Rheumatic fever – treat the cause

Written By: - Date published: 8:02 am, November 8th, 2016 - 14 comments
Categories: class war, health, housing, poverty - Tags: , , , ,

Rheumatic fever is one of the diseases of poverty that shame this country. There has been at least some attempt to address this particular disease – with mixed results:

Rheumatic fever rates fail to fall in central Auckland, Waitemata

The Government is reshuffling money to bolster its rheumatic fever prevention programme throughout much of greater Auckland after officials admitted targets are not being met.

In the year to June, the 31 new cases of the potentially fatal disease in the Waitemata and central Auckland health districts were at least double the target level. …

At least double the target level – and rising. See the full piece for various graphs.

“Most regions are seeing reductions in rheumatic fever,” said [Green] co-leader Metiria Turei, “but not in Auckland, where we know there are large numbers of people living in overcrowded, cold, damp and mouldy homes, and in cars and garages.”

The fact that most regions are showing reductions is good news, and a credit to the programme. But Turei is right about the regions that are getting worse. RNZ gets straight to the point:

Housing crisis blamed for Auckland’s rheumatic fever rates

The government is failing to make a dent in rheumatic fever rates across much of Auckland, despite millions of dollars being poured into tackling the problem.

The government has dedicated $65 million to its Rheumatic Fever Prevention Programme, which started five years ago with the aim of slashing incidents of the disease.

Though rates are falling across the country, children are still contracting the disease in the same numbers in the Waitemata and Auckland district health board (DHB) areas.

Under the Ministry of Health targets, Auckland DHB should have had seen seven new cases in the past 12 months. Instead it had 19 – two more than when the programme began.

It was a similar case in Waitemata which had around 12 cases last year – more than double its target number.

A prominent Auckland GP and the leader of a successful south Auckland prevention programme, Rawiri Jansen, said the DHBs were fighting against an increasing tide of child poverty and crowded housing.

“The key driver of acute rheumatic fever is housing and I think it is well known that there are concerns about he household crowding areas in wider Auckland. That may be the area where we need to increase our effort,” he said.

He said rates of the disease may actually have increased had the prevention programme not been in place. ….

Rheumatic fever is increasing in Auckland because poverty, poor housing and overcrowding are increasing. There’s only so far you can go with an ambulance at the bottom of the cliff. To treat the diseases of poverty you need to treat the cause.

14 comments on “Rheumatic fever – treat the cause”

  1. left_forward 1

    This is really tragic for Auckland.
    We are seeing very good progress in Northland with only one new case last year – a dramatic drop. It isn’t just as a result of Govt investment however (although they like to claim all the success), but the excellent throat swabbing performance, including financial support from Maori and community based health providers, well supported by schools, particularly in rural Maori communities. But why are the rates of this debilitating and lethal childhood illness in Auckland heading in the opposite direction?
    It is widely accepted that housing and poverty are the two main determinants.
    But there may well be another factor:
    While the Government has made an investment, the health care providers have actually been funded very poorly for what has been expected of them. If it wasn’t for the value added commitment of the communities themselves, I don’t think Northland would have been so successful – up to now at least.

    • Bill 1.1

      It is widely accepted that housing and poverty are the two main determinants

      Over crowding probably increases strep infection rates. If you want to tie poverty into that, then sure – ie, poorer people might tend to live in more crowded conditions.

      But still. From what I gather, a simple course of antibiotics deals with strep and if strep is dealt with, then voila! – no rheumatic fever.

      But how often is a sore throat just a sore throat and how often are other sore throats just ‘left be’ on that assumption, but they turn out to be strep and then (for some) rheumatic fever?

      And I’d be interested in the breakdown of rheumatic fever or strep by household rather than by population. The UK has a rheumatic fever rate of about 1 in 100 000. NZ ‘should’ have about 50 cases per year by that measure. Seems the number of cases is higher. I wonder if numbers of infected households compare?

      Anyway, on the over-crowding front, also wondering what contribution class rooms make. (Johnny had a sore throat. There were 40 other school kids in his class….). Or those gawd awful, somewhat heaving shopping malls? What about supermarkets where workers on low pay with very limited sick leave might have strep and turn up to stack (say) the veg isles…and sneeze?

      And so it goes.

      • stunned mullet 1.1.1

        The strong push from PHARMAC and microbiologists not to prescribe antibiotics for sore throats in the past years may have had some perverse effects on the numbers of rheumatic fever cases that are now popping up.

  2. Draco T Bastard 2

    To treat the diseases of poverty you need to treat the cause.

    True but which political party is willing to stand up and say that they’re getting rid of capitalism?

  3. Michelle 3

    To treat the diseases of poverty exacerbated by the gnats policies we need another government that actually cares

  4. inspider 4

    If rheumatic fever rates are thr fault of National policies, why are rates lower today than under the whole of the last government? Why did rates go up after the introduction of working for families?


    I agree it’s about poverty but why is it almost non existent south of taupo? And why are rates declining on target in the maori community but not the Polynesian?

    Looks a lot more complex than “it’s da nats!”

    • r0b 4.1

      If rheumatic fever rates are thr fault of National policies, why are rates lower today than under the whole of the last government

      Rates rose from 2008 – 2009 on (here, slide 7, here Fig 27). That triggered a significant programme since 2012 so rates have now fallen nationally. They are not lower in Auckland and Waitemata – as per the OP.

      Yes, it is complex, but the post doesn’t say “it’s da nats!”, it says “There’s only so far you can go with an ambulance at the bottom of the cliff. To treat the diseases of poverty you need to treat the cause.”

      • inspider 4.1.1


        Not sure where you are getting your data, but in my link above it shows that rates started growing in absolute and per capita terms from 2002. The growth looks slightly stronger in the 2005-09 period but the trend is fairly even. It peaked in 2013. Ok it’s not on target overall but it is for maori, and rates are now lower than it has ever been. It is not really fair to cherry pick two data points and say it’s rising when you can clearly see there is a lot of statistical noise in the historic record and the trend is very clear.

        Oh and it was supposed to be a response to Michelle’s comment not your post

        • dv

          On the graph, the incidence is the same as in 1878.

        • McFlock

          There’s a slight mismatch between the two of you in that inspider’s MoH link prioritises first hospitalisations whereas R0b’s two figures involve total hospitalisations, including recurring admissions (but it’s not actually a huge difference to numbers or trends).

          Looking at the xls download from MoH, one thing that took me aback (vaguely recall it doing so previously as well) is that the bulk, as in maybe 80/90% of cases, are in Maori or Polynesians. A completely insane disproportionate representation.

          But anyway, it looks to me like one of the problems we all swept under the carpet because of the low numbers, then the GFC comes along and the uptick throws not just it but our systemc demographic abuse in our faces.

          With relatively low overall states for morbidity there is a tendency to focus on other areas and view cases as “expected background radiation”, not noticing that some doctors might be dealing with such cases routinely. And they’re mostly preventable cases, is the indictment: crowding.

          We need to sort out the housing crisis.
          Not piecemeal, but now. This problem’s been festering for decades, and now it’s in our faces.

  5. JonL 5

    Rheumatic fever – good god, I thought that was a disease of Dickensian style third world countries stricken with poverty, not something you’d expect to see in a “modern, first world” country that looks after it’s citizens.

    Oh wait…………

    • miravox 5.1


      Throat swabbing programmes are all very good, but it would be nice if the government had a plan to treat the cause of strep throat that leads to rheumatic fever. But that would require working on cold and damp homes that reduce resistance to colds and fevers; and the inadequate housing supply that leads to over-crowding and shared sneezed and coughed droplets – especially when kids are sleeping together. As well, incomes need to be addressed to enable people to afford good food and to properly dry clothes and towels in winter and reduce sharing of these things. Would also be cool if each kid had their own flannels and towels that were able to be regularly and completely washed and dried (this would also reduce horrid skin infections too).

  6. Simon 6

    The writer needs to learn thr difference between causation and correlation.

    Personally I’m stoked to see some traction here…mych preferable to Laboye/Atden waffling on about measuring poverty for 8 or so years.

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