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October 4, 2022 is Double Ninth Festival, and the Lancet has been committed to paying attention to research related to aging and health. We have specially selected some articles to share with you.
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Detailed description of global hearing loss
The US Food and Drug Administration (FDA) has issued a long-awaited regulation. Thanks to this, adults with mild and moderate hearing loss in the United States will soon be able to buy hearing aids directly from retailers. The regulation establishes a new category of over-the-counter (OTC) hearing aids. The expectation of regulations to reduce the price of hearing aids without sacrificing the safety and effectiveness of hearing aids, a FDA announcement highlighted this. This belated move is a welcome advance for hearing loss patients in the United States and should provide impetus for global society to address often overlooked disability issues.
hearing loss currently affects 20% of the world's population, and has risen from the 11th largest cause of disability in 2010 to the third largest cause of 2019. There are a number of complex hearing-influence factors at different stages of life, including genetic characteristics, health status, living and working environment, and age-related degeneration. Many pathogenic factors of hearing loss can be prevented through public health measures. But if left uncontrolled, it can become a chronic disease and worsen over time. More than 280% of the population with hearing loss live in low- and middle-income countries. In these countries, access to health care, especially hearing care, remains limited. Many hearing loss patients do not actively seek hearing care for many reasons, including insufficient awareness, high spending, and stigma. People with uncorrected hearing loss may experience communication difficulties, mental health problems, social isolation and high unemployment rates.
In the 2021 " World Hearing Report ", the World Health Organization recommends taking a comprehensive set of interventions (H.E.A.R.I.N.G.), covering prevention, management, rehabilitation and environmental factors. A simulation study published earlier this year on The Lancet - Global Health used data from 172 countries to analyze the cost-effectiveness of the interventions recommended by WHO . The study estimates that implementing 90% of core interventions can reduce Disability Adjusted Life Years (DALYs) by 130 million in 10 years, equivalent to $15 for every dollar invested. Hearing aids are a major component of this cost-effective intervention and can be used as a frontline clinical management.
However, there are still some challenges that must be met for the hearing aid to really work. First and most importantly, the cost. The global supply of hearing aids is primarily controlled by manufacturers based in high-income countries whose current pricing methods seem to overlook affordability in low- and middle-income countries. Therefore, to reduce the price of hearing aids, investment and infrastructure support should be provided to new manufacturers in low- and middle-income countries to develop safe and inexpensive hearing aids that meet local needs. In addition, the national universal health coverage program should consider the inclusion of hearing aids and other hearing care to reduce out-of-pocket costs.
affordable devices eliminate economic barriers, but other factors that affect people's willingness to use hearing aids remain. The second challenge is how to mobilize people. Raising awareness of hearing loss and the harm of hearing impairment is a critical first step. Provide clear labeling, trial and convenient return policies that can further eliminate hesitation in using hearing aids. More importantly, we should work to eliminate the stigma of hearing loss. Unless we change society’s perception of hearing aid wearers and actively engage the community in actions that support hearing loss patients, it will be difficult for us to improve the health inequality that this group experiences.
The last challenge is that low- and middle-income countries lack qualified human resources to provide prevention, treatment and rehabilitation services for patients with hearing loss. Reliance on OTC hearing aids can temporarily alleviate disease management problems, but have little effect on prevention or rehabilitation. The long-term solution will be to strengthen the health system with a focus on primary health care.Primary care workers can play an important role in expanding the accessibility of hearing care by participating in screening, raising awareness and providing treatments such as fitting hearing aids. In the context of low- and middle-income countries, their work can be cost-effective.
Hearing loss is an urgent but often invisible problem that requires more attention from global health researchers and systematic efforts to pay attention to the diverse needs of different susceptible groups throughout the life process. Hearing aid accessibility is a key part of this effort, but also requires public awareness, supportive communities, qualified human resources, and a living and working environment that contributes to hearing safety. END
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