{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,15]],"date-time":"2026-09-15T12:31:52Z","timestamp":1789475512193,"version":"build-2803163510"},"reference-count":56,"publisher":"BMJ","issue":"Suppl 9","license":[{"start":{"date-parts":[[2023,10,31]],"date-time":"2023-10-31T00:00:00Z","timestamp":1698710400000},"content-version":"unspecified","delay-in-days":30,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Glob Health"],"accepted":{"date-parts":[[2023,9,9]]},"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:p>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.<\/jats:p>\n               <jats:p>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.<\/jats:p>","DOI":"10.1136\/bmjgh-2023-012467","type":"journal-article","created":{"date-parts":[[2023,11,1]],"date-time":"2023-11-01T01:50:15Z","timestamp":1698803415000},"page":"e012467","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":21,"title":["Research priorities for the primordial prevention of acute rheumatic fever and rheumatic heart disease by modifying the social determinants of health"],"prefix":"10.1136","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1865-1536","authenticated-orcid":false,"given":"Michael G","family":"Baker","sequence":"first","affiliation":[{"name":"Public Health, University of Otago Wellington, Wellington, New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3369-9183","authenticated-orcid":false,"given":"Mary Y","family":"Masterson","sequence":"additional","affiliation":[{"name":"Center for Translation Research and Implementation Science (CTRIS), National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maylene","family":"Shung-King","sequence":"additional","affiliation":[{"name":"Health Policy and Systems Division, School of Public Health, University of Cape Town, Rondebosch, Western Cape, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Beaton","sequence":"additional","affiliation":[{"name":"Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA"},{"name":"Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asha C","family":"Bowen","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia, Australia"},{"name":"Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geetha P","family":"Bansal","sequence":"additional","affiliation":[{"name":"HIV Research and Training Program, John E Fogarty International Center, Bethesda, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan R","family":"Carapetis","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases, Perth Children's Hospital, Nedlands, Western Australia, Australia"},{"name":"Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Nedlands, Western Australia, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,10,31]]},"reference":[{"key":"2025073014301320000_8.Suppl_9.e012467.1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.116.024769"},{"key":"2025073014301320000_8.Suppl_9.e012467.2","doi-asserted-by":"crossref","first-page":"15084","DOI":"10.1038\/nrdp.2015.84","article-title":"Acute rheumatic fever and rheumatic heart disease","volume":"2","author":"Carapetis","year":"2016","journal-title":"Nat Rev Dis Primers"},{"key":"2025073014301320000_8.Suppl_9.e012467.3","doi-asserted-by":"crossref","unstructured":"Ou Z , Yu D , Liang Y , et al . Global burden of rheumatic heart disease: trends from 1990 to 2019. Arthritis Res Ther 2022;24. doi:10.1186\/s13075-022-02829-3","DOI":"10.1186\/s13075-022-02829-3"},{"key":"2025073014301320000_8.Suppl_9.e012467.4","doi-asserted-by":"crossref","first-page":"1425","DOI":"10.1093\/eurjpc\/zwac044","article-title":"Global burden of rheumatic heart disease and its association with socioeconomic development status, 1990-2019","volume":"29","author":"Lv","year":"2022","journal-title":"Eur J Prev Cardiol"},{"key":"2025073014301320000_8.Suppl_9.e012467.5","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0006577","article-title":"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","volume":"12","author":"Coffey","year":"2018","journal-title":"PLoS Negl Trop Dis"},{"key":"2025073014301320000_8.Suppl_9.e012467.6","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph16224515","article-title":"Risk factors for acute rheumatic fever: literature review and protocol for a case-control study in New Zealand","volume":"16","author":"Baker","year":"2019","journal-title":"Int J Environ Res Public Health"},{"key":"2025073014301320000_8.Suppl_9.e012467.7","unstructured":"World Health Organization. Social determinants of health. 2022 Available: https:\/\/www.who.int\/health-topics\/social-determinants-of-health#tab=tab_1"},{"key":"2025073014301320000_8.Suppl_9.e012467.8","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1111\/jpc.12808","article-title":"Historical aspects of rheumatic fever","volume":"51","author":"Steer","year":"2015","journal-title":"J Paediatr Child Health"},{"key":"2025073014301320000_8.Suppl_9.e012467.9","doi-asserted-by":"crossref","first-page":"e1388","DOI":"10.1016\/S2214-109X(19)30360-2","article-title":"Rheumatic heart disease burden, trends, and inequalities in the Americas, 1990-2017: a population-based study","volume":"7","author":"Ordunez","year":"2019","journal-title":"Lancet Glob Health"},{"key":"2025073014301320000_8.Suppl_9.e012467.10","first-page":"135","article-title":"Prevention and control of rheumatic fever and rheumatic heart disease: the Cuban experience (1986-1996-2002)","volume":"19","author":"Nordet","year":"2008","journal-title":"Cardiovasc J Afr"},{"key":"2025073014301320000_8.Suppl_9.e012467.11","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(96)91202-7"},{"key":"2025073014301320000_8.Suppl_9.e012467.12","unstructured":"United Nations Development Programme (UNDP). What are the sustainable development goals? n.d. Available: https:\/\/www.undp.org\/content\/undp\/en\/home\/sustainable-development-goals.html."},{"key":"2025073014301320000_8.Suppl_9.e012467.13","doi-asserted-by":"publisher","DOI":"10.1161\/01.CIR.72.6.1155"},{"key":"2025073014301320000_8.Suppl_9.e012467.14","doi-asserted-by":"crossref","first-page":"e98","DOI":"10.3928\/19382359-20210221-01","article-title":"Rheumatic fever and rheumatic heart disease in the United States","volume":"50","author":"de Loizaga","year":"2021","journal-title":"Pediatr Ann"},{"key":"2025073014301320000_8.Suppl_9.e012467.15","doi-asserted-by":"crossref","DOI":"10.1161\/JAHA.120.016851","article-title":"Contemporary incidence and prevalence of rheumatic fever and rheumatic heart disease in Australia using linked data: the case for policy change","volume":"9","author":"Katzenellenbogen","year":"2020","journal-title":"J Am Heart Assoc"},{"key":"2025073014301320000_8.Suppl_9.e012467.16","doi-asserted-by":"crossref","first-page":"36","DOI":"10.3201\/eid2701.191791","article-title":"Rising ethnic inequalities in acute rheumatic fever and rheumatic heart disease, New Zealand, 2000-2018","volume":"27","author":"Bennett","year":"2021","journal-title":"Emerg Infect Dis"},{"key":"2025073014301320000_8.Suppl_9.e012467.17","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1016\/S2352-4642(20)30308-4","article-title":"Rheumatic heart disease in indigenous young peoples","volume":"5","author":"Wyber","year":"2021","journal-title":"Lancet Child Adolesc Health"},{"key":"2025073014301320000_8.Suppl_9.e012467.18","doi-asserted-by":"publisher","DOI":"10.1136\/heartjnl-2015-307444"},{"key":"2025073014301320000_8.Suppl_9.e012467.19","doi-asserted-by":"publisher","DOI":"10.1016\/j.puhe.2004.11.008"},{"key":"2025073014301320000_8.Suppl_9.e012467.20","first-page":"213","article-title":"WHO programme for the prevention of rheumatic fever\/rheumatic heart disease in 16 developing countries: report from phase I (1986-90). WHO cardiovascular diseases unit and principal investigators","volume":"70","year":"1992","journal-title":"Bull World Health Organ"},{"key":"2025073014301320000_8.Suppl_9.e012467.21","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0121363","article-title":"A cost-effectiveness analysis of a program to control rheumatic fever and rheumatic heart disease in Pinar del Rio, Cuba","volume":"10","author":"Watkins","year":"2015","journal-title":"PLoS One"},{"key":"2025073014301320000_8.Suppl_9.e012467.22","doi-asserted-by":"crossref","first-page":"248","DOI":"10.3390\/pathogens10020248","article-title":"A review of streptococcus pyogenes: public health risk factors","volume":"10","author":"Avire","year":"2021","journal-title":"Pathogens"},{"key":"2025073014301320000_8.Suppl_9.e012467.23","doi-asserted-by":"crossref","first-page":"e366","DOI":"10.1016\/S2666-5247(21)00332-3","article-title":"Frequency of transmission, asymptomatic shedding, and airborne spread of streptococcus pyogenes in schoolchildren exposed to scarlet fever: a prospective, longitudinal, multicohort, molecular epidemiological, contact-tracing study in England, UK","volume":"3","author":"Cordery","year":"2022","journal-title":"Lancet Microbe"},{"key":"2025073014301320000_8.Suppl_9.e012467.24","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2006-3368"},{"key":"2025073014301320000_8.Suppl_9.e012467.25","doi-asserted-by":"publisher","DOI":"10.1017\/S095026881500326X"},{"key":"2025073014301320000_8.Suppl_9.e012467.26","article-title":"Risk factors for group a streptococcal pharyngitis and skin infections: a case control study","volume":"26","author":"Bennett","year":"2022","journal-title":"Lancet Reg Health West Pac"},{"key":"2025073014301320000_8.Suppl_9.e012467.27","article-title":"Risk factors for acute rheumatic fever: a case-control study","volume":"26","author":"Baker","year":"2022","journal-title":"Lancet Reg Health West Pac"},{"key":"2025073014301320000_8.Suppl_9.e012467.28","doi-asserted-by":"crossref","first-page":"1133","DOI":"10.1016\/j.ajic.2016.03.058","article-title":"Outbreak of group a streptococcus infections in an outpatient wound clinic-Colorado, 2014","volume":"44","author":"Hancock-Allen","year":"2016","journal-title":"Am J Infect Control"},{"key":"2025073014301320000_8.Suppl_9.e012467.29","doi-asserted-by":"crossref","first-page":"1325","DOI":"10.1007\/s10096-018-3254-2","article-title":"Prevalence and molecular diversity of invasive streptococcus dysgalactiae and streptococcus pyogenes in a German tertiary care medical centre","volume":"37","author":"R\u00f6\u00dfler","year":"2018","journal-title":"Eur J Clin Microbiol Infect Dis"},{"key":"2025073014301320000_8.Suppl_9.e012467.30","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhin.2019.07.003"},{"key":"2025073014301320000_8.Suppl_9.e012467.31","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1093\/infdis\/jiac043","article-title":"Increased breadth of group a streptococcus antibody responses in children with acute rheumatic fever compared to precursor pharyngitis and skin infections","volume":"226","author":"Whitcombe","year":"2022","journal-title":"J Infect Dis"},{"key":"2025073014301320000_8.Suppl_9.e012467.32","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-022-22648-5","article-title":"The effects of sugar in drinking water on streptococcus pyogenes colonisation in a murine nasopharyngeal infection model","volume":"12","author":"Hashimi","year":"2022","journal-title":"Sci Rep"},{"key":"2025073014301320000_8.Suppl_9.e012467.33","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.317.7168.1287"},{"key":"2025073014301320000_8.Suppl_9.e012467.34","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2021-056294","article-title":"Definitions and measurement of health literacy in health and medicine research: a systematic review","volume":"12","author":"Urstad","year":"2022","journal-title":"BMJ Open"},{"key":"2025073014301320000_8.Suppl_9.e012467.35","first-page":"1","article-title":"Social determinants of indigenous health andIndigenous rights in policy: a scoping review andAnalysis of problem representation","volume":"10","author":"George","year":"2019","journal-title":"Int Indig Policy J"},{"key":"2025073014301320000_8.Suppl_9.e012467.36","doi-asserted-by":"crossref","unstructured":"Boot GR , Lowell A . Acknowledging and promoting indigenous knowledges, paradigms, and practices within health literacy-related policy and practice documents across Australia, Canada, and New Zealand. Iipj 2019;10. doi:10.18584\/iipj.2019.10.3.8133","DOI":"10.18584\/iipj.2019.10.3.8133"},{"key":"2025073014301320000_8.Suppl_9.e012467.37","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1177\/1757975916683385","article-title":"Toward a humanistic model in health communication","volume":"26","author":"Werder","year":"2019","journal-title":"Glob Health Promot"},{"key":"2025073014301320000_8.Suppl_9.e012467.38","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0005726","article-title":"\u201cAre scabies and impetigo \"normalised\"? A cross-sectional comparative study of hospitalised children in northern Australia assessing clinical recognition and treatment of skin infections\u201d","volume":"11","author":"Yeoh","year":"2017","journal-title":"PLoS Negl Trop Dis"},{"key":"2025073014301320000_8.Suppl_9.e012467.39","doi-asserted-by":"crossref","first-page":"4650","DOI":"10.3390\/ijerph19084650","article-title":"Living with rheumatic heart disease at the intersection of Biomedical and aboriginal Worldviews","volume":"19","author":"Haynes","year":"2022","journal-title":"IJERPH"},{"key":"2025073014301320000_8.Suppl_9.e012467.40","doi-asserted-by":"crossref","unstructured":"Kerrigan V , Kelly A , Lee AM , et al . A community-based program to reduce acute rheumatic fever and rheumatic heart disease in northern Australia. BMC Health Serv Res 2021;21. doi:10.1186\/s12913-021-07159-9","DOI":"10.1186\/s12913-021-07159-9"},{"key":"2025073014301320000_8.Suppl_9.e012467.41","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1016\/j.ijcard.2020.09.020","article-title":"Economic consequences of rheumatic heart disease: a scoping review","volume":"323","author":"Opara","year":"2021","journal-title":"Int J Cardiol"},{"key":"2025073014301320000_8.Suppl_9.e012467.42","doi-asserted-by":"crossref","first-page":"e957","DOI":"10.1016\/S2214-109X(21)00199-6","article-title":"An investment case for the prevention and management of rheumatic heart disease in the African Union 2021-30: a modelling study","volume":"9","author":"Coates","year":"2021","journal-title":"Lancet Glob Health"},{"key":"2025073014301320000_8.Suppl_9.e012467.43","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM197308162890701"},{"key":"2025073014301320000_8.Suppl_9.e012467.44","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(05)81146-1"},{"key":"2025073014301320000_8.Suppl_9.e012467.45","doi-asserted-by":"publisher","DOI":"10.1097\/INF.0b013e3181a282be"},{"key":"2025073014301320000_8.Suppl_9.e012467.46","doi-asserted-by":"crossref","first-page":"1113","DOI":"10.1097\/INF.0000000000001581","article-title":"First presentation acute rheumatic fever is preventable in a community setting: a school-based intervention","volume":"36","author":"Lennon","year":"2017","journal-title":"Pediatr Infect Dis J"},{"key":"2025073014301320000_8.Suppl_9.e012467.47","doi-asserted-by":"crossref","first-page":"1585","DOI":"10.1093\/ije\/dyy150","article-title":"Primary prevention of rheumatic fever in the 21st century: evaluation of a national programme","volume":"47","author":"Jack","year":"2018","journal-title":"Int J Epidemiol"},{"key":"2025073014301320000_8.Suppl_9.e012467.48","doi-asserted-by":"crossref","first-page":"995","DOI":"10.1097\/INF.0000000000002770","article-title":"School-based streptococcal a sore-throat treatment programs and acute rheumatic fever amongst indigenous M\u0101ori: a retrospective cohort study","volume":"39","author":"Walsh","year":"2020","journal-title":"Pediatr Infect Dis J"},{"key":"2025073014301320000_8.Suppl_9.e012467.49","article-title":"Descriptive analysis of group a streptococcus in skin Swabs and acute rheumatic fever, Auckland, New Zealand, 2010-2016","volume":"8","author":"Thomas","year":"2021","journal-title":"Lancet Reg Health West Pac"},{"key":"2025073014301320000_8.Suppl_9.e012467.50","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1136\/bmjgh-2021-007038","article-title":"Preceding group a streptococcus skin and throat infections are individually associated with acute rheumatic fever: evidence from New Zealand","volume":"6","author":"Oliver","year":"2021","journal-title":"BMJ Glob Health"},{"key":"2025073014301320000_8.Suppl_9.e012467.51","doi-asserted-by":"crossref","first-page":"279","DOI":"10.5694\/mja2.51692","article-title":"Roadmap to incorporating group a streptococcus molecular point-of-care testing for remote Australia: a key activity to eliminate rheumatic heart disease","volume":"217","author":"Barth","year":"2022","journal-title":"Med J Aust"},{"key":"2025073014301320000_8.Suppl_9.e012467.52","doi-asserted-by":"crossref","first-page":"1893","DOI":"10.3201\/eid2707.203045","article-title":"Ethnically disparate disease progression and outcomes among acute rheumatic fever patients in New Zealand, 1989-2015","volume":"27","author":"Oliver","year":"2021","journal-title":"Emerg Infect Dis"},{"key":"2025073014301320000_8.Suppl_9.e012467.53","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pntd.0004727","article-title":"Targeted echocardiographic screening for latent rheumatic heart disease in northern Uganda: evaluating familial risk following identification of an index case","volume":"10","author":"Aliku","year":"2016","journal-title":"PLoS Negl Trop Dis"},{"key":"2025073014301320000_8.Suppl_9.e012467.54","doi-asserted-by":"crossref","DOI":"10.1016\/j.eclinm.2021.100935","article-title":"Echocardiography for latent rheumatic heart disease in first degree relatives of children with acute rheumatic fever: implications for active case finding in family members","volume":"37","author":"Culliford-Semmens","year":"2021","journal-title":"EClinicalMedicine"},{"key":"2025073014301320000_8.Suppl_9.e012467.55","doi-asserted-by":"crossref","first-page":"588","DOI":"10.1111\/1753-6405.13219","article-title":"\"The world is so white\": improving cultural safety in Healthcare systems for Australian indigenous people with rheumatic heart disease","volume":"46","author":"Mitchell","year":"2022","journal-title":"Aust N Z J Public Health"},{"key":"2025073014301320000_8.Suppl_9.e012467.56","article-title":"Culturally supported health promotion to see, treat, prevent (SToP) skin infections in aboriginal children living in the kimberley region of western australia: a qualitative analysis","volume":"35","author":"McRae","year":"2023","journal-title":"Lancet Reg Health West Pac"}],"container-title":["BMJ Global Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjgh-2023-012467","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T21:30:22Z","timestamp":1753911022000},"score":1,"resource":{"primary":{"URL":"https:\/\/gh.bmj.com\/lookup\/doi\/10.1136\/bmjgh-2023-012467"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10]]},"references-count":56,"journal-issue":{"issue":"Suppl 9","published-online":{"date-parts":[[2023,10,31]]},"published-print":{"date-parts":[[2023,10]]}},"alternative-id":["10.1136\/bmjgh-2023-012467"],"URL":"https:\/\/doi.org\/10.1136\/bmjgh-2023-012467","relation":{},"ISSN":["2059-7908"],"issn-type":[{"value":"2059-7908","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10]]}}}