The case for global investment in rheumatic heart-disease control

Perspectives Rheumatic heart disease comprises a small proportion of the total global disease burden according to current estimates. A rare complication of a strepto-coccal throat infection, rheumatic heart disease causes heart valve damage and progressive heart failure. The cause and course of this disease can be difficult to explain to policy-makers and to people at risk. The relative burden and complexity of the disease have contributed to its neglect by governments, donors and decision-makers. We argue that the World Health Organization (WHO) and national governments should rekindle their rheumatic heart disease control programmes. Rheumatic heart disease is now unusual in most high-resource settings because of access to health care and availability of antibiotics. However, it remains endemic in socioeconomically vulnerable populations in high-income countries and in low-and middle-income country settings. 1 Prevention and control measures for rheumatic heart disease include reduction of household crowding, timely diagnosis and appropriate antibiotics for bacterial pharyngitis and – in people who develop rheumatic fever – antibiotic prophylaxis over several years to prevent disease progression. Global public health has no shortage of challenges such as improving sanitation, eradicating polio and preventing tobacco use. A utilitarian approach pervades attempts to deliver the best possible health care for the greatest number of people. Limited human , financial and logistical resources make prioritization essential. Funding and policy meetings are increasingly focused on identifying easily achievable and high impact global health interventions. However, only a fraction of global health needs are amenable to simple and scalable interventions. When and why should time, energy and money be invested in more complex problems? Reflecting on these uncertainties, we build the case for investing in global control of rheumatic heart disease, with a focus on highly endemic settings. Research is still needed on the causes, diagnostic methods, and clinical management of rheumatic heart disease. 2,3 However, the basic framework for disease control has existed since the 1950s, with incremental improvements in the structure of control programmes and the ways in which these are delivered. 4 The usefulness of comprehensive disease-control programmes has been demonstrated by local or state programmes in Australia, Cuba, Guadeloupe, Mar-tinique, New Zealand and the United States of America. 4 These data show that rheumatic heart disease is a preventable , noncommunicable cardiovascular disease acquired in childhood. Early and effective intervention can avert premature cardiovascular mortality in these patients. At a time when there is an increased focus on …