Expanding school sore throat clinics, improving access to primary health care and upgrading and insulating Northland's poor housing stocks could help rid the region of its high rates of the Third World disease rheumatic fever.
Northland has the highest rates of rheumatic fever in the country and last week visiting US expert Dr Stanford Shulman met health professionals to help with solutions.
The answer is already being worked on, but more is needed, with a sore-throats-in-schools programme due to be expanded, and a hui last month with GPs and health providers where a rheumatic fever information poster was adopted.
Northland's rheumatic fever rate of almost 10 per 100,000 is nearly three times the national average, with 78 new cases per 100,000 population of 5-to-15-year-olds every year.
About 95 per cent of cases in Northland are Maori.
Manaia Primary Health Organisation has put free insulation into 5000 of the region's poorest homes over the past three years, but there are still at least that many needing to be done.
Rheumatic fever is classed as a "Third World" disease and Dr Shulman was involved in the successful rheumatic fever eradication strategies in the US in the 1960s.
The disease is caused by a strep throat being left untreated and is directly linked to poverty, through overcrowded homes and poor access to primary health care.
It can lead to life-long heart disease and death.
Dr Shulman said it's a surprise to find such high rates of the disease in a First World country like New Zealand, but said the answer was relatively simple.
"You shouldn't be shocked [by Northland's high rates] but you should certainly be concerned. New Zealand is a First World country with pockets of considerable rheumatic fever, particularly in a certain population - your indigenous population," he said.
"This is how it used to be in the US several decades ago and we found the main problems were overcrowding, poor housing and poor access to primary health services - the same issues you have - and we addressed those."
Northland medical officer of health Dr Clair Mills said while 95 per cent of cases involved Maori, research showed that only one in four Maori children who went to their GP in Northland with strep throat infections are not getting appropriate treatment. Expanding the sore-throats-in-schools programme would provide free access to those most at risk and ensure they get the appropriate care.
Manaia PHO chief executive Chris Farrelly said the PHO was doing its bit and, with EECA, District Health Board, Top Energy and ASB Trust, about 5000 of Northland's poorest quality homes had been insulated.
"Despite that, we are only about half way through doing all the homes that need it ... but there's no more funding for it beyond July next year," he said.
"In Northland we have a shocking housing stock and rheumatic fever is linked to poor housing so we are going for broke to try to do as many as we can."
The PHO hopes to fit out another 1500 homes at a cost of about $3000 each - or about $4.5 million - in the next 12 months.
Mr Farrelly said access to primary health care was an issue. "We have free access to GPs and after hours services, but unfortunately that stops at age 6, so those aged 7-12 have to pay. Cost is still an issue."