A report on a government programme to combat rheumatic fever shows not enough is being done to stop the causes of the disease in New Zealand.
Several concerns were raised in the report, which analysed the first 18 months of the $24 million prevention programme.
Rheumatic fever is the leading cause of heart disease in childhood in New Zealand and disproportionately affects Maori and Pacific Islanders.
It can develop after a Group A streptococcus (strep throat) infection. About 150 people per year die as a result.
A key part of the programme is throat swabs for school children in high-risk areas, but the report raises concern that in many cases there is no follow-up.
It says the programme needs to be linked with other health and social services to address the underlying causes of rheumatic fever, such as damp housing, poverty and a lack of access to medical care.
The report also calls for raised public awareness about the link between strep throat and rheumatic fever.
The Health Ministry says it will work on improving the rates of people getting the disease.
Director of public health Dr Mark Jacobs says the rates of people getting the disease needs to improve and the ministry will work with other agencies to look at solutions, such as quality of living and housing.
A public health professor at the University of Otago says children will continue to get rheumatic fever if the root of the cause isn't addressed.
Michael Baker says not determining the cause is like having a revolving door approach, where children will become ill over and over again.
Professor Baker says health professionals need to use these opportunities to identify problems and deliver services to combat them, such as offering home insulation and heating programmes.
PM and Gates discuss disease
Prime Minister John Key says he talked about New Zealand's problems with rheumatic fever with Microsoft founder Bill Gates while both were visiting China.
Since retiring from running Microsoft, Mr Gates has launched several charitable programmes including the final elimination of polio.
Mr Key said on Sunday he told Mr Gates about work New Zealand and Australia are doing on rheumatic fever and Mr Gates was interested.