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111 8 Public Health of Deaf People Johannes Fellinger Defined by the World Health Organization in 1986 as a state of well-being in the physical, mental, and social areas of life,1 health is a gift but also a great responsibility . Individuals must take care of their health. It is society’s responsibility to establish a basis on which to promote health, as documented in the WHO Bangkok Charter for Health Promotion in 2005.2 Public health is the social and political concept of improving physical well-being, prolonging life, and improving the quality of life among whole populations through a variety of forms of health intervention, such as health promotion and disease prevention.3 Health inequities for deaf people have been reflected in editorial comments such as “Deafness might damage your health” and “The health of deaf people: Communication breakdown” in The Lancet (2012),4 which accurately express the problems of public health care for deaf people. In the same volume, the article “Mental health of deaf people” ends with a revision of the slogan “No health without mental health” and emphasizes that deaf people cannot get help for their mental health problems when barriers restrict access to general health care.5 Health inequities for deaf people are of increased interest in the field of public health research.6, 7, 8 Deaf patients report fear, mistrust, and frustration in health-care settings .9 A global survey carried out in 2011 by the World Federation of the Deaf Health Resources Initiative shows that 80% of Deaf leaders worldwide report significant problems in accessing health care.10 Although public awareness of these inequities for Deaf people is increasing, the problem itself is not new. Influenced by my father’s deafness and negative experiences in the health-care system (e.g., hearing comments like “The patient is deaf and dumb . . . impossible to take his/her history”), in 1991 I established a small psychiatric outpatient clinic at the hospital of St. John of God in Linz. When it became apparent that physical problems and social issues needed to be tackled as well, the clinic expanded in 1993 to offer multidisciplinary services for Deaf people according to the WHO’s holistic approach to health. ara86542_08_ch08.indd 111 ara86542_08_ch08.indd 111 12/10/15 6:56 PM 12/10/15 6:56 PM Johannes Fellinger 112 Other health centers for deaf persons (HCD) were founded in Vienna and Salzburg in 1999 and in Graz (Styria) in 2008; the HCD in Vienna and Graz are integrated into hospital run by the order of St. John of God, while the one in Salzburg is part of a state hospital). DATA FROM PATIENTS AT THE LINZ HEALTH CENTER FOR DEAF PEOPLE Upper Austria has approximately 1.4 million inhabitants. According to prevalence rates of 0.07 to 0.1 %11,12 approximately 988 citizens are prelingually deaf. In 2011 nearly three-quarters (724 persons) of these individuals were treated at the HCD (see Table 1) in Linz (the capital city of Upper Austria). In 2011, out of the 724 patients who visited the HCD in Linz, 252 used both medical and social services, 342 had appointments only with a general practitioner , and 130 had appointments only with social workers or psychologists. PATIENT CHARACTERISTICS From 1991 to 2011 the Linz HCD had nearly 1,900 Deaf patients, 85% of whom were prelingually deaf. These patients and clients were evenly distributed among all age groups. In 1993–1994 352 Deaf patients were interviewed. Approximately 60% of the Deaf patients were married or in a steady relationship. About 10% of the patients’ children had a hearing impairment. Approximately 67% of the patients reported having only friends with a hearing impairment, while 67% reported being active members of a Deaf club. Seventy percent reported being content with their job and having no problems with their hearing coworkers; however, 25% would rather TABLE 1. Demographics and HCD Users Linz (since 1991) Vienna (since 1999) Graz (since 2008) federal, state, and total population Upper Austria 1,411,041 capital city 1,692,067 Styria 1,207,588 estimated number of deaf inhabitants per federal state 988 1,184 845 number of HCD patients since inception of HCD 1,900 1,229 429 ara86542_08_ch08.indd 112 ara86542_08_ch08.indd 112 12/10/15 6:56 PM 12/10/15 6:56 PM 113 Public Health of Deaf People find different employment. The Deaf patients earned approximately 23.5% less than the general working population.13...


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