How internet access impacts underserved populations
Technology can help narrow the health equity gap worldwide. Today, many people use wearables, have access to internet of things devices, remote patient monitoring and other technologies that allow individuals to access their health and fitness levels in real-time. Using these devices, however, often requires high-speed internet or a cellular connection to move the data from one place to another.
If you live in a city or the suburbs and are middle-class, there’s a good chance you have access to a fast, reliable internet connection and cellular service. Ninety-two percent of U.S. adults with an annual income of more than $75,000 have home broadband. Ninety-six percent say they own a smartphone.
For those living in rural areas or older parts of cities with less modern infrastructure, the services many take for granted may not be readily available or dependable. Those living in these settings are less likely to possess broadband than those who live in the suburbs. For those with lower incomes—living in rural or urban areas—the same challenges may be even greater.
Having access to high-speed internet is necessary for more than streaming or online gaming. High-speed internet now is a healthcare necessity. Many health apps and data-connected devices require a high-speed, always-on internet connection. Unfortunately, the quality of one’s health may have more to do with a zip code than the medical care they receive.
People unable to access “high-speed, reliable internet with actual download speeds of at least 25 megabits per second (Mbps) and upload speeds of at least 3 Mbps” are considered to live in what is known as a broadband desert. Broadband deserts affect an estimated 21 million Americans, with over 30% of people living in rural locations impacted negatively.
With the advent of virtual healthcare solutions such as telehealth, mobile health apps and remote patient monitoring, the internet has become a key tool in helping to provide healthcare services, while supporting positive health outcomes and avoiding negative ones. Thus, access to the internet may be considered a social determinant of health (SDoH)—a social or living condition that can positively or negatively impact health.
In addition to affecting health outcomes, living without broadband makes it difficult to do crucial things such as attend or succeed in work or school, look for and find a job if unemployed, and stay in contact with friends and loved ones. These challenges may lead to less work, fewer educational opportunities and personal connections, among other challenges, for Americans living in broadband deserts—factors that may lead to negative health outcomes.
Just because someone doesn’t live in a broadband desert doesn’t mean they have broadband access. Other factors such as affordability can determine whether a person can or wants to have broadband services. Nearly half of non-broadband users cite cost as a reason they don’t have broadband.
An alternative to broadband
Many attempt to overcome the absence of broadband by using cellular data to access the internet on their smartphones. In fact, people in low-income populations are more likely to be dependent on their smartphones to access the internet than those with higher incomes. “As of early 2021, 27% of adults living in households earning less than $30,000 a year are smartphone-only internet users – meaning they own a smartphone but do not have broadband internet at home. This represents a substantial increase from 12% in 2013,” according to Pew Research Center.
While having a smartphone and cellular data may help with some healthcare technologies, such as health apps and some remote patient monitoring devices, a lack of internet speed or pockets where cellular service is slow or nonexistent can affect the use of other valuable healthcare services. Telehealth appointments and internet of things devices, for example, may be impacted by slower internet speeds, resulting in difficulties accessing healthcare services for those who rely solely on a smartphone for internet access.
Technology can help facilitate access to healthcare services for many, but what about the 21 million who live without broadband due to broadband deserts, the 15% of people who don’t have a smartphone or those who do have a smartphone but struggle with connectivity nonetheless? How can we allow everyone to leverage technology equally?
Broadband access is crucial in many ways; this became evident when the pandemic began in 2020. As a Pew Trusts article states: “Broadband is increasingly intertwined with the daily functions of modern life. It is…a critical piece of efforts to improve health care and modernize transportation.”
With the importance of broadband continuously growing, efforts are being made to improve the connectivity and affordability of broadband across the country. The most significant is the newly-passed Infrastructure Investment and Jobs Act (IIJA), which provides $65 billion in funding for broadband expansion and access. IIJA will work to extend broadband infrastructure and help make broadband more affordable to underserved communities and those with low incomes.
Another effort being made at a federal level to increase access to the internet is the Affordable Connectivity Program (ACP), which provides discounted internet services to Americans whose household income is at or below 200% of the Federal Poverty Guidelines, or if they meet certain other criteria. As of May 9, 2022, the goal is to provide plans of at least 100 Megabits per second of speed and cap the rate at $30 a month.
Despite efforts to extend broadband access, 100% coverage cannot be achieved overnight. We must find a solution to bring healthcare to those who need it, those who lack the means necessary to get access to the type of internet service that can help play a role in improving their health.
Meet the patient where they are
While the solution may seem complex, it could potentially be summed up in one phrase: meet the patient where they are.
Instead of a one-size-fits-all approach in healthcare, where technology is treated as the ultimate equalizer, we must marry the power of technology with a myriad of high-touch approaches to cater to the unique needs of each individual, especially those in underserved communities.
This means employing a holistic solution to help address the obstacles patients face on a day-to-day basis. The hurdle of receiving medical care for an acute or chronic condition could be remedied by a telehealth visit or the use of remote monitoring devices, but if someone can’t afford or can’t access the internet, their care gap becomes even wider. A person may want to eat healthier food, but if the closest store doesn’t carry it or it’s too expensive, eating healthy becomes an even greater challenge. Those who require non-emergency medical transportation likely will have an easier time getting a ride if they live in a city or the suburbs, compared to a rural location.
Meeting the patient where they are means helping healthcare become more accessible for underserved populations. Whether it’s helping the patient get where they need to go—to the doctor, the grocery store, the pharmacy—or bringing healthcare and healthy habits into the home.
The IIJA is a step in the right direction to improve broadband access in the communities that need it most. We also must strive to increase access to the other supportive care services designed to help improve health and wellbeing.
Technology can be a conduit to help promote health equity, but without careful thought and consideration of an individual’s unique needs, a change in healthcare will fail. To realize the full potential of technology and healthcare working together toward a common goal—improved access to healthcare services for the underserved—the industry must take steps to ensure that a zip code has nothing to do with healthcare.