Health care disparities in the deaf community
By Lawrence Pick, PhD
The National Center for Health Statistics reports that approximately 20 percent (48 million) of American adults report some degree of hearing loss. During the past four decades this number has significantly increased as people are living for longer time periods and experiencing age-related hearing loss (presbycusis). There also has been an increase in the number of young adults developing hearing loss as a result of noisy work environments, constant exposure to loud music and combat-related injuries. Finally, this statistic has increased as a result of programs established to detect hearing loss in newborns and infants. The estimated prevalence of newborns identified with a congenital hearing loss ranges between 1 to 3 per 1,000 newborns. A percentage of these infants and toddlers have a severe to profound hearing loss that may impede the natural acquisition of spoken English, but facilitate the acquisition of American Sign Language (ASL) as their primary language. Although the number of sign language users in the United States has not been measured by census efforts, estimates range between 500,000 and 2 million users.
The deaf community struggles with significant health disparities and is often excluded from health surveillances, outreach programs and mass media healthcare messages. Deaf users of ASL, through cultural and language barriers, are at high risk for poor health knowledge and inequitable access to medical and behavioral care in our health system. These barriers directly translate to inadequate assessment, limited access to treatment, insufficient follow-up and poorer outcomes. For example, in the deaf population compared with the hearing population there are lower rates of individuals accessing preventative services, worse cardiovascular health outcomes and higher rates of obesity. Some mental health disparities have been observed in higher rates of depression and anxiety (not related to hearing loss or medical status), and higher rates of adjustment disorders resulting from indigence, marginalization and/or additional disabilities. Behavioral health disparities have been shown to manifest as increased numbers of unplanned pregnancies, higher rates of abuse (including intimate partner violence) and increased rates of HIV and sexually transmitted infections.
A number of factors contribute to these disparities. First, members of the deaf community may have limited medical and mental health knowledge because they have not had direct access to health information during their primary and secondary education, which may result in less help-seeking behavior. Additionally, some members of the deaf community visit their doctors and mental health professionals less often, in part, due to limited access to direct communication. Although the Americans with Disabilities Act mandates provision of effective health communication, many health care settings do not provide certified and qualified medical and mental health interpreters. Finally, deaf ASL users often embody a unique culture that is unfamiliar to most medical and mental health care providers. This lack of cultural- and linguistic-competency on the part of the professional often results in higher rates of inaccurate evaluations, misdiagnoses and inappropriate treatments.
In attempts to meet the diverse needs of deaf and hard of hearing people, several programs across the nation have been developed to address health knowledge and practices, sexual education and prevention, substance use and violence, as well as the evaluation and treatment of mental health needs. Additionally, there are a handful of medical and mental health programs training their students to work with these populations. It is the continued efforts of these programs and trained professionals that will provide the foundation on which health equity can be achieved for the deaf community.