Rural Internet Access Is a Matter of Public Health

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As we inch further into the second decade of the 21st century, it’s hard to believe that some people still lack access to broadband services. With more than 4.7 million Americans working remotely and a recent surge in telehealth, high-speed internet has gone from a luxury to a modern-day necessity — and rural Americans are going without. This lack of broadband internet is wreaking havoc on already under-resourced rural communities, especially where their health is concerned.

The FCC reports about 19 million Americans (6% of the population) do not have access to high-speed internet, and some research estimates double that number. Internet for rural areas is even spottier, with about one-fifth of rural Americans lacking access to reliable internet, along with 27.7% of indigenous people living on tribal land. To put that into perspective, only 1.5% of their city-dwelling peers can say the same. Rural residents are facing a public health crisis from a lack of healthcare providers — and the lack of internet is yet another barrier to receiving proper care.

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To be fair, the digital divide has been closing over the past six years, albeit slowly. In 2016, for instance, there was a 30-percentage-point gap between urban and rural internet access (compared with the current 20.8-percentage-point gap). Plus, the Biden administration’s $1 trillion infrastructure bill promises to expand broadband internet for rural areas and tribal nations, much like Eisenhower’s national interstate system improved interregional travel access. These are positive gains, to be sure, but when reliable internet access is practically a prerequisite for participating in the 21st-century economy, we can’t just wait around for sluggish infrastructure upgrades.

Why Rural Areas Need Telehealth Technology

In the age of COVID-19, it’s hard to overstate the necessity of high-speed internet. It doesn’t just equip communities to participate in society and the economy; it also offers increased access to necessary healthcare services, something rural Americans severely lack.

According to a 2021 study on rural internet access and telemedicine, Americans living in isolated rural settings have less access to both primary and specialty care. And as critical-access hospitals continue to shutter operations, access to tertiary care facilities is swiftly declining, too. In fact, more than three-quarters of the 2,050 rural counties in the U.S. are experiencing a shortage of health professionals. To meet existing rural needs on a local level, it’s estimated that we need approximately 4,000 more primary care practitioners.

Without local providers to turn to, rural Americans must travel (sometimes far distances) to access in-person care, but travel isn’t an option for everyone. Many delay care due to social determinants of health like lack of transportation or childcare, often until a manageable illness turns into a serious or life-threatening health event.

It’s no wonder, then, that rural Americans have higher rates of death, disability, and chronic disease than their urban peers. This fact is particularly pertinent during a global pandemic: Rural Americans are twice as likely to die from COVID-19 infections compared with urban-dwelling Americans. And though lack of access to care isn’t the only factor contributing to these higher rates (rural Americans are also less likely to be fully vaccinated against the COVID-19 virus, for instance), it certainly plays a significant part.

The Future of Telemedicine Depends on Bridging the Digital Divide

When in-person health facilities are too far away, telemedicine technology offers a solution for decreasing health and care disparities between rural and urban populations. Rather than travel hundreds of miles to see a doctor, for example, a patient can simply log onto a telemedicine platform and see a provider virtually. That’s time and money put directly back into patients’ pockets. In fact, one report found telehealth visits across five Michigan counties lead to almost 70,000 fewer in-person visits — when factoring in travel, that’s almost $2.7 million in potentially lost productivity reclaimed.

However, we cannot fulfill the promises of telehealth without first ensuring equal access to reliable, high-speed internet for rural areas. In one survey from the Bipartisan Policy Center, respondents cited technology-related obstacles as a major telehealth barrier. For more than one-third of rural resident respondents, access to high-speed internet and a computer were their primary barriers to telehealth.

Today’s telehealth technologies require way less broadband usage than they once did, but patients and providers still need to be able to log on and connect. And for most telemedicine programs, there’s a telehealth equipment requirement of a minimum speed of 1.5 Mbps for both upload and download speeds. That’s because proper broadband access for effective telemedicine examinations goes beyond a rudimentary video connection. To properly implement telehealth in rural areas, providers need their patients’ internet service to stream information from telehealth technology, such as medical device data, so they can adequately assess those patients in real time. Medical device streaming grounds the telehealth exam in clinical data rather than just video observation.

Research shows that if people have that access, they’ll use it. The 2021 study mentioned above found that populations in areas with increased broadband access are more likely to use telemedicine compared to those with less access. In other words, if more rural patients had proper broadband access, we would see more of them seek out treatment, particularly for specialized care that’s not accessible on a local level. In contrast, if the rural internet connection fails or is unstable, people won’t use the technology and care won’t be given (or received).

Bringing clinical expertise and diagnostic quality care to rural patients is of utmost importance, but how can patients utilize telehealth in rural areas without high-speed internet in their homes? One solution is to set up telehealth stations. Local government leaders can designate areas with high-speed internet for patients who lack access to a personal broadband connection. Rather than travel hundreds of miles to see a specialist, patients can visit their local telehealth station to connect with a healthcare provider.

Telehealth technology and a stable internet connection might seem like old news for those of us who live in well-resourced communities, but for those in remote rural settings, that kind of connection is not a given. That’s why we need to prioritize rural internet access: It can mean the difference between life and death.

Eric Bacon is president at AMD Global Telemedicine, Inc. He has 20 years of experience designing new medical devices and telemedicine solutions that are deployed in more than 100 countries and used in millions of consults.