Global challenge of hearing impairment: Breaking the silence Commonwealth Health Partnerships 2015 89 Daksha Patel, Andrew Smith and Hannah Kuper World Health Organization (WHO) Director-General Margaret Chan may well have been right when she said that ‘universal coverage is the single most powerful concept that public health has to offer’. There are strong ethical arguments for working towards universal health coverage (UHC). Moreover, since good health drives development, UHC will protect people from poverty. The right to health is also enshrined within the Convention on the Rights of Persons with Disabilities. In the context of hearing loss, as with other disabilities, UHC implies adequate focus on both prevention and management, including neonatal screening to detect cases early. It also means ensuring access to health services and health promotion. Rehabilitation and treatment of impairments must be recognised as essentials, not optional extras. This includes the provision of hearing aids and other assistive technologies. But current production of hearing aids meets less than ten per cent of global needs. In most low- and middle-income countries (LMICs), fewer than one out of 40 people who need a hearing aid have one. People with hearing loss can also benefit from cochlear implants, captioning, sign-language training and educational and social support. Social determinants The best strategy for effective prevention makes changes to key risk factors in the population as a whole and not just the high-risk minority. An example is prevention of noise-induced hearing loss (NIHL). NIHL is the most common global cause of acquired adult onset hearing loss and is caused by excessive agricultural, industrial and social noise, such as from listening to loud music. A small reduction in exposure or protection from noise for all may result in large falls in the number of people with NIHL in the population. Other key targets for prevention of hearing loss are strengthening health systems to deliver immunisation, improving antenatal and perinatal care, monitoring and minimising, where possible, exposure to factors that can harm hearing, such as excessive noise (occupational and recreational), or governance in the use of ototoxic drugs (for example, anti-tuberculosis drugs, anti-malarial drugs and diuretics for blood pressure). The social and economic gains of prevention of hearing loss are difficult to compute, but are likely to be high. These include savings from a more productive workforce, with fewer acoustic injuries and the reduction in the costs of compensation, which in Europe overall make up about ten per cent of the total cost of compensation of occupational diseases. Hearing loss is an enormous and growing problem in the world. The WHO estimates that more than five per cent of the world’s population, which equates to 360 million people, have disabling hearing loss. This includes 328 million adults and 32 million children. Eighty per cent of these live in LMICs. A further 659 million in the world have milder levels of hearing loss, so that, overall, more than one billion people experience hearing loss. Hearing loss becomes rapidly more common with increasing age and is therefore becoming increasingly common worldwide. By age 65, one in three people are affected by disabling hearing loss. On top of this, there are 43 million 12–35-year-olds with hearing loss and a further 1.1 billion young people thought to be at risk (an estimate based on unsafe music volume). Challenges and possibilities In LMICs the challenges include not only lack of resources and infrastructure but also low awareness of the extent and Impact of hearing loss The biggest functional impact of hearing loss is on a person’s ability to communicate with others. Spoken language and cognitive development is often delayed in children with deafness, especially when it is not detected before the critical period of language development at age six months to 18 months; this in turn often results in poor academic performance, with lifelong consequences of poor employment and economic activity. However, when opportunities are provided for people with hearing loss to communicate they can participate on an equal basis with others through spoken or written language, or through sign language. The social and emotional impact of hearing loss is due to exclusion from communication, causing loneliness, isolation, frustration, stigmatisation and depression, particularly among older people. Prevention of hearing loss Half of all cases of hearing loss can be prevented through primary prevention and health promotion. Early detection and treatment of the causes of hearing loss is essential. A priority should be the provision of better access to treatment of chronic middle-ear infections and wax impaction at the primary level, especially in children. School screening would provide opportunities for early detection and management.
Commonwealth Health Partnerships 2015
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