The politics of hearing loss16 July 2010-Department of Public Health-University of Otago

Hazel Armstrong and Karen PullarA lawyer and an audiologist

What is the problem?

• Work related hearing loss• 53,000 New Zealanders currently suffer a work related

hearing loss (our parents’ generation)• Majority worked in noise between 1960 and 1980• Many make first claim to ACC for hearing loss at age

65 years• Worked in industries such as construction, heavy

engineering, farming, forestry, mining, rail, meat works etc. for 20-40 years – the back bone of NZ

• Both our fathers were hearing impaired farmers

What is the problem?

• 1960s-1980s – hearing protection rarely used• Little noise monitoring in the workplace/farm• Base-line hearing tests rarely done• Records mostly not available where tests were

done in this period• Occupational medical centres closed in 1980s• Companies closed down and records lost

What is the problem?

• We question whether workplace exposure standards were enforced in NZ in the 1960s to 1980s?

• Factory and Commercial Premises Act 1981

• 85dBA over 8 hours

• Department of Health provided guidelines for hearing protection, 1984

How loud is too loud?

If it is necessary to raise your voice to hear over noise, then the noise level can be damaging to your hearing.

0 40 80 120

20 60 100 140

Office (65 dB)

Jet take-off (140 dB)

Library(35 dB)

Heavy truck(92 dB)

Slide from DoL

Lifetime Noise Exposure without HPE

160 workers in heavy manufacturing(Overall, there was a correlation between age and years spent working in noise without HPE (r=0.480, p<0.001))Welsh et al, Auckland University, presentation at NZAS Conference 2010 www.audiology.co.nz

Noisy Equipment Top Ten

Rank Equipment name Mean Leq (dB(A))

1 Air gun 96.9

2 Angle grinder 93.2

3 Pedestal grinder 90.1

4 Saws 88.7

5 Roll former 85.2

6Steelworker -

punch and sheer83.2

7 Linisher 82.5

8 Electric drill 82.1

9 Air compressor 81.8

10 Guillotine 81.6Welsh et al, Auckland University, “Noise and Hearing Lpss” Presentation at NZAS Conference 2010 www.audiology.co.nz

Impulse Noise Top Ten

Rank Source of impulse noise Mean Lpeak (dB(C))

1Dropping sheet steel onto surface of an ArcWriter machine

141.5

2Sledge hammering a mild steel girder

139.6

3Dropping a steel bar onto a concrete floor from approx 0.5m

138.6

4Dropping a steel bar onto a concrete floor from approx 0.5m

137.5

5Sledge hammering a steel plate on a metal work surface

132.3

6Dropping sheet steel on top of other sheet steel from approximately 1m

131.8

7Hammering (ball-pein hammer) a galvanised steel sheet, on a metal work surface

129.3

8Rolling over a steel girder, on a metal stand

127.8

9 Centre punching a steel girder 125.3

10Dropping a large, hollow, aluminium tube onto concrete floor from approximately 1m

124.7

Welsh et al, Auckland University, “Noise and Hearing Lpss” Presentation at NZAS Conference 2010 www.audiology.co.nz

What is the problem?

• Our conclusion is in the 1960s and 1980s:– Minimal legal protection for workers from

noise exposure at work– Noisy workplaces– Little or no hearing protection– Cultural acceptance– 55% worked in low paid manual labouring

work building NZ

What’s happening now?

• These older workers, or retirees suffer hearing loss

Noise Induced Hearing Loss

• Gradual process• Symptoms are subtle in the early stages.  • Hearing loss tends to occur first for high-pitched sounds

only.  – No loss of volume– But loss of clarity  “People are mumbling”– Speech may be heard but not completely understood– The presence of background noise can make speech hard to

understand.  • Noise induced hearing loss has been reported to be

accompanied by a ringing in the ears (tinnitus) in 23% of subjects (Phoon, 1993). 

• Tinnitus can often be more annoying than the hearing loss itself. 

• Treatment of tinnitus is often unsatisfactory.  

Implications of Hearing Loss

• Missed opportunities for communication, information exchange, humour, emotion

• Social isolation – people stop going out • Can cause stress in the family• Reduced income/productivity • Leading to earlier assisted living• Reduction in Quality of Life• Depression• Dementia

Dr Alison Grimes, Presentation NZAS Conference 2010

Impact on older people

• Older listeners with or without hearing loss have more difficulty– understanding speech in noise– understanding speech in speech– rapid speech (e.g. grandchildren)

– with tests of auditory processing • e.g. compressed speech

• Younger people may cope with hearing loss, but as they age it becomes increasingly difficult and they seek help

Dr Alison Grimes, NZAS Conference 2010

Listening Effort Increases Task Difficulty

• Utilises greater cognitive resources to interpret– Energy expended in listening to degraded

speech, even when audibility is assured.

• Diminishes cognitive resources devoted to other auditory activities– Prediction/anticipation– Recall– “multi-task listening”—attention to more than one

auditory stimulus

Dr Alison Grimes, NZAS Conference 2010

Table 5 - Total % hearing loss compared to HHI score %HL vs HHI Missing *10-19 *20-29 *30-40Missing 2 2 16 21* 0-10% 1 2 5 5*11-20% 4 4 10 10*21-30% 2 1 5 12*31-40% 0 0 3 7*41-50% 1 1 1 2*51% or higher 2 0 1 4All 12 10 41 61

Severity” of hearing loss is not simply decibel-by-frequency threshold loss (Grimes 2010)

Audiometric measures explain less than 50% of the variance in hearing handicap (Weinstein and Ventry 1983)

Hearing Handicap InventoryA self-assessment tool designed to quantify the emotional and social effects of self-perceived hearing impairment. Score 0 to 40.

Audiogram does not predict handicapGreville, A. (2008) Hearing needs assessment trial results. Presentation at New Zealand Audiological Society 2008 Annual Conference.

Greville, A. (2008) Hearing needs assessment trial results.

The political response

• Analyse the liability for current and future claims costs

• Estimated at $1.3B

• Paid for by current employers through ACC levies

The National Government Agenda

Minister Nick Smith• Appointed a new

ACC Board in March 2009

• Wants to set a new direction for ACC

• His priority is cost control

• He wants to open up the work account to private competition

Administrative cost containment

• Focus on cost management– Re-aiding only when aids not repairable– Repairing hearing aids rather than replacing

even when 10 years old, even when not meeting client needs

• Reduce service levels– More claims declined

• Reduce injury prevention

How is this all playing out?Changes in the Act from 1 July 2010

• Removes cover for hearing loss below 6% (hard to hear in groups, women’s and children’s voices)

Proposed Regulations

• Will increase costs to claimants; was 100% of costs paid by ACC, if proven workplace hearing loss.

• ACC estimates that claimants will pay half the costs.• Now a proportion of costs will be paid by ACC, with significant

deductions as claimants get older.• ENTs asked to determine % of hearing loss due to work without

benefit of serial audiograms, workplace noise surveys, accurate description of exposure.

• Claimants expected to provide detailed history of tools used, environmental noise, etc. for period over 40 years ago.

• ENTs must make assumptions about noise exposure and link it to the audiogram.

• A .1% difference in an allocation of hearing loss can cost the claimant hundreds of dollars.

• Departure from providing rehabilitation, replaced with a subsidy linked to a % which cannot be scientifically proven.

Rehabilitation abandoned

• National Council on Aging - 1999• 4000 older hearing impaired persons

• Hearing aids result in – better relationships– better feelings about self– improved mental health – greater independence, security

• Non-use results in – Depression– Sadness– Worry and anxiety– Emotional turmoil– Insecurity– Reduced social activity– Paranoia

Conclusion

• The political cost-saving focus is penalising older, and often retired workers

• Their hearing has been lost – permanent injury• Current employers are being asked to pay for

past hazards• Government decided to shift cost from current

employers to older workers• This is a departure from the current ACC

scheme and original intention of a no fault scheme, based on community responsibility.

Sir Owen Woodhouse

Five principles 1. Community responsibility for accidents

and supporting accident victims

2. Comprehensive entitlement regardless of what caused the accident

3. Complete rehabilitation

4. Compensation for the whole period of incapacity at 80 per cent of previous earnings

5. Administrative efficiency.

Questions?