Bull World Health Organ 2019;97:646–646A | doi: http://dx.doi.org/10.2471/BLT.19.224683

Editorials

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The global prevalence of sensorineural hearing impairment was first reported by the World Health Organization (WHO) in 1985.1 At that time, 42 mil-lion people (approximately 1% of the world’s population) were estimated to have moderate to profound (or dis-abling) hearing impairment. By 2011, the estimate rose to 360 million, of whom 32 million were children younger than 15 years.2 The most recent WHO estimate suggests that approximately 466 million people (or 6.1% of the world’s population) were living with disabling hearing loss in 2018.3 This estimate is projected to rise to 630 mil-lion by 2030 and to over 900 million by 2050. Approximately 90% of people with moderate to profound hearing impairment reside in low- and middle-income countries. The Global Burden of Disease study, which incorporated mild and unilateral hearing loss, estimated that the population with hearing loss rose from 1.2 billion (17.2%) in 2008 to 1.4 billion (18.7%) in 2017.4 This trend has become a serious public health issue that deserves an appropriate and well-coordinated global action.

At the individual level, the burden of hearing loss over the life course is substantial and can be exacerbated by negative societal attitudes and prejudice towards affected people. In general, hearing loss has adverse consequences on interpersonal communication, psychosocial well-being, quality of life and economic independence.5–7 The condition impedes speech and language development from early childhood and can set affected children on a trajectory of sub-optimal educational and voca-tional attainment. Adults with hearing loss often experience social isolation and stigmatization, abuse, psychiatric disturbance, depression, difficulties in relationships with partners and children, restricted career choices, occupational stress and relatively low earnings.8 The economic impact of unaddressed hear-ing loss on health, education and productivity for society is staggering,

estimated to cost over 750 billion United States dollars globally.9 This figure is expected to rise as the number of people with hearing loss rapidly increases across the world.

The main drivers for the rising trend in hearing loss include demo-graphic changes attributable to global population growth and improved life expectancy.3,5,10 The substantial global investments on child survival pro-grammes since 2000 have also resulted in a growing population of beneficiaries with special health-care needs in low- and middle-income countries.6 Sen-sorineural hearing loss, which results from damage to the hair cells in the inner ear, is more frequently considered as the major pathway to permanent hearing impairment. Many countries lack programmes to reduce exposure to risk factors such as occupational and recreational noise. The use of ototoxic drugs needs to be minimized.5 Signifi-cant causes of increased prevalence include, common ear conditions such as chronic otitis media with effusion and vaccine-preventable infections such as measles, mumps, rubella and bacte-rial meningitis.10 A large proportion of the incidence of hearing loss could be prevented through appropriate interven-tions including community-oriented health education.

Since 2007, WHO has promoted increased public awareness of hearing loss through World Hearing Day, held every March. Actions required to cur-tail the growing number of people with hearing loss and to improve quality of life for those with hearing loss have also been extensively reported.3,5,10 However, progress is still limited, especially in low- and middle-income countries, due to insufficient local capacity to scale up proven interventions at all levels of health-care delivery. This shortcoming may be partly attributed to the lack of a robust global initiative and funding support for hearing health care. For example, the screening of newborns for possible hearing loss is routinely offered

in most high-income countries but does not appear to be considered as necessary in low- and middle-income countries. Yet, the needed investment on low-cost hearing technologies for early detection and rehabilitation of people with hearing impairment is likely to be outweighed by the overall long-term benefits of their economic participation in society.7,9

The sustainable development goals explicitly recognize the need for a bet-ter quality of life and opportunities for optimal well-being throughout the life course of all people with disability.11 With the World Health Assembly’s resolution on the prevention of deafness and hearing loss2 and the Convention on the Rights of Persons with Disability,12 the needed global policy framework for curtailing the growing burden of hearing loss is now in place. To monitor progress meaningfully, global initiatives for hear-ing health care must be accompanied by specific, measurable and time-bound targets to reduce the number of people with hearing loss. ■

Hearing loss: rising prevalence and impactAdrian C Davisa & Howard J Hoffmanb

ReferencesAvailable at: http://www.who.int/bulletin/vol-umes/97/10/19-224683

a The Ear Institute, University College London, 332 Grays Inn Rd, Kings Cross, WC1X 8EE, London, England.b Division of Scientific Programs, National Institute on Deafness and Other Communication Disorders, Bethesda, United States of America.Correspondence to Adrian C Davis (email: adriancjdavis@me.com).

Editorials

Editorials

646ABull World Health Organ 2019;97:646–646A | doi: http://dx.doi.org/10.2471/BLT.19.224683

References1. WHA39.14. Resolution on prevention of deafness and hearing

impairment. In: Forty-eighth World Health Assembly, Geneva, 27 March 1986. Resolutions and decisions, annexes. Geneva: World Health Organization; 1986. Available from: https://apps.who.int/iris/bitstream/handle/10665/178296/WHA48_1995-REC-1_eng.pdf?sequence=1 [cited 2019 Apr 2].

2. WHA70.13. World Health Assembly resolution on prevention of deafness and hearing loss: In: Seventieth World Health Assembly, Geneva, 31 May 2017. Resolutions and decisions, annexes. Geneva: World Health Organization; 2017. Available from: http://apps.who.int/gb/ebwha/pdf_files/WHA70/A70_R13-en.pdf [cited 2019 Apr 2].

3. Addressing the rising prevalence of hearing loss. Geneva: World Health Organization; 2018. Available from: http://www.who.int/pbd/deafness/estimates/en/ [cited 2019 Apr 2].

4. GBD 2017 Disease and Injury Incidence and Prevalence Collaborators; GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease study 2017. Lancet. 2018 11 10;392(10159):1789–858. doi: http://dx.doi.org/10.1016/S0140-6736(18)32279-7 PMID: 30496104

5. Olusanya BO, Neumann KJ, Saunders JE. The global burden of disabling hearing impairment: a call to action. Bull World Health Organ. 2014 May 1;92(5):367–73. doi: http://dx.doi.org/10.2471/BLT.13.128728 PMID: 24839326

6. Nordvik Ø, Laugen Heggdal PO, Brännström J, Vassbotn F, Aarstad AK, Aarstad HJ. Generic quality of life in persons with hearing loss: a systematic literature review. BMC Ear Nose Throat Disord. 2018 01 22;18(1):1. doi: http://dx.doi.org/10.1186/s12901-018-0051-6 PMID: 29386982

7. Huddle MG, Goman AM, Kernizan FC, Foley DM, Price C, Frick KD, et al. The economic impact of adult hearing loss. JAMA Otolaryngol Head Neck Surg. 2017 10 1;143(10):1040–8. doi: http://dx.doi.org/10.1001/jamaoto.2017.1243 PMID: 28796850

8. Shield B. Hearing loss numbers and costs. Evaluation of the social and economic costs of hearing impairment. London: Brunel University; 2019. [cited 2019 Aug 2]. Available from: Available from https://www.hear-it.org/sites/default/files/BS%20-%20report%20files/HearitReportHearingLossNumbersandCosts.pdf

9. Global costs of unaddressed hearing loss and cost-effectiveness of interventions: a WHO report, 2017. Geneva: World Health Organization; 2017. Available from: https://apps.who.int/iris/bitstream/handle/10665/254659/9789241512046-eng.pdf?sequence=1 [cited 2019 Apr 2].

10. Wilson BS, Tucci DL, Merson MH, O’Donoghue GM. Global hearing health care: new findings and perspectives. Lancet. 2017 Dec 2;390(10111):2503–15. doi: http://dx.doi.org/10.1016/S0140-6736(17)31073-5 PMID: 28705460

11. Resolution A/RES/70/1. Transforming our world: the 2030 agenda for sustainable development. In: Seventieth United Nations General Assembly, New York, 25 September 2015. New York: United Nations; 2015. Available from: http://www.un.org/ga/search/view_doc.asp?symbol=A/RES/70/1&Lang=E [cited 2019 Apr 2].

12. Convention on the Rights of Persons with Disabilities (CRPD). New York: United Nations; 2006. Available from: https://www.un.org/disabilities/documents/convention/convoptprot-e.pdf [cited 2019 Apr 2].