At twenty-nine years old and training for a 2019 marathon, Cecilia Johns discovered her own heart valve was not working properly during a routine self-check, leading to an unexpected diagnosis of rheumatic heart disease despite having no prior symptoms of acute rheumatic fever, ABC News reported.
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- Rheumatic Heart Disease (RHD): Permanent damage to the heart valves caused by immune system reactions triggered by untreated bacterial infections, specifically group A streptococcus.
- Acute Rheumatic Fever (ARF): The inflammatory predecessor to RHD, often starting from common childhood issues like tonsillitis or skin sores.
- Benzathine Penicillin: An injectable antibiotic administered every 28 days to treat early infections and prevent severe heart valve deterioration.
Global health leaders signing the Perth Declaration at a public health conference in Perth aimed to eliminate ARF and RHD globally by 2040, drawing sharp criticism toward Australia over persistent high rates among First Nations communities.
World Health Federation head Jagat Narula told delegates that Australia operates a world-class health system, making resource scarcity an invalid excuse for poor outcomes. “This is not a disease of poor countries, it is a disease of poor conditions,” Narula stated, highlighting that poor living conditions persist because societies tolerate them.
First Nations Australians account for roughly four in five cases in the country and die from RHD at more than five times the rate of non-Indigenous Australians, with highest infection rates concentrated in children aged five to fourteen.
Aunty Vicki Wade, associate professor at Menzies School of Health Research, stated that certain Indigenous communities endure substandard health, housing, and education services. “This disease typifies Australia’s failure to look after one of the oldest living cultures in the world,” Wade said, describing the emotional toll of identifying the condition in three-year-old children.
Heart Foundation Australia chief medical advisor Garry Jennings noted that while ARF is easily treated with benzathine penicillin, success depends entirely on active community screening and regular surveillance. Narula criticized the federal government for committing only a fraction of the $689 million required to fund the national Endgame Strategy designed to eradicate RHD by 2031.
Assistant Indigenous Health Minister Rebecca White stated that the federal government invested $95.8 million over a six-year period announced in 2021, alongside actions to secure alternative Pharmaceutical Benefits Scheme medicines during shortages and supply Aboriginal health services directly.
Similar disparities affect Māori and Pasifika populations across New Zealand and the Pacific Islands, where reporting systems remain fragmented and workforce shortages hamper diagnostic testing.
Joshua Agnew, a general paediatrician in Tauranga, Aotearoa/New Zealand, stated that international cooperation is essential to overcome workforce limitations and secure equitable access to medications and testing. The Perth Declaration calls for long-term government funding, investments in housing and environmental health, support for Indigenous community-controlled organizations, antibiotic supply security, and systematic patient registries.
| Demographic Group | Affected Population / Risk Factor | Key Clinical Challenge |
|---|---|---|
| Māori Populations | Roughly 26 times more likely to be hospitalised for first ARF case | Equitable healthcare access and systemic workforce shortages |
| Pacific Islanders | Estimated 1 to 3 percent prevalence | Lack of robust reporting systems and diagnostic data collection |
Patients with known hypersensitivity or severe allergic reactions to penicillin must avoid benzathine penicillin formulations, requiring alternative antibiotic regimens managed strictly under specialist care. Anyone experiencing recurring sore throats, skin sores, joint pain, or unexplained fatigue, particularly in high-prevalence regions or communities, should immediately consult a primary healthcare provider for an evaluation and echocardiographic screening to rule out acute rheumatic fever and early valve involvement.
“Unless that is taken seriously and some money is put behind it … and we look at housing, education and how Aboriginal people are treated in these communities, I don’t feel like we’re going to make that deadline,” Wade stated regarding the 2040 elimination target.
- World Health Organization (WHO) – Rheumatic Fever and Rheumatic Heart Disease Guidelines
- The Lancet – Global Epidemiology of Rheumatic Heart Disease
- World Heart Federation – Global Roadmap for Rheumatic Heart Disease
