ARF and RHD are the result of social, environmental and economic conditions which predominantly occur in situations of poverty.   Reducing the risk factors for GAS infection, ARF and RHD is known as primordial prevention.

Improved socio-economic status has reduced the burden of RHD in developed settings; with reduced overcrowding, improved hygiene and improved medical care RHD has been largely eliminated from these settings.  Primordial prevention activities can also be undertaken as part of RHD control programs to improve the living environment for people living with ARF/ RHD and their families. This may include family-focused education on hygiene and sanitation, promoting nutritious diet, reorganising sleeping arrangements in the house to minimise the number of people sleeping in the same room and providing access to soap and water for washing clothes and bodies.

Other population level prevention strategies include research to understand the genetic and autoimmune mechanisms of ARF and RHD. Improved understanding of the disease may make it possible to develop new therapies for prevention and treatment. Development of a vaccine against group A strep infection -  with potential to prevent ARF and RHD – is the most developed of these. Early diagnosis and treatment of RHD through echocardiography screening may also be an effective population prevention strategy.