NEWS: Western Australia Embeds Nine Healthy Living Practices as Framework for Aboriginal Environmental Health Model—State Policy Formalizes Housing Hardware as Health Infrastructure
Western Australia’s Aboriginal Environmental Health Model of Care, published in February 2025 by the Aboriginal Health Council of WA and WA Department of Health, explicitly embeds Healthabitat’s Nine Healthy Living Practices as the clinical framework for environmental health service delivery. The 63-page policy document identifies “washing people” and “reducing the negative impacts of overcrowding” as having STRONG associations with reducing disease transmission.
The Model was co-designed through consultation with Aboriginal communities, Aboriginal Community Controlled Health Services, and environmental health service providers across Western Australia. It identifies six domains of environmental health service, with “Healthy Homes” as the first domain requiring health hardware checks, basic plumbing repairs, and support for tenants to notify landlords of maintenance requirements.
Evidence Ratings for Housing Infrastructure
The Model provides specific evidence ratings for each Healthy Living Practice’s association with reducing Strep A infections. “Washing people” receives a STRONG rating: “Washing of hands and bodies, particularly for children, is clearly associated with a reduction in the risk of Strep A infections.”
“Washing clothes and bedding” receives a MEDIUM rating as “an important way to reduce the risk of Strep A skin infections.” “Reducing the negative impacts of overcrowding” receives a STRONG rating, with the notation that overcrowding is “a major contributor to the burden of Strep A, ARF and RHD.”
The Model clarifies that wastewater removal and dust receive WEAK ratings—neither are major contributors to Strep A spread. This evidence-based hierarchy makes visible which housing functions matter most for disease prevention.
Hospitalisation Costs Quantified
Data analysis for 2018-2022 demonstrates that $553.23 million was spent on hospitalisation costs for Aboriginal patients over four years (average $138.31 million annually) for conditions with environmental attribution. This excludes emergency presentations, outpatient visits, and primary care—actual burden is substantially higher.
Age Standardised Rates for environmentally attributed conditions are higher for Aboriginal people across all WA health regions. Per person costs for Aboriginal people are 2.6 to 3.7 times higher in some regions compared to non-Aboriginal people.
The WA RHD Register recorded 1,044 Aboriginal people with a history of ARF and/or RHD in 2019. That has increased to 1,485. RHD prevalence is 60 times higher in Aboriginal people under 55 years than other Australians of similar age.
Health Hardware as Clinical Service Delivery
The Healthy Homes domain specifies scope of service including conducting Health Hardware Assessments, undertaking basic plumbing tasks within scope, supporting tenants to notify landlords of maintenance requirements, identifying environmental health hazards, and providing cleaning packs and linen in response to identified hazards.
The Model states: “The circumstances in which people live affect the risk of Group A streptococcus infections, ARF and RHD. Living in crowded conditions and having limited access to facilities to wash people, clothes and bedding increase the risk.”
Under HLP 1, required health hardware includes “private, functional bathrooms with hot and cold-water supply, a shower, a bath, a hand basin and working drainage.” Under HLP 2, required infrastructure includes “a reliable water supply, a washing machine or trough to wash the clothes and provide safe disposal of the wastewater generated.”
When a state-level Aboriginal Environmental Health Model of Care embeds the Nine Healthy Living Practices as the clinical framework and specifies Health Hardware Assessments as core service delivery, housing maintenance isn’t separate from health service provision—it’s formalized as environmental health practice.
