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Building more and better living spaces is essential to eradicating rheumatic heart disease in remote Aboriginal people, but the current remote housing model is not improving the situation.
Australia’s 2020 Guidelines for the Prevention, Diagnosis and Management of Acute Rheumatic Fever and Rheumatic Heart Disease recognize that there is strong evidence to reduce the negative impact of overcrowding on Aboriginal people living in remote areas. Masu. Overcrowded living conditions are ripe for the spread of infectious diseases, either directly or indirectly. streptococcus, which triggers acute rheumatic fever in overexposed individuals. Reducing conditions that lead to overcrowding in living spaces reduces streptococcal colonization and subsequently reduces the incidence of acute rheumatic fever and rheumatic heart disease.
The physical problem of overcrowding, or living in close physical proximity to many other people, can only be addressed by housing and physical space that alleviates this. The guidelines acknowledge that a single strategy of building more homes may not solve the problem, and this has indeed proven to be true in the Northern Territory over the past five years. However, the information contained in the guidelines lacks clarity and direction and does not fully reflect what is known or could be known about addressing housing solutions to reduce rheumatic heart disease.
The reason Indigenous homes are so overcrowded in the Northern Territory is simple. Because there aren’t enough houses. Therefore, it makes sense that building more housing would solve the problem of physical overcrowding. But when homes are designed to crowd people indoors, they can actually exacerbate the overcrowding conditions that make diseases such as rheumatic fever more likely to occur, and this is what is happening now. In hot climates, overcrowding is exacerbated when housing performs poorly and costs too much to keep cool.
These new homes, built over the past five years in remote parts of the Northern Territory, are the least insulated homes built in Australia, meaning they are the most expensive to keep cool. here). They all live in the hottest part of the world, the poorest part of Australia. These structures do not meet the thermal performance requirements of state building codes and are therefore illegal to build in any other Australian state except Tasmania (here). Before construction, all trees on the block are removed and the ground is compacted like concrete for builders to ease the construction process, leaving a bare dusty garden with no trees or grass. These homes have minimal outdoor living space reflecting the Northern Territory Remote Aboriginal Housing Guidelines, are not designed for natural ventilation, have no cultural considerations whatsoever, and in fact, many residents He compares his new home to a prison cell.
It is well known that the residents of these homes are the most energy poor in the world. Pre-purchased electricity will be disconnected when the meter credit expires. Also, when the weather gets hotter and the air conditioner gets louder day and night, the disconnection rate increases significantly. In most homes, the line goes out at least once a week, and if residents don’t have money to recharge, everyone is moved to another family’s home, which may already be overcrowded. Without air conditioning, homes cannot survive, and electricity bills are extremely high. Opening the windows is unlikely to keep your home cool because it wasn’t designed with natural ventilation in mind. Coupled with these housing design failures, prepaid electricity is an unchecked health disaster that causes overcrowding, among many other health and social problems.
Only one remote Indigenous public housing complex has rooftop solar panels. Despite this pilot study’s evidence that rooftop solar panels can reduce energy insecurity, the Northern Territory Government has no plans to roll out rooftop solar panels across remote residential properties.
Given that these homes are designed with little natural ventilation and minimal outdoor living space to provide shade even in very hot weather, the only option is to The best option is to gather indoors and turn on the air conditioner, or move to another home if the situation worsens. I’m out of energy. These new homes predictably exacerbated physical overcrowding in prison-like housing.
The Room to Breathe program is part of this $1 billion in spending and does not hesitate to point out the fact that housing with more bedrooms could help reduce overcrowding in patients with rheumatic heart disease. seems to be following the guidelines. The program constructed new bedrooms in existing outdoor living spaces, such as lanais, converting three-bedroom homes with one bathroom into four-bedroom homes, but still with a bathroom. has one and currently has an additional room for another family. Mention the loss of a nice outdoor shaded space to sit during a power outage.
And what is the result? Despite this huge housing expenditure, the incidence of rheumatic heart disease shows little sign of slowing down, as do other diseases associated with overcrowding, such as scabies. The guidelines are correct. New housing isn’t necessarily the only thing that makes an impact. And we now have solid evidence that something has gone seriously wrong with the way $1 billion has been spent in the past.
The Rheumatic Heart Disease Guidelines are an excellent resource for diagnosing and treating this disease, but the section on prevention leaves room for improvement and guides our experts on the advocacy path. It should be at the forefront of explaining. Rheumatic fever and subsequent valvular heart disease can only be prevented by providing safe, thermally and culturally appropriate housing. Unless these guidelines take this issue more seriously, medical professionals will only be able to diagnose and treat, with very sad consequences for Aboriginal people. Doctors asked the Northern Territory Government what it intends to do to empower communities with the next $3 billion spent on remote housing, and how each community around it will create safe homes to raise children in. We need to advocate for communities that are explicitly asking for the same. their culture and climate.
Dr Simon Kilty is a specialist physician who has lived and worked in remote areas of the Northern Territory for 18 years and is currently Wiliya Janta The Walmung Elders of Tennant Creek are building climate-resilient and culturally sensitive homes to help their families thrive in a warming climate.
The statements and opinions expressed in this article reflect the views of the author and do not necessarily represent the official policy of the AMA. servant or Insight+ Unless otherwise stated.
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