A dramatic increase in funding will be needed to eradicate a disease which stems from poverty in Australia's Indigenous community, according to a leading paedeatrician.
The federal government has committed to ending rheumatic heart disease by 2030, but advocates are adamant the goal will not be met unless there's a major increase in investment and a radical shift in the way overcrowding is tackled in remote communities.
The disease starts with repeated strep A infections which damage the heart over time, leading to serious illness and death.
While the disease is no longer an issue in mainstream Australia, it disproportionately impacts Indigenous people, particularly women, in places like the Kimberley, Northern Territory and outback Queensland and South Australia, where overcrowding and poverty are entrenched.
Experts warn the current trajectory of new diagnoses means more than 8,000 Indigenous people are expected to develop the disease in the next decade, leading to the deaths of about 600 people.
Commonwealth funding is largely targeted towards treatment, a task made difficult by cultural barriers and logistical challenges.
Remote health workers and specialists who research the disease nationally say overcrowding and poverty among Indigenous Australians must be tackled meaningfully if the 2030 goal has any chance of being achieved.
'We are going to miss the target'
Telethon Kids Institute director Jonathan Carapetis helped develop a blueprint for eradicating the disease.
He said the Coalition's investment of $25 million through to mid-2025 fell dramatically short of the more than $600 million needed to fully fund the strategy for the decade.
"There's no doubt, not only are we going to miss the target but things are going to get worse," Professor Carapetis said.
Labor has pledged to continue existing funding for the disease with an additional $12 million towards the National Aboriginal Community Controlled Health Organisation and $1.5 million for portable echo-cardio machines in remote communities.
Commonwealth urged to improve remote housing
Cases are frequently emerging in Kimberley towns and remote communities at much higher rates than the rest of Western Australia at a time when local leaders say overcrowding is at crisis point.
The eradication strategy highlights overcrowding as a precursor for the poor hygienic conditions that fuel repeated strep A infections.
"Overcrowding in housing is not being fixed in the Kimberley and it's not being fixed in any remote Aboriginal community and it's not being taken seriously," Professor Carapetis said.
It came after the Commonwealth ended its remote housing national funding partnership, arguing it was a state responsibility.
However a half a billion dollars has continued to flow into the Northern Territory which the federal government said faced unique challenges.
If elected, Labor has pledged $200 million towards the repair, maintenance and improvements of housing in remote Indigenous communities.
Governments urged to better understand cultural shifts
Nirrumbuk environmental health workers Chicky Clements and Ray Christophers said they worked to improve the health of impoverished Indigenous people in the Kimberley.
They said governments and bureaucrats needed to pay more attention to a cultural and generational shift in the way Indigenous people lived that was driving overcrowding in housing.
They said funerals, lore and seasonal movements could dramatically increase the amount of people living in a single household at short notice.
"I think we've changed our way of living," Mr Christopher said.
He said there were more people living in homes.
"The infrastructure is at its capacity."
He said there were young people taking over houses who had never had a house before.
"Now they have kids of their own," he said
"[It's] sort of hard for them to identify the maintenance issues that need to be done."
Poverty helps disease flourish
Mr Clements said Nirrumbuk recently tackled the root causes of rheumatic heart disease through a Commonwealth-funded pilot program by educating people living in at-risk households.
"A lot of these strep A infections come from sores and broken skin… through the yards and mosquitoes… the little things which start with a bite or scratch," he said.
He said it stemmed from poverty.
He said the pilot program needed long-term funding to have a real impact.
"The sad thing with those pilots was people got on board with it, listened to the education, took in the knowledge, but once the pilot finishes… it stops," Mr Clements said.
Mr Christophers said while the solutions were complex, at a basic level, those at-risk of the disease needed to be empowered to view a healthy life as something attainable.
"When you talk to people (about skin sores) they say 'that's been like that for months'," Mr Christophers said.
"They just live with it and accept it. The sores become normalised."
