Perth heart declaration sets 2040 goal as First Nations funding and housing gaps persist

A global declaration endorsed in Perth has set a 2040 goal to eliminate rheumatic fever and rheumatic heart disease as a public health problem, putting renewed pressure on Australia to address the housing conditions, health-service gaps and funding shortages behind its high burden among First Nations people. The World Heart Federation confirms the declaration was launched and endorsed at the congress closing ceremony on 14 November.

The Perth Declaration argues that prevention, detection and treatment are already understood. Its central challenge is delivery: governments need sustained investment, political commitment, and a transfer of resources and decision-making power to the communities most affected. The target is elimination as a public health problem, not a claim that the bacteria causing the original infections will disappear worldwide.

An unexpected diagnosis before a marathon

Cecilia Johns discovered she had rheumatic heart disease while preparing for her first marathon in 2019. After helping screen children at the health service where she worked, she volunteered for a check herself. The echocardiogram showed a heart valve functioning abnormally, and she could hear evidence of blood flowing backwards through it.

She was 29, physically fit and apparently healthy, with no recognised symptoms of rheumatic heart disease or the acute rheumatic fever that can precede it. She wondered whether childhood tonsillitis and eczema-related skin sores had played a part, but that possible link had not been raised during her regular check-ups. That is her suspected history, not proof of the infection that caused her disease. She has since completed marathons from Alice Springs to New York.

The burden falls unequally

Australian registers in five states and territories recorded 11,800 people living with rheumatic heart disease and/or a history of acute rheumatic fever in 2024. About four in five were First Nations people. First Nations Australians die from rheumatic heart disease at more than five times the rate of non-Indigenous Australians, and the highest acute rheumatic fever rates are among First Nations children aged five to 14.

Rheumatic heart disease is lasting damage to heart valves following one or more episodes of acute rheumatic fever. That inflammatory illness can follow an untreated group A streptococcal infection. Prevention therefore depends on recognising and treating infections, avoiding repeated rheumatic fever and addressing the conditions that allow infections to spread.

Crowded homes, inadequate washing facilities and lack of reliable clean water can help throat and skin infections spread. At the Perth congress, World Heart Federation president Jagat Narula criticised the persistence of preventable disease within a wealthy country with a universal, well-funded health system. His argument was that poverty of living conditions, rather than simply national wealth, explains why the disease remains.

Senior Noongar woman Aunty Vicki Wade, an associate professor at the Menzies School of Health Research, said some communities lacked adequate health, housing and education services. She described the distress of diagnosing rheumatic heart disease in a three-year-old who would need an injection every 28 days, and said Australia's response reflected a failure to care properly for one of the world's oldest living cultures.

Screening, penicillin and the Australian funding gap

Heart Foundation chief medical adviser Garry Jennings called for better community screening, surveillance and early access to benzathine penicillin. The aim is to identify people at risk before serious valve damage develops and ensure they receive the antibiotics they need. Antibiotic prevention and treatment do not mean established permanent valve damage simply disappears.

Australia's Endgame Strategy aims to end rheumatic heart disease by 2031. Narula said only a small portion of the estimated A$689 million needed had been committed. The federal government says it is investing A$95.8 million in prevention and treatment, funding announced in 2021 for spending over six years. The figures describe different scopes and should not be mistaken for a newly announced full funding package.

Assistant Indigenous Health Minister Rebecca White said alternative Pharmaceutical Benefits Scheme medicines had been made available during the continuing shortage, and the government was working with Aboriginal health services to supply eligible medicines directly to patients. She also said prevention required action on housing, sanitation and wider living conditions, rather than medication alone.

Pacific health systems face connected challenges

Māori and Pasifika peoples also face high rates of acute rheumatic fever and rheumatic heart disease. Māori people are about 26 times more likely than non-Māori people to be hospitalised for a first episode of acute rheumatic fever. Estimates suggest 1 to 3 per cent of Pacific Island populations have rheumatic heart disease, but limited reporting systems make the true burden difficult to measure.

Tauranga paediatrician Joshua Agnew said each Pacific country had different circumstances, but workforce shortages and fair access to medicines and diagnostic testing remained recurring problems. Reducing the burden requires international political commitment as well as improvements within individual health systems.

What the declaration asks governments to do

The declaration calls for national control programmes backed by long-term, multi-year funding, investment in housing, water and environmental health, and resources for Aboriginal and Torres Strait Islander community-controlled health organisations to design and deliver programmes. It also seeks a reliable supply of benzathine penicillin G, registration of every diagnosed person and active follow-up rather than leaving patients to find care on their own.

For a Strep A vaccine, it asks partners to agree a regulatory pathway by 2028 and finance phase-three trials to begin by 2031. A peer-reviewed technical paper due within 12 months will define the thresholds for elimination. Another milestone is to reduce deaths from rheumatic fever and rheumatic heart disease among people under 25 by at least 50 per cent by 2035, compared with 2025, in countries with established surveillance.

The declaration was developed through the Second World Congress on Rheumatic Heart Disease, convened in Perth from 11 to 14 November by the World Heart Federation and the National Heart Foundation of Australia. It brings together the experience of people living with the disease, clinicians, researchers, advocates and policymakers. Its endorsement roll remains open to ministers, parliamentarians and organisations.

Globally, about 55 million people live with rheumatic heart disease and more than 360,000 die each year. Narula urged affected countries to act quickly; Heart Foundation chief scientific and medical officer Derek Chew said the causes and solutions were known and world leaders needed to deliver. Wade cautioned that Australia's deadline would be missed unless governments funded the existing strategy, addressed housing and education, improved how Aboriginal communities were treated and worked in genuine partnership with them.