APPLYING PUBLIC HEALTH

STRATEGIES TO REDUCE THE

BURDEN OF HEARING IMPAIRMENT

Dr Daksha Patel, Prof Andrew Smith

and Joanna Anderson

Presentation objective

Public health for hearing impairment:

Our approach and rationale

A2

Slide 2

A2 We may find some people from Gallaudet don't like word impairment (also burden may be a no-no). we may

have to think of some answers. At least its better than "hearing-impairmed people".Andrew, 10/5/2015

PUBLIC HEALTH: Health of populations

CLINICAL MEDICINE: Health of individuals

CLINICAL MEDICINE

PUBLIC HEALTH

• Consultation & Diagnosis,

• Treatment,

• Follow-up

• Survey, • Population interventions

• Prevention,

• Health system strengthening

• Policy

360 million people have

disabling hearing loss,

globally 328 million adults

32 million children

Burden is greatest in LMIC

0

2

4

6

8

10

12

14

High- income Central Asia & EEurope

SS Africa EMRO South Asia Asia pacific Latin America&Carib

East Asia

CHIDREN WITH HI ( MILLIONS)

Prevalence increases with

age

1.7%

children

7%

age 15 - 64

Approx 33%

age 65+

HI prevalence decreases as GNI increases

Global population growth

1960 2010 2060

3 billion

people

6.9 billion

people

10 billion

people

2 billion

1 billion

0

Developed

countries

Developing

countries

Number of people aged over 60

Ageing populations

A4

Slide 10

A4 would it be worth calculating the figures for 2050 using current prevalnces for <60 & >60Andrew, 10/5/2015

High

• Inherited causes

• Chronic otitis media

• Ageing (presbyacusis

Moderate

• Excessive noise

• Ototoxic drugs

• Ante- & peri-natal problems

• Meningitis, measles,

• mumps

• Foreign bodies,

• wax

Low

• Nutritional

• Trauma

• Toxic chemicals

• Menière’sdisease

• Tumours

• Cerebrovascular

• disease

PREVALENCE by Cause

WHO priority for action

Epidemiological data is used to

select appropriate control measures

GlobalAvoidable★

causes

50%

Prevention

Early detection

★ Preventable and treatable

Epidemiological data is used to

select appropriate control measures

Children Congenital

Infective

• Prevention.

• Early detection• Comprehensive

• Services

Epidemiological data is used to

select appropriate control measures

Acquired

causes Adult

Prevention

Early detection

Hearing Devices

Appropriate control measures can

avoid 50% of hearing impairment

Prevention Early

detection

Strengthen

services

PUBLIC HEALTH SPENDING

Slide courtesy of De Wet Swanepoel, PhD

360 million people with disabling hearing loss

• National programmes

• Local needs assessment

• Health systems strengthening

• Multi-sectoral involvment

A9

A10

Slide 17

A9 A neeeds assessment would be needed to set up the national programme. (note that WHO now tends to use

Strategy insted of Programme as in new guidelines. Typo in involvementAndrew, 10/5/2015

A10 The small caption mentions eye services - maybe cover it?Andrew, 10/5/2015

Public health planning approach

Slide 18

A11 The small font in the arrows may be difficult to seeAndrew, 10/5/2015

Public health model for service provision

Control strategies

Infrastructure &

technologyHearing health

team

1 Million people

Health systems approachGovernance Service

delivery

Information

systems

Medicines,

technology

Health

financing

Health

personnel

Leadership and governance • National programmes • National targets

• Multi-sectorial involvement

Finances • National budget

• NGO contributions

• Sustainability

• Cost containment/ recovery

• Insurance schemes

Human resources • Numbers of health workers

• Distribution • Skill mix

• Training programmes

Medicines / technology

• Availability

Repair and Management

Sustainability

Information/ data

• Monitoring Management

Accountability

Service Delivery • Prevention

• Detection • Treatment

• Rehabilitation

• Distribution

• Accountability Equity – Accessibity – Affordaility – Quality

Planning the change required – at a local level

Programme planning and management cycle

Challenges to overcome:•Lack of finances

•Engagement from leadership and wider ENT and

audiology community•Lack of local data

•Lack of political will and MoH involvement

•Clinicians – information and action beyond the patient

in-front of them

•Lack of resources e.g hearing aids. •Lack of public awareness.

A14

Slide 24

A14 + Lack of political will, Lack of awareness in whole populationAndrew, 10/5/2015

In conclusion:•Public health approach is essential to address the

growing burden of HI•National and International involvement •Facilitate Change at a local level

•Embedded within health system for sustainability •Prevention – early detection – comprehensive services are central to this approach.

Thank you for listening A16

Slide 26

A16 great - she was an early believer in public health!Andrew, 10/5/2015