What does the World Report on Hearing tell us about the future of hearing healthcare?

If you’ve read the World Report on Hearing¹, you’ll recognize the tagline, “Hearing Care for All”.

What does this tagline mean? It means we need to prioritize hearing health care in public health policies. One more time for the people in the back! – Hearing health care needs to be a public health priority.

This (first!) World Report on Hearing, released in 2021 by the World Health Organisation (WHO), was established in response to the WHO identifying hearing loss as a public health issue in 2017. It addresses both the challenges and strategies to achieving accessible hearing health for all.

While there’s a long way to go, with buy-in from all stakeholders, the future of hearing healthcare is looking bright.

The 250-page Report is structured in four sections. A breakdown of each section is below

Section 1: Why hearing matters across the life course

Unaddressed hearing loss is the third largest cause of years lived with disability globally.¹  This section addresses the common etiologies, the impact of untreated hearing loss on different stages across one’s lifespan, and the need to regularly test hearing across multiple domains.

Main points:

• Hearing loss can arise from a wide range of factors (environmental, genetic, biological, psychosocial and socioeconomic).
  
• The risks of unaddressed hearing loss differ across the life course. For example, poor speech and language development and poorer educational outcomes in children.^3,4 In adults, risk of social isolation, anxiety, depression⁵ and cognitive decline.^6-8
  
• Testing across multiple domains is essential. While basic diagnostic testing is a fundamental part of this, one’s hearing capacity should not be isolated to the periphery auditory system. Testing for central processing disorders and post-synaptic integrity should be considered,⁹ particularly when amplification does not achieve the desired outcome or hearing difficulties are evident in the absence of a hearing loss.

Key takeaway: Sufficient hearing is necessary across the course of the lifespan. Proper diagnosis and management are essential in reducing the impact of unaddressed hearing loss.  

Section 2: Solutions to prevent and address hearing loss

Prevention is always better than cure. Prevention strategies vary across stages of life. For example, nearly 60% of pediatric hearing loss is preventable through public health measures, including immunizations, adequate maternal and neonatal care and management of otitis media. Across life, reducing recreational and occupational noise exposure is essential.

Effective solutions to reduce the risk of hearing loss and its associated implications:

• Preventative strategies
• Identification of hearing loss across the life course
• Technological solutions and sign language
• Addressing hearing loss through a person-centered approach (we might also use a family-centred approach here!).
• Tools such as auditory training in hearing rehabilitation¹⁰

Key takeaway: Timely action is needed to prevent and address hearing loss across the life course.

Section 3:  Improving access to ear and hearing care

The challenges faced by countries and stakeholders are often further constrained by the capabilities of their health systems. A quote that captures this sentiment perfectly: “You don’t rise to the level of your goals, you fall to the level of your systems” – James Clear, Atomic Habits ¹¹

This quote often rings true regarding public health policy. You can have the best initiatives, but these need to have good infrastructure to ensure success. 

Current challenges:

• Demographic and population trends – For example, a global increase in aging population. It is estimated that by 2050, 1 in 4 people will have some degree of hearing loss, and 1 in 14 will require hearing care.
  
• Ear and hearing health literacy and stigma related to hearing loss – This limits access to care and limits prevention, early identification, and management strategies.
  
• Health system-related issues – Health systems are characterized by the WHO building blocks of health¹² which breaks health systems into:
  • Clinical services
  • Health workforce
  • Access to devices (medical products)
  • Data and indicators (health information)
  • Leadership and governance
  • Finance

Insufficiency in any one of these blocks can cause a health system to weaken. On the flipside, strengthening of these blocks can strengthen health systems in order to provide universal access to health.

Interventions to improve access to ear and hearing care:

• To strengthen health systems and build capacity, all six of WHO’s building blocks need to be invested in. The report addresses challenges and solutions in hearing health care in regard to each building block. This provides a great reminder that systems are the sum of their parts and should not be viewed in isolation.
  
• Some of these challenges can be overcome by improving communication around ear and hearing care in a culturally appropriate and safe way (read this blog here about cultural competence).
  
• By disseminating information regarding hearing care through multiple facets of society (e.g. educators, healthcare providers and community health care workers), an improvement in health literacy, and therefore hearing loss prevention, is more likely.

Key takeaway: Investing in cost effective interventions will benefit people with hearing loss and bring financial gains to the society.

Section 4:  Designing the way forward

It costs an estimated U.S. $1 trillion annually due to the collective failure to adequately address hearing healthcare.¹ Designing the way forward to make ear and hearing care accessible for all requires buy-in from stakeholders at all levels, from policymakers to health systems, clinicians, professional groups and private sector entities.

The report outlines critical public health interventions in the acronym H.E.A.R.I.N.G whereby, stakeholders can apply this framework to develop initiatives to the betterment of hearing health care. We all love acronyms in Audiology, so here’s another to add to the bank.

Proposed interventions:

H – Hearing screening and intervention
E – Ear disease prevention and management
A – Access to technologies
R – Rehabilitation services
I – Improved communication
N – Noise reduction
G – Greater community engagement

Key takeaway: Countries must integrate people-centered ear and hearing care within national health plans for universal health coverage.

What does this report tell us about the future of hearing healthcare? 

While it is clear there is no silver bullet, the recommendations in this report could spur stakeholders across the globe to start the necessary conversations, create tools to action local initiatives and work together in a collaborative way in order to improve hearing outcomes for all.

We each have a part to play to ensure these strategies are actioned and with a concerted effort, we can be the catalyst of change. 

References:

1. World Health Organization. (‎2017)‎. Global costs of unaddressed hearing loss and cost-effectiveness of interventions: a WHO report, 2017. World Health Organization.

2. World Health Organization (2021).  World Report on Hearing. 2021. Geneva, Switzerland.

3. Tomblin, J.B., Oleson, J.J., Ambrose, S.E., Walker, E., Moeller, M.P. (2014). The influence of hearing aids on the speech and language development of children with hearing loss. JAMA Otolaryngology–Head & Neck Surgery; 140(5): 403-9.

4. LeClair, K.L. & Saunders, J.E. (2019). Meeting the educational needs of children with hearing loss. Bulletin of the World Health Organization; 97(10): 722.

5. Jayakody, D.M., Almeida, O.P., Speelman, C.P., Bennett, R.J., Moyle, T.C., Yiannos, J.M., et al. (2018). Association between speech and high-frequency hearing loss and depression, anxiety and stress in older adults. Maturitas; 110: 86-91.

6. Thomson, R.S., Auduong, P., Miller, A.T. & Gurgel, R.K. (2017). Hearing loss as a risk factor for dementia: a systematic review. Laryngoscope investigative otolaryngology; 2(2): 69-79.

7. Lin, F R., Yaffe, K., Xia, J., Xue, Q.L., Harris, T.B., Purchase-Helzner, E., Satterfield, S., Ayonayon, H. N., Ferrucci, L., Simonsick, E. M., & Health ABC Study Group (2013). Hearing loss and cognitive decline in older adults. JAMA internal medicine; 173(4), 293–299.

8. Lemke, U. & Scherpiet, S. (2016). Oral communication in individuals with hearing impairment—considerations regarding attentional, cognitive and social resources. Frontiers in Psychology; 6:998.

9. Bharadwaj, H., & Shinn-Cunningham, B. (2021). What’s been hidden in hidden hearing loss. Neuron; 109(6): 909-11.

10. Stropahl, M., Besser, J. & Launer, S. (2020). Auditory training supports auditory rehabilitation: a state-of-the-art review. Ear and Hearing; 41(4): 697-704.

11. Clear, J. (2018). Atomic Habits: the life-changing million-copy# 1 bestseller: Random House.

12. World Health Organization (2010). Monitoring the building blocks of health systems: a handbook of indicators and their measurement strategies. Geneva, Switzerland.