The theme for this year’s World Hearing Day, which takes place annually on March 3, is ‘Ear and hearing care for all!’. The annual event put on by the World Health Organization (WHO) is a way to bring global awareness to the importance of hearing health.
In this week’s special episode, host Amyn Amlani is joined by Dr. Shelly Chadha, the Technical Lead for Ear & Hearing Care at the WHO. They discuss the work of the WHO and the importance of approaching ear and hearing care as a public health issue.
To learn more about World Hearing Day, including access to downloadable resources, visit: https://www.who.int/campaigns/world-hearing-day/2023
Full Episode Transcript
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.
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.
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.
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.
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 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,
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.
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.
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.
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.
certainly I think that that
legislation from the US has a lot of potential firstly to
improve access to hearing care within the country.
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.
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.
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.
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.
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?
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,
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.
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.
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.
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?
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,
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
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
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.
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.
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.
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,
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.
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,
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.
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.
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.
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
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.
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About the Panel
Shelly Chadha, MBBS, MSurgery (ENT), PhD (Public Health), Technical lead for Ear and Hearing Care, WHO Department Noncommunicable Diseases, at the World Health Organization in Geneva, Switzerland. Dr. Chadha is responsible for WHO’s work on prevention of deafness and hearing loss including advocacy for prioritization of hearing care; technical support to countries for development of hearing care strategies and relevant tools.
Amyn M. Amlani, PhD, is President of Otolithic, LLC, a consulting firm that provides competitive market analysis and support strategy, economic and financial assessments, segment targeting strategies and tactics, professional development, and consumer insights. Dr. Amlani has been in hearing care for 25+ years, with extensive professional experience in the independent and medical audiology practice channels, as an academic and scholar, and in industry. Dr. Amlani also serves as section editor of Hearing Economics for Hearing Health Technology Matters (HHTM).
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