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Efforts to Close the Digital Health Equity Divide May Improve Access to Healthcare

A Health Equity Story November 3, 2023

The internet is essential to modern life—and it is central to many modern healthcare innovations. Yet many people are not connected or are under-connected, including people with lower incomes, students, older adults, and those living in remote areas and tribal lands. In rural areas of the United States, nearly a fourth of the population—14.5 million people—lack access to this service, according to research by the Federal Communications Commission (FCC). In tribal areas, almost a third of the population lack access.

As of 2021, the FCC defined household broadband as having an internet connection of a minimum of 25/3 Mbps. The first number—25 megabits per second (Mbps)—is the time it takes to receive data (download speed), such as loading a web page. The second number —3 Mbps—is the time it takes to send data (upload speed) from a small digital device such as a smartphone or laptop to a larger server. For example, when backing up documents or photos into a cloud storage system. 

Even in areas where high-speed internet is available, it may not be affordable. A 2021 Consumer Reports survey of more than 2,500 adults found that the median monthly broadband bill, including taxes and fees, was about $70 per month. But half of the respondents to a 2019 Pew Research Center survey do not have broadband connection in their home because they say it is too expensive.
 

The Impacts of Digital Inequity

The COVID-19 pandemic highlighted societal dependence on the internet. It dramatically illustrated, and may have widened, the divide between those who can readily access and afford internet coverage versus those who cannot.  Of the approximately 50 million students sent home by school closings, more than 9 million lacked home internet access for remote learning, principally because the household couldn't afford it.

It's not just younger students experiencing access challenges. Colleges and universities learned quickly how real the lack of digital equity was for students.

Midwestern Higher Education Compact report found that:

  • About 16-19% of college students reported technology barriers, including inadequate computer hardware or internet connection
  • There were higher rates of “technology inadequacy” among lower-income students (20-30%) than higher-income students (10-12%)
  • Black (17-29%) and Hispanic (23-28%) students experienced a greater likelihood of inadequate technology than White students (12-17%)
  • Students living in a rural area (14-25%) experienced more challenges to technology access compared to those living in a suburban (16%) or urban areas.

Those without broadband often turn to cell phones to access the internet. About 17% of U.S. adults rely on mobile phones for shopping, seeking employment, doing academic work, or accessing healthcare. While smartphones can help conduct basic online tasks, they are inadequate for completing homework. They also provide spotty coverage in areas with insufficient cell phone towers and other infrastructure.

Inadequate technology has real consequences on student success. A large-scale study of 8th to 11th graders in Michigan found that cellphone dependency substantially hindered students’ academic progress. “Students without internet access and those who depend on a cell phone for their only access are half a grade point below those with fast access. This gap has ripple effects that may last an entire life,” said Keith Hampton, Professor of Media and Information and Director of Academic Research at Michigan State University’s Quello Center.
 

Broadband Access as a Social Driver of Health

Researchers are studying the impacts of digital inequity on individual well-being. “Access to broadband internet has become a basic need in this connected society,” said Jody Early, PhD, an associate professor at the University of Washington Bothell’s School of Nursing & Health Studies.

In a 2021 study, Early noted that broadband internet is a vital tool in creating digital health equity. Experts believe that broadband access and adoption can help improve healthcare delivery and literacy, offering new digital engagement tools and telehealth options. Many studies have shown that people experiencing poor health outcomes are more likely to have low or no high-speed internet access.

Bridging the Divide

Efforts are being made to fill the digital equity gap on multiple fronts. For example, many schools, like the Navajo Nation’s Diné College, have focused on improving broadband access for students.

The college used federal Coronavirus Aid, Relief, and Economic Security (CARES) Act funding to purchase student Wi-Fi hotspots and laptops. It built two additional micro-campuses—one in Aneth, Utah, and another in Newcomb, New Mexico—so students wouldn't have to drive as far to connect to broadband service. It also upgraded its current connection to increase speeds to 2.5 gigabytes per second.

Government programs are also trying to close the gap through policy initiatives. In 2021, pending legislation in 48 states, the District of Columbia and Puerto Rico addressed broadband in educational institutions and schools, funding, governance authorities and commissions, infrastructure, municipal-run broadband networks, rural and underserved communities, and taxes. The federal government is also working to expand access:

  • The 2022 Infrastructure Investment and Jobs Act (IIJA) includes the Broadband Equity, Access, and Deployment (BEAD) program, which includes significant financial and technical assistance from the National Telecommunications and Information Administration (NTIA) to states to build out their broadband strategies. States are eligible to receive a minimum of $100 million and territories can receive a minimum of $25 million.

  • The IIJA also provides the existing U.S. Department of Agriculture broadband programs with $2 million in additional funding.

  • The BEAD program also solidifies FCC’s Affordable Connectivity Program (ACP), which aims to connect households at or below 200% of the Federal Poverty Guidelines, or if a member of the household meets certain criteria, including receiving a Pell Grant, participating in federal assistance programs like SNAP or Medicaid, or lives on Qualifying Tribal lands. Eligible households receive a benefit of up to $30 per month for internet ($75 for households on tribal lands), and a one-time $100 discount for an electronic device (cell phones not included). Elevance Health is working with states to promote enrollment in ACP.

  • The USDA ReConnect Program is working to increase building facilities capable of providing high-speed internet (100 megabits per second download and 20 megabits per second upload).
     

The Role of Healthcare

For those in the healthcare industry, creating digital health equity is becoming increasingly important given the rise of telehealth services. Broadband and mobile devices provide foundational support for countless digital health tools that can expand access to healthcare. Broadband and device access, affordability, and digital literacy also support people in their daily lives and can help meet other health-related social needs, including education, commerce, and work. Through digitally enabled healthcare efforts, Elevance Health is working to:

  • Champion the recognition of broadband and device access, affordability, and digital literacy as a health-related social need.
  • Encourage the development of data collection and reporting standards to identify digital equity issues to inform solutions that best address access, affordability, and digital literacy.
  • Support policy developments that encourage coordination with federal, state, and community initiatives, including existing programs, so that investments can be made in the communities that most need them.
  • Encourage and support broadband initiatives that incorporate access (infrastructure), affordability, and digital literacy for individuals.
  • Develop a plan to screen people for digital access and skills so they can receive care and communication in the way that makes the most sense for them.

When it comes to bridging the digital health equity divide, governments, businesses, and schools all have roles to play. 

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Elevance Health increases access to health-related digital services

In early 2024 Elevance Health launched a first-of-its-kind program that helps to bridge the digital divide. The program will offer high-quality smartphones with unlimited data, talk, and texting service at no cost to eligible individuals enrolled in some of its affiliated Medicaid health plans. Devices will be preloaded with a customized experience and give individuals access to digital and virtual healthcare tools that they might otherwise not have had. This effort is a result of a collaboration between Elevance Health and Verizon, together with Samsung, AT&T, and T-Mobile, and is supported by funding from the Federal Communications Commission’s Affordable Connectivity Program (ACP).

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