Rheumatic heart disease (RHD) is a preventable condition rooted in environmental and social inequity. RHD is caused by repeated Strep A infections of the throat or skin and thrives where housing, hygiene, and living conditions are poor. In Australia, it disproportionately affects Aboriginal communities in remote regions. This presentation examines how overcrowding, inadequate housing infrastructure, and limited access to sanitation increases the risk of Strep A infection. Drawing on research and experiences from the Aboriginal Environmental Health Program, it highlights the critical role of environmental health in reducing transmission and preventing rheumatic heart disease.