Around one in six Australians has some form of hearing loss, ranging from mild to complete hearing loss. That figure is expected to grow to one in four by 2050, due in a large part to the country’s ageing population.

Hearing loss affects communication and social engagement and limits educational and employment opportunities. Effective treatment for hearing loss is available in the form of communication training (for example, lipreading and auditory training), hearing aids and other devices.

But the uptake of treatment is low. In Australia, publicly subsidised hearing care is available predominantly only to children, young people and retirement-age people on a pension. Adults of working age are mostly not eligible for hearing health care under the government’s Hearing Services Program.

Our recent study published in the journal Ear and Hearing showed, for the first time, that working-age Australians from lower socioeconomic backgrounds are at much greater risk of hearing loss than those from higher socioeconomic backgrounds.

We believe the lack of socially subsidised hearing care for adults of working age results in poor detection and care for hearing loss among people from disadvantaged backgrounds. This in turn exacerbates social inequalities.

Population data shows hearing inequality

We analysed a large data set called the Household, Income and Labour Dynamics in Australia (HILDA) survey that collects information on various aspects of people’s lives, including health and hearing loss.

Using a HILDA sub-sample of 10,719 working-age Australians, we evaluated whether self-reported hearing loss was more common among people from lower socioeconomic backgrounds than for those from higher socioeconomic backgrounds between 2008 and 2018.

Relying on self-reported hearing data instead of information from hearing tests is one limitation of our paper. However, self-reported hearing tends to underestimate actual rates of hearing impairment, so the hearing loss rates we reported are likely an underestimate.

We also wanted to find out whether people from lower socioeconomic backgrounds were more likely to develop hearing loss in the long run.

We found people in the lowest income groups were more than twice as likely to have hearing loss than those in the highest income groups. Further, hearing loss was 1.5 times as common among people living in the most deprived neighbourhoods than in the most affluent areas.

For people reporting no hearing loss at the beginning of the study, after 11 years of follow up, those from a more deprived socioeconomic background were much more likely to develop hearing loss. For example, a lack of post secondary education was associated with a more than 1.5 times increased risk of developing hearing loss compared to those who achieved a bachelor’s degree or above.

Overall, men were more likely to have hearing loss than women. As seen in the figure below, this gap is largest for people of low socioeconomic status.

Why are disadvantaged groups more likely to experience hearing loss?

There are several possible reasons hearing loss is more common among people from low socioeconomic backgrounds. Noise exposure is one of the biggest risks for hearing loss and people from low socioeconomic backgrounds may be more likely to be exposed to damaging levels of noise in jobs in mining, construction, manufacturing, and agriculture.

Lifestyle factors which may be more prevalent in lower socioeconomic communities such as smoking, unhealthy diet, and a lack of regular exercise are also related to the risk of hearing loss.

Finally, people with lower incomes may face challenges in accessing timely hearing care, alongside competing health needs, which could lead to missed identification of treatable ear disease.

Why does this disparity in hearing loss matter?

We like to think of Australia as an egalitarian society – the land of the fair go. But nearly half of people in Australia with hearing loss are of working age and mostly ineligible for publicly funded hearing services.

Hearing aids with a private hearing care provider cost from around A$1,000 up to more than $4,000 for higher-end devices. Most people need two hearing aids.

Lack of access to affordable hearing care for working-age adults on low incomes comes with an economic as well as a social cost.

Previous economic analysis estimated hearing loss was responsible for financial costs of around $20 billion in 2019–20 in Australia. The largest component of these costs was productivity losses (unemployment, under-employment and Jobseeker social security payment costs) among working-age adults.

Providing affordable hearing care for all Australians

Lack of affordable hearing care for working-age adults from lower socioeconomic backgrounds may significantly exacerbate the impact of hearing loss among deprived communities and worsen social inequalities.

Recently, the federal government has been considering extending publicly subsidised hearing services to lower income working age Australians. We believe reforming the current government Hearing Services Program and expanding eligibility to this group could not only promote a more inclusive, fairer and healthier society but may also yield overall cost savings by reducing lost productivity.

All Australians should have access to affordable hearing care to have sufficient functional hearing to achieve their potential in life. That’s the land of the fair go.

Mohammad Nure Alam, PhD Candidate in Economics, Macquarie University; Kompal Sinha, Associate Professor, Department of Economics, Macquarie University, and Piers Dawes, Professor, School of Health and Rehabilitation Sciences, The University of Queensland

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Medicare, Australia’s universal health insurance scheme, guarantees all Australians access to a wide range of health and hospital services at low or no cost.

Although access to the scheme is universal across Australia (regardless of geographic location or socioeconomic status), one analysis suggests women often spend more out-of-pocket on health services than men.

Other research has found men and women spend similar amounts on health care overall, or even that men spend a little more. However, it’s clear women spend a greater proportion of their overall expenditure on health care than men. They’re also more likely to skip or delay medical care due to the cost.

So why do women often spend more of their money on health care, and how can we address this gap?

Women have more chronic diseases, and access more services

Women are more likely to have a chronic health condition compared to men. They’re also more likely to report having multiple chronic conditions.

While men generally die earlier, women are more likely to spend more of their life living with disease. There are also some conditions which affect women more than men, such as autoimmune conditions (for example, multiple sclerosis and rheumatoid arthritis).

Further, medical treatments can sometimes be less effective for women due to a focus on men in medical research.

These disparities are likely significant in understanding why women access health services more than men.

For example, 88% of women saw a GP in 2021–22 compared to 79% of men.

As the number of GPs offering bulk billing continues to decline, women are likely to need to pay more out-of-pocket, because they see a GP more often.

In 2020–21, 4.3% of women said they had delayed seeing a GP due to cost at least once in the previous 12 months, compared to 2.7% of men.

Data from the Australian Bureau of Statistics has also shown women are more likely to delay or avoid seeing a mental health professional due to cost.

Women are also more likely to need prescription medications, owing at least partly to their increased rates of chronic conditions. This adds further out-of-pocket costs. In 2020–21, 62% of women received a prescription, compared to 37% of men.

In the same period, 6.1% of women delayed getting, or did not get prescribed medication because of the cost, compared to 4.9% of men.

Reproductive health conditions

While women are disproportionately affected by chronic health conditions throughout their lifespan, much of the disparity in health-care needs is concentrated between the first period and menopause.

Almost half of women aged over 18 report having experienced chronic pelvic pain in the previous five years. This can be caused by conditions such as endometriosis, dysmenorrhoea (period pain), vulvodynia (vulva pain), and bladder pain.

One in seven women will have a diagnosis of endometriosis by age 49.

Meanwhile, a quarter of all women aged 45–64 report symptoms related to menopause that are significant enough to disrupt their daily life.

All of these conditions can significantly reduce quality of life and increase the need to seek health care, sometimes including surgical treatment.

Of course, conditions like endometriosis don’t just affect women. They also impact trans men, intersex people, and those who are gender diverse.

Diagnosis can be costly

Women often have to wait longer to get a diagnosis for chronic conditions. One preprint study found women wait an average of 134 days (around 4.5 months) longer than men for a diagnosis of a long-term chronic disease.

Delays in diagnosis often result in needing to see more doctors, again increasing the costs.

Despite affecting about as many people as diabetes, it takes an average of between six-and-a-half to eight years to diagnose endometriosis in Australia. This can be attributed to a number of factors including society’s normalisation of women’s pain, poor knowledge about endometriosis among some health professionals, and the lack of affordable, non-invasive methods to accurately diagnose the condition.

There have been recent improvements, with the introduction of Medicare rebates for longer GP consultations of up to 60 minutes. While this is not only for women, this extra time will be valuable in diagnosing and managing complex conditions.

But gender inequality issues still exist in the Medicare Benefits Schedule. For example, both pelvic and breast ultrasound rebates are less than a scan for the scrotum, and no rebate exists for the MRI investigation of a woman’s pelvic pain.

Management can be expensive too

Many chronic conditions, such as endometriosis, which has a wide range of symptoms but no cure, can be very hard to manage. People with endometriosis often use allied health and complementary medicine to help with symptoms.

On average, women are more likely than men to use both complementary therapies and allied health.

While women with chronic conditions can access a chronic disease management plan, which provides Medicare-subsidised visits to a range of allied health services (for example, physiotherapist, psychologist, dietitian), this plan only subsidises five sessions per calendar year. And the reimbursement is usually around 50% or less, so there are still significant out-of-pocket costs.

In the case of chronic pelvic pain, the cost of accessing allied or complementary health services has been found to average A$480.32 across a two-month period (across both those who have a chronic disease management plan and those who don’t).

More spending, less saving

Womens’ health-care needs can also perpetuate financial strain beyond direct health-care costs. For example, women with endometriosis and chronic pelvic pain are often caught in a cycle of needing time off from work to attend medical appointments.

Our preliminary research has shown these repeated requests, combined with the common dismissal of symptoms associated with pelvic pain, means women sometimes face discrimination at work. This can lead to lack of career progression, underemployment, and premature retirement.

Similarly, with 160,000 women entering menopause each year in Australia (and this number expected to increase with population growth), the financial impacts are substantial.

As many as one in four women may either shift to part-time work, take time out of the workforce, or retire early due to menopause, therefore earning less and paying less into their super.

How can we close this gap?

Even though women are more prone to chronic conditions, until relatively recently, much of medical research has been done on men. We’re only now beginning to realise important differences in how men and women experience certain conditions (such as chronic pain).

Investing in women’s health research will be important to improve treatments so women are less burdened by chronic conditions.

In the 2024–25 federal budget, the government committed $160 million towards a women’s health package to tackle gender bias in the health system (including cost disparities), upskill medical professionals, and improve sexual and reproductive care.

While this reform is welcome, continued, long-term investment into women’s health is crucial.

Mike Armour, Associate Professor at NICM Health Research Institute, Western Sydney University; Amelia Mardon, Postdoctoral Research Fellow in Reproductive Health, Western Sydney University; Danielle Howe, PhD Candidate, NICM Health Research Institute, Western Sydney University; Hannah Adler, PhD Candidate, Health Communication and Health Sociology, Griffith University, and Michelle O’Shea, Senior Lecturer, School of Business, Western Sydney University

This article is republished from The Conversation under a Creative Commons license. Read the original article.