11.1 Local and Global Audiology

prevalence

number of people with HL in a population at a particular point in time

incidence

number of people with HL during a given time period

how to measure HL at a national level for a country?

via a census or household surveys (how many people in a given neighbourhood have HL and estimate it to wider population)

hospital screenings

clinic based screenings

school screenings

main cause of HL globally

noise exposure

ageing population

prevalence of HL in world

1.5 billion people have hearing loss as of 2021

15% mild HL

prevalence of HL for low income countries (of moderate degree or higher)

much higher than high income due to less access to hearing care in those countries where there is less funding by the government and HL perceived as less important health condition

patient side barriers

physical barriers: time for travelling lack of occupational flexibility

financial and non financial: low income opportunity costs (expensive care)

institutional: lack of health insurance and social insurance

communication: no sign language in their country, decision making (lack of patient centred care where patient autonomy is limited)

attitudes: stigma, fear adherence to rehab or treatment

provider barriers

physical barriers

lack of transport infrastructure or unequal distribution of providers

financial

direct cost of equipment

institutional

human resources, lack of devices that are cost effective

communication

no sign language

no referral system

no written instructions

attitudes

stigma, lack of regulation, low prioritisation (HL not viewed as highly)

lack of patient centred care

high income countries versus low income countries

people with HL in high income countries have higher access to hearing care

Levesque model describing access to care

supply versus demand

Supply (provider)

Approachability — visibility of services that can meet a need.

Acceptability — attitudes, cultural beliefs and service characteristics.

Availability — reachability and service capacity.

Affordability — direct and indirect costs (price, travel time, opportunity cost).

Appropriateness — technical and interpersonal skills, timeliness and quality of care.

Demand (patient)

Ability to perceive

Ability to seek

Ability to reach

Ability to pay

Ability to engage

prevention strategies for ear and hearing care

primary prevention- stop damage before it starts

secondary prevention- early detection and treatment

tertiary prevention- reduce long term impact

health systems in high income country versus low or middle income country

HICs have universal screening compared to limited screening in LICs and MICs (ad hoc only)

strong bigger workforce of hearing professionals versus shortage of hearing specialist

high access to HAs and CIs versus fewer HAs options available

government funding and insurance versus no govt funding and high out of pocket cost

integrated services versus more fragmented