1 March 2017

Africa: Deafness Carries a Huge Cost Burden - Economic As Well As Personal

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analysis

Deafness often remains invisible, especially in contexts of constrained resources and poverty. It can exact a high cost for both developed and developing countries because it has a significant impact on the lives of those affected, and the economies of the countries in which they live. Also, the services for people who are deaf can be very expensive.

By some estimates hearing loss costs economies US$750 billion globally each year. The economic implications have been measured by looking at the impact of late diagnosis, undiagnosed deafness, insidious deafness, the impact on employment, and the lack of employment opportunities because of deafness.

Countries with the lowest gross national income per capita have the highest numbers of children who are deaf. There are an estimated 32 million deaf children in the world. Most live in South Asia, Asia Pacific and sub-Saharan Africa.

According to the World Health Organisation there are about 6.8 million children whose deafness is considered disabling in sub-Saharan Africa. The figure is 0.8 million in high income countries.

The focus of World Hearing Day in 2017 draws attention to the economic impact of deafness in its tagline, "Action for hearing loss: makes a sound investment". Economic considerations are important because they drive the support and resources available for people with deafness.

There are various interventions available to address hearing loss. These include cochlear implants, hearing aidsand learning sign language. But in many resource-constrained countries, it's not always possible for people to access these.

For example, globally hearing aids reach one out of ten people who need them. In developing countries only about one out of 40 people who may want hearing aids get access to them.

A great deal more needs to be done in developing countries, particularly in sub-Saharan Africa, to tackle the problem. But governments need to take statistics and economic considerations into account during planning for activities that involve people who are deaf, the education of deaf children, and support services for people who are deaf.

Looking beyond the numbers

As the example of hearing aids shows, economic limitations often result in people not receiving the level of support they need, even when their right to access is enshrined in legislation.

But while it's important to plan for the costs related to deafness and to provide money for services and resources, the economic factors shouldn't overshadow the human element. Service provision for deafness shouldn't only happen to reduce costs. Deaf people deserve services because of their rights as people and because societies ought to strive for humanistic values in attending to people's needs.

Another way of looking at the effect of deafness is to compare the years lost to disability attributed to deafness. These also differ dramatically between developed and developing countries.

Years lost to disability can be described as years of "healthy" life lost by virtue of being in poor health or because of disability.

The WHO estimates that 232 million years are lost to deafness disability in developing countries compared with 4.2 million years in developed countries.

Africa has the highest number of years lost to disability to deafness and also has the greatest burden of disease compared to other regions in Europe, the Americas, and South East Asia.

The burden of disease is heavier in children up to the age of four who contribute 31% in low and middle income countries. In high income countries this age group only contributes 5% towards the burden of disease.

What is the way forward?

While the issue of resources is vitally important, the issue of deafness shouldn't simply by based on calculations of cost. As I've said, this focus is reductionist because it is directed at loss rather than analysing the entire human experience of deafness.

A valuation of human beings according to their functional capacity is in sharp contrast to the humanistic values laid down in the Declaration of Human Rights.

The adage goes, "money makes the world go round". For many people who are deaf, that is indeed the case. The economic context determines their access to services and so there is the risk that deafness remains invisible. In forging a way forward, service provision for deaf people ought to prioritise their human value as a precursor to economic value.

The call is to remember the deaf person when looking at the general ledger entries so that the human experience of deafness is given the prominence it requires and merits. Yes, it is an idealistic suggestion - some would say lofty - but it is not an impossible one.

Disclosure statement

Victor de Andrade received financial assistance from the University of the Witwatersrand for his PhD. He is affiliated with the University of the Witwatersrand, his place of employment, as well as with external organisations such as People for Disability Issues (PADI) and Polokong Children's Village. Victor has served as an advisor on the UN WHO Global Cooperation on Assistive Technology (GATE).

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