Dr. Susan Emmett: Hearing Loss Hits Underserved Hardest

Dr. Susan Emmett: Hearing Loss Hits Underserved Hardest
Dr. Susan Emmett (Steve Lewis)

Otolaryngologist Dr. Susan Emmett has led the new Center for Hearing Health Equity at the University of Arkansas for Medical Sciences since May. She is a professor, consults for the World Health Organization, serves as co-chair of innovations in service delivery for the Lancet Commission on Hearing Loss, and is the founder and director of the Global Hearing Loss Evaluation, Advocacy & Research (HEAR) and HEAR-USA Collaboratives. Previously, Emmett was an associate professor of surgery and global health at Duke University. She was named a TED fellow in 2017.

Emmett earned her bachelor’s degree from Princeton University, her doctorate from Duke and a Master of Public Health from Johns Hopkins, where she completed her residency. She completed her postdoctoral research fellowship in public health at Duke.

The center is the first of its kind in the world.

What is the goal of the Center for Hearing Health Equity?

There are an estimated 1.6 billion people living with hearing loss worldwide, and this number is only increasing. Today, 1 in 5 people globally is living with hearing loss, and, by 2050, the World Health Organization projects that 1 in 4 will have hearing loss. A major challenge with a problem of this scale is that the burden is unequally distributed, with 80% of affected individuals living in underserved communities. This includes low- and middle-income countries and underserved communities in high-income countries, including rural U.S. states such as Arkansas. The result is that the populations most likely to be affected by hearing loss are also the least likely to have easy access to hearing care. Through the UAMS Center for Hearing Health Equity, our goal is to change this narrative. We are working on innovative solutions to address disparities in hearing loss, both locally and globally. We lead cutting-edge science with large collaborative teams to develop new approaches that can be directly translated to policy change. 

What does Arkansas look like when it comes to hearing loss and treatment disparities? How are we positioned among other states or even other parts of the world?

Hearing loss is more common in Arkansas than in many other parts of the country. A national survey conducted by the Centers for Disease Control & Prevention in 2019 indicated that adult hearing loss is more than twice as common in Arkansas as in states in the northeastern U.S. or California. This survey ranks Arkansas as the fourth-highest state for hearing loss in adults. There is still a lot we need to learn about hearing loss and treatment disparities in Arkansas, particularly in children. The bottom line though is that similar to other rural states and underserved communities globally, there is an urgent need to address this public health challenge and reduce barriers to hearing care in our state.  

Is there any way to measure loss of productivity from hearing loss?

We know that hearing loss has significant economic consequences. I led a study in 2014 with a nationally representative sample of over 3,000 U.S. adults that showed that individuals with hearing loss are less likely to complete high school and more likely to be low income, unemployed or underemployed. The relationship between hearing loss and socioeconomic hardship — both low income and unemployment/underemployment — remained after controlling for education and other demographic factors. There are also studies showing that individuals with hearing loss in the workforce are more likely to retire earlier. WHO estimates that nearly a trillion U.S. dollars are lost globally every year due to unaddressed hearing loss. This estimate includes a loss of over $180 billion annually due to unemployment and early retirement. Importantly, all levels of hearing loss, including even mild hearing loss, have a significant economic impact.

How does it feel to be leading this one-of-a-kind center?

It is incredibly exciting to lead such a critically important initiative. Children in particular experience lifelong effects from hearing loss that include speech and language delays, poor academic performance and even limited job opportunities as they transition into adulthood. WHO estimates that 60% of all childhood hearing loss is preventable, and this estimate rises to 75% in underserved communities where hearing loss is most commonly caused by ear infections. What drives me is the potential to create lasting change that helps every child to reach their full potential, here in Arkansas, across rural America and worldwide.

What does your day-to-day work life look like as you lead the center? What things are you in charge of?

My day-to-day life reflects the multidisciplinary, collaborative approach that the center takes to address disparities in hearing loss. We work not only with other researchers and health care providers, but also policymakers, educators, parents, community members and individuals living with hearing loss themselves.

In a single morning, I may jump from speaking at a WHO event to meeting the scientific team for one of our projects in Appalachia or rural Alaska and then discussing device development with biomedical engineering collaborators and a startup company we are partnering with in South Africa. A typical afternoon includes meeting with state leadership in Kentucky about new ways to forge relationships between the health and education sectors to benefit rural children, meeting with parents and educators on our Community Advisory Board to gain their perspectives and insight, and holding mentor meetings with students and residents participating in our projects.

I also spend time writing grants and discussing our work with interested philanthropists to maximize the center’s impact for change. In addition to my role as director, I am also a practicing surgeon, so on some days I see patients with hearing loss in the clinic or perform cochlear implant microsurgery in the operating room to restore a patient’s hearing.

What are the challenges in setting up a center like this, which is the first of its kind in the world?

I would say that the main challenge is bandwidth, both with personnel and funding. We are a small team tackling one of the globe’s major health challenges, and there is so much to be done. The Global HEAR Collaborative (Hearing Loss Evaluation, Advocacy & Research) and HEAR-USA are international and national research networks I founded and direct that are both based at the center. Through these networks, we have collaborators in 28 countries and multiple U.S. sites who are all committed to addressing disparities in hearing loss. Our partnerships with collaborators facilitate large-scale projects that would not be feasible with center staff alone. For example, two HEAR-USA initiatives funded by the National Institutes of Health involve approximately 20,000 children in nearly 100 rural schools in rural Alaska and Appalachia. Another NIH-funded study through the Global HEAR Collaborative involves industry, academic and community partners in South Africa that include a startup company and local preschools. The projects we are doing now are just the tip of the iceberg. It’s exciting to think about the potential for transformative work that leverages even more of these partnerships to change outcomes for children across the U.S. and the world. We are fortunate to have $12 million in NIH funding and excellent support from UAMS. Continuing to expand our staff and funding base will facilitate accelerated growth with lasting impact. 

Why Arkansas? Does the state have a particular need for this kind of research?

Arkansas is the ideal home for the new center. Underserved rural communities, both in the U.S. and worldwide, bear most of the global burden of hearing loss. As a rural state, Arkansas faces significant challenges with access to care, and many rural children and adults do not have easy access to the hearing care they need. A strategic priority for UAMS is improving rural access to health care, and the infrastructure the university has built to expand access across the state has made placing the center in Arkansas a natural fit. The work that we are doing in other sites in the U.S. and abroad can help inform innovative programs for Arkansas, which can then be scaled up across the Southeast and across rural America. Through the Center for Hearing Health Equity, Arkansas will be a global leader in addressing hearing inequities.