dr daksha patel, prof andrew smith and joanna anderson · 2015-10-14 · dr daksha patel, prof...
TRANSCRIPT
APPLYING PUBLIC HEALTH
STRATEGIES TO REDUCE THE
BURDEN OF HEARING IMPAIRMENT
Dr Daksha Patel, Prof Andrew Smith
and Joanna Anderson
Presentation objective
Public health for hearing impairment:
Our approach and rationale
A2
Slide 2
A2 We may find some people from Gallaudet don't like word impairment (also burden may be a no-no). we may
have to think of some answers. At least its better than "hearing-impairmed people".Andrew, 10/5/2015
PUBLIC HEALTH: Health of populations
CLINICAL MEDICINE: Health of individuals
CLINICAL MEDICINE
PUBLIC HEALTH
• Consultation & Diagnosis,
• Treatment,
• Follow-up
• Survey, • Population interventions
• Prevention,
• Health system strengthening
• Policy
360 million people have
disabling hearing loss,
globally 328 million adults
32 million children
Burden is greatest in LMIC
0
2
4
6
8
10
12
14
High- income Central Asia & EEurope
SS Africa EMRO South Asia Asia pacific Latin America&Carib
East Asia
CHIDREN WITH HI ( MILLIONS)
Prevalence increases with
age
1.7%
children
7%
age 15 - 64
Approx 33%
age 65+
HI prevalence decreases as GNI increases
Global population growth
1960 2010 2060
3 billion
people
6.9 billion
people
10 billion
people
2 billion
1 billion
0
Developed
countries
Developing
countries
Number of people aged over 60
Ageing populations
A4
Slide 10
A4 would it be worth calculating the figures for 2050 using current prevalnces for <60 & >60Andrew, 10/5/2015
High
• Inherited causes
• Chronic otitis media
• Ageing (presbyacusis
Moderate
• Excessive noise
• Ototoxic drugs
• Ante- & peri-natal problems
• Meningitis, measles,
• mumps
• Foreign bodies,
• wax
Low
• Nutritional
• Trauma
• Toxic chemicals
• Menière’sdisease
• Tumours
• Cerebrovascular
• disease
PREVALENCE by Cause
WHO priority for action
Epidemiological data is used to
select appropriate control measures
GlobalAvoidable★
causes
50%
Prevention
Early detection
★ Preventable and treatable
Epidemiological data is used to
select appropriate control measures
Children Congenital
Infective
• Prevention.
• Early detection• Comprehensive
• Services
Epidemiological data is used to
select appropriate control measures
Acquired
causes Adult
Prevention
Early detection
Hearing Devices
Appropriate control measures can
avoid 50% of hearing impairment
Prevention Early
detection
Strengthen
services
PUBLIC HEALTH SPENDING
Slide courtesy of De Wet Swanepoel, PhD
360 million people with disabling hearing loss
• National programmes
• Local needs assessment
• Health systems strengthening
• Multi-sectoral involvment
A9
A10
Slide 17
A9 A neeeds assessment would be needed to set up the national programme. (note that WHO now tends to use
Strategy insted of Programme as in new guidelines. Typo in involvementAndrew, 10/5/2015
A10 The small caption mentions eye services - maybe cover it?Andrew, 10/5/2015
Public health planning approach
Slide 18
A11 The small font in the arrows may be difficult to seeAndrew, 10/5/2015
Public health model for service provision
Control strategies
Infrastructure &
technologyHearing health
team
1 Million people
Health systems approachGovernance Service
delivery
Information
systems
Medicines,
technology
Health
financing
Health
personnel
Leadership and governance • National programmes • National targets
• Multi-sectorial involvement
Finances • National budget
• NGO contributions
• Sustainability
• Cost containment/ recovery
• Insurance schemes
Human resources • Numbers of health workers
• Distribution • Skill mix
• Training programmes
Medicines / technology
• Availability
Repair and Management
Sustainability
Information/ data
• Monitoring Management
Accountability
Service Delivery • Prevention
• Detection • Treatment
• Rehabilitation
• Distribution
• Accountability Equity – Accessibity – Affordaility – Quality
Planning the change required – at a local level
Programme planning and management cycle
Challenges to overcome:•Lack of finances
•Engagement from leadership and wider ENT and
audiology community•Lack of local data
•Lack of political will and MoH involvement
•Clinicians – information and action beyond the patient
in-front of them
•Lack of resources e.g hearing aids. •Lack of public awareness.
A14
Slide 24
A14 + Lack of political will, Lack of awareness in whole populationAndrew, 10/5/2015
In conclusion:•Public health approach is essential to address the
growing burden of HI•National and International involvement •Facilitate Change at a local level
•Embedded within health system for sustainability •Prevention – early detection – comprehensive services are central to this approach.
Thank you for listening A16
Slide 26
A16 great - she was an early believer in public health!Andrew, 10/5/2015