World Hearing Day – Making Ear and Hearing Care Accessible to All: Interview with Dr. Shelly Chadha

Welcome to this Week in Hearing.

World Hearing Day 2023 is upon us,

and we are fortunate to have Dr.

Shelley Chadha join us today to discuss the World Health

Organization’s awareness campaign

on deafness in hearing impairment,

as well as discuss her thoughts on ear and hearing

health on a global scale for our audience.

Shelly,

would you tell us about you and your role

at the World Health Organization?

Thanks Amyn, thanks for that question,

and a pleasure to join you here today.

And hello to all the viewers and listeners.

So I’m Shelly Chadha, as you mentioned,

and I’m the technical lead for Ear and hearing

care at the World Health Organization.

In terms of background.

So I come from India and I am an otolaryngologist,

an ear nose specialist.

I spent the first half of my career working with patients in

one of the largest hospitals in northern India and also

teaching students as a professor of otolaryngology.

Um, but then I also did a PhD in public health.

And the second half of my career up to now has has

been spent really on integrating these two aspects.

So that is

hearing health in terms of clinical hearing health,

but then applying those principles to public health,

or applying the principles of public health

to making hearing health accessible.

And that’s essentially what I do at

the World Health Organization.

I lead the program on hearing care.

That aims that everybody in the world should have access

to hearing to services that they require to prevent,

identify or address their hearing loss.

Well,

we are certainly fortunate to have you and your leadership in.

Many of the tools and information that comes out from

the World Health Organization under to your

leadership has really been fabulous.

One of the things that I think has really not been defined well

within our area is the fact that hearing loss is a public health

issue. You need to talk a little bit about that, please.

Sure.

So let me start by giving you something.

Facts and figures.

The fact is,

currently there are about 1.5 billion people

who have hearing loss of some.

Intensity could be mild, it could be profound.

So across the range, majority of them, of course,

have mind hearing loss.

But if we look at those who have

moderately severe or moderate or higher severity of hearing loss,

people whom we estimate require required hearing care services,

that number is nearly touching half a billion now.

And the vast majority of them live in low and middle income

countries of the world where services for ear

and hearing care are commonly lacking.

Where human resources are commonly lacking.

What we also know now is, is that these numbers are rising.

By the year 2050,

we estimate that over 700 million people would require

ear and hearing care services, and there would be many, many.

More who have mild hearing loss.

But at the moment we are focusing ready on those who

have moderate or higher severity of hearing loss.

So that’s going to be 700 million.

And while this rise is driven by demographic factors,

to a great extent there will be more people in the world,

more older people.

But it’s also that risk factors for hearing

yours are persisting and increasing.

So

risk factors such as exposure to loud sounds,

exposure to noise on occupational settings,

but then also in recreational settings, increasingly so.

Also common ear infections, which are extremely common,

especially in low and middle income countries of the world.

These continued to affect millions of people across the

world. And these are conditions which can be prevented,

they can be treated.

The hearing loss that is associated with them that can

be mitigated. So that’s just to give you the frame.

The problem,

the fact is,

we have all of the solutions in the field of hearing.

We have clinical interventions, surgical interventions.

We have technologies that can identify

hearing loss in any age group,

in any

community setting, clinical setting, whatever.

And we also have the solutions to address hearing

loss through interventions, through technology,

through use of hearing devices,

use of various rehabilitative measures.

But currently,

what WHO estimates is that all only 17%,

17% of those who are in need of these services actually

are accessing. Services. So that’s a gap of over 80%.

And this gap is high across the board.

It’s high in low middle income, low income countries, of course,

where it is about 90%, but it’s also as high as about 74,

75% in high income countries.

So that’s just to say that that is the extent of trouble.

So so we have this challenge, we have solutions,

but to make sure that the benefit of the solutions

reaches this 80% or above that it is missing,

we need a public health approach,

and that’s why it is a public health issue and that’s why

we need to work at it.

From WHO

you brought up a really important point,

and that is the fact of accessibility.

And accessibility is a supply side issue.

So are we looking at a supply?

Issue in terms of not enough providers?

Or are we looking at an accessibility

aspect in terms of the demand can’t reach the providers

because they don’t have access, or is it a combination of both?

So I would say it’s more than that because

I wouldn’t put it as only a supply issue.

I look at it more as a demand and supply issue

and I’ll explain why. So as we see it,

from a public health perspective,

if we drill down all of the barriers that we

think restrict the growth of this field,

we can kind of summarize them into two blocks.

On one side is the awareness challenge the lack of awareness

about the importance of hearing,

about the fact about prevention of hearing loss,

or about the need to provide hearing care.

And so on. So there is this lack of awareness at all levels,

whether it is policymakers or at the level of even health care

professionals at times, and also at the level of the community,

the wider community.

And this raises the demand issue because the need is there.

We see from the numbers that the need is there,

but what is not coming from the community is the demand.

And then of course, there is the supply issue.

The supply issue,

because of course we have a lack of human resources.

So

in 2021 we launched the World Report on hearing.

It shows also it gives a lot of detail

on human resource availability.

And we see you can just take a glance that’s some of the maps

which are there and look at the paucity of human resources

for hearing care ENT specialists or audiologists.

Language pathologists or teachers for deaf

and so on and so forth across the world.

So there is also the issue of lack of human resources,

but then also lack also of financial

resources to provide training,

also lack of equipment or capacity within the healthcare

institutions to provide services to people.

The two are not distinct from each other

in the sense that they are interlinked.

We know that from the business model that demand drives

the supply and that’s why it’s really important to focus

on raising awareness and try that demand,

which can also stimulate the supply.

But it’s not enough to just drive demand,

because we can’t just create a demand and not have the answer,

not have the service. This is available for people.

So while we raise awareness on one hand,

we have to also complement that with increasing the human

resources that are available to provide hearing care and deliver

those services to the people who are in need for them.

You bring up an interesting point,

and that is that we have the supply and demand end issue,

but we also have this gap now in the US.

As you know,

we just had the final ruling and approval for the

over the counter hearing aid component.

Do you think that that is something that will eventually

be accepted worldwide and globally, depending of course,

it’s very early in this process,

depending on how we formulate the policies

that dictate the use the application.

And the outcomes from this particular

new regulation that’s come out.

Yes,

certainly I think that that

regulation or

legislation from the US has a lot of potential firstly to

improve access to hearing care within the country.

Secondly,

I would say

is driving the market so driving our shift in the market and how

the hearing aid service delivery is currently being done,

who is developing these aids,

who is buying them and how they are being provided.

So I think the other is the influence it’s going to have on

the entire hearing industry or the market related to hearing

services and of course the third is adoption by other countries

and I think there are many factors influence the.

Adoption.

What we have to be cognizant of is that while on

one hand it is good to have the OTC devices,

but it must also be accompanied by the regulatory

kind of provisions that ensure safety of those devices.

Quality of those devices is so that the consumer at the end of

the chain is benefiting from it and not in any way it going

to be calm. So wherever this policy is further applied,

implemented or adopted, we need to make sure,

or the countries need to make sure,

that it is done in a way that is well recognized

as it has been done in the United States.

But I see that, like I said,

the implications of this would be vital

than simply improving access.

To unite into hearing care in the US.

Or driving policy change in other countries.

I think the main impact of this would be to driving

a shift in the market of hearing industrial.

That’s fascinating,

and I appreciate your commentary there.

So let’s turn back to World Hearing Day since

that’s coming end up here in a week or so.

And if you can just tell us a little bit about

what World Hearing Day is.

As you and I were talking before we began this session.

It’s actually been around for over a decade now,

started in 2012.

Once we get into this,

I think there are opportunities for individuals to take

these awareness campaigns as you talk about

and use them locally that would then benefit them,

increase that demand and allow them to meet.

The supply meet the demand

in those areas.

Yeah.

So the volunteering day is really our annual advocacy event

where we want to bring evidence based messages that are

developed by who. We spend a lot of time developing the data,

developing the information that informs these messages,

and then also by packaging it in a way that

those messages can be used by our partners in the field.

So whether that is people working

in countries or within the who

realm, who universe,

but also anybody could be used by any individual,

could be used by web journals, publications.

As well as by NGOs big and small,

working in the communities.

So the idea is that we bring these messages,

evidence based messages, which on one hand,

so usually we always have a dual purpose.

So on one hand,

this is our day to raise awareness within the community,

to try and bridge that gap.

When I say the community, I mean the general population.

So bring those messages about simple things like how to

protect your hearing, or why to protect it about ear care.

So what to do, what not to do, simple tips,

or how to check your hearing, or when to suspect hearing loss,

or what to do if you suspect hearing loss,

and things like that. But then the second target of this,

of this day are really policymakers.

So, because we also want to use this data to sensitize them.

To the need and the importance of paying attention to hearing

care and to integrating it as part of national health

services and national health systems,

not just at the tertiary level or at the level of very

specialized services, or even at the secondary level of care.

The training to integrate it starting

across the continuum of care.

So starting from primary health services and in all age groups.

So for children, for adults, or older adults.

So the focus is twofold on one hand,

to raise awareness within the communities and on the

other hand, to raise awareness with policymakers.

If you look at the World Hearing Day and our materials there,

you would usually find them structured like that.

We have infographics with a lot of data, information, strategy.

And so on and so forth.

The target of which our policymakers and our partners,

people who observe the day,

are the ones who take these messages,

organize events with policymakers within their

countries, within their regions, and so on,

to bring the messages to them.

And the second target are very really the population at large

to whom we reach out through our whu social media channels,

but also, very importantly,

through our collaborators who work within communities

in different countries across the world.

Yes, you’re talking about collaborations.

And as I was looking through the website,

I noticed that that the World Health Organization for World

Hearing Day invites applicants for funding opportunities.

Can you talk?

Little bit about that for those individuals who

might be interested in something like this.

Sure. So like I said,

the purpose of World Hearing Day is really

to use this day, one day to create noise, pun intended.

There about hearing across the world,

and we encourage our partners to reach out to whichever section

of the society they can reach out to and to support some of

them in planning their outreach activities that may be in the

form of an advocacy event or an awareness raising event.

Could be a screening program or a school

know, kind of hearing camp or something like that.

It varies.

We ask people that if they need support.

We can offer a very small support to them.

These are grants of $800.

So that’s why it’s called small grant because

that is what the allowance is.

But it does go a little bit of the way and in some places

a longer way than others to support the organization.

This grant is actually being provided these grants

are actually being provided not by who directly,

but by another partner that we have the

Coalition for Global Hearing held.

So the coalition provides these grants and who is one

of the contributors to this grant that is provided?

It.

But it’s really the purpose is simply to provide some support

to those partners who are planning their

awareness or advocacy activities.

And who want to apply and get some support.

There is an application process and then an evaluation

process and this is all available online.

So for this year, the small grant is closed,

but we usually do it every year,

so it will come around again next year.

Well, thank you for sharing that information.

And as you pointed out,

the amount may not be large, but even a small amount will help,

particularly if you’re doing some sort of

a community awareness or if you’re in,

for example,

a third world country,

it may provide transportation or meals or something

like that for those individuals who are participating.

So thank you for sharing that.

One thing that I’ve always wondered,

so I’ll ask selfishly here from my perspective,

is we’ve noticed over the last.

Couple of decades or so that the ear has become more of a point

of discussion as it relates to overall health

at the World Health Organization.

Have you seen

perhaps that the hearing health component has taken

more of a step towards the top of priorities for

global overall health?

So the short answer to your question, of course, is yes,

indeed, this is so.

I think there are multiple factors which are driving this.

Firstly, of course, is the growing need.

But more than in the growing need,

it is the realization of the growing need.

And this is due to data which is, of course,

on one hand published by the who, but then also.

Published by others like the Global Burden of Disease study.

So it is

the realization of the high need.

I think

it has also been the fact that we have been able

in this field to provide all the clinical solution.

We have the possibility to address

hearing loss of any degree.

We also have the possibility for people to learn sign

language and communicate through that,

but also of hearing aids and implants and so on and so forth.

And the demonstrated success of these outcomes is what

is responsible for bringing this into the limelight.

So to say.

So that is just to say what?

Could be driving this increasing awareness.

But how?

We evidence it through the fact that

in recent years, in 2017, actually,

and in the couple of years preceding that,

the countries you know, at the World Health Organization,

we are a UN. Body,

and all of the countries that are members

of the United Nations,

they’re also members of the Wwho and their ministries of health,

the ministers of health, secretaries of health,

they’re the ones who sit on the on the board and in the World

Health Assembly, which is the decision making body.

So over 2015 to 2017, what we saw was this.

Increasingly,

the questions being asked by countries

regarding what is WHO doing about it,

and asking for the extent of the problem and so on.

And this then led to.

Resolution being adopted by the World Health Assembly in

2017 which called Ready for Action on Your Inherent Care,

asking also who to do certain actions and also

outlining steps which countries need to take.

So that has really been that is sort of the evidence for saying

that this is moving up the ladder of priorities, for sure.

I think the fact that we have in the recent years had some

fantastic publications and are expecting to get

more like the Lancet Commission on Hearing.

There is a Lancet Commission on Hearing and we

expect to have the report of that later this year.

So these are also developments which show that this is

increasingly being accepted as a public health priority.

One of the things that we are wrestling with here

in the States is we talked a little bit about this.

We have a shortage of providers and the question becomes,

should hearing care only be provided

by ENTs and audiologists?

Should we actually consider reaching out and extending,

if you will, an olive bridge to other communities?

You pointed out speaks language pathologist earlier as a

possibility hearing aid specialist or

hearing instrument specialist?

Do you think in order to meet the needs of these individuals

and meet the demand that that should be something

that we as a community need to embrace?

Absolutely.

Again and short answers. Absolutely yes.

Because there is no way that the handful of ENT specialists.

Audiologists or even these language topologists are going

to address the needs of millions and

hundreds of millions of people.

So this is something that who is very

clear about and in the world report and hearing

that I mentioned earlier, we outline, like I said,

the

we map the availability of human resources and we also

show through this report and Linked publications

what would it cost? How many doctors?

How many doctors or audiologists would we need in an example

to cater to the needs of the entire population if all of

them were seeking services we could not cater to?

That mean, given the resources,

the human resources that we currently have.

The World Health Organization for this has

a term which is called task sharing.

And we go much into this into this approach,

task sharing in the report where we talk about

who can we share these tasks with,

how and also how it needs to be done in a very logical way.

Because it’s not about simply taking taking the tasks

and shifting it to somebody else and saying, okay,

teach somebody else to do an audiometry or hearing

aid bidding or a surgery or something.

It’s really about considering

what are the

steps or what are the interventions

that can be provided by

professionals,

by health care providers who have lower training needs or

lower educational needs as compared to a fully trained ENT.

Or an audiologist or a speech language pathologist.

So that is the kind of approach that this presents.

And as a matter of fact,

in consideration or in support of this approach,

which who strongly

promotes,

we are launching on board hearing day

this year a train training resource,

a training manual which is for primary level service providers.

So these may be gym practitioners or they

may be trained health workers and so on.

So it is about how to train them

in identifying common ear diseases,

in identifying hearing loss in the community,

addressing those needs which can be addressed the community,

and then referring those that require specialist intervention.

So identifying also those who need that specialist.

And directing them in the right direction.

So we are just going to launch this now and we will in the

coming years also be proposing a service delivery model

for hearing aid which is specifically

for resource limited setting where

services to some people who need these devices can

actually be provided without that highly trained,

highly specialized human resources

that normally provide this care.

So we’re developing that model and more

about that in the coming months.

Again,

it’s very exciting and it’s audiology is an interesting

place given its evolution and having

resources and data to support it,

like the World Health Organization provides will

get us to the right path and allow us to meet.

The needs of the individuals who are struggling

with hearing loss. Before we wrap up here,

just a couple of things if we can.

Number one,

health literacy is probably a big portfolio component

of World Health Organization.

Given that you have industrialized countries

and then you have third world countries,

can you talk a little bit about the

importance of health literacy?

So when you say health literacy,

of course you mean within the general population.

That’s right, correct.

So absolutely I agree that there is.

Health literacy is a big component of the work that we do

and what we need to do as well to make sure that the demand

side of hearing care is kind of supported and augmented.

And yes, it forms a bit.

Big part of the work that we do.

That is why we also observe the World Hearing Day as a part of

our campaign to raise awareness on hearing loss, on prevention.

We also have certain specific initiatives that look

at a specific issue. So we have, for example,

the Make Listening Safe Initiative,

which is really about preventing hearing loss, that is,

or mitigating the risk of hearing loss that is caused

by listening to loud sounds.

So, for example,

music over your headphones at loud levels or for all periods

of time, and also entertainment venues and so on.

And it’s a lot about about informing people,

educating them, why this is the risk, what is the risk,

how can it be addressed?

And also about providing them with the tools.

So health literacy is really the core of health promotion

because we need to need to inform, raise awareness,

educate people so as to drive behavior change and to drive

those behaviors or those actions that

we would like people to have.

So,

last question that I have is how if

I had a clinic today and I was not

doing all of the things I needed to do to increase

my awareness of hearing healthcare,

to

increase the preventative aspects of hearing health

care modifiable, risk factors and what have you,

what would you tell me?

What would you tell the average audience geologists that the

World Health Organization provides in order

to help them with these messages?

So thanks for that question.

They’d.

My favorite one because I think whether

we are working in a clinic,

in a big hospital or providing services in a community,

all of us have to play a role in this effort to raise awareness,

to inform, to educate,

to make sure that people access services

and also to provide services.

So and I would say that one of the simplest things that we

can do as we are in hearing care professionals

is really to inform people,

not just to

well address their clinical needs, of course,

because that’s what we are trained to do.

But they also make sure that we raise awareness

amongst them about

the need for prevention,

how to prevent hearing loss in their own when they may already

have hearing. But also in their families, in their communities,

how to become also proponents of those messages?

And we can do that very simply in a way by making

sure this information is available in clinic.

So you could have flyers, you could have posters, banners,

you could also have certain videos and so on playing.

And who does make these resources available to people?

So, for example,

let’s say

a parent comes to you with her hearing glass,

but she’s also the parent of a child.

If she sees a flyer which includes the milestones

of hearing, speech and language development,

it may spur her to think, oh, my niece or my child, or X,

my neighbor’s child doesn’t really come up to this.

Does not.

These milestones.

So may encourage that person to bring that child

for an examination. And similarly,

it may spur them to think more about why they are

older adults in their homes or in places that they visit,

are not engaging so well with them in conversation and so on,

and encourage them to bring them to the clinic.

So I would say that that is

the thing that all of us, as people working in this field,

we can consider doing for sure without

too much of additional effort.

The other things we could do is really reaching out into

to the community, so providing care, of course,

to the people who come to the clinics.

But then what I realized while working in India and what.

Drove me to public health was the realization that the people

who actually come to us in clinics

is the tip of the iceberg.

The wider body of the iceberg is really in the community,

so and we have to go out to seek them.

So you could have outreach programs maybe a few times in a

year, maybe on World Hearing Day and if you’re so motivated,

and a couple of other days,

and for those who work also in academic settings and so on,

I think it’s important for us to also research these aspects,

research public health aspects of hearing.

And we focus a lot on clinical developments, as we should,

not denying the importance of that.

But I think it’s important for us as clinicians to realize the

value of integrating public health into our research, into.

The teaching and education of the

audiologists of ents and so on,

and making sure that we bring this to Limelight to talk about

it in conferences, through interviews or webcasts,

podcasts and so on. So include that public health perspective,

both in our clinic clinical work,

our research work and our academic work as well.

That’s funny that go along with that message.

No,

I think it’s an important message to have and I think it’s

one that we sometimes overlook because we get so ingrained in

the everyday nuances that we sometimes forget that there’s

there’s an extended group of individuals that could benefit

from our help and we are just not reaching them.

So, thank you very much.

Now, is there anything that.

Forgotten that you wanted to add before I close this out.

Thank you.

It’s been really nice talking to you.

I just have one message.

The World hearing day is coming up on 3 March.

Well, it’s there now on 3 March.

And it is observed every year on 3 March.

As we mentioned previously, we started over ten years ago.

And last time we had about 100 countries and over 500

people in different so over these hundred countries,

500 organizations organizing activities and events.

So I invite you all,

all the viewers and listeners of this webcast to pleased join

this join this movement and to become a part of this

as a way of contributing to global hearing health.

Well, thank you so much, Shelley.

What we will do is we will make those links

available to the viewers that they can click and go see.

And again, thank you so much for your time,

for your sharing of information.

I learned a lot.

And we look forward to having you on down the road and

idea again.

Really appreciate all of the public health

things that the World Health Organization does on

a global scale to help individuals live a better life.

So thank you very much.

Thank you. To you, Amyn.

Thank you.