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The simple fact that internet access has become an essential component of Americans’ daily life has only been exacerbated in the wake of the COVID-19 pandemic. Still, broadband access is far from universal. 

The term broadband itself refers to various high-capacity technologies that transmit data, voice, and video across long distances and at high speeds. While research in this area is incomplete at best, the correlation between increasing broadband access and improved health outcomes is significant. 

Given the overlap with other social determinants of health (such as education and employment), broadband access is now considered a “super-determinant” of health — in other words, a key environmental factor capable of determining the overall health of any given community. 

In rural communities, the digital divide remains vast — as evidenced by the 19 million Americans lacking access to reliable broadband service (or high-speed internet)  according to the FCC. In the absence of this critical infrastructure, the broadband health gap (defined as the time and distance between doctors and patients) is widening as well. Outcomes clearly show the least connected communities exhibiting the highest rates of chronic disease, with obesity and diabetes prevalence — a whopping 25% and 41% higher respectively — leading the way. 

While the advent of telehealth has been shown to reduce health disparities, especially in rural regions with fewer healthcare providers and lack of public transportation to access them, the platform is dependent upon broadband access — leaving this much-needed resource, namely as a means of addressing gaps in mental health and substance use treatment, largely untapped. 

Disparities in broadband access continue to persist among certain demographic groups — including racial and ethnic minorities; those individuals residing on Tribal lands; older adults; and those with lower levels of education and income — all of whom are less likely to have broadband at home. A report by the National Telecommunications and Information Administration (NTIA) revealed that, in 2021, rates of wired, high-speed internet use were lower in “households where the main renter or owner was 65 years or older, had a disability, or was a Hispanic, African American, American Indian, or Alaska Native.” Furthermore, over 8 in 10 households earning above $100,000 used high-speed internet service at home during the same period when compared with just 5 in 10 households earning income below $25,000. Complicating the issue is the fact that while socioeconomic factors including education and employment have been shown to play an important role in health outcomes, lack of broadband among marginalized populations severely limits access to these opportunities. 

Efforts to deepen the understanding between broadband access and health outcomes are thriving. In the eight years since the mere concept of broadband connectivity as a social determinant of health was first introduced, it has grown to be recognized as a super determinant of health. 

Efforts to address the gap — by funding broadband and expanding telehealth availability — remain on the rise across the country. Individual households can apply to take part in the FCC’s Affordable Connectivity Program which provides eligible households a $30 monthly discount toward the cost of internet services. The National Broadband Map, which allows individuals to add, correct or file address-specific information/challenges directly with the FCC, generates the data necessary to deliver broadband to underserved communities. 

Integral to their Advancing Broadband Connectivity as a Social Determinant of Health Initiative, the Connect2Health FCC Task Force created the Mapping Broadband Health in America — a platform aimed at enabling users to visualize the intersection of broadband and health data at national, state, and county levels. To date, research has revealed that “internet adoption appears to have an even stronger correlation to health outcomes, even after controlling statistically for other potentially confounding factors, such as education, income, and rurality. 

Photo by riopatuca/
Photo by Somchai Daengngam/

Of the 76,000 homes represented by Northwest ConneCT, roughly two-thirds connect through cable television providers while one-third rely upon DSL over telephone lines, satellite connections, or spotty mobile coverage. As many as 250 customers may share a single cable line that was never designed to handle pandemic level activity.

In the absence of County-wide government, the Goshen-based Northwest Hills Council of Governments serves as Northwest Connecticut’s regional planning organization — one tasked with meeting the growing needs of 21 rural communities stretching from Salisbury in the very northwest corner to Roxbury at the southernmost border. 

Since 2014, the organization has been providing a forum for local officials to discuss issues of inter-municipal concern — such as the need for updated broadband access.

“Broadband is critical to the health of our communities, and the entire region, which COVID really pointed out,” said Emily Hultquist, assistant director at NHCOG, in a nod to everything from education and employment to healthcare becoming increasingly virtual in the past three years.  

As such, Addressing Broadband Needs in Northwest Connecticut was created in 2020 (on behalf of NHCOG and Northwest ConneCT) as a regional resource, one that deems up-to-date broadband a critical infrastructure as essential as roads and sewers.  

“When there is no way to consistently and easily access [those services], it creates a huge health gap, especially in our rural, aging region,” Hultquist said in a nod to pockets so sparsely populated they remain without broadband service.

Ironically, lack of widespread broadband is an issue that connects all residents of the region — one that, if not imminently addressed, stands to thwart the future of the region and those who live here.  

As to the bottom line? “We want to get that last mile covered,” said Hultquist, as “the health of the region is going to be dependent upon having consistent and excellent access to being online.” 

In our next installment we’ll examine the role of nutrition security — defined as consistent access, availability, and affordability of foods and beverages that not only promote well-being but also prevent disease — in creating healthy communities,  particularly among racial/ethnic minority, lower income, and rural populations.