who-itu consultation on make listening safe: meeting report...the safe listening standards once...

WHO-ITU consultation on the Make

Listening Safe initiative: meeting report 7-8 February 2018, WHO headquarters, Geneva, Switzerland

WHO Department for Management of NCDs, Disability, Violence and Injury Prevention

ITU Telecommunication Standardization Bureau

WHO-ITU consultation on Make Listening Safe: meeting report February 2018

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Executive Summary

A WHO-ITU consultation on the Make Listening Safe initiative was held in Geneva, Switzerland

on 7-8 February 2018 involving members of expert groups and other stakeholders, with the

objectives to: review progress made in the different areas of work as part of this initiative;

further the process of standards’ development for personal audio systems; develop a health

communication strategy and a research protocol.

Meeting participants included representatives of all relevant stakeholders in this field, including

experts.

The meeting highlighted the need for a collaborative and consistent approach towards safe

listening which takes into account the viewpoints of all stakeholders. Discussions focussed on

the standards for personal audio systems including their promotion and adoption; health

communication for safe listening including messaging to be included in the standards; outlining

the research protocol and need for regulatory framework for safe listening entertainment

venues.

The key outcomes and next steps with respect to different areas are:

Global standards for personal audio devices: drafting of the global standard ITU-T F.SLD

initiated in October 2015 is progressing. This "integrative" standard will be aligned as far

as possible to specifications from other standardization organizations and is expected to

be finalized in 2018.

Section on health communication which is to be included within the standards would be

revised by WHO, based on feedback received from the stakeholders.

Following the launch of the standards, efforts would have to be made to promote its

adoption by Member States and industry partners. This would require a coordinated

effort from civil society in partnership with the UN agencies.

The process for development of an evidence-based protocol was outlined. The first draft

of the protocol will be developed and circulated to an expert group.

A situation analysis on existing regulations regarding noise control in entertainment

venues will be done by WHO.


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1. Introduction

Unsafe listening poses a significant threat to the hearing of over a billion young people. The

trend of regularly listening to music at high volume and for long duration is a risk factor

contributing towards the rising prevalence of hearing loss.

In consideration of these facts, WHO launched the Make Listening Safe initiative in 2015. The

objective of this initiative is to prevent hearing loss caused by exposure to recreational noise.

This must be achieved through raised awareness about the need and means for safe listening,

along with an evidence-based regulatory approach to personal audio devices and

entertainment venues.

WHO has adopted a consultative approach in this effort and has organized a series of

stakeholders’ consultations over the last 2 years. The present consultation was organized with

the objectives to:

Share the progress made in different areas of work

Review and refine the proposed standards for safe listening devices

Determine dissemination strategy for standards and safe listening messages

Finalize the research protocol

Outline process for development of a regulatory framework for control of sound

exposure in entertainment venues

Participants included experts in the field of audiology, otology, public health, epidemiology,

acoustics, sound engineering; and representatives of professional organizations,

standardization organizations, manufacturers and users. A detailed list is available in Annex 1.

2. Summary of proceedings

2.1 Opening session

The meeting was opened by Dr Etienne Krug, Director of Department for Management of

Noncommunicable Diseases, Disability, Violence and Injury Prevention, WHO. Dr Krug

introduced the Make Listening Safe initiative and highlighted past developments that the WHO-

ITU consultation had achieved. He touched on the challenges ahead regarding creation of

listening standards for devices, publicising the finalised standards and expanding these

advancements into recreational venues and other settings. He emphasized the need to have a


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clear strategy for adoption of standards by Member States and industry partners. He also

welcomed the attendees and thanked them for their participation in the meeting.

Dr Alarcos Cieza, Coordinator of the Prevention of Blindness and Deafness, Disability and

Rehabilitation Unit, WHO welcomed all visitors and led introductions of all present. She then

specified each section of the agenda, including the content and aims of the working groups,

before introducing the speakers.

2.2 Updates

Dr Shelly Chadha introduced the structure and goals of the WHO as a whole during her opening

statement and detailed the WHA resolution on the prevention of deafness and hearing loss.

She also outlined a way to achieve these goals via member states, especially working towards

to goal of reducing Noise-induced hearing loss (NIHL). She presented the content of the World

Report on Hearing, to be published in the near futures, as well as a technical support toolkit.

The concept of the Make Listening Safe initiative was highlighted, including its progress to date

and the objectives of the WHO-ITU consultation.

Mr Simao Campos introduced the work of the ITU up till this meeting. He outlined the process

and timeline for publication of the standard.

Mr Jean-Louis Horvilleur outlined UNESCO’s newly created resolution 39C/49, that addresses

sound-related issues and promotes best practices. He described the goals to raise awareness

among the public, the elected officials and all the actors in society regarding the societal issues

of sound. The resolution focusses on different aspects of sound including its adverse health

impacts and the need to address these through an improved sound environment.

Mr Thomas Lund described the 2008 review from the Scientific Committee on Emerging and

Newly Identified Health Risks (SCENIHR), which led the European Commission to a 2009

Decision of putting a limit to maximum sound exposure from personal music players (PMPs). He

explained the currently enforced sound level limit, EN50332-1, along with updated

methodology (EN50332-3) and requirements (EN62368-1) for 80 dBA/40 hour dose-based

warnings and 3 minute limitation of exposure level, not to exceed 100 dBA. Mr Lund

recommended there to be only one international standard on these matters.

2.3 Communication campaign Ms Elena Altieri proposed strategies for communicating the ‘Make Listening Safe’ message

once the global standard for safe listening is finalised, in order to promote implementation of


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the finalized standards. She outlined the timeline and importance of each stakeholder in this

effort. She specified the next steps in the process, which were the finalisation of the strategy as

well as defining targeted messages products and channels, prior to the launch of the standard.

Dr Deanna K Meinke highlighted the importance of hearing in peoples’ lives. She showcased

examples of public awareness campaigns, including the use of the ‘Jolene’ mannequin to

engage youth involvement. She also set examples on how to utilise the media, advocates,

technology and anatomy to promote hearing health, and the message that there is a limited

amount or ‘dose’ of sound exposure over a set period of time. She provided examples of how

to convey what hearing loss feels like to assist laypeople to empathise with those with hearing

loss, and to experience what obstacles people with hearing loss sometimes face.

Mr Michael Santucci joined the meeting remotely to share a video made with celebrities in the

music industry, highlighting the importance of ear and hearing healthcare. He also spoke of

how hearing loss affected those whose careers were in music.

2.4 Standards for safe listening devices

Professor Sara Rubinelli spoke of how to communicate to users the ramifications of safe

listening habits; what information should or should not be included. The focal points

highlighted included the following questions: what are the risks of unsafe listening; what is

safe/unsafe listening; what are the standards for safe listening? Education will be required for

users to learn how to listen safely and how to limit unsafe listening. She advised the group how

to convey this message to different audiences with varying levels of knowledge and language,

as well as how to influence consumers via their personal audio systems. The communication

aspects which are to be included within the technical standards were outlined.

Professor Masahito Kawamori outlined the progress of the WHO-ITU standards (ITU-T Q28/16),

for safe listening audio systems. He described the reasoning behind the standards and how

they might be implemented. The technicalities of the term ‘dose’, and how it is measured were

specified, including various scientific formulae, as well as the term ‘sound allowance’.

Dr Richard Neitzel spoke about the noise exposure limit in recreational settings, specifically in

children, and the scientific evidence upon which this is based. A literature review was

performed examining how the defined noise exposure limits in adults could differ from children,

and how to determine a similar value for children. Rather than basing a sound level exposure

limit for children based on occupational standards or adult standards, a more conservative

recreational exposure limit for children was proposed, (75 dBA over 8 hours, or 70 dBA over 24

hours).


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2.5 Group Work: strategies for promotion and adoption of standards

Three working groups were established to explore the strategies that might be used to promote

the safe listening standards once finalised, as well as to improve the rates of adoption of the

same standards, both by manufacturers and governments. The groups were asked to develop

an analysis of current stakeholder involvement – who has been missed out and how should

they be classified in terms of influence and interest in this topic. Main suggestions include:

Environmental protection agencies (ministries of environmental health)

Heads of governments; City governors/mayors

Governmental agencies such as NIOSH (National Institute of Occupational Safety and Health Personal Data Protection Notice)

Musicians, music producers and influencers

Hearing health clinicians, pediatricians

Professional associations eg BIAP (Bureau International d’Audiophonologie)

Technology retailers

Consumer protection agencies

Charities

Organizations to facilitate advertisement of standards o Sports companies (apparel / teams) o Public transport companies

The groups were then asked to discuss what factors could motivate the industry partners to

voluntarily implement the standards. These were some of the responses:

Labelisation of the product (Eg., a label that the product meets WHO standards)

Positive perception of the company for complying to the standard

Unity/harmonization of standards

Classification of compliance for product lines (eg., Class A, Class B, Class C)

Having an ecosystem of sound production that complies with the standards as a whole

Inclusion of other industry partners prior to meetings in specific focus groups

Draft standards disseminated as early as possible

Sticker/label, for product meeting WHO hearing standards. There would be a lot of consumer interest for this

Flexibility within the standard will foster quicker adoption of WHO standards

Provision of source code would assist adoption of safe listening standards universally

2.6 Group work

A group discussion on the policy brief on health communication was mediated by

Prof Sara Rubinelli. Many stakeholders from private sector participated in the discussion and

provided feedback on the draft policy brief on health communication aspects of the standards.


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The participants were divided into 3 groups that discussed specific questions. The outcomes of

the group work are summarized below.

2.6.1 Drafting Group

The drafting group worked on progressing the current draft of the standard TD62-R1/WP2.

They proposed adding text concerning messaging for users, and made some editorial

modifications. A request was made for access to the current draft of CENELEC standards, in

order to align the two as best as possible.

2.6.2 Research Group

The research group aimed to compare, compile and discuss current research findings on the

topics of assessing the prevalence/occurrence of noise-induced hearing loss in recreational

settings. At the conclusion of the working group, five topics were assigned to various attendees

for detailed literature review. It was agreed that Dr Adrian Fuente will coordinate work within

the group members. These topics would be revisited with thorough analysis in July 2018.

Specific areas requiring in-depth research include: how to best measure hearing status

(including confounding factors such as tinnitus, hyperacusis) taking into account previous levels

of noise exposure. Further research will explore how best to assess hearing, including

extending frequencies up to 16 kHz, and assessing temporary threshold shifts, permanent

threshold shifts, acoustic reflexes and vestibular function. Further research will assess how

these tests apply across all age ranges.

2.6.3 Communication Group

A focus group discussed effective ways to communicate the risks of unsafe listening and

promote safe listening behaviours among youth. Some ideas shared are as follows:

Use of testimonials, especially from role models (such as musicians);

provision of incentives for safe listening to users (eg discount on music platforms)

Use positively framed messages

Demonstrate what hearing loss feels like, through multimedia videos

Change the perception that listening loud is cool (like smoking or sunbathing

without sunscreen)

In-built phone apps that keep track of sound use and allow users to see the

“remaining allowance” as a percentage, similar to the battery display

Explore possibility of including a section on “your optimal user sound experience” in

the initial settings of the devices (e.g. when you switch on the device for the first

time, you have to set the language, time).


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2.7 Safe listening entertainment venues

All attendees participated in an exercise where they ranked a list of entertainment venues

according to their need for noise regulation. These venues, ranked in order of most in need of

regulation, were nightclubs, concerts, fitness classes, bars, indoor stadiums and outdoor

stadiums. Further discussions went into detail on why these venues should be targeted and

how regulations may be implemented.

Dr Shelly Chadha explained the current status of regulations on recreational sound exposure.

She highlighted how most high-income and many low- and middle-income countries have

legislation to regulate occupational noise exposure, with less countries regulating noise

exposure from the environment. Where countries have specific regulations for entertainment

venues, these are mostly intended to protect the environment outside the venue. Only a few

countries have regulations that aim to protect clients within the entertainment venues from

excessive sound exposure. She acknowledged the role of Dr Catherine McMahon and her team

at Macquarie University in Australia in this preliminary situation analysis.

Dr Warwick Williams detailed a current code of practice for sound exposure in recreational

venues in Australia, given a lack of formal regulations. He also outlined how this may be

converted to formal regulations in practice.

Mr Nicolas Lounis spoke about the acoustical considerations to maintain quality music when

introducing regulations into recreational venues. He mentioned that we should strive for high

quality sound while maintaining safe listening levels. He shared ideas on how to preserve the

feeling of live music while regulating noise exposure, including the use of tactile generators

throughout venues as well as using healthy materials for acoustic diffusion or absorption.

Mr J-L Horvilleur described the outcome of regulations implemented in France in August 2017.

These regulations were designed to prevent people in entertainment venues from noise

exceeding 102 dBA or 118 dBC over 15 minutes for adults, and 94 dBA or 104 dBC over 15

minutes for children. He also described different scenarios and their implementation.

Mr Raphael Elmiger described the outcome of the Sound Levels and Laser Ordinance (SLO)

regulation in Switzerland. It was first implemented in 1996 before being revised in 2007, as is

enforced by each of the Swiss Cantons. All public events with an hourly sound level between 93

and 100 dBA were required to notify the authorities and display posters advising the audience

of the risk of hearing loss. These also required hourly sound level measurements and provision

of free hearing protectors. If the hourly sound level between 93 and 100 dBA continued for

longer than 3 hours, additional provisions were required, namely that hourly sound level


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measurements are submitted to the Swiss authorities on request. They are also required to

provide a respite area for the audience where the sound level is less than 85 dBA. Those events

with hourly sound levels less than 93 dBA had no restrictions. The main challenges to enforcing

these regulations were measurement uncertainties and regulation of small live music venues.

3. Conclusions and next steps

3.1 Standards for safe listening personal audio systems and communication

The work on finalization of standards for safe listening personal audio systems will

continue, with expectation of the standards to be finalized in 2018.

Draft of CENELEC standards would be received by WHO and ITU, in order to better

harmonize the two sets of standards.

The group representing private sector would provide, within two weeks, written

feedback on the health communication policy brief, in addition to suggestions already

made during the meeting.

A strategy for dissemination of the standards and promotion within Member States

and industry partners will be outlined by WHO, in consideration of inputs received

during this meeting. Relevant materials to support this process would be developed.

3.2 Research protocol

Background reviews would be done by group members to answer specific questions

raised in relation to the research protocol.

The writing of the protocol would be undertaken by group members, coordinated by

Dr Adrian Fuente and an update provided in July 2018.

3.3 Regulations for safe listening venues

Situation analysis on regulation regarding noise exposure in entertainment venues will

be completed by WHO, in collaboration with Macquarie University in Australia.

A case study of regulations in Switzerland will be made.

Further steps regarding developing a regulatory framework will be defined by WHO.

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