Hearing health around the world
For 71 years, the United Nations has promoted cooperation among the world's countries. In honor of United Nations Day, celebrated every year by its members on October 24th, Healthy Hearing looked at hearing heath across the globe. What we found was that cultural differences, socioeconomic disparities and widely diverging systems of healthcare mean that all hearing health is not created equal.
Around the world, countries differ not only when it comes to their approach to hearing loss, but also when it comes to the percentage of the population affected by it. Accessibility to treatment is a major factor when it comes to the percentage of the population that have hearing loss; according to the World Health Organization (WHO), those countries with the least income and therefore the least access to healthcare also happen to have the highest rates of hearing loss.
The developing countries tend to place a low priority on hearing health issues. Ear infections, for example, will often go untreated. According to WHO the incidence of disabling hearing loss among both children and adults over age 65 is highest in South Asia, Asia Pacific and Sub-Saharan Africa.
One organization is doing its part to ensure that children in still-developing countries have the same access to hearing equipment as their peers in developed countries. In order to help children with hearing loss in those developing nations where hearing healthcare is limited, researchers at SINTEF in Norway are developing a basic version of a hearing aid that is easily adaptable to a child’s hearing loss and can be used without the services of a hearing healthcare specialist. For most of these children and their families it is simply too difficult and expensive to see a doctor or audiologist, so SINTEF is trying to streamline the process. "For many families living in rural villages in countries like Kenya, even a journey to the capital city in order to see an ear doctor is a huge financial burden that can cost more than the hearing aid itself. This is what we want to tackle," says project initiator and researcher Tone Berg.
Even among the developed nations with established health care systems, approaches to hearing loss vary widely. Financial coverage for hearing tests, hearing aids and other assistive devices isn’t always available. For example, in the U.S., most insurance plans, including Medicare don’t cover hearing aids. This lack of coverage leaves millions of people, including many senior citizens on fixed incomes, unable to afford the hearing aids they need.
At the root of the differences in hearing health coverage between the U.S. and other developed countries is the fact that many of the other countries have universal healthcare, a system which is designed to ensure all citizens have access to healthcare without causing financial hardship. This coverage often extends not just to general care, but to hearing loss and hearing aids as well.
In the UK, for example, hearing aids are distributed free of charge through the National Health Service (NHS), which is the taxpayer funded national healthcare system. Citizens can also buy hearing aids privately if they would like to choose from a wider selection. Bulk buying power allows the NHS to purchase these hearing aids at affordable prices, and they are then loaned to the patients at no cost. Even though patients who receive hearing aids distributed by the NHS don’t have as wide a selection, that doesn’t mean they have to settle for inferior hearing aids. “The NHS can procure high-quality digital hearing aids. For most situations, they perform very well and the waiting time to get one is short," says Louise Hart, an audiology specialist with Action on Hearing Loss.
Progress in terms of accessibility for those with hearing loss has been made in the U.S. since the Americans with Disabilities Act (ADA) was passed in 1990. Since its implementation, the ADA has been instrumental in improving services, access, healthcare, education and awareness for those with hearing loss. The United States still has a long way to go to catch up with the accessibility and coverage enjoyed by Europeans.
In the UK, the free hearing aids distributed by the NHS come equipped with telecoils, which enable access to the loop systems installed in many public places such as train stations, airports, theaters and places of worship. Loop systems are common in the UK and Scandinavia and are spreading throughout the rest of Europe.
However, one 2013 study by the advocacy group Reduced Mobility Rights found that even though loop technology is becoming more common in Europe than in the U.S., the majority of European airports do not yet provide adequate support to deaf passengers or those with hearing loss. With the exception of UK and Denmark, the study found that European airports still have far to go in terms of visual announcements, clear signage, up-to-date flight displays and induction loop systems at check-in counters and security gates.
According to the WHO, current hearing aid production meets only 10 percent of global need. And in developing countries, only 3 percent of those who need hearing aids have them. These statistics prompted a group of researchers to examine cultural differences to see whether those differences were a factor in the decision to seek help for hearing issues. The group examined healthcare systems and audiology services in many different countries as well as how culture influenced hearing-related behavior and attitudes.They found that from culture to culture, differing attitudes toward aging, hearing loss and disability in general had a profound effect on the decision to use hearing aids and other assistive devices.
While in western cultures, hearing loss is viewed from a scientific perspective, in other cultures it may be seen from a different perspective: the result of evil spirits, bad luck, sin or other negative cause-and-effect. That stigma can be reason enough for many, especially in developing countries, to avoid seeking treatment for themselves and their loved ones.
Cultural and socioeconomic differences aside, one study in 2011 found a striking and surprising cross-cultural similarity: just because hearing aids are free or significantly less expensive doesn’t necessarily mean more people get them. Even in Europe, where hearing aids are more accessible due to universal healthcare, the rate of adoption remains similar to that of the United States.
How much does cost matter?
Virginia Ramachandran, an audiologist at Henry Ford Hospital in Detroit, led the 2011 study. Patients were divided into three groups: one group was to receive hearing aids at no cost to them, another group would receive partial coverage, and the last group was to pay full price with no coverage. What researchers found was that lowering the cost of hearing aids didn't make any difference to those adults with mild hearing loss and did not influence them to purchase hearing aids sooner.
The United States still has a long way to go to catch up with the accessibility and coverage enjoyed by Europeans.
As a result, Ramachandran concludes that cost isn’t the entire issue when it comes to hesitation in purchasing hearing aids, but that stigma still plays a significant role. "People genuinely perceive hearing loss as being associated with older age, so any excuse not to get them is a good one if it is something that you do not really want," she says.
Remember: Hearing loss might be universal, but avoiding treatment for it doesn’t have to be. If you or someone you care about has hearing loss, quality care is an easy phone call away. Check out our directory of consumer-reviewed professionals near you and make the call today.