In Sound Health
ISBN 9789395515801




Part VIII: Challenges and Future Directions

23: Challenges and Future Directions

Sujith John Chandy Sunil Philip Chandy


When talking of sound, it is important to reflect on how we understand sound and how we as humans interact and engage with it. Sound is not merely physics, nor is hearing purely biology. Sound has social, political and religious roles to play in society. Therefore, to talk of challenges and future directions regarding sound and its interaction with health requires a holistic multi-disciplinary engagement. This is a large task not possible within the confines of this concluding piece. What we will explore therefore are some ways in which sound can be understood and present some possibilities of how we could interact with sound in ways that promote healthy living and healing. This will then help us to understand the challenge and future directions for the sound-health inter-phase.

Learning Objectives

Recognising the historical importance of sound

Realising the shift in the place of sound in human experience

Understanding how sound affects us and our environment

Knowing the importance of paying attention to sound

Integrating the association between sound, music and health


We will first clarify the terms we use to contextualise how we speak of sound, music and health.


Health is often narrowly defined from a hospital culture, but the WHO defines it as: ‘Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.’1 This holistic understanding of health forms the backdrop of how we will talk of the impact, effect and influence of sound and music in our lives.


Sound is understood physically to be a vibration experienced through a medium that the majority of humans experience as an acoustic phenomenon. Vibrations outside the range of human hearing might be classified differently. Understanding sound as physical vibration is important to understand how we interact with sound, not just through our ears but also through our entire body.


Music is primarily a form of sound making which is organised under the principles of the culture it arises from.2 Music understood in this way highlights two inter-connected features of sound:

Sound Can Be Made

The making of sound is a relatively simple task, and most creatures make sound. In contrast, the making of light is biologically rare. Sound is therefore something human beings can produce and control.

Sound Can Be Organised

The ability to make sound and our ability to produce and control sound allows us to organise it in different ways. The primary ways humans have organised sound is through language and music. Both music and language are present in all cultures. While there are overlaps between the two, all cultures have a distinction between the sound of language and that of music.

Having identified our terms broadly, let us explore some interactions of sound.

Sound and Time

Sound is an experience of time. A simple contrast between our experience of sound and that of light is the speed with which they reach us. The flash of lightning alerts us to the coming sound of thunder. We wait for the sound of thunder. That is an experience of time. A painting can be experienced in an instant or reflectively over a period of time. The choice is ours. A piece of music however requires being experienced in the time with which the sounds unpack themselves. We cannot hurry our perception of it. We talk of the slowness of sound and as an experience of time, because it has implications in how we engage with it and in how we talk of our future engagement of sound.

The Past

Any talk of future directions needs to take account of the past. Our response to sound is a key part of our human evolution. Sound gave us information about our environment, especially that which we could not see. It alerted us to the presence of other creatures, the arrival of rain, and of others like ourselves. It provided modes of survival, one of which was social bonding.


From the earliest time, humans used sound to form social groups. The voice was the way by which we communicated, and this became the basis of language. Language through sound provided increasingly complex communicative systems which then allowed us to form social systems for survival. Language until very recently was primarily oral and framed around the acoustic. Therefore, language in the oral sense can be understood as an organisation of sound. There is another arguably equally important organisation of sound, which also has been an important feature of human evolution: music. Some scientists like Steven Pinker considered music to be ‘auditory cheesecake,’3 in other words, sound that’s aesthetically pleasing. However, research has shown that music is fundamentally connected to both our evolutionary past and our current existence.4 Researchers have generally understood that language and music arose from similar neurobiological mechanisms and that possibly they were initially a singular form of acoustic communication.4 Music forms several functions within societies, from the declaration of war, to healing and bringing together the community for celebration and lament. Sound through language and music was always a key area of human flourishing.


On an individual level, sound has a history as well. Our sense of sound forms in the womb, and our first impressions of the outside world come through sound. Touch is the first sense we develop, and it is important to note that sound is something we can sense through touch. The experience of deaf musicians (which we will expand later) is testament to how our interaction with sound isn’t only through our hearing mechanisms. Retaking our theme of development in the womb, we first hear our mother’s voice and then other distinguishable voices and sound which create our initial understanding of the world outside ourselves and the womb. The effect of music on the foetus is a rich vein of research that shows how in our personal histories we start to process and respond to sound.

Simply summarised sound historically was a key part of our health, whether it was personal, social or spiritual. Our interaction with sound was key in forming our identity as individuals and groups. We highlight the above ‘historical’ aspects of sound for an important point about sound: Sound is a crucial way of connecting and interacting with the world, others and the divine. This is a fact that we are less and less aware of today as our culture has become far more visual. It is worth discussing this shift away from sound by talking about some developments over the last few centuries to our current one.

The Present

Our relationship to sound in today’s world is based on the different developments that have happened across the world culturally, socially and technologically. We’re going to focus on the technological side, by exploring some important technological developments that have fundamentally changed our relationship to sound.

Historically sound was always ethereal. Sounds were without permanence; they arose, and they died, a sound happened and faded away. Unlike an image which remains in place, sound always peters to nothing. The only way sound remained was in human memory and imagination. As suggested before, sound was fundamental to how language functioned within society. Language was tied to the abilities of speaking and listening. It was core to how human beings connected with each other and organised themselves. A technological development started changing how we interacted with language. It is known as ‘Writing’.

Writing and Printing

Writing and later printing changed the possibilities of interacting with language. Speech and what was heard could now be recorded. Writing becomes the first way of recording sound. The language of human beings could now be placed on a page for others to ‘hear.’ Writing was still connected to sound because the assumption of writing down was tied to the notion that it would be read out aloud (including private reading). Additionally, writing and reading were skills of the elite, while for most people oral acoustic interactions were still primary. This connection between writing and sound went through a fundamental change when the technology of printing spread widely in Europe and then the rest of the world. Now language could be industrially produced in the printing press, making it far more accessible to all people.

Walter Ong researched the appearance of printing in society, and proposed that it fundamentally changed human consciousness itself.5 It is worth thinking of how it changed our relationship to sound as well. Previously our ears were far more attuned to remembering things that were said in our more oral societies. As education spread, we became less dependent on the oral. Today, there are groups of people especially within more technologically advanced societies who primarily communicate through written text (electronically) than by voice and sound. There are accounts of people who haven’t heard a single human voice within earshot for days.

This ‘silencing’ of the human voice didn’t make things quieter for humanity. Industrialisation brought new sounds in the environment that humans have struggled with in terms of health and wellbeing. Printing was the industrialisation of writing. Sound itself later became industrialised with the next development that significantly changed our relationship to sound: that of recording technology

Recording Technology

Previously, writing ‘stored’ sounds as a set of abstract symbols that then had to be deciphered by the reader. The development of sound recording technology provided the ability to ‘imprint’ the waveforms themselves that could then be activated at any time of choosing. If printing changed our relationship to language, then sound recording changed our relationship to the other important sound that was part of human existence: music. Sound recording meant that music didn’t need to be only performed and heard in particular places and times, but could be heard anywhere and anytime. All it required was the technology to record and hear. Sound became something increasingly manipulated and manufactured. While sound was previously something that occurred within shared spaces, now sound was held in objects, heard at one’s leisure. A further development in the form of headphones made transferability and experience of sound even more personal and flexible. Sound now didn’t have to be spread in the spaces they were produced, they could be confined to mere proximity of one’s ears.

These technologies come with a set of implications for our health. Beyond the obvious reality that loud sound damages our ears, it is worth asking what our present-day interaction with sound and music mean for us today, its effect on health, and the challenges it raises.

Links between Sound, Music and Health

Research shows the influence of music on physiological parameters such as the heart rate, blood pressure, respiration, body temperature, brain waves, skin response and even the systems of endocrine and immune function 6.Different types of music may affect these functions in various ways. For example, fast paced dance beats and rock music can increase the heart rate, while lullabies decrease the heart rate, sometimes inducing sleep. The pitch, rhythm, tone, tenor, type of instruments, chords and harmonies all have varied effects on the body. It is important that we recognise this as we listen and participate in different types of music.

In the mental dimension, parts of the brain recognise and interpret various properties of music. Different centres process rhythm, pitch, timbre and so on 7. These processes are required not just for music but for speech as well. Aniruddh Patel’s Music, Language, and the Brain, 8 is an excellent exploration into the overlaps and distinctions that occur in our perception of music and language, both within the realm of sound. Music also has well known effects on our emotions, based on cultural context and other factors, causing joy and celebration, while also evoking sadness and reflection. Music also has important connections to our memory, where songs evoke feelings from the past. This connection to memory might be an important part of the formation of our self-identity.

The social aspects of music are well known. Music creates a sense of togetherness, especially when those who like a particular type of music come together. Many of our get-togethers are for music performances, concerts and programmes. Music gives an opportunity for social recognition, leadership and teamwork. All in all, music gives a strong sense of social well-being, thereby contributing to health.

What Sound Does Today – Challenges

Previously we spoke of the fundamental shift in our interactions with sound that have brought us to the current state in today’s world.

Prioritisation of the Visual

Our current understanding and perception of sound is formed by what we assume sound does and the importance it has for us today. When thinking about sound, we have to first contrast it to the visual for the simple reason that our culture today has become overwhelmingly visual. While there are large pockets globally where visual technology hasn’t taken hold, it can be argued that much of the world now uses smart phone screens to interact. Our eyes are at the forefront of our experience.

The prioritisation of the visual today inevitably affects our understanding of sound. In Western societies, sound is something to be controlled and privatised. Public sound is considered a nuisance while music is relegated to the background when doing other tasks. This means that we don’t give as much attention to how sound affects us and its importance to us.

The prioritisation of the visual means that we pay less attention to sound as a whole and its impact on our health. The emphasis on the instantaneous visual over the slower experience of sound creates individuals and societies ever more in a hurry. As said earlier, sound is an experience of time, and the far quicker visual is causing us to hanker for the immediate rather than resonate with the rhythms of sound, the ebb and flow of its waves. Another impact of the prioritisation of the visual could be the presence of far more technologies around eye-care compared to ear-care. The care of the ear is far less understood and developed in the mind of ordinary individual, compared to the eye. Other than hearing aids and earplugs what do most people understand about ear care?

The lack of understanding of sound shows itself in the world beyond health too. In any building, the infrastructure for sight is far more developed than for hearing. Buildings are budgeted and equipped with sufficient lighting and projection, but when it comes to sound, there is far less investment in budgeting, design and implementation. This presents a very basic challenge: the need to give sound its due importance by giving sound more attention in itself i.e. paying attention to the medium of sound rather than always giving ‘focus’ to its content. Giving sound due attention will provide better information to assess its impact on our health as individuals and society. This challenge could be met by a combination of educational and creative channels. Employing pedagogical methods that centre on sensory experience as a mode of learning would be an overall strategy in terms of education. Schools could be encouraged to engage with sound through curriculum, by incorporating experiential models of learning about sound as experience rather than the abstract physics model of teaching about sound.

Additionally, sound could become part of pedagogical practice through different practices of listening. A story of a teacher and her students illustrates this: A teacher was struggling to hold the attention of a disruptive class. She decided to play a game with them. They had to close their eyes and say out aloud what they could hear. Each child had to name a unique sound that they were experiencing. The usual suspects of traffic, wind and footsteps were mentioned. Finally, a child said, ‘I can hear my breathing.’ The teacher said, ‘Good, now we can begin our class.’ The act of listening provided a centring of the person and her attention. Attending to sound in the content and mode of the curriculum could be expanded in higher education especially amongst healthcare professionals.

Attending to sound in this way would improve understanding and practice of sound and its impact on our individual and societal health. It will also help those who suffer from sensory overload and conversely those who have impaired sensory functions.

Perception of Sound

The last few decades have produced considerable research into our perception of sound. Yet researchers accept that the understanding of neuro-biological mechanisms of hearing is still in its infancy.9 Previously, it was considered that the ear merely transferred sound waves across its constituent parts to the nerve, from which it was translated and carried on to relevant neural networks of the brain. The reality as ever is far more complex. At each stage of the hearing mechanism there is a filtering of the sound. By the time it reaches the nerve, the sound has already changed in some form.10 Additionally, the hearing mechanism isn’t just a one-way system where sounds travel from outside ourselves, through our ears, to our brains. Rather, the neural networks actively impact the sensitivities of the ear, fashioning what we hear based on prior experience, expectation, emotional states and so on.11 This has different implications in how we understand the treatment of hearing loss and other acoustic deficiencies. The top-down fashioning of our hearing means that it becomes highly contextual. Hearing tests that play individual sine tones (simple frequencies) might give an indication as to some features of our ability to hear. However, someone with a strong sense of context will be able to manage their hearing because of an ability to fill the gaps which are caused by deficiencies of their biological ear. Conversely, someone with a poor sense of context might have perfectly healthy ears but will be unable to hear what is happening. The psychological and neurological influences on hearing are a challenge for understanding our hearing health.

Our hearing health is also not merely connected to our ears. Earlier we said about how touch is a way to perceive sound. That is simply because sound is a vibration and therefore our sense of touch is also a way of ‘hearing.’ Sound as a vibration has an impact on our entire body. There is limited research on the impact of sound on our body as a whole. What are the impacts of living in close proximity to different loud sources, whether they are factories, machinery or domestic appliances? There are many frequencies that are beyond human hearing as well and the question arises about their impact.

These challenges need to be met by further research into the impact of different sound environments on the body. The human body today is experiencing a set of vibrations at several frequencies which it never did before. The impact of these vibrations needs to be assessed on short and long terms basis on both physical and emotional levels while also examining the relation between the physical and emotional impacts that sound can have. Music’s variable impact upon us shows the complexity of these tasks as music has different effects upon body, mind and memory all of which constitute the core identity of a person.


The talk of vibration and touch as a form of hearing leads us back to the experience of the deaf. Deaf communities are unique in that they developed languages which were devoid of sound. This doesn’t mean that the deaf cannot engage with sound. It is just that deafness makes acoustic speech a deficient way of communicating. The deaf in fact experience sound and this experience is in stark contrast to the blind person’s experience of light. The vibration of sound means that it is accessible for those whose hearing mechanisms are deficient. There are cases of several deaf musicians (such as Evelyn Glennie) who can perform to high levels of traditional musicianship. With the right infrastructure (like a resonant platform), they can experience the sound in a way that they too can play and sing along with other people.

The deaf experience of sound points towards the multi-layered nature of sound. Since sound is vibration, it can travel through air, water, solid and we can experience it through our bodies. The deaf experience also shows that the way society sets itself up can exclude or include people. In many cases the ability to listen might be tied closely to the way in which the sound is produced and/or the way it is being received. Deafness provides a challenge in how we understand sound and its impact on our bodies, while also asking questions on the inclusive ways of accessing sound.

The challenge of the hearing impaired on our societal norms is worth engaging with. Recently in the UK, British sign language (BSL) was accepted as an official language by the government. An official acknowledgment of the language means that it acquires funding and societal status that allows hearing impaired people more access to different areas of society. Sign language has shown wider application in helping those with developmental differences in the acquisition and use of language.

Environment and Climate Change

So far we have spoken in very anthropocentric terms. It is important to consider the environment that we are a part of. Our actions on the environment and the sound we make have significantly affected the sonic landscape of our environment. There is research showing how birds in urban areas have changed their song and the times at which they sound it. Birdsong is essential for species survival and the sonic disruption that human action has produced is disruptive to the survival of different creatures. David Haskell writes of the loss of sonic diversity in our world indicating the loss of biodiversity which is crucial for the well-being of our planet.12 His books The Songs of Trees 13 and Sounds Wild and Broken 12 are a biologist’s reflections on attending to the sounds of our environment and are worth reading.

Overall Challenges

These discussions on prioritisation of the visual to the environment bring us to the challenges that sound presents to us through the various chapters of this book. If one were to summarize the main challenges that the ‘sound world’ face today, one could think of it in various domains. One domain is research. Quantifying the effects of music on health, both quantitatively and qualitatively would be very important as we go into the future, from a risk and benefit point of view. In relation to this, there also needs to be more research on how confounders such as background noise, vibrations and effect modifiers affect health. It would be important to design and make available the right infrastructural and service tools to conduct such a research.

The other domain which remains a challenge in sound is in the domain of learning. One learns music, but not much about sound itself, except some aspects of the biology of hearing. We need to learn more about sound, not just from a science point of view, but also an art point of view, if we are truly to imbibe the values of sound and learn about its harmful and beneficial effects for health and life as a whole. It would be important therefore to create interactive and experiential educational modules to understand the physics, biology and art of sound, hearing and speech. These educational modules need to address the needs of not just professionals, but also the public at large, especially as the noise pollution in the world increases at a rapid scale.

The other domain is in the preventive strategies to mitigate the harmful effects of sound. One way is to promulgate laws and regulations. However, implementation in a uniform manner is always a problem and that too to sustain the implementation. That is why having an ethical attitude towards sound as an individual is important. Internal regulation through behaviour change and understanding, that sound needs to be respected as individuals and as a society, will help in the long term. Other preventive strategies also need to be thought about. However, for any strategy, evaluating the baseline problems and assessing the effect of a particular strategy is important. Unfortunately, many challenges exist, including the high cost of sound measuring equipment and resource personnel with sufficient expertise. Another challenge is in monitoring and maintaining any sound protocols once implemented.

All these challenges require a lot of thought, brainstorming, but above all, an understanding of the problems of sound, and a commitment to address the challenges posed through collective wisdom, research, learning and policy implementation.

Future Possibilities

What has been covered here in this short article on sound is merely a scratching of the surface. The possibilities of sound and its future potential are enormous for life’s journey and our health and well-being. How we approach sound and how we deal with sound in the future, therefore, needs to be explored further, especially in the light of the challenges which have been described in the previous section.

Sound Studies

There needs to be a building of volume around the study of sound especially in the non-Western world. Over the last two decades, a multidisciplinary field of research into sound has grown which offers many interesting possibilities regarding our understanding, perception and use of sound in our lives. Broadly this research field has been called ‘Sound Studies’.14

‘Sound studies’ is a set of research activities around sound. It crosses various established disciplines from astrophysics, sociology and law. In astrophysics, it could be understanding the different frequencies emitted across space, while in sociology it could be research into slang, and in law it might be analysis of witness testimony. Sound studies as a multi-disciplinary field reflects sound’s own multi-layered nature as has been reflected above. If health is understood in terms of the whole person, then sound studies is something healthcare professionals should start to engage with. It opens up different methods and practices, and how various disciplines can interact for the flourishing of human beings. Furthermore, sound studies show the direct impact of sound on us at different levels, from the biological to the psychological, from the social to the communal. What sound studies does, and this is the future direction that is proposed, is that sound needs to be given closer and careful attention.

Possibilities of Sound

Giving sound closer attention will open and offer several possibilities for health. Here are a few of them:

    1. Sound gives us fluid ways of interacting with each other.

    Sound is a transfer of energy, and unlike light is something which we have more control over, in terms of making sound or ignoring it. We can communicate not just through language, but also through different tones and rhythms by which we speak. Beyond language, sound can be used to interact through music and more basic sound making actions. Rudy David is a music practitioner who works with children with different abilities and development using sound.9 He designed a drum that gives access to children of different abilities to communicate and express themselves through sound. David’s engagement of children through sound shows the ways in which pedagogies can be developed to account for variable abilities of people in society.

    2. Sound can provide ways of achieving a healthy cohesion of self and society.

    Meditation has been increasingly accepted as an important practice for health. In the different traditions of meditation there are different approaches to sound, from pure silence, to chanting, to music. These approaches are ways of attending to sound in order to enhance the cohesive possibilities that meditation offers.

    3. Many sounds can coexist together, and this could inspire how groups of people can coexist together without oppression or violence.

    Multiple sounds occur concurrently and our perception processes filter out unwanted sounds while elevating others. This is illustrated in the ‘cocktail party problem’15 where our hearing is examined to understand how we are able to hear one voice speaking to us amongst several other simultaneous voices. In music however, we hear multiple sounds simultaneously, and all those sounds interact in our perception to create a ‘harmonious’ whole. We can hear percussion, different instruments and voices, and yet they all belong together contributing to each other. This perception of sound is something worth exploring in terms of how we understand social cohesion, where people belonging to different communities intermingle and work together.

    4. Attending to sound and hearing shows that there is much that exists in the ‘background’ which is worth exploring and experiencing.

    Sounds are constant on a pure physical level. There is the story of the composer John Cage, being in an anechoic chamber, a specially constructed room where no external sound or vibration can enter. Cage was surprised to hear a high sound and a low one. They turned out to be the sounds of his nervous system and circulatory system.16 The stethoscope, the tool to hear the heart, is the iconic image for the medical profession. Sound as shown in multiple medical disciplines offers important information of what is happening within the body. Sounds from the body are often considered vulgar, but if we are willing to hear them for what they are, these sounds will provide important indicators of the state of our bodies and beings.

    5. Listening is an important skill to be developed.

    Attending to sound is fundamentally connected to listening. We have seen how the perception of sound can often be fashioned by top-down processes. Quite often our attention to sound is modulated by our prior experience and bias. For the medical profession this is a key issue, as practitioners need to listen on different levels from patients’ ailments to colleague’s discussions and departmental conversations. A lack of careful listening has consequences which only need to be imagined. The ability to listen is something that can be developed, and is also worth speaking of the energy and the cost of listening. The appropriate amount and types of rest required will improve listening practices, which in turn will deliver better health outcomes.


The challenges and possibilities mentioned above are again a whisper, and sometimes a soft pouring of speculation. However, the act of attempting to listen to what we don’t normally hear is an important part of our engagement with sound and health. The future directions of sound and health are fundamentally connected to the basic act of listening. The process of listening, the attention given to sound, is the kind of attention we should be giving to the nature of sound and our perception of it. For this to happen there needs to be a re-appraisal of how we are choosing to experience the world and stepping back from the bright lights of the visual world, with its demanding colours and requirements for immediate response. Instead, we need to step into the sound world where, as each sound wave rises and falls in crests and troughs, sounds will come to us and then die, slowing us to experience time as a gift, resonating with our body, echoing into our memory. We hope that through this reading, you will step into the world of sound and music, surmounting the challenges, and embracing its potential in the future for the well-being of you and the society.

Key Messages

Across multiple spheres today, sound isn’t getting the attention it deserves

A deeper engagement of sound, especially through different practices of listening is required

Sound and music are essential for the well-being of individual, society and the planet

In order to preserve our well-being, we should rekindle our relationship with sound and music through learning, research, and application in our daily lives

The challenges that are faced with sound today should be understood and researched, so that we can strategise towards a better relationship with sound for the future.




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