The politics of hearing loss 16 July 2010-Department of Public Health-University of Otago

1. The politics of hearing loss16 July 2010-Department of Public Health-University of Otago Hazel Armstrong and Karen Pullar A lawyer and an audiologist

2. 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

3. 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

4. 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

5. 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. Office (65 dB) Jet take-off (140 dB) Library (35 dB) Heavy truck (92 dB) Slide from DoL

6. 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

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

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

9. 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

10. What’s happening now? • These older workers, or retirees suffer hearing loss

11. 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.  

12. Implications of Hearing Loss Dr Alison Grimes, Presentation NZAS Conference 2010 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

13. Impact on older people Dr Alison Grimes, NZAS Conference 2010 • 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

14. Listening Effort Increases Task Difficulty Dr Alison Grimes, NZAS Conference 2010 • 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

15. Greville, A. (2008) Hearing needs assessment trial results. Presentation at New Zealand Audiological Society 2008 Annual Conference. Audiogram does not predict handicap Severity” of hearing loss is not simply decibel-by-frequency threshold loss (Grimes 2010) Audiometric measures explain less than 50% of the variancein hearing handicap (Weinstein and Ventry 1983) Hearing Handicap Inventory A self-assessment tool designed toquantify the emotional and social effects of self-perceivedhearing impairment. Score 0 to 40. Greville, A. (2008) Hearing needs assessment trial results.

16. The political response • Analyse the liability for current and future claims costs • Estimated at $1.3B • Paid for by current employers through ACC levies

17. 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

18. 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

19. 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)

20. 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.

21. 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

22. 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.

23. Sir Owen Woodhouse Five principles • Community responsibility for accidents and supporting accident victims • Comprehensive entitlement regardless of what caused the accident • Complete rehabilitation • Compensation for the whole period of incapacity at 80 per cent of previous earnings • Administrative efficiency.

24. Questions?