Author(s): Clarisse Huang, Andrew Huang and Eric Huang
Paper Details: Volume 3, Issue 5
Citation: IJLSSS 3(5) 68
Page No: 773 – 777
ABSTRACT
Adolescent hearing loss caused by unsafe listening and excessive noise exposure has emerged as a global health and legal-policy concern. While newborn hearing screening is mandatory in many nations, systematic programs for school-aged youth remain inconsistent. This paper evaluates the economic and legal feasibility of introducing a nationwide, school-based hearing-screening mandate in Taiwan. Drawing on comparative analysis of U.S. state legislation, cost-benefit modeling, and Taiwan’s legal framework, it argues that tri-annual screening yields the highest cost-efficiency (benefit-cost ratio 2.4:1) and is compatible with constitutional and administrative law principles. The study situates hearing protection within broader debates on social equity, state responsibility, and health rights. It concludes with policy recommendations for regulatory reform, inter-agency coordination, and civic participation in adolescent health advocacy.
Keywords: adolescent hearing, education law, cost-benefit, public policy, Taiwan, social justice
1. INTRODUCTION
Noise-induced hearing loss (NIHL) increasingly affects adolescents, not only industrial workers. The World Health Organization estimates that over one billion young people are at risk from unsafe listening practices. ¹ In the U.S., 15.2% of adolescents aged 12–19 present measurable hearing loss. ² In Taiwan, newborn screening is mandated but no structured follow-up exists for school-aged children. This legal and institutional gap undermines the right to education and health.
This study investigates whether Taiwan can legally and economically institutionalize a tri-annual school hearing-screening program. It asks: (1) what lessons can be drawn from U.S. state policies; (2) is such a program cost-effective; and (3) can it be reconciled with Taiwanese legal norms of proportionality, necessity, and privacy protection.
2. METHODOLOGY
2.1 COMPARATIVE POLICY ANALYSIS
Ten U.S. states were analyzed using the ASHA database (2024). Each was scored on a Mandate Strength Index (MSI) from 0 (voluntary) to 5 (statutory requirement with funding). ³ Policy effectiveness was assessed by coverage rate and referral completion.
2.2 ECONOMIC SIMULATION
Cost-benefit modeling was based on Taiwan’s Ministry of Education (2023) and NHI data. Scenarios simulated various screening frequencies:
| Scenario | Frequency | Coverage (%) | Cost per Student (NTD) | Benefit–Cost Ratio |
| A | Annual | 95 | 320 | 1.8 |
| B | Every 3 years | 90 | 200 | 2.4 |
| C | High-risk only | 70 | 150 | 1.2 |
2.3 LEGAL ANALYSIS
Taiwan’s Education Act, School Health Act, and Personal Data Protection Act (PDPA) were examined. Comparative frameworks include the U.S. Individuals with Disabilities Education Act (IDEA) and Section 504 of the Rehabilitation Act.
2.4 Expert Consultation
Twelve semi-structured interviews (education officials, audiologists, nurses, and legal experts) informed qualitative insights on feasibility and equity.
3. COMPARATIVE LEGAL AND POLICY FINDINGS
3.1 U.S. STATE-LEVEL LESSONS
| State | Legal Mandate | Screening Frequency | Implementing Body | Coverage Rate |
| Texas | Statutory (Health Code §36.001) | Annual (K–12) | Dept. of State Health Services | 94% |
| Minnesota | Rule 4717.7100 | Entry + Grade 7 | Local Education Agencies | 91% |
| California | Health & Safety Code §124035 | Grades K, 2, 5, 8 | County Health Offices | 87% |
| New York | Public Health Law §2164 | Entry + Every 2 Years | Local School Districts | 83% |
| Washington | WAC 246-760-020 | Entry + Grades 3, 7 | Dept. of Health | 78% |
States with MSI ≥ 4 exhibit higher completion and referral rates (r = 0.72).⁴ Legal mandates supported by clear funding mechanisms—such as Texas—achieve durable outcomes. The findings demonstrate that “soft law” or voluntary schemes seldom sustain compliance.
4. LEGAL FEASIBILITY IN TAIWAN
4.1 CONSTITUTIONAL COMPATIBILITY
The School Health Act may be expanded by ministerial regulation to include hearing tests, consistent with Article 22 of the Constitution (health rights). The PDPA allows data processing for “public-interest necessity” if parental notice and opt-out are ensured. ⁵
4.2 Administrative Pathways
Two legal routes are viable: (a) a ministerial ordinance under existing education-health statutes, or (b) legislative amendment establishing a Youth Hearing Protection Act. The first ensures rapid implementation; the second embeds long-term accountability.
4.3 Equity and Non-Discrimination
Failure to provide preventive screening risks violating the Special Education Act’s equal-opportunity clause. Early detection aligns with the Convention on the Rights of the Child (CRC), reinforcing state duties to prevent disability discrimination.
5. DISCUSSION
5.1 GOVERNANCE AND MULTI-LEVEL REGULATION
Adolescent hearing protection implicates multi-level governance. Central ministries must set technical standards, while municipalities manage logistics. This dual structure mirrors U.S. practice and enhances policy diffusion across jurisdictions. ⁶
5.2 ECONOMIC JUSTICE AND SOCIAL EQUITY
Access disparities remain a legal concern. Without state funding, rural schools cannot sustain screening. A dedicated health equalization grant—modeled after Japan’s community health fund—could mitigate inequality.
5.3 CIVIL SOCIETY AND YOUTH ADVOCACY
HAT Action exemplifies civic participation in public policy formation. ⁷ Youth-led advocacy fulfills the participatory governance envisioned by the Fundamental Law of Education and international human rights norms.
5.4 COMPARATIVE AND THEORETICAL CONTRIBUTION
The paper engages with policy diffusion theory and the advocacy coalition framework (ACF) to explain how social movements influence legislative agendas. This theoretical grounding elevates the study beyond applied policy analysis, situating it within legal sociology.
6. CONCLUSION AND POLICY RECOMMENDATIONS
- Tri-annual Screening Mandate: Legally feasible, economically efficient, ethically justified.
- Regulatory Integration: Amend School Health Act; issue joint directive by MOE and MOHW.
- Data Protection: Apply opt-out consent; anonymize records per PDPA.
- Equity Funding: Establish rural subsidy mechanism to ensure nationwide coverage.
- Public Awareness: Embed safe-listening education within school curricula.
Taiwan stands poised to lead East Asia in adolescent hearing protection through evidence-based legislation integrating economics, law, and social equity.
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