Redefining the survival of the fittest: Communication disorders in the 21st century

Objectives: To determine the economic effect on the US economy of the cost of caring for people with communication disorders as well as the cost of lo st or degraded employment opportunities for people with such disorders, inc luding disorders of hearing, voice, speech, and language. Study! Design: Survey of available historical and contemporary governmental and scholarly data concerning work force distribution and the epidemiology of disorders of hearing, voice, speech, and language. Method: Analysis of epidemiological and economic data for industrialized co untries, North America, and the United States. Results: Communication disorders are estimated to have a prevalence of 5% t o 10%. People with communication disorders may be more economically disadva ntaged than those with less severe disabilities. The data suggest that peop le with severe speech disabilities are more often found to be unemployed or in a lower economic class than people with hearing loss or other disabilit ies. Communication disorders may cost the United States from $154 billion t o $186 billion per year, which is equal to 2.5% to 3% of the Gross National Product. Conclusions: Communication disorders reduce the economic output of the Unit ed States, whose economy has become dependent on communication-based employ ment. This trend will increase during the next century. The economic cost a nd the prevalence rates of communication disorders in the United States ind icate that they will be a major public health challenge for the 21st centur y.