Dr Daksha Patel, Prof Andrew Smith and Joanna Anderson · 2015-10-14 · Dr Daksha Patel, Prof...
Transcript of Dr Daksha Patel, Prof Andrew Smith and Joanna Anderson · 2015-10-14 · Dr Daksha Patel, Prof...
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APPLYING PUBLIC HEALTH
STRATEGIES TO REDUCE THE
BURDEN OF HEARING IMPAIRMENT
Dr Daksha Patel, Prof Andrew Smith
and Joanna Anderson
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Presentation objective
Public health for hearing impairment:
Our approach and rationale
A2
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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
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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
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360 million people have
disabling hearing loss,
globally 328 million adults
32 million children
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Burden is greatest in LMIC
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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)
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Prevalence increases with
age
1.7%
children
7%
age 15 - 64
Approx 33%
age 65+
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HI prevalence decreases as GNI increases
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Global population growth
1960 2010 2060
3 billion
people
6.9 billion
people
10 billion
people
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2 billion
1 billion
0
Developed
countries
Developing
countries
Number of people aged over 60
Ageing populations
A4
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Slide 10
A4 would it be worth calculating the figures for 2050 using current prevalnces for <60 & >60Andrew, 10/5/2015
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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
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Epidemiological data is used to
select appropriate control measures
GlobalAvoidable★
causes
50%
Prevention
Early detection
★ Preventable and treatable
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Epidemiological data is used to
select appropriate control measures
Children Congenital
Infective
• Prevention.
• Early detection• Comprehensive
• Services
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Epidemiological data is used to
select appropriate control measures
Acquired
causes Adult
Prevention
Early detection
Hearing Devices
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Appropriate control measures can
avoid 50% of hearing impairment
Prevention Early
detection
Strengthen
services
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PUBLIC HEALTH SPENDING
Slide courtesy of De Wet Swanepoel, PhD
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360 million people with disabling hearing loss
• National programmes
• Local needs assessment
• Health systems strengthening
• Multi-sectoral involvment
A9
A10
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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
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Public health planning approach
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Slide 18
A11 The small font in the arrows may be difficult to seeAndrew, 10/5/2015
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Public health model for service provision
Control strategies
Infrastructure &
technologyHearing health
team
1 Million people
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Health systems approachGovernance Service
delivery
Information
systems
Medicines,
technology
Health
financing
Health
personnel
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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
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Planning the change required – at a local level
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Programme planning and management cycle
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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
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Slide 24
A14 + Lack of political will, Lack of awareness in whole populationAndrew, 10/5/2015
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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.
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Thank you for listening A16
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Slide 26
A16 great - she was an early believer in public health!Andrew, 10/5/2015