Over the past year, different parties within the hearing industry have increasingly found each other in calling attention to and making visible the impact of hearing loss and the need for more attention to prevention, education, hearing protection and good hearing care. The momentum was accordingly. The health council’s advice on the noise standard at events stirred up a lot and, partly because of this, caused attention in The Hague and a lot of interest from the (social) media. but now that we are a little further along in time, the question arises: How do we ensure that this issue stays on the agenda from a positive grounding? Recent reports by the World Health Organization (WHO), which make frightening predictions, actually need much more of that attention. but that is still lacking. Earline and NVAB sat down with peers in Utrecht (NL). Read along as if you were sitting at the table yourself.
Moderator Anneke Pastoor – Text Liesbeth Immink – Image Miranda Becker Hoff
Carmen de Jonge president NVAB
Dyon Scheijen clinical physicist – audiologist Adelante Hoensbroek
Wil Verschoor director Hoormij Foundation
Roy Boers sales manager Audiology Comfoor/Akouz/Pluggerz
Stephen Emmer (virtual) owner Stephen Emmer Media Music, founder Artists Against Tinnitus, Foundation and experience expert.
Problems with hearing are still too much seen, as far as I am concerned, even within our industry, as a problem of the hearing industry. On the contrary, I see it as a social problem. If you can no longer participate because you have poor hearing, are tired, lack concentration, or if you withdraw more and more because you can no longer keep up with parties, for example, that also has a huge social impact. According to the most recent figures, we are dealing with a broad target population of 3.3 million people with hearing problems: 1.3 million hearing impaired and an estimated 2 million people with tinnitus. These are huge numbers, which will only increase due to the aging population.
There is still insufficient awareness of this in the Social Domain. Many people still seem to think that if you have problems with your ears, you just go to the audiologist, like you go to the optician for glasses, and that that solves everything. But that’s not how it works. We are really dealing with a major social problem and that is the message we need to spread widely so that more people can get behind us and we can achieve more.
I agree with that; with that, we move the topic forward. Hearing protection, according to European
legislation in Category 3, the highest risk category for personal devices that protect against potentially serious or irreversible damage to health. It still amazes me then that we, as a society, still don’t see earplugs as something we need. Just like sunscreen or a seat belt. I think we need to make that more top-of-mind, that it’s very normal to wear hearing protection. It is of course nice that the standard at the maximum sound level for safe listening may be lowered from 103 to 100 dB thanks to the advice of the Health Council, but that is only the beginning of a possible solution.
There are now great reports about the social impact of hearing loss, about how much money it costs society and about how many people are affected, but what it does to those people is, as far as I’m concerned, insufficiently known. For example, that Stephen, due to tinnitus and dizziness, prefers to stay in Amsterdam and join this conversation online, because a trip to Utrecht is too much for him; so there are numerous aspects in severe hearing complaints that are currently under-researched.
What struck me, when we recently sat down at the table at the Ministry of Social Affairs and Employment to talk about this topic, was that they mainly thought there that we wanted to talk about the Occupational Health and Safety Standard. But precisely what we wanted to say was: realize that in the labor force there is an increasing proportion of people who will have problems at work due to hearing loss. We need to talk about the impact hearing damage has on their lifestyles. We are facing a silent disaster; by 2050, one in four people will suffer from hearing problems. Therefore, we need to go outward, not just within the hearing industry to convince each other with all kinds of research results, but rather to work with other sectors of society; to understand what happens when someone has hearing loss and develop actions so that it is better dealt with. In a preventive sense, and also to help people stay involved.
Awareness is indeed an important step, I think also the first step. The other day I got to give a pitch at a meeting of the InnoInnovation Network of the Federation of Medical Specialists. The theme was the importance of prevention and lifestyle to keep healthcare accessible and affordable. As a clinical physicist – audiologist, I got to speak on prevention of hearing problems, but you know what I did first? Making my listeners aware of how important hearing is in our society, because you need that awareness to then prevent major problems from arising. And by the way, can I just say that I actually think the word “hearing protection” is just a bad name? By emphasizing “protection,” we make people afraid, and in some, that fear component can become prevalent, something that does not help us move forward.
Will
Nice that it’s now about raising awareness, because especially among the youth up to 15 to 16 years old, much more awareness is needed. Too loud noise and hearing loss is often still a taboo subject in that group. We at Stichting Hoormij have come to realize that peers who are one or two years further along are the only ones that young people listen to: fellow young people who are just one step more experienced. That is a very narrow group and that is what we are looking for more and more now. This is also how we try to get closer to our target group with our Hearing buddies project. An experienced hearing aid user can advise a beginner and lower the threshold. We see that works.
What Wil is now heading for, on the issue of looking for and finding “credible ambassadors,” is also true in the music world. Only it’s not so easy there. Many artists are afraid to “come out of the closet” with their hearing problems because there is a fear that it could hurt their careers. And that stagnates the link to ambassadors from within the profession.
Carmen
Still, what I did see in general over the past year is that more and more people are daring to talk and write about their own hearing loss. Wil and I increasingly caught sounds of “hey, I got that too” or “how good that this is being told. By the way, what I still find complicated is that we always formulate positively. We don’t want to scare people away, as Dyon pointed out, or create fear by naming the dangers of too loud noise.
On the other hand, it is true that people now use sunscreen because they are also warned about skin cancer. As peers, we need to think about whether we should indeed always communicate positively or whether that big warning should be there after all. For me, this is sincerely a dilemma, because if soon a quarter of the population will no longer be able to understand each other properly, we will have a substantial problem. And I do want the government to think now about what policies go with that. I don’t want the House of Representatives to see this issue as hype, as a checkmark that will soon be signed off too. That silent disaster, those 3.3 million people who are going to have problems: more attention needs to be paid to that. We need to get past the hype!
Dyon
It is imperative to keep this issue on the agenda; I work hard for it every day. And a lot of parties, fortunately, are already moving in the right direction. But we do need to make sure that we can find one voice together, and that may well be more official and less incidental than it is now. We all pursue the same thing, in my opinion.
Stephen
I think with this “Roundtable,” as far as I’m concerned, we have the preliminary “lead coalition” to properly highlight these kinds of dilemmas and create lasting awareness. But we must guard against duplication. I would advocate more joint action, looking for mutual coordination, so that the irritation factor does not arise in other parties and we do not alienate parties unnecessarily.
Dyon
That peer to peer approach that Wil mentioned is something that we could very well take up together. During the Federation of Medical Specialists network meeting, the example of pulmonologists came up. Have you seen their TikTok videos in the news? Their mission is to get young people off vaping, because too many young people still mistakenly believe that vaping is the healthy version of smoking. After extensive research, they chose to target the influencers on TikTok because they are the ones the actual target audience listens to; they are the peers. The moment those influencers become your ambassadors, you create a three-stage rocket from messenger to influencer to actual target audience, a chain of influence. We can do something like that, too.
Stephen
Yes, of course it does help when influencers or BN-ers speak out, but there is also the danger of short-term risk. I’m already noticing it with talk show editors, for example. These days, when I knock on that door, I get the response, “We’ve already covered that subject.” So I became a little more cynical about that. Therefore, I think you have to work primarily with your own media. Such a plan may be born out of necessity, but if we seek continuity in this debate, perhaps we should start a Podcast or YouTube channel together.
Carmen
I think that’s an interesting thought, because then you can also communicate with each other in a coordinated way to
different target groups.
Stephen
Exactly. I just compare us to a broadcaster. You have the KRO-NCRV, the AVROTROS and you name it.
But we still need an NPO for our communications.
Carmen
I find that it is quite a challenge to widen the circle of people who understand what it is about. As far as I’m concerned, we should look more at the professionals who are close to the people, who are just barely hearing or just barely hearing. That is also a form of peer to peer. For example, the NVAB recently started a project with occupational physicians together with Stichting Hoormij and the “other NVAB” [Dutch Association for Occupational and Work Medicine, ed. Together, we aim to map the noise environment at nine employers in the healthcare, education and automotive industries and then work with the occupational physicians involved to improve that environment and any hearing problems employees may have.
…But implementing such a directive is proving to be a huge challenge. With this pilot, we hope to contribute to that. This is how we bring our knowledge closer to the people who can use it in their sector.
Stephen
We are trying to do the same from the Artists against Tinnitus Foundation, the foundation I set up six months ago, where we took the perspective from the artist’s point of view. We look at what we can contribute creatively, but also appeal to our industry’s own responsibility, which is our two-sided mission. We seek collaboration with orchestra managers, executives and health and safety people to see what we can improve for artists and musicians, as well as for our audiences.
…including through venues and pop venues. For example, TivoliVredenburg accepted our proposal to include hearing protection in their internal communications. You can now order earplugs there through the website, the ticketing system, in the venue and at the bar. It should become as normal as ordering a beer. We hope the rest of the halls will follow. We are already in talks with Paradiso, Muziekgebouw aan ‘t IJ, Het Koninklijk Concertgebouw, Melkweg, and at Flux in Zaandam they even want to offer everyone free single-use earplugs upon entry.
Will
Those are great steps Stephen! And also what Carmen mentioned, the project at those nine organizations: that’s where we broaden the topic. We’re not just looking at people with hearing loss, but anyone who is affected by noise in the workplace. These can include people with good hearing who are getting dead tired of all the noises in their offices. That makes the target audience a lot bigger and hopefully it will sink in faster with people that you can really be bothered by noise. We hope that people will then say, I’m not hearing impaired right now, but I want my work environment to improve.
Roy
That’s great, because we talk a lot about prevention, but this also puts you on the prevention side. We have a lot of data, but we are also missing a lot of data. So the moment we are in a position to deploy all those professionals, then we also finally get the data we are waiting for.
Carmen
We have known for ages that poor hearing and work are a tricky combination. We’ve also known for ages that when people have incipient dementia as well as poor hearing, they go downhill faster. I looked at the guidelines of the Dutch College of General Practitioners (NHG) the other day and it neatly describes that people with incipient dementia symptoms should also have a hearing test. Yet this still hardly ever happens! So there is still work for us there as well: I keep saying it, we have to go to the professionals, in this case the family doctors. Perhaps a joint, coordinated media strategy in this area would also help.
Dyon
Thanks to the two recent WHO reports, we are in a good time to keep the issue on the agenda.
It is now very clear to the profession, associations and patient organizations that by 2050, some 25 percent of the population will be affected by hearing loss. We also all recognize the risks to young people of hearing problems from loud music, especially in the group between the ages of 12 and 35. And “mild hearing loss” is especially prevalent among those over 55, both in work and private situations. How do we ensure that this story sticks with a wider audience?
Will
And how do we permanently bring attention to how much it costs us if we do nothing? That, too, is interesting.
Carmen
In itself, of course, all that has been calculated; it is about 5.8 billion euros. Half of that amount is based on quality of life, but its definition is very personal, and the signal from the government is soon that the healthcare budget is not sufficient for that. The other half of that amount is based on work. Hence also the need to go to that shop floor. In my opinion, it would be very good if there were periodic screening for everyone aged 50 and older. That could prevent a lot of suffering in the workplace.
Stephen
Such mandatory 50-plus screening, that’s a gamble though. Indeed, that has communicating vessels with the fear of losing your job. There is still a definite taboo side to it.
Carmen
But if you use such a screening early on as a preventive measure, and people see that it allows you to intervene in a timely manner, allowing people to practice their profession for longer, then maybe it’s something we can carefully put down together. After all, we all get to work until age 67.
Will
Then again, we come back to the question of how we can strengthen each other within the industry and how we can hold on to each other, even after this conversation ends. What steps can we take collectively toward other professional groups? What initiatives are there? How do we move forward and find politics?
Roy
Above all, we must continue to talk not about, but with all parties. For example, I was appalled that Koninklijke Horeca Nederland (KHN) was not at the table during the discussions on the noise standard and hearing damage during the prevention debate in The Hague at the end of March. We must continue to seek the connection. In that regard, I am also somewhat conflicted now that the third covenant on decibels and noise has expired. Should there be another covenant or should noise levels be regulated by politics and legislation? With the latter, many people will possibly dig their heels in, quite apart from the possibility of whether it would all be manageable and enforceable. I personally still prefer to see a covenant, but it has to be one that rings like a bell.
Carmen
I happened to receive a response this morning from a member of the House of Representatives who would be quite willing to continue talking about the opinions of the Health Council and who knows … also our desire to broaden the debate.
Dyon
You know what we might have to do? Organize a very good symposium. By sharing knowledge
we hold up a mirror to people at the same time. This also provides time and space to properly convey our drive, our conviction that something must be done. Participants then include the hearing industry, occupational physicians, general practitioners, ENT doctors, experts by experience, musicians, patient organizations, etc. The step we can then take after that is to educate individuals.
Carmen
That’s a great idea! Indeed, I think we have a few steps to take
collectively. We need to reach the professionals who are on the other side, and I think we need politics to do that. Not so much for legislation, but to make others aware that we are dealing with a social problem. So those Lower House members with whom Wil is in contact, they can then nicely join us at that symposium. We need to stop thinking from hearing and instead start thinking from combinations with hearing: musician & hearing, aging & hearing, work & hearing.
Will
Exactly! We need to make the problem more specific to the conscious audiences and stop thinking
from within ourselves. We have politics and a lot of industries with us, so hearing care now has to step over its own shadow. We are working on a social problem, it is not about our competitiveness.
Stephen
I think we can consider a letter of intent of cooperation, which we can then
use as leverage when approaching people. Because simply put, fencing on my own still carries less weight than fencing with a serious delegation.
Responding to this conversation? Agreed on issues or not at all? Have a good idea of your own or share a great anecdote? Or next time join in on another topic? Mail to anneke.pastoor (at) ltmedia.com
[Earline Magazine – Liesbeth Immink – 7 Juni 2023]
