An Environmental Scan: Challenges and Gaps in Canada's Healthcare System Regarding Vision and Hearing Rehabilitation Care

Research Objectives: To identify challenges and gaps in Canada's healthcare system regarding vision and hearing rehabilitation care for individuals with combined hearing and vision loss. Globally, over 1.5 billion people have hearing impairment, and about 2.2 billion have vision impairment. Projections indicate these numbers will reach over 5 billion by 2050. Roughly 2% of the global population experience combined hearing and vision loss (or dual sensory loss/DSL) in the same individual. In Canada, an estimated 1.1 million people have DSL. Evidence from the 2023 Global Report on DSL points out the lack of comprehensive identification, assessment, and referral systems for individuals within various countries, including Canada, across different age groups and regions.

Design: An extensive review of Canada's healthcare system and current public health policies was conducted regarding vision and hearing care, aiming to address two key research questions: 1) What is the current provision of hearing and vision care across federal, provincial, and territorial levels under the universal healthcare system? and 2) What challenges and gaps exist for Canadians in meeting WHO recommendations on vision and hearing health? The review utilized published literature from five scientific databases (Embase, Medline, PsycINFO, PubMed, and CINAHL) and grey literature from federal, provincial, and territorial government and non-profit organization websites. Data were analyzed thematically to identify service delivery challenges and gaps in Canada.

Setting: Canadian scientific and grey literature.

Participants: Individuals with hearing and vision loss

Interventions: Not applicable

Main Outcome Measures: Vision and hearing rehabilitation care for individuals with hearing and vision loss.

Results: 82 studies out of 1257 articles screened met the inclusion/exclusion criteria, with an additional 13 reports included from the grey literature search. Thematic analysis revealed ongoing stigma and discrimination against individuals with disabilities and marginalized groups, particularly those with hearing, vision, or dual sensory loss. Barriers to accessing vision and hearing healthcare include insufficient policies, inadequate investment in services, the detrimental impact of undiagnosed or untreated conditions, limited collaboration and coordination among services, disparities in insurance coverage, lack of support within the healthcare system, and the presence of multiple co-existing conditions and disabilities.

Conclusions: Our findings suggest that there are systemic and structural barriers in integrating hearing and vision rehabilitation care in Canada. It stresses the importance of future efforts to address identified gaps and to develop and assess public education initiatives and integrated sensory healthcare programs, aligning with recommendations outlined in the WHO Report on Hearing and Vision.

Author(s) Disclosures: No conflicts to declare