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Why we need a public health approach to hearing

Introduction by Croakey: Hearing loss and deafness affect millions of Australians, and should be positioned as a public health priority, according to Dr Caitlin Barr, CEO of Soundfair, a non-profit organisation that is committed to hearing equality.

Below she reviews relevant articles in a recent themed edition of the journal, Public Health Policy & Research, that was guest edited by Soundfair and the Macquarie HEAR Centre.

Amongst the articles is a call for education campaigns to promote prevention and management, at individual and societal levels, and “to escalate society-wide actions to remove accessibility and inclusion barriers”.

The edition also includes a call by Professor Tom Calma, an Aboriginal Elder from the Kungarakan and Iwaidja nations, for a “strong population health education program, as part of the new National Preventive Health Strategy, to educate our community about the social determinant issues that impact on hearing care, like overcrowded housing and poverty, and the critical importance of early presentation, diagnosis and follow-through with treatment”.


Caitlin Barr writes:

When listening to Deaf and hard of hearing people’s stories about their experiences, one word comes up time and time again – hidden.

Just as hearing loss is an invisible disability, people with lived experience tell us that its impacts – physical, social and emotional – are not only invisible, but also, crucially, actively hidden because hearing loss is stigmatised by society.

Taking a public health approach to hearing health reveals these previously hidden impacts and shows, starkly, that hearing loss is itself a social determinant of health, with lifelong implications.

It is well recognised that the social determinants of health weigh more heavily on the disadvantaged in our society, and hearing health is no exception.

A paper by Professor Catherine McMahon and colleagues concludes that more than one in 10 school-age children in NSW from lower socioeconomic backgrounds experience hearing loss.

The consequences of sensorineural hearing loss in young children include poor speech and language development, poor educational outcomes, and delayed socio-emotional development.

For children who face socioeconomic disadvantage, middle ear disease is more prevalent, access to primary health care is more difficult, and psychosocial and education supports are limited.

Diverse viewpoints

Importantly, the journal explores the lack of equitable access to healthcare from many viewpoints:

  • from older adults, where a high prevalence of hearing loss contrasts with a small proportion of people who seek help and where stigma and trust, rather than cost and access, are the key barriers to help seeking
  • from Aboriginal and Torres Strait Islander parents, where community health literacy deficits and barriers to access combine to delay referral to specialist care with consequent lifelong impacts
  • from Deaf researchers who highlight the inequity of navigating a health system that not only often has English literacy as a prerequisite for access, but also applies a medical model (rather than a social model) of disability to Deafness (also read more in this previous Croakey article).

Hearing loss is one of the most common long-term health conditions associated with ageing, and a considerable contributor to Australia’s late-life disability burden. Acquired hearing loss in adulthood presents significant challenges for the health of many Australians.

Yet hearing loss remains poorly recognised and is under-treated in many communities. A paper by Dr Kim Kiely and Professor Kaarin Anstey urgently calls for a broad public health strategy to reduce the long-term disability burden attributable to hearing loss with a mix of prevention, public awareness campaigns, targeted education for medical and healthcare professionals, screening programs, and adoption of inclusive design principles.

A paper by Dr Rebecca Bennett and colleagues highlights the many ways in which GPs could be better equipped to support patients with age-related hearing loss in their help-seeking and rehabilitation journey.

Approaches were described within five overarching concepts: three were specific to hearing (having knowledge and understanding; being connected to expert hearing professional networks; and making hearing assessment part of routine care) and two described more general traits of high-quality patient care more broadly (asking questions and raising concerns; and listening with empathy and respect).

There is scope to optimise how GPs support the help-seeking pathway for adults with hearing loss within general practice.

Accountability matters

Hearing health has been the topic of numerous high-profile reports filled with recommendations for policy, practice and research. Despite commonalities, few have translated into policy change; practice is slow to accept change; and research lacks sustained and secure funding needed to innovate and robustly evaluate new models of care.

With a projected one in four Australians set to experience hearing loss by 2050, those affected find themselves trying to stay afloat amid fast-paced technological changes, with complex and imposing funding arrangements, while experiencing the well-evidenced psychosocial, emotional and educational impacts.

Decision makers must be held to account to ensure hearing loss and deafness are strategically positioned as a public health priority, including:

  • An awareness-raising campaign, focused on the diversity of lived experiences seeking to reduce stigma and create a more inclusive society
  • Funding to encourage innovation in clinical and non-clinical service models in hearing care to better suit the needs of the population at different stages
  • Ongoing funding to encourage development and implementation of supports for vulnerable populations.

Hearing loss and deafness should no longer be stigmatised; but viewed as a widely acknowledged experience that requires society-wide action.


See Croakey Conference News Service coverage of the launch of Soundfair’s HearMe project in 2021:

 

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