Hearing is intrinsic to the lives of most Australians; it underpins the conversations that form the basis of our relationships and social lives, it gives us access to the beauty of music, and it can warn us of approaching danger. Hearing seems so natural that is not until it is gone or affected in some way that we realise how much we have taken it for granted. In Australia, 3.6 million people are affected by some form of hearing impairment and, by 2060, it is estimated that this will increase to 7.8 million.
In so many respects Australia is a leader in supporting those with a hearing loss. Universal newborn screening, the Community Service Obligations overseen by Australian Hearing, our voucher scheme for people over 65 to access hearing aids, and the incredible work of our medical researchers, health care providers and organisations working with children are world-class. An enduring example of Australian research and innovation is the invention of the Cochlear implant.
Yet there is much more that can be done to support the needs of those with hearing loss.
In 2010, the Senate Community Affairs References Committee tabled a significant report, Hear Us: Inquiry into Hearing Health in Australia. While some of its recommendations have been implemented, many have not. Seven years on, this inquiry of the House Standing Committee on Health, Aged Care and Sport heard similar evidence and drew similar conclusions. There was a sentiment of frustration among those with hearing loss or in the medical and support community that bipartisan recommendations had not been implemented – hence the title of this report.
Most notably, hearing health must be treated as a national health priority and we must do so much more to respond to Indigenous hearing health. It is no exaggeration to describe Indigenous hearing health as at a crisis.
The Committee is very grateful to the individuals who, during the inquiry, relayed their experiences of living with hearing loss and balance disorders and the impact that this has on those closest to them; their family, friends, and work colleagues. Challenges recounted by individuals with hearing impairment and/or a balance disorder included negative impacts on: self-esteem, personal relationships, and the ability to cope in education and employment situations.
Hearing impairment does not just impact those immediately affected. On a broad scale, it has been estimated that hearing loss costs the Australian economy $33.3 billion, comprised of $15.9 billion in financial costs and $17.4 billion in lost wellbeing for individuals. The economic impact of balance disorders is less certain but one estimate suggested that their cost for hospital emergency departments alone could be as high as $148 million per year.
Two key issues relating to hearing services for children were repeatedly raised during the inquiry: the implementation of the National Disability Insurance Scheme (NDIS); and the rate of otitis media, middle ear, infections among Aboriginal and Torres Strait Islander children.
The future framework underpinning hearing health services is the implementation of the NDIS. The NDIS is expected to introduce competition into the market for children’s hearing services which will require parents of children recently diagnosed with hearing impairment to navigate through a multitude of service providers.
For a young child even a small delay in the diagnosis and treatment of hearing impairment can result in a life-long reduction in their language and communication skills. Concerns were raised that emotionally vulnerable parents are less likely to be equipped to rapidly make an informed decision about the future healthcare needs of their child.
While there are many laudable elements of Australia’s system of providing hearing health care for children there is also one area where it is clearly failing. The prevalence of otitis media infections among Aboriginal and Torres Strait Islander children is at crisis point. At any time 90 per cent of children in remote communities will be experiencing an otitis media infection. While the problem is most severe in remote communities, Aboriginal and Torres Strait Islander children in urban and regional areas also experience otitis media at much higher rates than most children. Repeated otitis media infections in childhood can result in permanent hearing damage and have been found to have a detrimental impact on life opportunities that can stretch well into adulthood. For a child with otitis media the constant struggle to hear at school may leave them frustrated and disengaged and unlikely to reach their full potential in education.
Preventing hearing damage and providing support for hearing impaired Australians of working age was also raised during the inquiry. Many hearing impaired Australians in the workforce are reliant on a hearing device to maintain their employment. Yet, due to the high cost of hearing devices, hearing impaired working Australians may not be able to afford to replace a broken or outdated hearing device. In addition, the cost of hearing devices may cause people in their fifties or sixties whose hearing is deteriorating to simply struggle on, or turn to early retirement, instead of seeking treatment.
Hearing loss is particularly prevalent among older people affecting three out of every four Australians over 70 years of age. An issue of particular concern is the potential for financial exploitation of vulnerable older Australians due to the use of commissions in the hearing aid clinic industry. Older Australians entering a hearing aid clinic should be able to trust that the advice they receive will be based solely on their healthcare needs. The use of commissions creates an incentive for clinicians to instead provide advice based on the potential for personal financial gain. This is clearly unacceptable. The Committee has recommended that Australian Hearing cease the use of commissions as soon as is feasible and that the Department of Health takes steps to phase out their use by private providers.
While associated with hearing health, balance disorders do not receive a lot of attention but their effects on sufferers can be debilitating. Balance disorder sufferers can experience unexpected attacks of dizziness that are accompanied by intense nausea and a loss of balance so acute that those affected are unable to stand. Acute attacks, and the anxiety of not knowing when they will occur, can make everyday activities, such as working or driving a car, difficult or impossible. The causes of balance disorders are not well understood and there is a need for more research, which may result in the development of new treatment options.
The evidence is clear, regardless of the age or background of the people they affect, hearing impairment and balance disorders have significant social and economic impacts. These impacts can be lessened, however, if they are diagnosed and treated as early as possible.
In recent years, hearing health issues have been the subject of investigations by Senate Committees, the Australian National Audit Office, the Australian Competition and Consumer Commission, and Deloitte Access Economics. This suggests a growing recognition that hearing impairment, a condition affecting 3.6 million Australians, should be a government priority.
The Committee strongly believes that hearing health requires greater recognition and prioritisation by government and that implementing the actions recommended in this report will improve the hearing health and wellbeing of Australia.
My thanks to the organisations, agencies, and individuals who participated in this inquiry, especially those hearing impaired and deaf Australians who provided the Committee with accounts of their personal experiences. Thank you also to the Auslan interpreters who assisted with interpretation at public hearings. I would like to thank my fellow Committee colleagues for their commitment and constructive contributions during this inquiry – inquiries such as this show parliament working at its best. Finally I would like to thank the Committee staff who have collated the evidence, run the hearings and assisted in the preparation of this report. The Committee has been exceptionally well-served by its Secretariat.
Mr Trent Zimmerman MP
Chair