Healthy voice use is essential in society because of impacts of voice disorders on work, quality of life (QOL) and health costs, and because of the value of singing to public health.
Professional voice users – teachers, singers, actors, actresses, broadcasters, clergy, salespeople, courtroom attorneys, telemarketers, and health care specialists – constitute about 30% of the working population (Titze et al., 1997). These professionals require a functional voice; however, their intensive voice use exposes them to vocal trauma (Williams, 2003). Many and rapid collisions of the vocal folds constitute an occupational risk (Fritzell, 1996) comparable to the exposure to dangerous chemicals or to sun (Titze, Švec & Popolo, 1996). Occupational safety and health (OS&H) are still lacking in supporting for vocal problems (Vilkman, 2001). Prevalence of voice disorders has continued to increase, augmenting healthcare costs (Benninger, Bryson & Milstein, 2017) with up to 35% of work absence (teachers) (Ahlander, Rydell & Löqvist, 2011).
There are different groups of professional voice users, according to amount of voice use and vocal demand (Koufman & Isaacson, 1991). These groups can be organized in a, at the top having those who are elite performers, such as singers and actors, and at the bottom professional whose work is not compromised even when sever vocal difficulties exist (see Figure 1).
Voice problems are perceived as negative not only to work ability of professional voice users, but also to QOL (Behlau, Hogikyan & Gasparini, 2007; Cohen, Dupont & Courey, 2006Verdolini & Ramig, 2001), especially to women (Hunter, Tanner & Smith, 2011). Females have higher prevalence of chronic voice disorders compared to males (Roy et al., 2004). Both gender-related differences in voice (Klatt & Klatt, 1990; Roers, Mürbe & Sundberg, 2009) and endocrine system affect more recurrently the female voice (Lã & Davidson, 2005; Lã et al., 2007; Lã et al., 2009; Lã & Sundberg, 2012). Voice-related quality of life (V-RQOL) is also more affected in females (Behlau, Hogikyan & Gasparini, 2007. If voice conditions are a problem, what can we do?
To raise awareness of healthy voice use is essential, not only because of the impacts of voice disorders; singing has benefits at both individual and social levels (Kreutz et al., 2004). Group singing can be therapeutic (Clift, 2012), and a public health resource (Stacy, Brittain, & Kerr, 2002). Singing is a common and appreciated creative activity in the support of health care and wellbeing in communities (Bungay, Clift, & Skingley, 2010). Singing promotes: social inclusion and cohesion (Greaves & Farbus, 2006); mental and physical health (Glick, 2011); psychological wellbeing (Clift et al., 2010); cognitive development, (Bilhartz, 1999). No wonder the growing interest in socio-cultural dimensions of singing, and the provision of quality education for healthy and effective voice use.
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