking rheumatic heart disease in Indigenous Australians. Lancet. 2016;388(10040):e1.
[8] Rémond MGW, Wheaton GR, Walsh WF, Prior DL, Maguire GP. Acute Rheumatic fever and Rheumatic Heart Disease – Priorities in Prevention, Diagnosis and Management. A Report of the CSANZ Indigenous Cardiovascular Health Conference, Alice Springs 2011. Heart Lung Circ. 2012;21:632-8.
Posted 25th February, 2017
Overcoming systemic disadvantage
The single greatest challenge to eradicating ARF and RHD among Indigenous Australians is to address the complex issues of socioeconomic disadvantage that have existed since colonisation and span many generations.
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Unfortunately Australia has fallen behind on its target to "close the gap" between the non-Indigenous and Indigenous populace in a number of areas including child mortality, school attendance and employment [1]. As systemic disadvantage is a multidimensional problem, such lack of progress will inevitably hinder success in eradicating RHD looking ahead.
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An image on the right also revises the main geographical factors that have intensified systemic disadvantage and are likely to persevere as future challenges.
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Additional challenges to anticipate
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Different jurisdictions are progressing at different rates
New South Wales has the greatest population of Indigenous people in Australia, yet has no RHD register in place. Victoria, Tasmania, South Australia and Australian Capital Territory also have no register-based control programs, seriously limiting the potential for these jurisdictions to prevent or control ARF and RHD into the future [2].
Australia's urban boom
As more people flock from regional areas towards the major cities, remote Indigenous communities are likely to become even more neglected in the political decision-making progress. Increased urbanisation also threatens the multidisciplinary care linking urban-based specialist units, rural health care providers and communities [3].
Reduced health expenditure
A mere 0.1% of all governmental health expenditure in Australia is allocated to ARF and RHD [4]. Further, some economic commentary has suggested that the current annual health expenditure growth rate of 5% is not sustainable [5]. This could detrimentally impact the continued funding of prevention and control initiatives into the future.
Climate Change
Projected changes in the Earth's climate will increase the frequency of natural disasters such as cyclones in regions that are populated by Indigenous communities susceptible to ARF and RHD. Extreme weather events could isolate communities, destroy housing and reduce sanitation levels, amplifying barriers that already exist [6].
An Expert Opinion: Directions for the future in light of difficulties
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Johnathan Carapetis is the director of the END RHD Centre for Research Excellence and head of the Telethon Kids Institute, as well as being a leading researcher on this issue. He believes that one of the biggest challenges will be convincing governments to invest adequate resources into control programs [7]. When the Rheumatic Fever Strategy was established by the Australian Government in 2009, only a bare minimum of funding was provided to maintain a register of cases. Carapetis believes that "the danger here is that people judge the current program as being a success or failure without putting the right resources in to achieve success" [7].
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Improvements in nutrition, hygiene and overcrowding are also regarded by Carapetis as a crucial priority: "Existing resources can start targeting high-risk families and looking at living conditions. We want to see housing overall improve" [7].
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Primary prevention will likely prevail as a future challenge due to the often asymptomatic nature of sore throats and skin sores, preventing early treatment. Echocardiograms may signify a promising, cost-effective approach for RHD screening in schools, however further research is required to evaluate the full potential of this [7,8].
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Perhaps most importantly, more Australians need to start engaging in discussion about how they can act as a catalyst for change. As Carapetis says,
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"It's time we started talking about eliminating the disease. It will take a generation, but we should be able to do it - we've got the resources... If you want to 'close the gap', then this is the disease we have to combat" [7].
Note: Images in the graphic above were sourced from Google Images: https://images.google.com/?gws_rd=ssl