Middle ear infection is a contributing factor to disadvantage, and it is treatable and preventable. Aboriginal and Torres Strait Islander children experience a disproportionately high burden of persistent middle ear infections such as otitis media and associated hearing loss – about 5 times higher than general Australian population.
This profoundly affects their adult life trajectories. It has life-long impacts on educational participation and outcomes and psycho-social development (including speech development) that bring a greater risk of a range of adult social problems including un/underemployment and involvement with the criminal justice system.
Australian Government programs that provide devices and supports such as the Hearing Services Program and its Community Service Obligation component, the National Disability Insurance Scheme, and outreach programs enabled by public funding must continue to enjoy bipartisan support while striving to find synergies and share best practices.
It is critical that strategies and actions are co-designed with Aboriginal communities and communicated by Aboriginal-led media organisations. Duplication of effort must be avoided by making use of resources from existing successful ear health programs. Deafness Forum is aware that it does not have the cultural authority and reach to be a direct contributor. But we will actively support programs throughout Australia that are true and effective partnerships between Aboriginal and Torres Strait Islander peoples and Hearing Health professionals who have both the skills and the cultural knowledge necessary to make useful and lasting impacts.*
* From Making a noise about hearing: Factors to consider when developing hearing health awareness messages for Australians. Prepared by the National Acoustic Laboratories for the Australian Government Department of Health and Aged Care, May 2020, revised September 2020.
Background.
The socio-political (housing, food systems, education and employment, income and poverty, access to health care) and behavioural (including exposure to tobacco smoke, diet, and exercise) determinants of health are especially significant for Aboriginal and Torres Strait Islander peoples. In its broadest sense, poverty limits education and awareness of hearing health, and the capacity of families and communities to maintain healthy and hygienic environments that prevent ear disease. Social determinants like poor nutrition, lack of running water, hygiene issues, and, exposure to tobacco smoke, are all significant contributing factors to ear disease.
Health and housing agencies can work together to ensure that homes support healthy living, through increased housing stock, reliable access to functioning health hardware (eg toilets, showers, taps, kitchen cupboards and benches, stoves, ovens and fridges) and raising awareness of hygiene practices that support ear health. Health services also need to increase their focus on early identification, appropriate medical intervention in primary care and ongoing allied health support. In communities where there is a high risk of otitis media and conductive hearing loss it should be standard practice to check the ear and hearing health of all young children whenever they present at clinics.
In the education sector, early years centres and kindergartens in those high-risk communities can help identify hearing problems through surveillance and can provide additional support to children with a hearing impairment. Schools can play a similar role, orienting all teachers in accommodating the learning and communication needs of students with past and current hearing loss, providing specialist teaching support where necessary, and better listening environments through sound-field amplification systems and classroom acoustics.
Improved hearing health for Aboriginal and Torres Strait Islander people is intrinsically linked to broader improvements in health, education, and social and economic outcomes. The complex interaction of multiple risk factors means that action is needed across multiple sectors. This should be led by Aboriginal and Torres Strait Islander people themselves.
Aboriginal and Torres Strait Islander peoples are significantly more likely to seek services from culturally safe health services. This in turn has implications for leadership, governance and workforce development.
Outcomes for better hearing.
- There is a sustained and trending reduction in the prevalence of otitis media and hearing loss among Aboriginal and Torres Strait Islander people, particularly children 0-7 years old.
- State and Territory health and education policy relating to hearing services to sub-populations experiencing early, chronic otitis media and significant hearing loss is reviewed and updated to reflect current evidence on the early developmental long term impacts on language and communication outcomes.
- Aboriginal and Torres Strait Islander families have high expectations and understand the importance of ear and hearing health, know the signs of ear disease and hearing loss, request ear checks, know what they can do to prevent ear disease, and minimise the impact of hearing loss when it does occur. Awareness programs should focus on children reaching their full potential as well as on the disease process.
- Aboriginal and Torres Strait Islander families have functional health hardware in their homes that enables them to keep themselves and their living environment clean, and are not required to live in overcrowded conditions due to a poor supply of appropriate housing.
- Health services collect and report on agreed data points to enable assessment of Aboriginal and Torres Strait Islander ear and hearing health at local, national and jurisdictional levels, schools provide attendance and performance records for data linkage with ear and hearing health, and allied health and cross-jurisdiction (housing, education and justice) data sharing agreements are established.
- Primary health care services are well resourced and able to provide regular scheduled and opportunistic ear and hearing health checks and provide ongoing care to children with ear and hearing conditions in partnership with audiology, speech therapy and Ear, Nose and Throat (ENT) services as needed.
- Speech pathology, audiology and ENT services are accessible within appropriate wait times, particularly for people living in regional and remote locations and in low-socioeconomic urban areas.
- Early childhood centres, schools, health and youth detention services understand the impacts of poor hearing health on the children and young people they service and its relevance to their missions, are proactive in early identification and referral of children who may have hearing loss, and support those with hearing loss, including through the use of soundfield amplification in schools in high risk areas.
- Aboriginal and Torres Strait Islander adults and children with significant hearing loss have equity of access to and choices regarding the supports they need to live well in the community.
- The hearing health workforce delivers patient-centred care that responds to the social and cultural needs of those receiving care.
- At local, jurisdictional and national levels, services work together within and across sectors (including health, education, housing and justice) to reduce prevalence of ear disease and hearing loss, to identify ear disease and hearing loss earlier, to treat and remediate more effectively so that the impacts of ear disease throughout the life course are mitigated or avoided all together.
- Community-led, strategically planned and coordinated research into effective strategies for promotion, prevention, identification, treatment, remediation and mitigation of the impacts of early onset, chronic ear disease and associated hearing loss in Aboriginal and Torres Strait Islander children is appropriately and consistently funded, managed and evaluated.
Taken from Australia’s Roadmap for Hearing Health.
* From Making a noise about hearing: Factors to consider when developing hearing health awareness messages for Australians. Prepared by the National Acoustic Laboratories for the Australian Government Department of Health and Aged Care, May 2020, revised September 2020.