Across rural and remote Western Australia, children grow up surrounded by the natural beauty of Country. But for many, the environment within their homes is working against their health.
Environmental health isn’t just about clean air and water – it’s about whether children can grow up with the basic conditions required to stay well. It’s about functional taps, showers that work, homes that are safe and clean. And the consequences of neglecting these foundations are stark.
“In some of our most remote communities, nearly every child has had otitis media by the time they turn five,” said Matthew Lester, a leader in Western Australia’s environmental health sector. “And we’re not talking about a one-off ear infection – we’re talking about kids living with recurrent and persistent ear infections with moderate to severe hearing loss through their entire early childhood.”
That hearing loss can have lifelong effects: delayed speech development, disrupted learning, social withdrawal, and poor educational attainment. In later years, it’s often linked to disengagement from school, unemployment, poverty and involvement in the justice system. “Otitis media isn’t just a health issue; it’s a social justice issue,” Matthew said.
“When children can’t hear properly, they struggle in school – and that disadvantage follows them.” But it doesn’t have to be this way. Otitis media is preventable. What makes it difficult to address is not a lack of treatment options, but a lack of attention to the root causes. “Simple interventions can make a difference.
“Things like hygiene education in schools, or making sure a child has access to washing facilities at home that work – these aren’t high-cost solutions, but they have high impact.” One example is the Simon Says campaign by the Aboriginal Health Council of WA, which has successfully promoted handwashing and face-cleaning in Aboriginal communities. Programs like these, grounded in culturally safe practice and community-led education, are helping reduce the burden of ear infections.
Primordial prevention of otitis media requires both health promotion and functional health hardware, which provides the ability for people to wash themselves and their children safely in a home.
Support at a national level for an Aboriginal workforce that links primary care, health promotion and housing maintenance together as primordial prevention is lacking. “There is a national roadmap for ear health, eye health, renal health and heart health – and yet the fundamental element that is capable of preventing all of these conditions is environmental health – where is its roadmap?” “We need a proper plan. We need to work alongside families in their homes – supporting them to improve conditions, maintain health hardware, and create healthier living environments. That’s where real change happens.”
The story is similar when it comes to eye health. Trachoma, a disease largely eliminated in most developed countries, continues to affect Aboriginal children in remote WA. But recent gains show that change is possible.
The World Health Organization strategy for trachoma prevention is known as SAFE: Surgery, Antibiotics, Facial cleanliness, and Environmental improvement. But local experts are pushing for a new model: EFAS – putting Environmental change and Facial cleanliness first.
“We’ve seen facial cleanliness rates rise from 55 per cent to 70 per cent in just one year. That’s a big step forward – and it’s thanks to community-driven approaches.” “If we want to eliminate trachoma, we need to start by making sure every home has a working shower, a basin with soap, and proper drainage,” Matthew said.
“We need to prioritise health hardware and support housing maintenance – not just rely on medications after the fact.”
Initiatives like healthy homes ‘intensives’ – where environmental health workers assess health hardware in the home and repairs that follow are coordinated and timely – have proven highly effective. These intensives not only fix immediate hazards, but build trust and create a stronger link between health services and community members. “Aboriginal environmental health practitioners visiting homes, sitting with families, yarning about what’s working and what’s not – this is what culturally safe, meaningful health promotion looks like.
“You can’t fix health problems without fixing the places where people live.”
Health professionals working in rural and remote WA are increasingly recognising the link between environment and health outcomes. But Matthew believes more needs to be done to connect clinical practice with upstream prevention. The Aboriginal environmental health program now offers clinic-generated environmental health referrals.
“We want GPs, nurses, and allied health workers to be able to offer patients with preventable contagious health conditions an environmental health referral that involves taking ‘health into the home’ and managing the conditions in the home that are contributing to these conditions,” he said. “These aren’t just infrastructure issues – they’re clinical risk factors.”
The message is clear: improving health in remote WA starts with getting the basics right. Clean water. Safe homes. Functioning health hardware. When these needs are met, kids can thrive. “Health doesn’t start in the clinic – it starts in the home,” Matthew said.
“And every child in WA deserves a healthy home.”