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How Does Audiology Fit into the Public Health Domain?

Clark, Jackie L. PhD

doi: 10.1097/01.HJ.0000612556.50996.4c
Editorial
Free

Dr. Clark is a clinical professor at the University of Texas at Dallas and a co-founder/co-director of the Coalition for Global Hearing Health. She also serves on the editorial board of The Hearing Journal.

As we near the unveiling of the World Report on Hearing (WRH) at the 73rd World Health Assembly (WHA) in May 2020, one can surmise that there will be a few unfamiliar concepts in the audiology realm that are more deeply entrenched within the public health sector. Some may be wondering, “What is the World Report on Hearing?” or “Why should I care?”

In May 2016, we reached a tipping point in global ear and hearing health care when the WHA resolution (WHA70.13) called upon the World Health Organization (WHO) to prepare a World Report on Hearing (WRH) prior to the 2020 WHA Assembly. The report is to be based on the best available evidence, highlight any shifts in global hearing loss distribution, and bring attention to priorities and best practices for ear and hearing care. Ultimately, the WRH will set a global agenda to not only bring ear and hearing care to the global forefront but also guide public health efforts in addressing the need for advocacy of ear and hearing care.

So what will the report say? We will not know until the momentous presentation at the 73rd WHA. However, when looking within the public health domain, the WRH will most assuredly address at least four of the 17 Sustainable Development Goals (SDGs) adopted by the United Nations in 2015. All 17 SDGs were developed to be universal (i.e., for low-, middle, and high-income countries), with the vision of ending poverty, protecting the planet, and ensuring that people enjoy peace and prosperity between now and 2030. The report will most likely address SDGs relating to ending poverty (Goal 1), ensuring good, healthy lives (Goal 3), improving chances for education (Goal 4), and promoting employment opportunities (Goal 8)—goals that resonate well within the context of our professional laser-focus on patient-centered care. After all, evidence is abundant on the benefits of early identification and remediation in ensuring greater educational success, future employability, and improved quality of life for people with hearing impairment. (I hope that I have whet your appetite for a Google search on the remaining 13 SDGs. It makes for a great read and pushes us into a broader view of patient-centered care from a public health perspective!)

Another foundational public health concept that was the impetus behind over-the-counter hearing aids legislation is accessible and affordable health care. While audiology employment has been projected to grow by 16 percent between 2018 and 2028, it's important to note that the number of Americans with hearing loss is projected to reach 53 million by 2050 (Bureau of Labor Statistics, 2019; Kochkin, 2005). This concerning phenomenon of having an inadequate number of highly trained health professionals can be seen on a global level. One viable means to address this shortage within the public health domain is task shifting, a delegation process used to meet the ever-growing demands for health care services while still maintaining quality. In general, task shifting would depend largely upon the creation or enhancement of another tier of health workers. The WHO defines task shifting as “the rational re-distribution of tasks among health workforce teams… where appropriate, from highly qualified health workers to health workers who have fewer qualifications in order to make more efficient use of the available [health workers]” (WHO, 2010). For example, nurses would delegate some of the frontline non-specialized tasks to nursing assistants and community health workers, allowing them to engage in more specialized daily tasks. In audiology, we're now beginning to understand the benefits of task shifting by delegating fewer specialized tasks to well-trained audiology assistants. Consequently, increasing the number of appropriately trained health workers helps address this shortage while improving accessibility of services in the context of chronic limitation of health professionals who have advanced skill levels.

Although we have to wait until May 2020 for the WRH to be published, we are assured that the WHO's mission to provide a cohesive and consistent narrative on hearing care will help raise broader awareness and identify the next steps for global policymakers to achieve richer collaborations.

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