This edition of the Australian guideline for the prevention, diagnosis and management of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) has a new focus which places people with ARF and RHD, and their families and communities, at the centre of care. To achieve a value-based healthcare system that breaks down the complex and hierarchical structures based on Western ideologies, we must look at whose values are represented.
- Despite advances in medical treatment and management of ARF and RHD, the associated health benefits at population and community level have not been as evident for Aboriginal and Torres Strait Islander peoples as they have for non-Indigenous Australians. These challenges are more than biomedical and are driven by the social, cultural and environmental determinants of health.
- Aboriginal and Torres Strait Islander peoples with RHD are dying young as a direct consequence of their disease. In contrast, nonIndigenous people with RHD are living longer with their disease and are dying from other or associated causes. Non-Indigenous people are also more likely to be the survivors of a time when RHD was relatively common. People who had severe disease at that time would be less likely to have survived to the current time.
- The socioeconomic and political factors that influence people’s lives can cause structural barriers and inequalities in health. These social determinants of health within an Indigenous cultural context have profound impacts on health and wellbeing.