EXECUTIVE SUMMARY
One in six Australians suffers from some degree of hearing
loss. By 2050 this is forecast to grow to one Australian in four. Hearing
health is a mainstream health issue which touches the lives of most Australians
in one way or another, yet as a public health issue it is not ranked as a
national health priority. Australians with hearing loss must live with the
paradox that their disability is so prevalent in our community, and yet suffers
from a generally low level of awareness and understanding.
One message above all others came through from the evidence
before this inquiry, and this message forms the title of this report: Hear Us.
It is the message to a hearing society from people with a hearing loss who live
the terrible isolation and frustration that is often their daily lot. It is the
message to governments and funding bodies from the many volunteer support and
representative groups who advocate to improve the lives of people with a
hearing impairment. It is the message to program administrators from hearing
health practitioners working within systems that need an overhaul. It is the
message from researchers striving to advance our understanding of the causes of
hearing loss, and the technologies that can improve the lives of future
generations. It is the message from Indigenous Australians, for many of whom
hearing loss is so pervasive it has become a normal and accepted part of
growing up.
The forecast increased prevalence of hearing loss among
Australians is largely driven by our ageing population. However over a third of
all people with hearing loss acquired their impairment through preventable
means. Workplace hearing damage is often associated with industrial work sites
where people work with noisy machinery. A large proportion of rural workers and
farmers suffer from acquired hearing loss, though the prevalence is falling
among younger farmers.
Hearing loss can also be caused by diseases and disorders,
including middle ear infections, growths in the ear canal and Meniere's
Disease.
People exposed to acoustic shock can also suffer permanent
hearing damage. The committee heard that armed services people who have been
exposed to artillery explosions have been susceptible to acoustic shock in the
past, as have call centre workers experiencing unexpected loud noise through
telephone headsets.
There is a widespread concern in the community about the
effects of personal music players on hearing loss, especially among young
people. Whilst the proof that personal music players cause permanent hearing
loss is ambiguous for now, expert opinion is that the potential is there if
devices are played loud enough and over a long enough period of time.
The costs of hearing loss to Australia were estimated at $11.75
billion in 2005, which represented 1.4 per cent of Australia's then Gross
Domestic Product. The largest element of this cost, at over half the total, was
lost wages and productivity among people with a hearing loss. The value to the
nation of retaining or re-engaging people with a hearing loss in the workforce
is thus huge.
The committee heard that hearing loss can affect people's
physical health and emotional wellbeing. The economic cost of low workforce
participation has been noted, but at the core of this lies the personal distress
for individuals who stop working in their forties because they can no longer
hear, or who work in jobs far below their capacity because their employers do
not support them as well as they might.
For children who are diagnosed with hearing loss within the
first six months of life, the chances are good that, with appropriate
intervention and support, they will acquire good communication skills and be
well equipped to engage with the world. For children whose hearing loss is not
picked up at birth, or who acquire hearing loss later in life – a much greater
number – their chances are more uncertain. Much will depend on when they are
diagnosed, the choices their parents make, and the support they receive from
school and from healthcare professionals.
The single issue most raised by submitters to the inquiry was
that of eligibility to Australian Hearing services, and especially the cut off
age of 21 years. At a time in their lives when they are studying, or not yet
established in their careers, young Australians find themselves without the excellent
care they have received to date, and often without the means to replace that
care, or their hearing devices, in the private sector.
The costs of hearing loss to individual people can be very
high, particularly for those who fall outside the eligibility criteria for
Office of Hearing Services program support. Expenses include hearing aids at
between $3,000 and $10,000 a pair, cochlear implant speech processors at
between $8,000 and $12,000, batteries and maintenance, and special assistive
devices such as flashing fire alarms and doorbells. Hearing aids and processors
can need replacing every three to five years.
The committee heard from many submitters that the level of
cover available for hearing devices from their private health insurers was minimal.
The cost of hearing aids has generated the establishment of
hearing aid banks in most states and territories. These facilities recondition
second hand hearing aids and make them available to people who cannot afford
new aids.
Hearing assessment and support services are more difficult to
access in regional and remote parts of Australia. Hearing care providers have
trouble attracting and retaining qualified practitioners in these areas. People
who need to travel to larger centres for audiological services are not eligible
for Patient Assisted Travel Schemes.
Universal screening for newborns, a Council of Australian
Governments initiative due for implementation by the end of 2010, was widely
applauded by submitters to the inquiry. However the access to hearing screening
for school aged children is more patchy, even though the benefits to the child
and to society of early diagnosis, intervention and ongoing engagement with
hearing health professionals are well known.
There is a level of concern among consumers of hearing health
services that some in the hearing industry are more interested in selling
hearing aids than improving the lives of the hearing impaired. Representatives
of the private hearing aid industry told the committee that unless they sell
top-ups to government hearing aid vouchers, their businesses are not
financially viable. The Department of Health and Ageing has amended eligibility
for its voucher program so that it is better targeted toward those with the
highest need.
Around 24 per cent of all Australians who would benefit from a
hearing aid have one, which is comparable with international standards. There
is an issue around the extent to which people use these hearing aids, however,
with up to 30 per cent of hearing aids sitting in the bedside drawer unused, or
not used as much as they could be.
Cochlear implants have been a great innovation for many people
with hearing loss, with take-up expected to grow as the technology improves and
widens user eligibility. The cost of the clinical aspects of implants are met
from public funds, but for many people the cost of replacing speech processors
must be met privately.
The committee heard about the research currently underway in
hearing health, and about the gaps in the research field. Many researchers
called for a national database that can facilitate follow up from the national
newborn screening initiative. More research is needed around: the effects of
recreational noise on permanent hearing loss; Occupational Noise Induced
Hearing Loss; the relationship between health and hearing impairment; the
effects of ototoxicity; and Meniere's Disease.
There is a place in Australia for a large-scale hearing health
awareness-raising and education campaign. Such a campaign could have three
aims: to target high-risk groups about preventable hearing loss; raise the
general level of community awareness about hearing loss issues; and promote
access to support and resources for people with a hearing loss.
There is a crisis in Indigenous ear and hearing health in
Australia. Indigenous people suffer ear disease and hearing loss at up to ten
times the rate of non-Indigenous Australians, and arguably the highest rate of
any people in the world. The rate of middle ear infection (otitis media) among
Indigenous Australians far exceeds the level that the World Health Organisation
describes as 'a massive public health problem...which needs urgent attention'.
The root causes of such a high prevalence of otitis media are
the home environmental conditions associated with poverty – overcrowded
housing, poor nutrition, poor sanitation and passive smoking.
The consequences of early onset hearing loss can be devastating
for Indigenous Australians. Their capacity to access education – arguably the
best way out of the poverty cycle - is limited. The classroom facilities are
often inadequate. Teachers and school leadership may be untrained to manage
hearing loss in the classroom, or even unaware of the scale of the problem
among Indigenous children. The momentum to demand improvements is slowed by a
widespread acceptance among families and communities that chronic ear disease
among Indigenous children is a normal part of growing up.
The extent of hearing loss among Indigenous Australians in
custody is unknown, though informed estimates provided to the committee suggest
that the incidence may be very high indeed. The implications for Indigenous
Australians who may have been convicted and incarcerated with an undiagnosed
hearing loss could be most profound.
Evidence was presented to the committee about a relationship
between hearing impairment and a person's engagement with the criminal justice
system. For Indigenous people with a hearing loss, whose first language - if
they have one - is not English, this relationship can be disastrous. Engagement
between Indigenous people with a hearing loss and police can spiral into
confrontation, as police mistake deafness for insolence, or for cultural or
language communication difficulties.
Inquiry recommendations by theme
This report, along with its recommendations, is structured
around the terms of reference for the inquiry. These terms of reference provide
a suitable framework for the conduct of the inquiry, and for presenting its
findings. However the recommendations of the inquiry, when taken as a whole,
can be usefully grouped into categories which reflect the priorities for
hearing health as this committee sees them: education, criminal justice, access
and services, awareness and research, and hearing loss among young people. The
committee believes it is useful to re-present the inquiry recommendations here
under these categories.
Access and services
Recommendation 2 (chapter four)
The committee recommends that the Department of Education,
Employment and Workplace Relations engage with state and territory
jurisdictions, and with employment and hearing loss peak bodies, to develop a
10 year strategy to better support, engage and retain hearing impaired
Australians in the workforce. The strategy should be made publicly available,
and detail annual performance targets and the level of resources committed to
achieving them.
Recommendation 4 (chapter five)
The committee recommends that eligibility for the
Australian Government Hearing Services Voucher Program be extended to include
all Australians, subject to eligibility and a means test.
Recommendation 5 (chapter five)
The committee recommends that former child clients of
Australian Hearing remain eligible for Australian Hearing support until the age
of 25. This eligibility is to be subject to a means test. Former child clients
of Australian Hearing who do not meet the means test are to have the option to
access Australian Hearing support on a fee-for-service basis until the age of
25.
Recommendation 6 (chapter five)
The committee recommends that state and territory
governments expand eligibility for Patient Assisted Travel Schemes to include
support for people accessing audiological services.
Recommendation 7 (chapter five)
The committee recommends that the Commonwealth provide
funding to expand services for hearing impaired children in rural and remote
areas through e-technology based program such as that developed by the Royal
Institute for Deaf and Blind Children.
Recommendation 9 (chapter five)
The committee recommends that the Audiological Society of
Australia develop and make available to its members resources and professional
development that promotes better understanding about the impact a diagnosis of
hearing loss can have on people, and which provides resources and techniques
for counselling and supporting people at the time of diagnosis.
Recommendation 11 (chapter five)
The committee recommends that the Office of Hearing
Services engage with representatives of the hearing aid manufacturing and
distribution industry, private providers of hearing health services, and
hearing health consumers to investigate:
(a)
the
relationship between the voucher program, top-ups and the financial viability
of private health services; and
(b)
whether
extending the capacity to audiologists to bulk bill Medicare directly for
clinical services would have any impact on the financial viability of private
health services (i.e. would it ameliorate the need to push 'top-ups' to stay
viable?); and
(c)
that the
findings of these investigations be made publicly available for the
consideration of all hearing health stakeholders.
Recommendation 12 (chapter five)
The committee recommends that the Office of Hearing Services
review its policy with regard to the replacement of damaged, lost or obsolete
cochlear implant speech processors for eligible clients over 21 years of age,
and if possible align it with the replacement policy for eligible clients less
than 21 years of age.
Recommendation 13 (chapter five)
The committee recommends that the public counters in all
government service shopfronts be accessible to people with a hearing impairment
through the provision of hearing loop technology. The committee recommends that
the Office of Hearing Services coordinate a project which sets targets toward
that end for all government agencies, at all levels of government, and that
these be publicly reported upon.
Recommendation 26 (chapter eight)
The committee recommends that the Department of Health and
Ageing make the changes to Medicare necessary to enable specialists and
practitioners to receive public funding support for ear health services
provided remotely via ear telehealth.
Education and learning
Recommendation 3 (chapter four)
The committee recommends that the Department of Education,
Employment and Workplace Relations engages with state and territory education
systems, higher education providers of training for teachers of children with hearing
impairment, and major stakeholders (including the Royal Institute for Deaf and
Blind Children and parent representative bodies), to develop and implement an
agreed national qualification standard for teachers of children with hearing
impairment. This standard is to be benchmarked against international best
practice.
Recommendation 8 (chapter five)
The committee recommends that the Council of Australian
Governments extends its commitment for universal newborn hearing screening to
include a hearing screening of all children on commencement of their first year
of compulsory schooling. Given the crisis in ear health among Indigenous
Australians, the committee believes urgent priority should be given to hearing
screenings and follow up for all Indigenous children from remote communities on
commencement of school.
Recommendation 10 (chapter five)
The committee recommends that education providers develop
professional standards for interpreters working in educational environments.
These standards should be based on existing standards, such as the National
Accreditation Authority for Translators and Interpreters paraprofessional level
accreditation, or the National Auslan Interpreter Booking and Payment Service /
Australian Sign Language Interpreter's Association Deaf Relay Certification.
Recommendation 21 (chapter eight)
The committee recommends that the Department of Education,
Employment and Workplace Relations and Department of Health and Ageing jointly
establish a task force to work across portfolios and jurisdictions on a plan to
systemically and sustainably address the educational needs of hearing impaired
Indigenous Australian children.
Recommendation 22 (chapter eight)
The committee recommends that Australian Hearing be enabled
under the Australian Hearing Services Act 1991 to supply and maintain
sound field systems for classrooms in all new classrooms, and in all existing
classrooms where there is a significant population of Indigenous children.
Recommendation 23 (chapter eight)
The committee recommends that the Department of Health and
Ageing work with the Department of Education, Employment and Workplace
Relations to develop a program with Australian Hearing to:
(a)
supply and
maintain sound field amplification systems and acoustic conditioning in all new
classrooms, and in all existing classrooms where there is a significant
population of Indigenous children; and
(b)
report
publicly on where sound field amplification systems and acoustic conditioning
are installed to assist parents in making informed choices about schools for
their children.
Recommendation 24 (chapter eight)
The committee recommends that education providers ensure
that teacher induction programs for teachers posted to schools in Indigenous
communities emphasise the likelihood that hearing impairment among their
students will be very high. Induction programs for these teachers must include
training on the effects of hearing health on education, and effective,
evidence-based teaching strategies to manage classrooms where a majority of
children are hearing impaired.
Recommendation 25 (chapter eight)
The committee recommends that the Department of Education,
Employment and Workplace Relations work with jurisdictions to develop
accredited professional development programs for teachers and school leaders on
the effects of hearing health on education, and effective evidence-based
teaching strategies to manage classrooms with hearing impaired children.
Awareness-raising and research
Recommendation 14 (chapter six)
The committee recommends that the national data set and
register for neonatal hearing screening, currently under development by the
Neonatal Hearing Screening Working Group on behalf of the Australian Health
Minister's Advisory Council, be expanded to include a national database which
can:
(a)
track
children through neonatal hearing screening, diagnosis and intervention;
(b)
record and
report cognitive, linguistic, social and emotional development outcomes of
children diagnosed at birth with a hearing loss; and
(c)
be expanded
in future years to track all children diagnosed with a hearing impairment later
in life.
Recommendation 16 (chapter six)
The committee recommends that Australian Governments continue
to prioritise and fund research into occupational noise exposure. The focus of
research should be informed by the results of the ‘Getting heard: effective
prevention of hazardous occupational noise’ project, currently being
undertaken by Safe Work Australia, and include investigation into the
effectiveness of current legislation in limiting occupational noise exposure.
Research should continue to develop understanding about the design of workplace
equipment, hearing protection, and the long-term effects of acoustic shock and
acoustic trauma.
Recommendation 17 (chapter six)
The committee recommends that Australian Governments prioritise
and fund research into the reasons for the under use of hearing aids, and
develop practicable strategies for hearing health practitioners to help
overcome the under use in the community.
Recommendation 18 (chapter six)
The committee recommends that the Department of Health and
Ageing work closely with Safe Work Australia to investigate the relationships
between ototoxic substances and hearing impairment, and the possible
implications for workplace safety practices.
Recommendation 19 (chapter six)
The committee recommends that the Department of Health and
Ageing works with Meniere's Australia to identify opportunities for research
into the prevalence of the Meniere's disease in Australia, rates of diagnosis,
options for treatment and personal management, and the socio-economic impact of
the disease, including on the employment and lifestyles of those affected.
Recommendation 20 (chapter seven)
The
committee recommends that the Department of Health and Ageing provides funding
for Australian Hearing to develop, in close consultation with major hearing
health stakeholders, a national hearing health awareness and prevention
education campaign. This campaign should have three dimensions. It should:
(a)
target those
at highest risk of acquired hearing loss (including employers and employees in
high-risk industries, farmers and rural workers, and young people) to improve
their knowledge about hearing health and change risky behaviours;
(b)
raise the
level of awareness about hearing health issues among the broader Australian
population to help de-stigmatise hearing loss; and
(c)
promote
access to support services for people who are hearing impaired.
Recommendation 29 (chapter eight)
The committee recommends that the Department of Health and
Ageing:
(a)
provide
funding and resources to manage a national biennial Indigenous ear health
conference; and
(b)
make the
outcomes of those conferences publicly available to assist researchers and
practitioners in the field of hearing health.
Recommendation 30 (chapter eight)
The committee
recommends that the Department of Health and Ageing work with state and
territory health agencies to provide funding to support the continuation,
promotion and expansion of the Ear Health Infonet.
Criminal Justice
Recommendation 27 (chapter eight)
The committee recommends that the Department of Health and
Ageing work closely with state and territory jurisdictions to develop and
implement a national plan which:
(a) provides
resources to conduct hearing assessments for all Australians serving custodial
sentences who have never received such an assessment, including youths in
juvenile detention; and
(b)
facilitates
prisoner access to those hearing assessment; and
(c)
encourages
a high level of participation in those hearing assessments; and
(d) makes the
findings of the hearing assessments available to the public (within privacy
considerations).
Recommendation 28 (chapter eight)
The committee recommends that the relevant ombudsman in
each state and territory conduct an audit of Australians serving custodial
sentences, including youths in juvenile detention, and consider whether
undiagnosed hearing impairment may have resulted in a miscarriage of justice
and led to any unsafe convictions.
Recommendation 31 (chapter eight)
The committee recommends that guidelines for police
interrogation of Indigenous Australians in each state and territory be amended
to include a requirement that a hearing assessment be conducted on any
Indigenous person who is having communication difficulties, irrespective of whether
police officers consider that the communication difficulties are arising from
language and cross-cultural issues.
Recommendation 32 (chapter eight)
The committee recommends that the National Judicial College
of Australia work with state and territory jurisdictions to develop and deliver
accredited professional development programs for judges, lawyers, police,
correctional officers and court officials on the effects of hearing impairment
on Indigenous engagement with the criminal justice system, and effective
evidence-based techniques for engaging effectively with people with a hearing
impairment in courtroom environments.
Recommendation 33 (chapter eight)
The committee recommends that hearing loops are available
in interview rooms and public counters of all police stations, and in all
courtrooms, and that loop receiver devices be made available for people without
hearing aids.
Recommendation 34 (chapter eight)
The committee recommends that correctional facilities in
which greater than 10 per cent of the population is Indigenous review their
facilities and practices, and improve them so that the needs of hearing
impaired prisoners are met.
Recreational hearing loss among
young people
Recommendation 1 (chapter two)
The committee recommends that the Department of Health and
Ageing work with the appropriate agencies and authorities to devise
recreational noise safety regulations for entertainment venues. Specifically,
where music is expected to be louder than a recommended safe level, that the
venues be required to:
(a) post prominent
notices warning patrons that the noise level at that venue may be loud enough
to cause hearing damage; and
(b) make ear plugs
freely available to all patrons.
Recommendation 15 (chapter six)
The committee recommends that the Australian Government
fund the National Acoustic Laboratory to undertake longitudinal research into
the long-term impacts of recreational noise, particularly exposure to personal
music players.
Navigation: Previous Page | Contents | Next Page