Access to hearing care

Sonova and the United Nations Sustainable Development Goals (SDGs)
Through this CR focus area, Sonova contributes to SDGs 3 and 4. More information is provided in the corresponding section of this CR Report: Sustainable Development Goals.

Hearing – an underestimated topic

Global prevalence of hearing loss and consequences

The importance of good hearing and the consequences of hearing loss continue to be underestimated, even though the World Health Organization (WHO) estimates that about 15% of the world’s population is affected by hearing loss¹. Over 5% – or 466 million people – has a disabling hearing loss² (432 million adults and 34 million children). The number of people with hearing loss continues to rise, due both to the aging of populations in high income countries and to growing noise pollution in our environment. The WHO estimates that by 2050 over 900 million people will have disabling hearing loss³.

People with untreated hearing loss are often faced with serious consequences. These range from disadvantages at work to relationship problems and social isolation, which may even lead to depression. Especially severe are the consequences for children with untreated hearing loss, as the development of speech and language is fundamentally dependent on the sense of hearing. Untreated hearing loss also is often associated with academic underachievement, which can lead to lower job performance and fewer employment opportunities later in life.

In addition to the impact of hearing loss at an individual level, untreated hearing loss puts a heavy cost burden on society. Unaddressed hearing loss costs countries an estimated USD 750 billion annually in direct health costs and loss of productivity³. Today’s hearing solutions offer the opportunity to reduce this significantly.

Need for hearing solutions

The fundamental growth drivers of the hearing care market remain intact, driven by long-term socioeconomic forces. The number of people on our planet will continue to increase. Although populations in low- and middle-income countries are expected to grow the most, even high-income countries with stable populations will face a growing proportion of elderly citizens, who are likely to experience hearing loss. These trends create an increase in demand for hearing care: a large unmet need remains.

People in low- and middle-income countries often have little or no access to audiological services; the hearing care market remains relatively underserved. Nearly 90% of people with disabling hearing loss live in low- and middle-income countries, according to WHO statistics¹. The most affected areas are the South Asian, Asia Pacific and Sub-Saharan African regions, with a prevalence rate almost four times that of higher-income regions. WHO estimates that today global hearing aid production meets only around 3% of the need in these countries¹. We expect, however, that the growth of the middle classes in emerging economies will boost consumption significantly. Upward trends in spending power and aspiration will open up substantial opportunities to increase access to hearing care in low- and middle-income countries. Our strategy therefore calls for a strong focus on the potential of high growth markets, serving the demands of newly empowered consumers with suitable product and service formats.

Around 10% of people with disabling hearing loss globally live in high-income countries¹. We estimate the overall rate of penetration for hearing technologies in high-income countries to be in the range of 25–30%, meaning that around one in four people with hearing loss wears a hearing aid. We estimate that the majority of people in these countries who have severe-to-profound hearing loss also have hearing aids, but only few of those with mild-to-moderate hearing loss currently use hearing instruments. Younger and less-affected people, however, are increasing their adoption of hearing aids as technology moves toward ever better sound quality and smaller, more discreet devices. Our growing emphasis on convenience – including rechargeability, connectivity and digital applications – means that we can both broaden and deepen access and engagement with consumers, offering trusted, valuable support at every stage of their journey to better hearing.

Accessibility and affordability

Affordable hearing care is still a challenge for many people in low- and middle-income countries and for underprivileged social groups in high-income regions. Sonova is committed to increase accessibility and affordability of hearing care by expanding its presence in underserved markets: providing a broad product portfolio with a wide range of performance and pricing levels, creating customized solutions, leveraging digital technologies, expanding our global distribution network, enhancing remote access, and investing in partnerships.

Underserved markets

Sonova is striving to expand its presence in high growth emerging markets, such as China. We have set the target of a 50% increase in the number of hearing aids and of cochlear implants sold in low- and middle-income countries by 2022/23. In the 2019/20 financial year, unit sales for hearing aids in low- and middle-income countries increased by 1% and cochlear implants by 2%. One of the main reasons for the low growth rates is the impact of COVID-19 starting in February 2020 in key markets such as China. The global health and economic crisis resulting from the COVID-19 pandemic severely affected the hearing care market and with it our business activities. We expect to see a significant impact on unit sales during the crisis but remain confident that demand will rebound thereafter.

Changes to governmental reimbursement and subsidy regimes affect the amount of funding available to end-users and thus the number of hearing aids sold. This has a significant impact: regions with high reimbursement levels show higher market penetration; the lower end of the market penetration table mostly comprises low- and middle-income countries with no reimbursement regimes.

Broad product portfolio

The hearing care market is highly diverse, requiring a broad range of technologically advanced solutions and versatile customer service channels. Our declared goal is to offer the most innovative hearing solutions and services available to consumers worldwide, continuously improving speech intelligibility, sound resolution and quality, and ease of use. The comprehensive, interdisciplinary knowledge that we acquire in the process is factored into each of our products. It also enables us to offer a broad spectrum of service and pricing levels for individual needs and different markets in countries of all income levels.

Customized solutions

We develop dedicated products and services for underserved markets. For example, around 1.3 billion people around the world speak a Sinitic language such as Mandarin or Cantonese¹. These are tonal languages, where the basic frequencies communicate the information content of words. To better understand the specific needs of Chinese people with hearing loss, we are working with China’s largest hospital, the Tongren Hospital in Beijing. The result is a specific prescription formula for the amplification/frequency curve shapes of tonal languages – or, to put it more simply, hearing aids offering significantly better speech clarity for millions of people in Asia.

Digital solutions

In addition to improving audiological quality and ease of operation, Sonova continuously expands digital solutions that bring together the healthcare provider and the consumer in real time through all stages of the hearing journey. From online-based histories and customer support to remote adjustment and optimization under real-life conditions, digitally networked solutions offer consumers a higher degree of control and autonomy. Wherever users might be, their audiologist can be by their side online, directly capturing data on the specific audiological situation and providing immediate assistance. Continuous data monitoring and statistical analysis of listening situations allow user-specific fine tuning, as well as more targeted advice.

A key example is the myPhonak app, which was updated in 2019 and gives wearers an enhanced and personalized hearing experience, including remote support, fitting and control, a hearing diary, and advanced customization options such as noise reduction and speech focus. The consumer response has been overwhelmingly positive with over half a million downloads since the launch of the Marvel platform.

To complement our strong R&D hubs in Stäfa and around the world, we announced in November 2019 the opening of the Sonova Innovation Lab in Waterloo, Ontario, Canada, where we will explore new digital capabilities in one of the leading consumer app development centers in North America, bringing together experts from our various specialties with people from the mobile industry to accelerate our app development.

Distribution network

Innovation is not limited to products – it also drives the way we approach the market, both through our wholesale companies and our audiological care network. Operating through many channels multiplies the potential paths to hearing in all markets, even in parts of the world where hearing care has been in short supply. Our Audiological Care business represents the second-largest store network in the industry, with a clear path to further growth. We operate a global network of about 3,500 stores and clinics with more than 7,000 employees in 19 countries.

Access in remote areas

Sonova’s efforts to increase access to hearing care for people living in rural areas led to the TeleAudiology model, pioneered by Triton Hearing, a Sonova Group company in New Zealand. Despite Triton’s nationwide network of 70 clinics across the country, many New Zealanders still find seeing an audiologist difficult, especially in communities of indigenous people living in remote areas. In 2017 and 2018, Triton fitted out two buses with state-of-the-art diagnostic hearing equipment and turned them into mobile, full-service hearing clinics. A hearing care professional provides the in-room support, including performing video otoscopy, positioning transducers, and handling hearing aids. Through TeleAudiology, clients are connected with audiologists over a high-definition teleconferencing system. It is possible to provide a full diagnostic assessment, hearing and communication needs assessment, impression taking, hearing aid fitting and verification, purchase, and follow-up services through a synchronous, live connection. In 2019/20, the two mobile hearing clinic buses traveled more than 7,000 kilometers across New Zealand, visiting 50 locations and reaching almost 4,000 new consumers.

Partnerships and collaborations

At Sonova, we consider interdisciplinary collaboration as the guarantor of progress – and essential for such a complex subject as hearing. A key area of our innovation strategy is therefore establishing and promoting international networks, which pool the expert knowledge of leading research bodies, hospitals, companies, and institutions and bring it to fruition in new hearing solutions.

Long-term partnership and open exchange are the hallmarks of our collaboration with over fifty top-class universities and centers of excellence and technology. The focus of this interdisciplinary work is to leverage all potential for innovation: Together, we are broadening our understanding of auditory perception and its cognitive processing, driving forward digital signal processing and the miniaturization of electronics, improving material and implantation technologies, and researching the possibilities of bionics. We work especially closely with the international groups of experts from the Pediatric Advisory Board to develop hearing solutions that counteract hearing loss in early childhood and at the same time include and support the entire family.

One example of a research project is our collaboration with the VU University Medical Center in Amsterdam (Netherlands) examining the correlation of hearing loss with other health considerations in elderly people. In this research theme we have been studying various comorbidities between hearing loss and health issues such as psychosocial health, depression, arthritis, cognitive decline, risk of falls, and diabetes. This research will provide us with a new, more holistic perspective of hearing care in the broader context of healthy aging.

COVID-19
The strong restrictions in many major markets, aimed at slowing down the spread of the virus, are impacting the entire hearing care industry, including Sonova as a market leader. Audiology stores – the primary distribution channel for hearing care products and services to consumers – had reduced operating hours or were temporarily closed. Senior citizens, who account for a large proportion of hearing care consumers, are part of the high-risk group for COVID-19 and had been asked to stay at home to protect their health. Elective surgeries, including cochlear implants, had been deferred in many countries.

Our utmost priority is to protect our employees, their families, our customers, consumers, and partners. At the same time, hearing remains a fundamental human need. Sonova is working hard to ensure continued access to necessary hearing care and solutions in compliance with regulations. We are aware of our responsibilities, especially towards elderly consumers, and have therefore taken strict precautions. Employees supporting people who need hearing care all work compliantly while giving top priority to safety, health, and hygiene.

In countries with high infection rates, we have safety protocols in place to fully serve our consumers; and digital solutions were enhanced. As an example, Phonak has responded to the immediate need for those with hearing loss to receive essential care during the COVID-19 pandemic with technology that allows hearing care professionals to deliver remote audiological care. This new telehealth technology is comprised of a suite of Phonak eSolutions featuring online hearing testing as well as real-time remote hearing aid fitting, programming, and fine-tuning. These tools work together to connect remote providers with consumers in the comfort and safety of their homes, at every stage of the hearing care journey. Phonak is also increasing support for its hearing aid repair home delivery service and making it available in more markets.

Sonova partner Cosinuss supports a research project by the Technical University of Munich (TUM), Germany aiming to find out whether fast detection and treatment in case of declining vital signs can improve the chance of survival in COVID-19 patients.

Training and education

Many countries lack trained health personnel, educational facilities, and necessary data to address the needs of those living with hearing problems. These factors, and the lack of hearing care professionals and infrastructure in certain markets, can impede efforts to raise the penetration rate. Building local capacity worldwide and training hearing care professionals to the highest standards is very important to Sonova.

As an example, China faces the challenge of a rapidly growing number of people with hearing loss, which could potentially exceed the capacity of qualified hearing care professionals to help them. Sonova decided to tackle the significant lack of comprehensive, practical training for hearing care professionals and build a training center – the Global Hearing Institute in Suzhou. The center offers advanced audiology courses and practical training for hearing care professionals from the entire Asia-Pacific region; it features a soundproof room for hearing tests and workstations for fitting ear-molds. The uptake of training courses by hearing care practitioners from across China has been very strong since the center opened in May 2017. After the courses, participants keep in touch with their trainers via chat and can contact them if they need advice on issues back in the workplace. In 2019/20, the Global Hearing Institute provided around 50,000 online training sessions.

Sonova’s commitment to provide high-quality training for hearing care professionals applies to both developing and developed markets. In addition to the Swiss International Hearing Academy (SIHA) in Switzerland operated by Sonova, we opened our first training center in Germany in 2019. Located in Dortmund, the new Sonova Academy offers comprehensive training and development opportunities at the cutting edge of science and technology in ultra-modern training facilities. The program of in-person and eLearning modules complements Germany’s existing training offerings in hearing acoustics: The Sonova Academy cooperates closely with the German Academy for Hearing Acoustics and the German Vocational School for Hearing Acoustics.

Philanthropy

Sonova’s philanthropic engagement at Group level has a strong focus on increasing access to hearing care in low- and middle-income countries, especially for children. We achieve this primarily by supporting the charitable Hear the World Foundation – initiated by Sonova in 2006 – with funding, expertise, and hearing solutions.

The mission of the foundation is to improve the quality of life of people in need with hearing loss worldwide and create equal opportunities by giving them access to hearing healthcare. The foundation makes essential contributions to the UN Sustainable Development Goal (SDG) 3 (good health and wellbeing) and SDG 4 (quality education) by investing in projects benefitting children in need with hearing loss, providing training and building local capacity in countries that lack qualified hearing care professionals, and supporting prevention of hearing loss. In 2019/20, the foundation supported 24 programs globally, in which over 190 professionals were trained and over 35,000 hearing screenings conducted. Sonova employees conducted around 2,200 hours of volunteer work for the foundation.

In the 2019/20 financial year, the total monetary value of Sonovaʼs contribution to corporate citizenship and philanthropic activities amounted to around 4.4 million CHF. Broken down by type of activity (see first table below), the vast majority (92%) of the monetary value of all contributions were community investments: long-term strategic involvement with community partner organizations by the Hear the World Foundation with the aim to improve quality of life and create equal opportunities. A total of 3% of the cost of all activities were charitable donations, and 5% were for commercial initiatives, e.g. our partnership for hearing loss prevention with the concert and event organizer abc Production, research projects, sponsoring of community organizations, and other initiatives related to the topic of hearing. Broken down by type of contribution (see second table below), the total of around 4.4 million CHF comprises 68% in-kind contributions (mostly hearing instruments and cochlear implants), 15% direct cash contributions, 12% management costs (e.g. staff salaries and overheads), and 5% time (e.g. employee volunteering).

Monetary value of philanthropic contributions by type of activities

Monetary value of philanthropic contributions by type of contribution