Introduction

Housing and sociocultural practices are critical influences on human health globally. Yet, the World Health Organization's Housing and Health Guidelines (WHO, 2018) have identified that low-income groups, including Indigenous peoples, are more likely to live in housing that is unsuitable. In turn, this raises their exposure to health impacts from housing and crowding, such as mental stress and infectious disease transmission (WHO, 2018).

For Australian Indigenous communities experiencing relatively high levels of socio-economic vulnerabilities, sufficient, well-maintained housing infrastructure can support healthy living practices (Healthabitat, 2019). However, if there is insufficient housing stock to meet community need, as is the case in much of Aboriginal Australia, crowded social housing can adversely impact occupants’ health through recurring transmission of infectious diseases between residents in regular close bodily contact (Lowell et al, 2018). This can manifest as high-frequency of upper respiratory tract (URT) and otitis media (OM) infections. These infections are problematic on their own but can be lethal because key organisms involved in these diseases, such as Streptococcus pneumoniae, may cause meningitis and pneumonia (Subramanian et al, 2019). Moreover, the risks of infection with Streptococcus pneumoniae are greater in individuals who are immune-compromised, elderly or young (Subramanian et al, 2019). There is also a relationship between recurrent infections and chronic diseases. Damaged skin after scabies and pyoderma disorders can attract infections by group A Streptococcal (GAS) infections. Recurrent infections by this bacterium can lead to acute rheumatic fever (ARF) and post-streptococcal glomerulonephritis (PSGN). These associations are significant, as PSGN can lead to chronic kidney disease (CKD) (White et al, 2010; Garcia-Garcia et al, 2017) and ARF to rheumatic heart disease (RHD) (Kerdemelidis et al, 2010).