“Peeling the Onion” is a monthly column by Harvey Abrams, PhD.
When we last left John on his journey to better hearing, he was engaged in, what is described by the Transtheoretical (Stages of Change) Model, the contemplation stage. The decision-making dynamics that take place as John contemplates taking action, are further explained in the Health Belief Model that suggests that, prior to taking action on a health issue, John will conduct a type of cost-benefit analysis; on the cost side, he will calculate the threat (his susceptibility to and severity of the condition) and on the benefit side he will calculate the likelihood of a desired outcome of his action (e.g. improved hearing, improved relationship with friends and family, improved quality of life).
A “Special Case” Created by Stereotyping and Negative Perceptions
In terms of the models described above, hearing loss is, in many respects, a special case – it’s painless, slowly progressive, we learn to compensate and adapt to the condition, it’s not life-threatening, and non-medical treatment (i.e. hearing aids) is perceived to be expensive, unattractive and associated with other negative percepts such as aging. So the “costs” of not taking action are often perceived as being minimal and the benefits associated with taking action are often not well understood or appreciated.
We who work in this field strive to overcome these stereotypes, negative perceptions and daunting obstacles; it would certainly be good to know that our healthcare policy makers are on our side. Alas, recent events have called into question one of the Nation’s leading healthcare opinion drivers’ – the Centers for Disease Control and Prevention (CDC) – understanding of the disabling nature of hearing loss.
The CDC Skips a Disabling Condition
As reported by HHTM on July 31st, the CDC published a report on the “Prevalence of Disability and Disability Type Among Adults – United States, 2013.” The report is based on a state-based annual telephone survey conducted as part of the Behavioral Risk Factor Surveillance System (BRFSS). These surveys have been going on since 1984 the purpose of which, according to the CDC’s report, is to “… identify the prevalence of and demographic characteristics associated with different disability types among U.S. adults and better target appropriate interventions to reduce health disparities.”
What was new in 2013 was the addition of five disabling conditions to the annual survey: vision, cognition, mobility, self-care, and independent living. Notice anything missing here? That’s right, folks, nothing there about hearing (nor was hearing included in any of its previous surveys). Could it be possible that the CDC doesn’t consider hearing loss a disabling condition; that the CDC doesn’t believe the states need to consider the disabling effects of hearing loss to (as described in their report) “…better target appropriate interventions to reduce health disparities”?
Outrage, Uproar, Troubling Q&A
Well, you can imagine the uproar that ensued from the consumer and professional communities. The Hearing Loss Association of America (HLAA) immediately issued a press release expressing “outrage” with the CDC study; the AAA Audiology Community Listserv lit up with outrage as well. The Hearing Health Foundation initiated a petition to be sent to the White House “demanding” that CDC acknowledge hearing loss as a disability.
Ironically, a footnote to the report reads:
“The BRFSS does not include the recommended question [italics mine] on deafness or serious difficulty hearing.”
If the question on deafness or serious difficulty hearing was recommended, how, why, and by whom was it decided that it should not be? That question was asked of the CDC by Arlene Romoff, the author of two books on hearing loss and a past president of the Hearing Loss Association of New Jersey. As was reported in AARP’s Health Talk newsletter, Ms. Romoff received the following response from CDC officials:
“We would have loved to include data on people with hearing loss. The report is based on the BRFSS, which is a telephone survey that doesn’t reach people with hearing loss.’”
Hmmm… CDC’s “explanation” is as troubling as the omission of hearing loss as a disabling condition in the BRFSS survey. What CDC appears to be suggesting is that individuals with hearing loss are incapable of using the telephone and, by logical extension, the agency appears entirely unaware of the many adaptations for telephone use employed among individuals with hearing loss. Using CDC’s logic, I’m surprised that the mobility question was added to the BRFSS survey; after all, how are individuals with mobility problems going to get to the telephone to answer the survey?
With Friends Like CDC, Does John Need Enemies?
Well enough “outrage.” Let’s get back to John’s journey and the implications of CDC’s omission. As earlier mentioned, individuals take action as a function of their perceived threat (susceptibility to and severity of a condition) and perceived benefits. It’s hard enough to encourage individuals to take actions related to serious health conditions like colon and lung cancer even when their government funds campaigns to change health behavior.
What are the chances that John will take action when his government minimizes the disabling effects of untreated hearing loss coupled with his existing negative perceptions related to its treatment?
Harvey Abrams, PhD, is a principal research audiologist in the hearing aid industry. Dr. Abrams has served in various clinical, research, and administrative capacities in the industry, the Department of Veterans Affairs and the Department of Defense. Dr. Abrams received his master’s and doctoral degrees from the University of Florida. His research has focused on treatment efficacy and improved quality of life associated with audiologic intervention. He has authored and co-authored several recent papers and book chapters and frequently lectures on post-fitting audiologic rehabilitation, outcome measures, health-related quality of life, and evidence-based audiologic practice. Dr. Abrams can be reached at firstname.lastname@example.org