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Why is Hearing Loss a Public Health Concern?

Tremblay, Kelly L. PhD

doi: 10.1097/01.HJ.0000515653.04493.b1
Public Health and Hearing Loss

Dr. Tremblay is a professor at the University of Washington in Seattle. She has a 30-year history of serving and advocating for people with hearing loss. She studies the effects of hearing loss and hearing prosthesis on the brain, and the public health benefits of intervention for our aging society.

Question: People do not die from hearing loss, so why should it be added to the list of public health concerns like tobacco use and obesity? Answer: Because hearing loss is highly prevalent, with numerous associated health risks that burden affected individuals, their family, and their community.

Older adults in the United States are disproportionately afflicted with hearing loss, with as many as one-third of adults over 65 years old exhibiting hearing loss (Ear Hear. 2012;33[3]:437 http://bit.ly/2lT6zo6). The World Health Organization (WHO) estimates the number of people with hearing impairment increased from 42 million in 1985 to about 360 million in 2011 (Bull World Health Organ. 2014;92:367 http://bit.ly/2m4dw4G).

Because hearing loss is highly prevalent, patients are often told “your hearing is normal for your age,” or “you'll have to learn to accept and deal with your hearing loss.” However, research tells us that hearing loss has a tremendous impact on a person's quality of life. It is associated with numerous health issues, including accelerated cognitive decline, depression, increased risk of dementia, poorer balance, falls, hospitalizations, and early mortality. Therefore, despite what patients are told, hearing loss and related health issues are not easy to “accept” or “deal” with.

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A MEDICAL & PUBLIC HEALTH CONCERN

Hearing loss is a burden. The WHO measures the burden of all health conditions and diseases with the Disability-Adjusted Life Year (DALY). One DALY equals one year of healthy life lost. In the case of hearing loss, DALYs are primarily related to years lived with disability (YLD). The number of years lived with a disability because of hearing loss is significant. In 2013, the top five causes of global YLD were back pain, major depression, iron deficiency anaemia, neck pain, and hearing loss (Lancet. 2015;386[9995]:743 http://bit.ly/2lAsUsK).

Traditionally, hearing health care falls within a medical model where diagnostic assessments are used to determine if the hearing loss can be treated with medications and/or surgery. However, when there is no evidence of medical pathology, as is the case with most age-related hearing problems, there's also no clear and effective pathway of care. Without a known cure for hearing loss at this time, people with hearing loss, as well as those in their communication circles, have needs that are not being met because they require services that fall outside the medical model. Such services include education and counselling (e.g., increasing knowledge, changing attitudes, and reducing stigma), support in promoting behavior change (e.g., adapting communication strategies), and environmental modifications (e.g., reducing noise; Gerontologist. 2016;56 Suppl 2:S25 http://bit.ly/2lAChsi). In other words, what is lacking is a hearing health care system that can serve a broader population of people with hearing loss and include the larger ecological context within which hearing loss occurs. For these reasons, there is increased awareness that hearing loss is not only a medical problem but also a public health concern.

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A SHIFT IN PERSPECTIVE

When hearing loss is viewed from a public health perspective, the mission expands to include improving health and quality of life, not only through prevention and treatment of hearing loss but also through the promotion of healthy behaviors. An essential component of public health is the “collective action for sustained population-wide health improvement” (Lancet. 2004;363[9426]:2084 http://bit.ly/2lALIIj; Bull World Health Organ. 2014;92[5]:367 http://bit.ly/2lAFqIq). As such, there are many ongoing initiatives aimed at making hearing health care more accessible and affordable within and outside of the medical model (Ear Hear. 2016;37[4]:376 http://bit.ly/2lAL6SW; Ear Hear. 2010;31[1]:2 http://bit.ly/2lAIMew).

Some initiatives include specialized pre-conferences such as the U.S. Department of Veterans Affairs’ National Center for Rehabilitative Auditory Research biennial conference, “Hearing Loss as a Public Health Concern,” in 2015. Another is the establishment of a special interest group called the Population Hearing Health Care Group, which held a pre-conference at the 33rd World Congress of Audiology 2016 and an upcoming one at the American Auditory Society Annual Meeting in 2017. At these meetings, scientists and clinicians gather evidence to identify gaps in knowledge, service, and policy to develop new approaches to hearing health care.

The hearing health care landscape is changing rapidly. The time is right for bold and innovative changes. As an example, the Food and Drug Administration (FDA) announced in December 2016 that they were waiving the requirement that individuals 18 and up have to receive a medical evaluation or sign a waiver prior to purchasing most hearing aids, in addition to possibly creating a new category for over-the-counter hearing devices. This month, the Federal Trade Commission (FTC) is hosting a workshop called “Now Hear This: Competition, Innovation, and Consumer Protection Issues in Hearing Health Care.” The workshop is open to stakeholders such as health care providers, consumers, hearing health advocates, industry representatives, and policymakers. The goal is to explore how innovation and competition in the hearing health care industry can improve access to and use of hearing aids by those who need them.

What we are witnessing is “collective efforts” aimed at providing sustainable, population-wide hearing health improvement. Depending on who you are (audiologist, engineer, or patient with hearing loss) the proposed changes may or may not sit well with you. Shifts in perspective can be challenging and time-consuming. However, when hearing health care is viewed from a public health perspective, it becomes clear that change is needed. There is a high prevalence of hearing loss and only about one-fifth of people who could benefit from a hearing aid seek intervention. Even fewer make use of technology or communication strategies that might help them. Thus, we have a large population of people living with unmet communication needs.

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