Evaluating Strategies to Reduce the Global Burden of Hearing Loss (2021-2022)


In 2015, hearing loss was the fourth leading cause of years lived with disability worldwide, and half a billion people had a disabling hearing loss. Reaching far beyond sensory impairment, hearing loss is damaging to childhood development and is strongly associated with dementia and other health conditions among older people. Prevention and treatment of hearing loss are particularly important at the two ends of the age spectrum. 

In 2019, the Lancet announced a commission to identify ways to reduce the global burden of hearing loss. The work of the Lancet Commission is being done alongside efforts by the World Health Organization and other organizations and will complement and extend those efforts. 

Project Description 

Building on the work of the 2020-2021 team, this project will synthesize available evidence to inform cost-effectiveness modeling to evaluate strategies to reduce hearing loss. The overall goal is to envision a world where the evidence on the economics of global (and country-specific) hearing healthcare policy is available to and understood by all stakeholders, and where evidence-based economic analyses are incorporated into strategies for reducing the burden of unaddressed hearing loss.

The team will pursue three specific aims: 

  • Develop and validate a robust quantitative model to understand the dynamics of hearing loss, use of hearing healthcare and hearing healthcare policy
  • Synthesize available evidence of the barriers to scale-up
  • Develop an investment case for the global scale-up of novel and existing evidence-based hearing healthcare interventions.

Team members will work with the Lancet Commission to identify existing systematic reviews of the empirical literature and perform novel evidence synthesis. They will also identify needed primary data collection to inform a modeling framework evaluating the costs and benefits of potential strategies to reduce hearing loss. The modeling framework will represent the populations of interest (varying by both individual demographics and geographic location), the interventions and comparators under consideration, the outcomes of interest and varying settings for implementation. 

The team will write reports to inform the work of the Lancet Commission, develop decision models to evaluate the cost effectiveness of the available strategies, perform analysis of the models for diverse geographical locations and interpret the findings to inform decision-making.

Learn more about this project team by viewing the team's video.

Anticipated Outputs

Contributions to Lancet Commission main report; reports summarizing evidence and cost effectiveness; peer-reviewed publications; presentations

Student Opportunities

Ideally, this project team will be comprised of 3 graduate students and 10 undergraduate students. Students from all majors/disciplines are encouraged to apply. Given the topic area, students from the social sciences, natural sciences, medicine, global health and public policy may be the most interested. Composition of the team will reflect the multidisciplinary ethos of Bass Connections and real-world approaches to complex healthcare and policy issues, which demands involvement and consideration of different disciplines, perspectives and experiences.

Students can expect to develop qualitative and policy analysis research, oral and written communication, self- and group-management skills; gain exposure to a wide variety of healthcare stakeholders and increased understanding of diverse perspectives; contribute to every stage of a research project, from its design to drafting publications to delivering findings in both academic and applied settings; and cultivate new collegial relationships with peers, faculty and external contributors. Master’s students may have the opportunity to leverage the project to form the basis of a thesis or project and gain experience translating research to inform and impact complex health policy and educational issues.

Students will work as a group to perform the literature and systematic review, develop the decision-modeling framework, synthesize available data and findings, perform model analysis, draft papers and policy briefs, and participate in stakeholder meetings and presentations. The team will meet weekly to discuss key concepts, project tasks and progress, and troubleshoot and project concerns or issues.

During Spring 2022, the Lancet Commission plans to have a final release of the report in Geneva. If travel is permitted, a few students would be selected to travel to Geneva to participate in delivering findings from the team’s work and also to interact with the full Commission.

Students would have the opportunity to work on the project during either Summer 2021 or 2022. The Lancet Commission work is ongoing and will be released May 2022, although there will be follow-up dissemination projects and also development of downstream research projects based on identified gaps that will span Summer 2022. The summer component is optional. Students would work for 10 weeks (40 hours per week) during the
summer and participate in the established Duke-Margolis summer internship.

Ethan Borre will serve as project manager.


Summer 2021 – Summer 2022

  • Summer 2021 (optional): Finalize evidence reviews; populate modeling framework
  • Fall 2021: Perform analysis of cost effectiveness; tailor analyses to target populations
  • Spring 2022: Draft findings from analysis; present findings to Lancet Commission and pursue other dissemination opportunities
  • Summer 2022 (optional): Work with Lancet Commission and stakeholders to develop policy proposals


Academic credit available for fall and spring semesters; summer funding available

See earlier related team, Evaluating Strategies to Reduce the Global Burden of Hearing Loss (2020-2021).


Image: Assistive Listening at Pharmacy, by Melinda Young Stuart, licensed under CC BY-NC-ND 2.0

Assistive Listening.

Team Leaders

  • Ethan Borre, Medicine–Population Health Sciences–Ph.D. Student
  • Osondu Ogbuoji, Duke Global Health Institute
  • Gillian Sanders Schmidler, School of Medicine-Population Health Sciences|Margolis Center for Health Policy

/graduate Team Members

  • Austin Ayer, Medicine MD Second Year
  • Ethan Borre, Clinical Research - Non-Degree, Population Health Sciences-PhD
  • Gloria Zhang, Medicine MD Second Year

/undergraduate Team Members

  • Isabella Caracta, Psychology (AB), Global Health (AB2)
  • Haley Cionfolo, Biology (BS), Global Health (AB2)
  • Mohini Johri, Economics (BS), Global Health (AB2)
  • Elizabeth Kayzman, Neuroscience (BS), Global Health (AB2)
  • Megan Knauer, Program II (BS)
  • Brenna Morley
  • Juliana Shank
  • Yajur Sriraman, Biology (BS), Global Health (AB2)
  • Jacqueline Vicksman, Public Policy Studies (AB)
  • Emily Xu, Economics (BS)
  • Danah Younis, Public Policy Studies (AB)
  • Anna Zolotor, Statistical Science (BS)

/yfaculty/staff Team Members

  • Janet Prvu Bettger, School of Medicine-Orthopaedic Surgery
  • Mohamed Mustafa Diab, Duke Global Health Institute-Center for Health Policy
  • Susan Emmett, School of Medicine-Head and Neck Surgery and Communication Sciences
  • Howard Francis, School of Medicine-Head and Neck Surgery and Communication Sciences
  • Debara Tucci, School of Medicine-Head and Neck Surgery and Communication Sciences
  • Blake Wilson, School of Medicine-Head and Neck Surgery and Communication Sciences

/zcommunity Team Members

  • Lancet Commission on Hearing Loss