Research priorities for the primordial prevention of acute rheumatic fever and rheumatic heart disease by modifying the social determinants of health

Michael G Baker; Mary Y Masterson; Maylene Shung-King; Andrea Beaton; Asha C Bowen; Geetha P Bansal; Jonathan R Carapetis

doi:10.1136/bmjgh-2023-012467

Research priorities for the primordial prevention of acute rheumatic fever and rheumatic heart disease by modifying the social determinants of health

BMJ Glob Health. 2023 Oct;8(Suppl 9):e012467. doi: 10.1136/bmjgh-2023-012467.

Authors

Michael G Baker¹, Mary Y Masterson², Maylene Shung-King³, Andrea Beaton^{4

5}, Asha C Bowen^{6

7}, Geetha P Bansal⁸, Jonathan R Carapetis^{6

7}

Affiliations

¹ Public Health, University of Otago Wellington, Wellington, New Zealand michael.baker@otago.ac.nz.
² Center for Translation Research and Implementation Science (CTRIS), National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA.
³ Health Policy and Systems Division, School of Public Health, University of Cape Town, Rondebosch, Western Cape, South Africa.
⁴ Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
⁵ Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
⁶ Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia, Australia.
⁷ Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia.
⁸ HIV Research and Training Program, John E Fogarty International Center, Bethesda, Maryland, USA.

Abstract

The social determinants of health (SDH), such as access to income, education, housing and healthcare, strongly shape the occurrence of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) at the household, community and national levels. The SDH are systemic factors that privilege some more than others and result in poverty and inequitable access to resources to support health and well-being. Primordial prevention is the modification of SDH to improve health and reduce the risk of disease acquisition and the subsequent progression to RHD. Modifying these determinants using primordial prevention strategies can reduce the risk of exposure to Group A Streptococcus, a causative agent of throat and skin infections, thereby lowering the risk of initiating ARF and its subsequent progression to RHD.This report summarises the findings of the Primordial Prevention Working Group-SDH, which was convened in November 2021 by the National Heart, Lung, and Blood Institute to assess how SDH influence the risk of developing RHD. Working group members identified a series of knowledge gaps and proposed research priorities, while recognising that community engagement and partnerships with those with lived experience will be integral to the success of these activities. Specifically, members emphasised the need for: (1) global analysis of disease incidence, prevalence and SDH characteristics concurrently to inform policy and interventions, (2) global assessment of legacy primordial prevention programmes to help inform the co-design of interventions alongside affected communities, (3) research to develop, implement and evaluate scalable primordial prevention interventions in diverse settings and (4) research to improve access to and equity of services across the RHD continuum. Addressing SDH, through the implementation of primordial prevention strategies, could have broader implications, not only improving RHD-related health outcomes but also impacting other neglected diseases in low-resource settings.

Keywords: Cardiovascular disease; Prevention strategies; Public Health; Review; Treatment.

Publication types

Review

MeSH terms

Humans
Primary Prevention
Research
Rheumatic Fever* / complications
Rheumatic Fever* / epidemiology
Rheumatic Fever* / prevention & control
Rheumatic Heart Disease* / epidemiology
Rheumatic Heart Disease* / etiology
Rheumatic Heart Disease* / prevention & control
Social Determinants of Health