The World Health Organization estimates that at least 120 million people in the world have a disabling degree of hearing impairment. Other experts estimate that seven percent of the world's population over 400 million people have hearing loss. WHO estimates that at least half of all hearing impairment could be prevented or reversed through improved availability of hearing aids. However, the cost of hearing aids is prohibitively high for the great majority of the hearing impaired who are poor.
Given that the Affordable Hearing Aid Project (AHAP) proposes a cost-effective intervention to remedy hearing impairment, there is every reason to consider provision of a low-cost, high quality hearing aid as one of the most worth-while public health and developmental interventions that can be undertaken.
Economic Cost of Hearing Impairment
Our research indicates that to date, there has been no study that directly delineates the social and economic cost of hearing impairment in developing countries. However, these costs have been indirectly determined in a collaborative study undertaken by the World Health Organization (WHO) and CIBA. The study compared the burden of mortality and loss of disability-adjusted life years (DALYs) between otitis media and other conditions of importance in developing countries.
The comparisons demonstrated that the burden from otitis media is substantially greater than from trachoma, and comparable with that from polio. The study report concluded that a major part of the DALY burden of otitis media must be due to hearing impairment. See WHO/CIBA Foundation, Prevention of Hearing Impairment from Chronic Otitis Media, Report of a Workshop, November 1996.
In the United States, the economic cost of hearing impairment has been estimated with greater vigor and precision. A recent in-depth study, "The Societal Costs Of Severe To Profound Hearing Loss In The United States," published in the International Journal of Technology Assessment in Health Care, estimates the societal costs of severe to profound hearing loss in the U.S. to be $297,000 per person during that person's life. The study estimates that lifetime costs for those with pre-lingual onset of deafness exceed $1 million. A number of American researchers from different institutions carried out the study. A summary of the methodology and results of the study is attached to this brief.
According to the study, the largest part of societal costs from hearing impairment are a consequence of lost work productivity, which is estimated to represent 67 per cent of total costs. Special education for children and young people amount to 21 per cent of societal costs in connection with hearing loss. Persons who experience severe to profound hearing loss before retirement are expected to earn only 50-70 percent of their non-hearing impaired peers and lose between $220,000 and $400,000 in earnings over their working life depending on when their hearing loss occurs. The particularly high costs associated with pre-lingual onset suggest that interventions aimed at children, including early identification and medical intervention may have a substantial payback.
The studys approach to cost estimation, known as the human capital approach, places a heavy emphasis on earnings potential and does not value intangible losses, such as the social isolation and psychological stress imposed by hearing impairment. Compared to many other diseases, hearing loss more often involves the social welfare system rather than the medical care system. Therefore, medical costs, e.g., hearing aids, only account for 11 per cent of societal costs in connection with hearing loss.
Analogies From The Social And Economic Impact of Blindness
Analogies from the social and economic impact of blindness may have some bearing on establishing the link between poverty and hearing impairment. According to the Vision 20:20 paper, Benefits and Costs of Blindness Prevention, preliminary analysis recently undertaken suggest that the direct economic cost of the global burden of blindness is US$ 25 billion; this figure may double, or triple, if indirect costs are also considered.
Research done at Aravind Eye Hospital, India, in 1983 found that 85 per cent of males and 58 per cent of females who had lost their job as a result of blindness regained those jobs after cataract surgery. A number of those who did not return to work freed other family members from their household duties, thereby enabling them to work. The same researchers calculated that the average individual regaining functional vision through cataract extraction in this setting generated 1500 per cent of the cost of surgery in increased economic productivity during the first year following surgery. (Disease Control Priorities in Developing Countries, Jamieson D.T. et al).
WHO/CIBA Foundation, Prevention of Hearing Impairment from Chronic Otitis Media, Report of a Workshop, November 1996.
Penny E. Mohr, Jacob J. Feldman, Jennifer L. Dunbar, "The Societal Costs Of Severe To Profound Hearing Loss In The United States " International Journal of Technology Assessment in Health Care, vol. 16, 2000.
British Department for International Development, Disability, Poverty and Development, Report, February 2000.
Elwan, Ann, (World Bank), Poverty and Disability: A Survey of the Literature, December 18, 1999
Kelles-Viitanen, Anita (Asia Development Bank), Disability, Poverty Reduction and Social Development, Disability International; Disabled Peoples' International, Asia-Pacific Region, Vol.11, No. 2 1999.
Nordquist, Kaj. Survey of Disability Projects The Experience of SHIA, Swedish International Aid for Solidarity and Humanity, Report for the World Bank, June 2000.
World Health Organization. International Classification of Functioning, Disability and Health, WHO/EIP/GPE/CAS/ICIDH-2 FI/ 01.1., Geneva, Switzerland, 2001.
Poverty and Disability: A Position Paper, SIDA, Health Division, Ingrid E. Cornell, Apr. 1995.
Jamieson D.T. et al, Disease Control Priorities in Developing Countries.
Vision 20:20 Paper, Benefits and Costs of Blindness Prevention.Lots of links to briefs on AHAP aspects: delineation of the problem, poverty and hearing impairment, children a priority, genesis of the project, elaboration on business model and guiding principles (compassionate capitalism, multi-tiered pricing, financial sustainability, training, manufacturing, distribution, new paradigms