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Corresponding author. Correspondence to Kaloyan Kamenov (email: tni.ohw@kvonemak). Copyright (c) 2021 The authors; licensee World Health Organization.This is an open access article distributed under the terms of the Creative Commons Attribution IGO License (http://creativecommons.org/licenses/by/3.0/igo/legalcode), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In any reproduction of this article there should not be any suggestion that WHO or this article endorse any specific organization or products. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL.
In 2017, the World Health Assembly drew attention to the rising global prevalence of hearing loss. The Health Assembly called upon the World Health Organization to develop an evidence-based world report on hearing that provides guidance to Member States for improving access to ear- and hearing-care services. The report, developed through a multistakeholder consultative process, and published in March this year, reveals that by 2050 nearly 2.5 billion people will be living with some degree of hearing loss; of these, at least 700 million will require rehabilitation services. 1 , 2 Failure to act will be costly both in terms of the health and well-being of those affected, and the financial losses arising from their exclusion from communication, education and employment.
The report highlights why investing in preventing and addressing hearing loss is warranted at this time. First, across the life course, hearing loss can be prevented. Over a billion young individuals are at risk of avoidable hearing loss associated with recreational use of personal devices 3 and about 200 million have chronic ear infections 4 that can be prevented or treated. Second, effective and cost-effective solutions for the identification and rehabilitation of hearing loss are already benefiting millions of people at all stages of life. Combining the power of these interventions with public health strategies will ensure that those interventions can reach all in need. 1 Third, in 2020 nearly 1 trillion international dollars were lost due to unaddressed hearing loss globally. 5 With the current prevalence, unless action is taken, this amount may grow in coming decades. Fourth, an additional annual investment of 1.33 United States dollars (US$) per capita by governments can increase coverage of ear and hearing care services up to 90%, benefiting 1.3 billion people and bringing a return of around US$ 16 for every dollar invested over the next 10 years. 1
The report further elucidates the huge gap in services for ear and hearing care in all parts of the world. For example, there is an estimated gap of 83% between the need for and access to services for such care – taking hearing aid use as a tracer indicator. 6 The reasons for this gap are manifold and include the lack of accurate information and stigmatizing mindsets surrounding ear diseases and hearing loss. 7 , 8 Even among health-care providers, knowledge relevant to prevention, early identification and management of hearing loss and ear diseases is commonly lacking, thereby hampering their ability to provide the care required. 8 – 10 Moreover, in most countries, especially low- and middle-income, ear and hearing care is not integrated into health systems, which commonly lack the capacity to deliver the required services at primary and secondary levels, where they are most needed. The most glaring gap in health system capacity is in human resources. 11 Among low-income countries surveyed, 78% (14/18) have fewer than one ear, nose and throat specialist per million population and 93% (14/15) have fewer than one audiologist per million. Even in countries with relatively high proportions of professionals in the field of ear and hearing care, inequitable distribution and other factors can limit access. This lack of access poses challenges for people in need of care and places unreasonable demands on the cadres providing these services. 11
These challenges can be overcome through strategic government-led planning that integrates people-centred ear and hearing care within national health plans for universal health coverage (UHC). Care services can be implemented through adoption of established public health approaches such as task-sharing and telemedicine. Countries can deliver such people-centred care throughout the life course by ensuring access to evidence-based interventions that are delivered through a strengthened health system. The World report on hearing proposes such a package of interventions 1 that countries should consider when developing their national health plans or policies for UHC. This package, called H.E.A.R.I.N.G., includes hearing screening and intervention; ear disease prevention and management; access to technologies; rehabilitation services; improved communication; noise reduction; and greater community engagement. Identified through a consultative process based on evidence of their effectiveness, the first four concepts must be integrated and delivered through strengthened health systems. Countries should determine which interventions best suit their needs by conducting an evidence-based consultative prioritization exercise.
Without integrated people-centred ear and hearing care, governments risk depriving their citizens of the right to achieve the highest possible standard of health, functioning and well-being; and of the possibility of communicating optimally with others. The report on hearing presents a call to action, inviting Member States to work for the needs of all those who need ear and hearing care and to achieve the target of a 20% relative increase in effective coverage of such services by 2030.
1. Highlighting priorities for ear and hearing care - World report on hearing. World Health Organization: Geneva; 2021. Available from: https://www.who.int/activities/highlighting-priorities-for-ear-and-hearing-care [cited 2021 Mar 9].
2. GBD 2019 Hearing Loss Collaborators. Hearing loss prevalence and years lived with disability, 1990-2019: findings from the global burden of disease study 2019. Lancet . 2021; (Forthcoming) [PMC free article] [PubMed] [Google Scholar]
3. Estimation of the risk of developing hearing loss due to exposure to loud sounds in recreational settings. Geneva: World Health Organization; 2019. Available from: https://www.who.int/deafness/make-listening-safe/Meta-Analysis-Detailed-Report.pdf?ua=1 [cited 2021 Feb 5].
4. Monasta L, Ronfani L, Marchetti F, Montico M, Vecchi Brumatti L, Bavcar A, et al. Burden of disease caused by otitis media: systematic review and global estimates. PLoS One . 2012; 7 ( 4 ):e36226. 10.1371/journal.pone.0036226 [PMC free article] [PubMed] [CrossRef] [Google Scholar]
5. McDaid D, Park AL, Chadha S. Estimating the global costs of hearing loss. Int J Audiol . 2021. February 16;1–9. 10.1080/14992027.2021.1883197 [PubMed] [CrossRef] [Google Scholar]
6. Orji A, Kamenov K, Dirac M, Davis A, Chadha S, Vos T. Global and regional needs, unmet needs and access to hearing aids. Int J Audiol . 2020. March; 59 ( 3 ):166–72. 10.1080/14992027.2020.1721577 [PubMed] [CrossRef] [Google Scholar]
7. McCormack A, Fortnum H. Why do people fitted with hearing aids not wear them? Int J Audiol . 2013. May; 52 ( 5 ):360–8. 10.3109/14992027.2013.769066 [PMC free article] [PubMed] [CrossRef] [Google Scholar]
8. Olusanya B. Screening for neonatal deafness in resource-poor countries: challenges and solutions. Res Rep Neonatol . 2015. May; 2015 ( 5 ):51–64. 10.2147/RRN.S61862 [CrossRef] [Google Scholar]
9. McMahon CM, Gopinath B, Schneider J, Reath J, Hickson L, Leeder SR, et al. The need for improved detection and management of adult-onset hearing loss in Australia. Int J Otolaryngol . 2013; 2013 :308509. 10.1155/2013/308509 [PMC free article] [PubMed] [CrossRef] [Google Scholar]
10. Adeyemo AA. Knowledge of caregivers on the risk factors of otitis media. Indian J Otol. 2012. October 1; 18 ( 4 ):184. 10.4103/0971-7749.104795 [CrossRef] [Google Scholar]
11. Kamenov K, Martinez R, Kunjumen T, Chadha S. Ear and hearing care workforce: current status and its implications. Ear Hear . 2021. January 21; 42 ( 2 ):249–57. 10.1097/AUD.0000000000001007 [PubMed] [CrossRef] [Google Scholar]
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