15NRHC Recommendation - 03/25/2019 - 10:55

Conference delegates confirm our commitment for urgent and comprehensive action to Close The Gap in Aboriginal and Torres Strait Islander health and well-being.
- We are alarmed that Rheumatic Heart Disease is entirely preventable but it remains the greatest cause of cardiovascular disease inequality in this country, and that if Australia does not close the gap on RHD we cannot close the gap between Indigenous and non-Indigenous life and health outcomes
- We seek a public commitment from major political parties - prior to the Federal election - to substantial funding for community-led solutions as part of a comprehensive strategy to end RHD.
- We recognise that on-the-ground actions now on RHD will have much broader benefits in the prevention and management of other diseases including kidney, skin, eye, ear and respiratory disease.

Recommendation Type: 


The early signs of RHD include topical sores treated by topical antibiotics (eg Bactroban (r)) which are not covered by PBS and therefore CTG. The oral antibiotic (Flucloxacillin liquid) has short shelf life once mixed, requires refrigeration and qid dosing. The community pharmacy can provide options in areas of high prevalence of RHD utilising the s100 (extra PBS) system. Pharmacy organisations and pharmacy schools must be involved to make this first step more easily managed.
Pharmacists also should be alerted to the need to manage and refer these topical sores in high prevalence RHD areas.

There are often onerous KPI requirements dictated to Aboriginal Community Controlled Health Organisations (ACCHOS) that can influence where ACCHOS focus there efforts. In some of the very remote communities we work in there are requirements to do monitoring for KPIs that are not necessarily the priorities of the community (eg the communities are more concerned about RHD than eye disease). I suggest that remote Aboriginal Communities should be able to set their own priorities with respect to addressing their specific health needs rather than being forced to meet state/territory and federal mandatory KPIs.

The resolution should include a strong commitment to act on housing and environmental health otherwise there is a risk of a focus on biomedical solutions rather than addressing the root causes. To complement this resolution, there needs to be a resolution committing to equitable well funded Aboriginal community controlled primary health care services- as mentioned in the presentation, clinics are often overwhelmed - and this is due to under funding relative to the burden of disease.

Addressing health workforce is critical. As is addressing education around infectious disease. Re-introducing school nurses to high risk communities sounds like a good first step. More importantly increasing number of aboriginal health workers and community workers. Addressing housing will not only reduce infectious disease but will improve school attendance with its flow on affect around productivity and positive impact on economy. Investment is critical.

Inclusion of attention to and genuine investment in improving environmental health determinants in a culturally responsive way must be integrated in any call to action for the raft of preventable conditions from arf and RHD to psgn to scabies, skin sores and other neglected tropical diseases. Let's not forget empowerment and self determination at the individual, household and community level in this.