Socioeconomic and environmental factors
Poor living conditions increase the risk of ARF and RHD. This section draws on the data from the 2022–23 National Aboriginal and Torres Strait Islander Health Survey to provide information on 2 key risk factors associated with ARF and RHD:
- dwelling standards
- household overcrowding.
A house in acceptable condition, with working facilities that support healthy living, is important in reducing the risk of Strep A. A house is in an acceptable condition if it has no more than 2 structural problems and has the following facilities:
- Working facilities for washing people
- Working facilities for washing clothes or bedding
- Working facilities for preparing food
- Working sewerage facilities (ABS 2025).
Household overcrowding is a risk factor that is associated strongly with Strep A. An overcrowded dwelling is defined here using the Canadian National Occupancy Standard (CNOS) as one that requires at least one additional bedroom to accommodate the people who usually live there, given their ages, sex and relationships to each other (CMHC 2022). Although the concept of overcrowding can be a subjective one, influenced by cultural and personal factors, the CNOS-type standard generally underpins housing design across Australia.
National Agreement on Closing the Gap: housing-related targets
In 2020, all Australian governments and the Coalition of Aboriginal and Torres Strait Islander Peak Organisations worked in partnership to develop the National Agreement on Closing the Gap (the National Agreement), built around 4 Priority Reforms. The National Agreement also identifies 19 targets across 17 socioeconomic outcome areas. Two of these targets directly relate to housing.
Outcome area 9: People can secure appropriate, affordable housing that is aligned with their priorities and needs. Within this outcome area, there are 2 targets.
Target 9a: By 2031, increase the proportion of Aboriginal and Torres Strait Islander people living in appropriately sized (not overcrowded) housing to 88 per cent.
Target 9b: By 2031, all Aboriginal and Torres Strait Islander households:
- within discrete Aboriginal and Torres Strait Islander communities, receive essential services that meet or exceed the relevant jurisdictional standard
- in or near to a town, receive essential services that meet or exceed the same standard as applies generally within the town (including if the household might be classified for other purposes as a part of a discrete settlement such as a “town camp” or “town based reserve”). (All Australian governments & Coalition of Aboriginal and Torres Strait Islander Peak Organisations 2020)
Dwelling standards
Based on the results of the 2022–23 National Aboriginal and Torres Strait Islander Health Survey, in 2022–23, about 80% of First Nations households lived in houses meeting the acceptable condition definition above, except in the Northern Territory, where only 57% lived in acceptable housing conditions (ABS 2025). The poorest housing conditions in the NT correspond to the highest prevalence rate of ARF/RHD in this jurisdiction.
In same period, over 80% of First Nations people lived in acceptable housing in major cities and regional areas. This proportion decreased greatly in remote areas (70%) and very remote areas (52%) (ABS 2025). A similar pattern was observed in the prevalence of ARF/RHD, with rates increasing as remoteness of residence increased.
Robust data on housing conditions at the small area level are not available from the survey but can be provided for Indigenous Advancement Strategy (IAS) regions. In most IAS regions about 69% to 83% of First Nations people lived in housing that met acceptable conditions, except in Arnhem Land and Groote Eylandt and Central Australia, where only 38.5% and 47.7%, respectively, lived in acceptable housing (AIHW analysis of ABS 2025). Both regions also had a very high prevalence of ARF and/or RHD.
Household overcrowding
The results from this survey also show that about 1 in 6 (15%) First Nations people lived in overcrowded households in 2022–23. Among those jurisdictions where ARF/RHD data are available, the proportion of First Nations people living in overcrowded households was highest in the NT (44%), followed by WA (20%), Qld and Vic (15%), SA (13%) and NSW (10%) (AIHW analysis of ABS 2025).
Across IAS regions, the highest proportion of First Nations people living in overcrowded households was in Arnhem Land and Groote Eylandt (70%), followed by Central Australia (49%), Kimberley (35%), and the Top End and Tiwi Islands (31%). The proportions in other regions were below 17% (Figure 1.3).
Figure 1.3: Map of overcrowded First Nations households by Indigenous Advancement Strategy regions, 2022-23
The Northern Territory and northern parts of Western Australia and Queensland have a higher proportion of overcrowded housing compared to the rest of Australia.
Note: Due to small numbers, Victoria and Tasmania have been combined.
Source: AIHW analysis of ABS 2025.
https://www.aihw.gov.au
ABS (Australian Bureau of Statistics) (2025) Microdata,TableBuilder: National Aboriginal and Torres Strait Islander Health Survey, Australia, AIHW analysis of TableBuilder, accessed 12 August 2025.
All Australian governments & Coalition of Aboriginal and Torres Strait Islander Peak Organisations (2020) Closing the Gap targets and outcomes | Closing the Gap, Department of the Prime Minister and Cabinet, accessed 2 June 2023.
CMHC (Canada Mortgage and Housing Corporation) (2022) Canadian National Occupancy Standard, CMHC website, accessed 28 February 2024,