La dignidad como bien fundamental en la teoría de la justicia de John Rawls

Voice problems are important not only for individual teachers who experience the effects directly but they may also affect school communities and wider society both academically and economically.

3.4.1 Effects on pupil learning

Research has shown that children perform less well during tests when instructed by a dysphonic, rather than a healthy voice, such as may happen when a teacher continues to teach with voice problems [67]. If a teacher is absent due to ill health this may also adversely affect the continuity of pupil learning. If voice problems and related absences are widespread among teachers, this has the potential to impact on the educational progress of many children.

3.4.2 Economic and societal costs

The reasons for teacher absences are not fully recorded as part of publicly available data, however based on the questionnaire surveys detailed in Chapter 14 voice problems appear to be a significant reason for absence. The most recent figures showed 2.21 million teaching days lost annually to sickness in England [68].

If voice problems are responsible, or contribute, to a proportion of teacher absences then this must be considered as an economic cost in terms of the need to employ substitute teachers. In the United States the cost of treatment and substitute teachers as a result of voice problems has been estimated at $2.5 billion annually [56]. For the UK the estimated annual figure is £15 million [68]. If teachers leave the profession or retire early due to voice problems, this has a substantial cost to society in terms of lost talent and the wasted costs of training teachers.

3.4.3 Personal costs

On a psychological level our voices are intrinsically linked to our sense of identity, with each voice being unique to the individual. Changes to voice quality can influence how individuals see themselves and influence the perceptions of others. When voice problems severely reduce the ability to speak there may be a sense of enforced isolation due to an inability to convey emotions or communicate effectively.

With the sea change in post-industrial economies away from mass manual employment, a greater proportion of the population now depend on their voice as an

essential part of their occupation compared with past generations. The result is that voice problems now may be considered analogous to physical impairments in the industrial age in terms of the impact on an individual’s livelihood.

As well as the general shift towards the importance of voice use in the workplace, there are specific professions for which voice quality is vital and where the demands on the voice are high such as for teachers, barristers, actors, singers and similar.

In these professions the impact of voice problems can be significant when substantial loads are placed on the voice as part of the occupation, and where speaking for long periods and/or with heavy loading cannot readily be avoided. The nature of teaching is such that during term times the voice cannot easily be rested nor the load on the voice readily reduced as a precautionary or reactionary measure without significant interventions such as with the use of voice amplification systems.

Voice quality itself is also important for teaching compared with other occupations where the need is only for effective communication but where voice quality is not a substantive requirement.

For sufferers of occupational voice problems the psychological impacts can be significant, with a study showing that nearly 76% felt that voice problems would negatively affect their future work [56]. This would be expected to cause or increase stress which as noted in section 3.5.7 is a risk factor in its own right.

There have been examples of teachers leaving the profession as a result of voice problems which indicate that the concerns of sufferers of occupational voice problems are justified. One case in 2010 [69] highlighted the apparent risks of working in classrooms with high external noise levels and the low levels of awareness of voice problems among those responsible for the occupational health and safety of teachers.

The teacher in question accepted an out-of-court settlement from her employer due to claimed chronic occupational voice problems which resulted in her no longer being able to teach. This settlement was for £145,000 and at the time of the settlement the individual had at least 15 years remaining in her career. This indicates that those who leave teaching through ill health may not be compensated fully for future lost earnings and may show why many continue teaching with voice problems.

The impact of voice problems on individuals can be assessed according to the World Health Organisation International Classification of Functioning, Disability and Health framework [70] with an example shown in Table 3.2 [71].

Table 3.2: Impact of voice disorders [71]

ICF Dimension Impact

Impairment

Phonation difficulties Vocal fatigue Altered voice quality Altered pitch Altered resonance

Altered breath control for sustaining voice and volume Hyper and hypotension in musculature

Vocal cord changes, e.g. oedema, inflammation, nodules Impact on speech & language development

Pain/discomfort when vocalising

Activity

Diminution of a speaker's ability to communicate effectively Reduction in speaking time from discomfort in speaking Inability to communicate by phone

Dependence on synthetic voice

Reduction in communicative interactions

Avoidance of difficult communicative environments Reliance on communicative partners

Need for assistive/augmentative communication (e.g. amplification, writing)

Participation

Effect on ability to participate fully in educational curriculum Disruption of career in professional voice users,

Adverse effects on job performance, attendance, and future career choices Social isolation

Limited participation Loss of autonomy Avoidance of situations Well-being

Frustration, anxiety, mood, self-esteem, depression, repression of emotions, stress Impact on peer/adult perception

Reduced self-image

Table 3.2 illustrates the wide range of impacts that voice problems can have on the sufferer and highlights how these can influence many areas of life.