Primordial prevention means reducing risk factors for disease by addressing the social determinants of health which cause or increase the risk of the disease in a population. For example: reducing the opportunity for streptococcal (Strep A) infections in people who are at risk of acute rheumatic fever (ARF) and rheumatic heart disease (RHD).1^,2

Social determinants are the circumstances in which people live, and they are influenced by environmental, cultural, social and political systems.3 If the systems that influence the way people live are strong and well-supported, the risk of disease is reduced. Examples include healthy housing and sanitation, reduced household crowding, cultural safety, access to quality education and employment, and access to health services.4 These measures are known to reduce the rates of ARF and RHD in the population.5^,6

It may take some time for all the key factors to be addressed and remedied for communities who continue to experience high rates of ARF and RHD. In the meantime, specific strategies are needed to address these underlying drivers of ill health. This includes action on the indirect determinants of health (including racism, discrimination, education, and economic exclusion) along with focused action on the direct determinants of health, such as inadequate housing and hygiene infrastructure.

Healthy Living Practices

Nine Healthy Living Practices7 have been widely adopted in Australia as a framework for addressing the links between housing and health for Aboriginal and Torres Strait Islander peoples and used as a foundation for communities and governments to guide priorities for action.

Primordial prevention includes a range of improvements to living conditions that reduce poverty and over-crowding in populations at risk of ARF and RHD. There have been dramatic reductions in the rates of ARF and RHD in populations that have experienced improvements in socioeconomic and environmental conditions.

1. Washing People
2. Washing clothes and bedding
3. Removing wastewater safely
4. Improving nutrition, the ability to store prepare and cook food
5. Reducing the negative impacts of over-crowding
6. Reducing the negative effects of animals, insects, and vermin
7. Reducing the health impacts of dust
8. Controlling the temperature of the living environment
9. Reducing hazards that cause trauma

There is strong evidence that washing people and reducing the negative impacts of household crowding are strongly associated with reducing Strep A infections that can lead to ARF. Washing clothes and bedding is moderately associated with reducing Strep A infections and reducing the negative effects of animals, insects and vermin and reducing hazards that cause trauma reduce skin damage and lower the risk of Strep A skin infections.8

For more information, see Chapter 4 in the RHDAustralia 2020 Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease (3rd edition).

• 1. Coffey PM, Ralph AP, Krause VL. The role of social determinants of health in the risk and prevention of group A streptococcal infection, acute rheumatic fever and rheumatic heart disease: A systematic review. PLOS Neglected Tropical Diseases 2018;12(6): e0006577. View Source 
• 2. Gillman MW. Primordial prevention of cardiovascular disease. Circulation. 2015;131(7):599-601. View Source 
• 3. Commission on Social Determinants of Health. Closing the gap in a generation: health equity through action on the social determinants of health. Final report of the Commission on Social Determinants of Health. Geneva: World Health Organization, 2008.
• 4.  Coffey PM, Ralph AP, Krause VL. The role of social determinants of health in the risk and prevention of group A streptococcal infection, acute rheumatic fever and rheumatic heart disease: A systematic review. PLOS Neglected Tropical Diseases 2018;12(6): e0006577.
• 5. Watkins DA, Johnson CO, Colquhoun SM, et al. Global, Regional, and National Burden of Rheumatic Heart Disease, 1990–2015. The New England Journal of Medicine. 2017;377:713-722. View Source 
• 6. Brown A, McDonald MI, Calma T. Rheumatic fever and social justice. The Medical Journal of Australia.2007;186(11):557-558. View Source 
• 7. Health Habitat Safety and the 9 Health Living Practices Safety. https://www.healthabitat.com/what-we-do/safety-and-the-9-healthy-living-... (Accessed on 8/12/2022)
• 8. RHDAustralia (ARF/RHD writing group). The 2020 Australian guideline for prevention, diagnosis and management of acute rheumatic fever and rheumatic heart disease (3rd edition), 2020. View Source