Hearing impairment—the silent barrier to Closing the Gap

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Hearing impairment—the silent barrier to Closing the Gap

Posted 15/06/2012 by Carol Ey

On May 15 students in Years 3, 5, 7 and 9 across Australia commenced the annual tests for the National Assessment Program – Literacy and Numeracy (NAPLAN) testing. No doubt when the 2012 results are released they will continue to show a substantial gap between the achievement of Indigenous and non-Indigenous students. For example, the 2011 Year 3 reading results report that 21.3 per cent of Indigenous children were below the national minimum standard compared to just 3.3 per cent of non-Indigenous children.

A significant, but often overlooked, factor inhibiting the school achievement of Indigenous children is the high rate of middle ear disease. Evidence presented to the Senate Community Affairs Committee in 2010 estimated that some 10 per cent of Indigenous children under the age of 14 were reported as having ear or hearing problems, compared with 3 per cent of non-Indigenous children. Many consider this figure likely to underestimate the actual rates of hearing problems in Indigenous children. The major cause is the failure to appropriately treat common middle ear infections in infants and young children, leading to chronic otitis media (COM)—a persistent inflammation of the middle ear. Prevalence of COM has been estimated at over 20 per cent among Indigenous children and is among the highest in the world, and far higher than the rate of 4 per cent which the World Health Organisation (WHO) defines as ‘a massive public health problem...which needs urgent attention’.  

The problem is particularly acute in remote communities, with testing undertaken as part of the Northern Territory Emergency Response (NTER) showing 66 per cent of children had at least one type of middle ear condition. It is also an issue in urban centres with the Telethon Speech and Hearing Centre finding that 50 per cent of Aboriginal children under the age of 12 tested in Perth failed a simple hearing test.

The impact of hearing impairment on education, employment and emotional wellbeing are well known. The link with high levels of imprisonment is less commonly known and addressed. However a recent study found that 94 per cent of the Aboriginal inmates in Northern Territory Correctional Centres had significant hearing loss. The study notes that impaired hearing—particularly when not diagnosed—leads to poorer educational, employment and social outcomes which are all linked to a higher incarceration rate. However it also found that many of the inmates reported having difficulty hearing corrections’ officers’ instructions, and suggests that a similar situation would probably apply in relation to police interviews and court proceedings, potentially resulting in a more adverse outcome in the criminal justice system.

While a range of programs are being implemented to address ear health in Aboriginal communities, these will be of limited assistance to those already in the education system and beyond it. Improved testing and greater recognition of the issue may at least provide more appropriate services to alleviate the consequences of hearing loss, and reduce the extent of disadvantage experienced by hearing impaired Indigenous Australians.


  • 21/01/2014 2:49 PM
    Martin Butterfield said:

    Excellent post. It is a great pity that the evidence, as described in the linked report, about the cause of the medical problem seems to be limited to 'poverty' or 'social disadvantage'. It would seem that some urgent work is needed on the pathway through which poverty leads to very young children having severe ear health issues. What precisely are the kids missing out on, or getting too much of, which causes the problem?

  • 21/01/2014 2:50 PM
    Carol Ey said:

    A major factor in the development of hearing problems in children is ineffective treatment of ear infections, either through not seeking medical attention or not adhering to treatment programs (usually taking a course of antibiotics). The Longitudinal Study of Indigenous Children1 found that six per cent of children in the Study had needed a doctor but did not see one at some time in the previous year. This increased to eight per cent in remote areas. The most common reasons given were ‘Waiting time too long or inconvenient hours’ (46 per cent), ‘Felt they could cope’ (31 per cent) and ‘Transport/distance’ (14 per cent). Access to appropriate health care is a particular issue for anyone in rural and remote areas2, not just for Indigenous people, however a significant proportion of people living in remote locations are Indigenous. There are a range of other factors3 where Indigenous disadvantage contributes to poor health outcomes generally. In relation to ear infections particular issues include overcrowding, potentially leading to increased rates of infection, and poor education levels, which may mean that parents are unaware of the consequences of lack of treatment or are less likely to ensure the child completes a prescribed course of antibiotics. 1. LSIC Wave 2 summary report http://www.fahcsia.gov.au/sa/indigenous/pubs/families/lsic/Pages/wave2_summary_report.aspx 2. AIHW, Rural, regional and remote health: indicators of health system performance http://www.aihw.gov.au/publication-detail/?id=6442468150 3. Australian Human Rights Commission, Social determinants and the health of Indigenous peoples in Australia – a human rights based approach, http://www.hreoc.gov.au/about/media/speeches/social_justice/2007/social_determinants_n_the_health_of_indig_peoples.html

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