Fixing the digital divide in Kansas City is important to public health

The digital divide is considered a “super determinant of health” because of its impact on a person’s ability to access critical resources like education, economic mobility, workforce opportunities, and health care.

Despite all the hardships that COVID-19 has brought us, the pandemic has a silver lining – the digital divide is now getting the long overdue attention it deserves.

The digital divide is the gap between the under resourced members of society who do not have computers, high-speed internet, and literacy the more affluent members of society do.

The COVID-19 era has highlighted the fact that broadband internet is an essential need for a community’s well-being, similar to electricity and plumbing. That’s because the pandemic has caused a greater need to operate remotely using technology, which has made the divide more of a chasm.

Students who can learn from home continue to progress in their education while those who cannot have fallen even further behind. Access to technology also separates those who have been able to access quality health care in the past several months via telemedicine and those who had limited access to health care while stay-at-home orders were in place.

Broadband access

Despite the rapid advancements in broadband technology, these innovations are not available to everyone. According to the Federal Communications Commission, U.S. households making $25,000 or less have a broadband adoption rate of 47 percent, while those making more than $100,000 have an adoption rate of 92 percent.

The KC Digital Inclusion Coalition reports that 25 percent of Kansas Citians do not have broadband access at home. It also reports that of those who do not use the internet at home, 46 percent are African American and 42 percent make less than $25,000 per year.

Broadband infrastructure has not been constructed in many rural and lower-income communities. According to the Federal Reserve Bank, laying glass fiber costs $10,000 to $30,000 per mile – a cost many private internet service providers struggle to justify in low population density or low internet adoption rate areas.

Low-income earners must decide which needs are a family priority. Internet connectivity is often deprioritized among food, water, electricity, and gas.

“We, as a country, need to determine digital equity is a priority and then act on it. The stakes are high. For individuals, for our communities and for our country,” said Angela Siefer, executive director of the National Digital Inclusion Alliance, of which Kansas City is a founding member.

Impact of COVID-19 pandemic

The pandemic has expedited the transition to a digital economy. The interplay of the pandemic and the virtual economy – increased reliance on remote work, virtual learning, and telehealth – has hit individuals and families on the wrong side of the digital divide the hardest.

“Kansas City is ranked as the No. 1 city in the U.S. for remote work.” says Rick Usher, assistant city manager for the City of Kansas City, Missouri, and member of the KC Digital Inclusion Coalition steering committee. “We have a highly competitive market for internet service providers and nearly ubiquitous availability of high speed internet. Yet, many families in low-income households cannot afford internet services and are therefore left in the digital divide, unable to compete in the virtual economy and struggling to survive during the pandemic.”

In a post-COVID world, the chasm between the digital haves and have-nots could widen.

People with lower incomes in both rural and urban communities, and people of color, report poorer health even in ordinary times due to a variety of socioeconomic and environmental factors. These factors are far more challenging in the COVID-19 environment. Telehealth provides an opportunity for these individuals to access quality care and improve their health outcomes, but this opportunity cannot be realized without these individuals also having access to broadband.

Telehealth

During the COVID-19 crisis, the White House and the Centers for Medicaid and Medicare Services increased flexibility for the provision of telehealth to allow doctors to provide diagnosis, remote patient monitoring, and other health care services without having to physically see patients.

Physicians and specialists have been able to continue earning a living, and hospitals have been able to continue earning revenue by providing care to patients virtually, including residents of low-income and remote areas. Physicians and nurses can gain insight into a patient’s condition and environment to ensure adequate supply and reduce medication interactions through virtual visits. Additionally, the provider can see if patients have difficulty navigating their home environment, or if they have visible symptoms that indicate necessary adjustments to medication or diet.

Patients have benefited by being able to meet with doctors without having to leave the safety and comfort of their homes or take time off from work. Many patients have also had remote access to specialists during the pandemic that they would not have access to otherwise, due to an underrepresentation of specialists in rural and urban safety net health care arenas.

Telehealth usually requires a high speed internet connection that many low-income, rural residents and hospitals do not have; however, some telehealth services are available via audio. According to a 2020 University of Pennsylvania study, people from zip codes with a median household income below $50,000 were half as likely to use video to see the doctor when compared with zip codes with a median income above $100,000.

Through telehealth, hospitals can provide and patients can receive real-time quality care at a fraction of the cost of an in-person visit. By leveraging telemedicine through in-home care, outsource diagnostics analytics, and remote specialist consultations, hospitals can service patients at better costs, save time and receive the care they need much faster.

Yet, rural hospitals report that the primary barrier to providing remote care is broadband access. Patient access to rural hospitals is already a challenge due to recent closures and the limited number of hospitals in rural communities.

Federal telehealth provisions will likely continue into 2021 and beyond, as they make quality health care more accessible to patients and cost effective for providers. CMS is considering rules to effectuate a White House executive order calling for flexibilities around telehealth to continue after the pandemic.

But telehealth and the efficiencies it affords to providers and underserved patients are of no benefit if hospitals in rural and urban areas lack the connectivity needed to use it.

Regional efforts

Locally, there are efforts underway to narrow the digital divide. The KC Digital Inclusion Coalition, made up of municipalities, libraries, foundations, internet service providers, and nonprofits, leads this work and is a thought leader on localized solutions.

Health Forward Foundation, along with several other area foundations and civic organizations, awarded a grant to the SchoolSmartKC technology fund to help close the equipment divide for low-income K-12 families in the Kansas City area who do not have a computer at home. These computers can also be used by the family to access telehealth and other critical services at home.

The Kansas City Regional COVID-19 Response and Recovery Fund, for which Health Forward Foundation participates on the advisory board, recently awarded over $850,000 toward digital equity initiatives aimed at closing digital equipment, accessibility, and literacy gaps in the Kansas City region.

On the state level, both Kansas and Missouri recently dedicated around $50 million each to improve broadband access. The funding will be allocated in the form of vouchers that will make high speed internet more affordable for families, for infrastructure projects, and to provide connectivity to schools, libraries, hospitals, and other anchor institutions.

Broadband access is necessary to succeed in the 21st century economy. As long as the digital divide exists, we will be unable to maximize our individual or collective economic potential. In a highly digital world, where jobs are posted online, most learning opportunities are offered online, and most other services and social interactions are also online, digital connectivity and capabilities are necessary to compete.

How you can personally make a difference

There are many opportunities for local businesses and philanthropy to help secure our economic future – you can make a donation of surplus computer equipment to PCs for People, or donate to the payment assistance program for internet services established by the Mid America Assistance Coalition and the Mid-America Regional Council or the school technology fund at SchoolSmartKC. You can also encourage our elected officials to prioritize broadband and provide additional support in underserved communities during the upcoming legislative sessions in Kansas and Missouri.

This post originally appeared on the Kansas City Business Journal.