WORLD REPORT
O
N HEARING
EXECUTIVE SUMMARY
EXECUTIVE SUMMARY
PEOPLE WILL BE LIVING
WITH SOME DEGREE
OF HEARING LOSS
BY 2050 NEARLY
2.5
billion
OF WHOM WILL REQUIRE
REHABILITATION
SERVICES
AT LEAST
700
million
The World report on hearing envisions a world in
which no individual experiences hearing loss due
to preventable causes, and those with hearing loss
can achieve their full potential through rehabilitation,
education and empowerment.
World report on hearing: executive summary
ISBN 978-92-4-002157-0 (electronic version)
ISBN 978-92-4-002158-7 (print version)
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Design by Inis Communication
WORLD REPORT ON HEARING
EXECUTIVE SUMMARY
WHO estimates that by 2050 nearly 2.5 billion people will be living with some degree
of hearing loss, at least 700 million of whom will require rehabilitation services.
Failure to act will be costly in terms of the health and well-being of those aected,
and the nancial losses arising from their exclusion from communication, education
and employment.
At this time especially, when the world is faced with the devastation caused by the
COVID-19 pandemic, investing eorts and resources to prevent and address hearing
loss is warranted for several reasons:
WORLD REPORT ON HEARING
EXECUTIVE SUMMARY
PEOPLE WILL BE LIVING
WITH SOME DEGREE
OF HEARING LOSS
BY 2050 NEARLY
2.5
billion
OF WHOM WILL REQUIRE
REHABILITATION
SERVICES
AT LEAST
700
million
The World report on hearing envisions a world in
which no individual experiences hearing loss due
to preventable causes, and those with hearing loss
can achieve their full potential through rehabilitation,
education and empowerment.
1
WORLD REPORT ON HEARING
EXECUTIVE SUMMARY
O
Many cases of hearing loss can be prevented through eective and available
measures. With more than 1 billion young people at risk of avoidable
hearing loss, and around 200 million suering with preventable or treatable
chronic ear infections, this gives cause for urgent action.
O Innovative, cost–eective technological and clinical solutions can improve
the lives of most individuals with hearing loss. Millions are already benetting
from these developments. Combining the power of technology with sound
public health strategies can ensure that these benets reach all, especially
those in underserved and remote areas of the world.
O
The lockdowns precipitated by COVID-19 have highlighted the importance
of hearing, and the need for ear and hearing care. When deprived of visual
and social contact, the sense of hearing allows us to remain connected.
O At the current rate of prevalence, nearly 1 trillion International dollars
are lost annually from unaddressed hearing loss. Unless action is taken,
this gure will continue to rise in the coming decades. At the same time,
investment in ear and hearing care has been shown to be cost–eective,
and governments can expect a return of nearly 16 International dollars for
every 1 dollar invested.
O
This phase in the world’s history, with all governments and global agencies
focused on public health and health-systems strengthening, presents a
unique opportunity to integrate ear and hearing care into health systems.
Integration at this time will benet millions of people at risk of, or living
with, hearing loss, bring nancial gains to countries, and advance the global
vision of universal health coverage.
This rst-ever World report on hearing elaborates these points and presents
an imperative call to action. It summarizes the current status and extent of ear
and hearing problems, the causative and preventive factors of hearing loss, and
cost–eective clinical and public health solutions. The report acknowledges the
challenges of implementation, shares potential solutions, and provides direction on
the way forward through integration within universal health coverage. The report
is structured into four sections with three annexes providing quality of evidence,
and details both of the indicators and of the cost–eectiveness of ear and hearing
care interventions.
2
Genetic factors
Meningitis and
other infections
Hypoxia or
birth asphyxia
Low-birth
weight
Otosclerosis
Smoking
Otitis media
Perinatal
morbidities
Exposure to
noise/loud sounds
Ototoxic medicines
Age-related
sensorineural
degeneration
Nutritional
deficiencies
Trauma to the
ear or head
Work related
ototoxic chemicals
Hyperbilirubinemia
Causative factors
Hearing capacity
Protective factors
Maternal
nutrition
Maternal hygiene
Breastfeeding
Good ear
hygiene
Immunization
Protection
against head
or ear injury
Avoiding loud
sounds and
noise
Healthy lifestyle
Good nutrition
WORLD REPORT ON HEARING
EXECUTIVE SUMMARY
SECTION 1
THE IMPORTANCE OF HEARING
ACROSS THE LIFE COURSE
The sense of hearing is a key aspect of functioning
at all stages of life; and its loss, unless appropriately
addressed, impacts society as a whole.
Every individual has a unique hearing trajectory that is shaped by genetic
characteristics and inuenced by biological, behavioural and environmental factors
experienced throughout the life course. Hearing capacity results from the interplay
between negative (causative) and positive (protective) inuences. Causative factors
that impact the hearing capacity range from birth-related adverse events and ear
infections, to viral infections, noise exposure, ototoxic medicines and lifestyle choices.
Many of these can be prevented throughout the life course by following good ear
hygiene, avoiding loud sounds and adopting healthy lifestyles.
HEARING ACROSS THE LIFE COURSE
3
WORLD REPORT ON HEARING
EXECUTIVE SUMMARY
When measured audiometrically, hearing thresholds greater than 20 dB denote
clinical hearing loss. Hearing loss currently aects more than 1.5 billion people
worldwide, of whom 430 million have moderate or higher levels of hearing loss
in the better hearing ear, and are more likely to be adversely aected unless the
condition is addressed in a timely manner. This epidemiological measure excludes
single-sided and mild hearing loss which also pose signicant challenges and require
care based on the level of diculty experienced. Rather than being determined
solely by severity, the impact of hearing loss is measured largely by the eectiveness
of the clinical or rehabilitative interventions adopted, and the extent to which the
environment is responsive to the needs of those with hearing loss.
Hearing loss if unaddressed, can impact negatively many aspects of life:
communication; the development of language and speech in children; cognition;
education; employment; mental health; and interpersonal relationships.
430million
people globally require
rehabilitation services
for their hearing loss
Note: This illustration represents WHO regions, not country boundaries.
4
EUR
57.3
MILLION
AMR
62.8
MILLION
AFR
39.7
MILLION
EMR
22.1
MILLION
WPR
136.5
MILLION
SEAR
109.4
MILLION
Currently, around
WORLD REPORT ON HEARING
EXECUTIVE SUMMARY
SECTION 2
SOLUTIONS ACROSS THE
LIFE COURSE: HEARING LOSS
CAN BE ADDRESSED
Effective and timely interventions can benefit all those
at risk of, or living with, hearing loss.
Hearing loss is preventable throughout the life course through eective public health
interventions. In children, almost 60% of hearing loss is due to causes that
can be prevented through measures such as immunization, improved maternal
and neonatal care, and screening for, and early management of, otitis media. In
adults, legislation on noise control and safe listening, and surveillance of ototoxicity
can help maintain hearing trajectories and reduce the potential for hearing loss.
Identication is the rst step in addressing hearing loss and related ear diseases.
Clinical screening at strategic points of life ensure that these conditions can be
identied at the earliest possible stage. Recent technological advances, including
accurate and easy-to-use tools, can identify ear disease and hearing loss at any age,
in clinical or community settings, and with limited training and resources. Screening
can even take place in dicult situations such as those encountered during the
current COVID19 pandemic.
HEARING LOSS CAN BE ADDRESSED THROUGH SYSTEMATIC SCREENING TO
IDENTIFY HEARING LOSS EARLY IN
Newborn babies
and infants
Pre-school and
school-age children
People exposed to noise
or chemicals at work
People receiving
ototoxic medicines
Older adults
5
WORLD REPORT ON HEARING
EXECUTIVE SUMMARY
Once diagnosed, early intervention is the key to successful outcomes. Medical and
surgical treatment can cure most ear diseases, potentially reversing the associated
hearing loss. However, where hearing loss is irreversible, rehabilitation can ensure
that those aected, and society at large, avoid the adverse consequences. Signicant
progress has been made during the past decades in this respect, and a range of
eective options are now available to address the needs and preferences of people
with hearing loss.
Hearing technology, such as hearing aids and cochlear implants are eective and
cost–eective and can benet children and adults alike. However, it is essential that
their use is accompanied by appropriate support services and rehabilitative therapy
to
ensure the desired outcomes, and that any decisions relating to treatment and
rehabilitation follow a person-centred approach and involve the individual’s family
or carers. The use of sign language and other means of sensory substitution (such
as speech reading) are also valuable options for many deaf people; hearing
assistive
technology and services (such as hearing induction loops, captioning and
sign language interpretation) can
further improve access to communication and
education for those with hearing loss.
TIMELY AND APPROPRIATE CARE CAN ENSURE THAT PEOPLE WITH EAR DISEASES
OR HEARING LOSS HAVE THE CHANCE TO ACHIEVE THEIR FULL POTENTIAL
Medicines
and surgery
Rehabilitative
therapy
Sign language
access
Hearing assistive
technology
Captioning
services
Hearing aids
and implants
6
WORLD REPORT ON HEARING
EXECUTIVE SUMMARY
SECTION 3
CHALLENGES FACING EAR
AND HEARING CARE
There are a number of challenges in the field of ear
and hearing care, but they can be addressed. Health
is an investment and the cost of doing nothing is one
we cannot afford.
Demographic and population trends reect the high and rising prevalence of
hearing loss globally across the life course. The number of people with hearing
loss may increase more than 1.5-fold during the next three decades, with over
700 million likely to experience a moderate or higher level of hearing loss. Unless
action is taken, this outcome will almost certainly result in a proportionate rise in
associated costs.
2019
2030 2040 2050
0
500
1000
1500
2000
2500
Number of people in millions
711
430
509
612
1582
1889
2206
2497
Disabling hearing loss
All hearing loss
PROJECTED INCREASE IN PREVALENCE OF HEARING LOSS, 2019-2050
7
WORLD REPORT ON HEARING
EXECUTIVE SUMMARY
The lack of accurate information and stigmatizing mindsets surrounding ear diseases
and hearing loss often limit people from accessing care for these conditions. Even
among health-care providers, knowledge relevant to prevention, early identication
and management of hearing loss and ear diseases is commonly lacking, thereby
hampering their ability to provide the care required.
In most countries, ear and hearing care is not integrated into the national health
system, and accessing care at dierent levels of service provision (community,
primary, secondary and tertiary) may prove challenging for those with ear diseases
and hearing loss. Moreover, access to ear and hearing care is poorly measured and
documented, and relevant indicators often lacking in the health information system.
Perhaps the most glaring gap in health system capacity is in human resources.
Among low-income countries, for example, approximately 78% have fewer than
one ear, nose and throat specialist per million population; 93% have fewer than one
audiologist per million; only 17% have one or more speech therapist per million;
and 50% have one or more teacher for the deaf per million. Even in countries with
relatively high proportions of professionals in the eld of ear and hearing care,
inequitable distribution and other factors can limit access to them. This not only
poses challenges for people in need of care, but also places unreasonable demands
on the cadres providing these services.
These, among other factors relating to
regulation, pricing and stigmatization, reect the
notable gap in the use of hearing aids: of those
who could benet from a hearing aid, only 17%
actually use one. The gap is consistently high
in all parts of the world, ranging from 77% to
83% across WHO regions, and from 74% to 90%
across income levels.
Such challenges can be overcome through
a strategic government-led planning and
prioritization process.
17%
83%
GLOBALLY THERE IS A 83%
SERVICE GAP
8
WORLD REPORT ON HEARING
EXECUTIVE SUMMARY
SECTION 4
DESIGNING THE WAY FORWARD:
A PUBLIC HEALTH FRAMEWORK
FOR EAR AND HEARING CARE
1
See: https://www.un.org/sustainabledevelopment/health/
Integrated people-centred ear and hearing care
implemented through a strengthened health
system can overcome the challenges faced.
Ear and hearing care is an integral component of universal
health coverage. Goal 3 of the Sustainable Development
Goals for 2030
1
requires that all people, including those
with hearing loss and ear diseases, have access to high-
quality services without experiencing nancial hardship.
This can be achieved through an integrated, people-
centred ear and hearing care (IPC-EHC) approach, with ear
and hearing care services included in national health plans
and delivered through a strong health system to ensure
that those aected have equitable access to a continuum
of care across the life course.
Essential public health interventions for the provision
of ear and hearing care services across the life course
are summarized in the acronym “H.E.A.R.I.N.G.”: Hearing
screening and intervention; Ear disease prevention and
management; Access to technologies; Rehabilitation
services; Improved communication; Noise reduction; and
Greater community engagement. The rst four (H.E.A.R.)
can be integrated and delivered through strengthened
health systems.
UNIVERSAL ACCESS TO
QUALITY EAR AND HEARING
CARE IS POSSIBLE THROUGH
HEARING SCREENING
& INTERVENTION
EAR DISEASE
PREVENTION &
MANAGEMENT
ACCESS TO
TECHNOLOGIES
REHABILITATION
SERVICES
IMPROVED
COMMUNICATION
NOISE REDUCTION
GREATER COMMUNITY
ENGAGEMENT
9
WORLD REPORT ON HEARING
EXECUTIVE SUMMARY
Countries should determine which interventions best suit their needs by conducting
an evidence-based consultative prioritization exercise. Implementation using the
IPC-EHC approach requires actions at all levels of the health system through:
•
policy guidance and planning with a collaborative approach, including the setting
of realistic and time-bound targets;
• sustainable nancing and health protection to ensure that people access high-
quality ear and hearing care services without impoverishment;
•
workforce capacity development, achieved by expanding education programmes
for the relevant ear and hearing care workforce; task-sharing with, and training
of, non-ear and hearing care cadres;
•
health information and data that help determine population needs and priorities,
identify gaps, and track progress towards the targets set;
• equitable access to high-quality hearing technologies, which could be furthered
by their inclusion in governments’ lists of essential devices;
• access to safe and high-quality diagnostic and surgical equipment, as well as the
medicines required for ear and hearing care; and
•
relevant and impact-oriented research that supports implementation of IPC-EHC
across the life course.
Implementation of these public health interventions through the health system will
benet not only the lives of those aected and their families but also yield signicant
economic benets and productivity gains. It is estimated that scaling up ear and
hearing care during the next 10 years, through integrating the H.E.A.R interventions
into health systems, will require only an additional annual per capita investment of
US$ 1.33. The resulting health gain over 10 years will avert nearly 130 million DALYs
(disability adjusted life years) and yield a return of nearly US$ 16 for each 1 dollar
invested in ear and hearing care.
POPULATION
BY 2030 WOULD:
SCALING UP EAR
AND HEARING CARE
SERVICES TO COVER
90
%
$16 for every
$1 invested
REQUIRE
an additional
annual
investment
of $ 1.33 per
capita
AVERT
130 million
DALYs
BENEFIT
1.4 billion
people
EARN
10
WORLD REPORT ON HEARING
EXECUTIVE SUMMARY
TARGETS FOR SCALING UP EAR AND
HEARING CARE BY 2030
To energize global action for ear and hearing care, WHO has identied tracer
indicators and set ambitious but realistic targets that aim to achieve:
20% 20%
20%
relative increase
in the effective
coverage of
newborn hearing
screening services
relative increase
in the effective
coverage of adults
with hearing loss
that use hearing
technology
(i.e. hearing aids
and implants)
relative reduction
in the prevalence of
chronic ear diseases
and unaddressed
hearing loss in
school-age children,
aged 5–9 years
11
WORLD REPORT ON HEARING
EXECUTIVE SUMMARY
RECOMMENDATION: MAKE EAR AND
HEARING CARE ACCESSIBLE TO ALL
Integrated people-centred ear and hearing care must be
available and accessible to all, where and when needed,
without causing financial hardships.
Ear and hearing care interventions should be systematically integrated into national
health care plans, taking into consideration the needs and priorities of each country.
All stakeholders in the eld of public health should take the following actions:
MINISTRIES OF HEALTH
1. Include people-centred ear and hearing care in universal health coverage.
2. Strengthen health systems to deliver IPC-EHC at all levels of care.
3. Undertake awareness campaigns that address attitudes towards, and
stigma, related to ear diseases and hearing loss.
4. Determine targets, monitor national trends and evaluate progress.
5. Promote high-quality public health research on ear and hearing care.
INTERNATIONAL AND NONGOVERNMENTAL ORGANIZATIONS
1. Align with WHO’s global targets for ear and hearing care and support
their monitoring.
2. Take steps to improve knowledge, attitude and practices with respect
to ear and hearing care.
3. Stimulate generation and dissemination of knowledge on ear and
hearing care.
4. Participate actively in global action for ear and hearing care.
STAKEHOLDERS IN EAR AND HEARING CARE, INCLUDING PROFESSIONAL
GROUPS, CIVIL SOCIETY AND PRIVATE SECTOR
ENTITIES
1. Support national governments and WHO in the provision and
monitoring of ear and hearing care.
2. Contribute to the generation of knowledge regarding the public health
aspects of ear diseases and hearing loss.
3. Collaborate to ensure that all stakeholders can contribute to, and have
a common vision of, ear and hearing care.
4.
Highlight the importance, need, and means for ear and hearing care and
advocate for its prioritization.
12
O The number of people living with
unaddressed hearing loss and ear
diseases is unacceptable.
O Timely action can prevent and address
hearing loss across the life course.
O Investing in cost-eective
interventions will benet people with
hearing loss and bring nancial gains
to the society.
O Countries must act to integrate
people-centered ear and hearing
care within national health plans for
universal health coverage.
World Health Organization
Department of Noncommunicable Diseases
20 Avenue Appia
1211 Geneva 27
Switzerland
For more details refer to:
https://www.who.int/health-topics/hearing-loss
