By Edgar Camero
Lack of broadband connection has widened the digital divide and further exacerbated health inequities in rural communities. The term digital divide describes the gap between people or communities that have access to affordable and reliable broadband connections and those that do not. As defined by the Federal Communications Commission (FCC), “broadband connection is a service that has a download speed of 25 Mbps, upload speeds of at least 3 Mbps, and is delivered by a fixed ground-based system.” In practice, this means an internet connection that is fast and reliable and that facilitates access to remote education, employment, and health care opportunities that are essential for health and well-being, which is especially important in rural communities where a higher proportion of residents live a significant distance from institutions and services.
Based on the FCC’s definition, only 61.9% of rural households have broadband connection (which includes cable, fiber optic, and DSL), compared with 77.6% of non-rural households. In fact, 2.7 million households in rural communities have no internet subscription at all. Further, studies show that rural residents who lack access to broadband are more likely to have low income and live in Black, Indigenous, People of Color (BIPOC) households. For example, a Brookings Institute report shows that on average, 40% of individuals making less than $25,000 had no access to high-speed broadband. In addition, a greater proportion of American Indian (34%), Black (31%), and Hispanic (31%) rural households with children lack access to broadband in comparison with 21% of white rural households with children. Inequitable access to broadband contributes to unjust health disparities and denies some individuals in rural communities equal opportunities to participate in remote learning, employment, medical appointments, and other health-promoting services and activities.
When considering solutions to improve broadband access, changemakers should consider how broadband-related systemic inequities affect individuals of different races, classes, and abilities. Similar to solutions to the housing and water access issues that rural communities are facing, strategies to close the digital divide must be community-specific. However, two strategies that can help facilitate access to reliable broadband connections in many rural communities are access to capital and flexible state laws and policies to enable locally tailored solutions. In the end, improving broadband connection has the potential to improve the quality of life and health of all individuals in rural communities.
The Connection Between Broadband & Public Health
Access to broadband is a central tool that connects and influences many social determinants of health (SDoH). SDoH are the conditions in the places where people live, learn, work, and play that affect the risks and outcomes related to an individual’s health and quality of life. In fact, broadband connection is a super determinant of health because it influences whether individuals can access various SDoH that affect an individual’s health outcomes. For example, broadband connection can facilitate access to clinical care, improve educational opportunities for all students, and stimulate economic development. Therefore, broadband connection is a foundational tool for creating healthier communities and prosperity for all.
Broadband & Health Services
Rural communities already face a range of barriers to accessing health care services due to provider shortages, hospital closures, and long travel times. For example, less than 11% of US physicians practice in rural communities, and the rate of hospital closures continues to grow. In 1990, telehealth began to address these concerns and make health care services and resources more accessible to rural communities. However, data from the US Census Bureau showed that in 2015, a smaller proportion of rural residents engaged with telehealth services and resources, compared with urban residents. Disparities in telehealth usage can be explained by differences in internet access; for example, in 2021, approximately 20% of households in rural communities had no internet subscription (compared with 12% of urban households). Thus, broadband access could help reduce health inequities in rural communities by effectively and equitably expanding telehealth services.
Broadband & Education
Broadband is no longer just a luxury. Access to broadband is a foundational element that is needed to support students of all ages and abilities. In fact, broadband is a tool that contributes to educational outcomes, which in turn are linked to health outcomes. For example, a 2015 study showed that people with low income and education levels were 46–76% more likely to die from cardiovascular disease than those with high levels of income and education. For students in rural communities, connectivity is needed beyond the classroom. Access to broadband provides students with the opportunity to build skills in digital technology and provides an entry point for expanding their knowledge outside of the classroom. During the pandemic, 69% of the students living in rural communities had poor or extremely poor access to broadband connection. Access to broadband can promote tech-based learning and exploration for students in rural communities and thus is an investment in their future and the future of their communities.
Broadband & Economic Stability
Broadband infrastructure can stimulate economic opportunities by increasing economic stability and catalyzing economic development. Economic stability is the ability of an individual to participate in and contribute fully to their economy. Economic stability can improve the overall health of a population by affecting the social and psychological conditions that rural residents experience. For example, economic stability can increase the number of rural residents who have access to healthier food choices and housing quality options. And economic stability can decrease the amount of stress that low-income residents experience, leading to the decreased rates of stress-induced health conditions such as heart disease, depression, and gastrointestinal diseases. In addition, broadband access and adoption are essential in facilitating economic development in rural communities. Broadband access and adoption have been shown to catalyze economic development by increasing median income, expanding the local labor market, and decreasing unemployment. Investing in broadband infrastructure is a commitment to promoting healthier, more equitable rural communities by increasing economic stability and development.
Obstacles Affecting Broadband Infrastructure Improvements
The fundamental drivers of health inequity are the laws and policies that have widened health disparities by concentrating the distribution of money, power, and resources away from rural communities. Applying this framework to the issue of broadband access, laws and policies have affected rural communities by restricting or limiting investment for broadband infrastructure improvements or upgrades. In addition, laws and policies have reduced competition within the broadband market, which has disincentivized improvements to broadband infrastructure. Disinvestment and state-level policies that reduce competition are two factors that deepen the digital divide and thereby perpetuate inequities in education, employment, and health care opportunities, leading to negative health outcomes. However, as further described later in this article, new laws and policies can also be part of solutions to key challenges.
How Access to Capital Limits Improvements to Broadband Infrastructure
Increased and dedicated access to capital for broadband infrastructure in rural communities is needed to incentivize public and private internet service providers (ISPs) to improve and upgrade their broadband services. Although ISPs can be locally owned, many ISPs in rural communities are large telecommunications network providers. Historically, federal and state governments have dedicated little or no funding to rural communities for broadband infrastructure. This disinvestment has contributed to the inability of rural communities to maintain or upgrade their broadband infrastructure. And because investment has fallen behind, rural communities have suffered from the absence of quality broadband connections, directly and indirectly affecting the lives of rural residents. Areas without broadband are correlated with rural communities that have high rates of poverty, low homeownership rates, and low educational attainment. In addition, disinvestment has affected the local economy by limiting economic development, which has contributed to declines in population, local revenue, and workforce opportunities.
State-Level Legal Barriers to Municipal Broadband Infrastructure
Preemption is an additional barrier to broadband expansion in rural areas. Preemption occurs when a higher level of government limits or even eliminates the power of a lower level of government to regulate a specific issue. As of May 2023, 18 states have laws that restrict or prohibit the establishment or operation of a municipal broadband network. Municipal broadband is a network that is built and operated by a public entity, such as a local government, or through a public-private partnership. As of 2021, there were more than 600 forms of municipal networks that serve more than 900 communities in the United States. Despite support from local leaders and community members who have advocated for municipal networks in rural communities, states have maintained or enacted legal barriers that make municipal network services difficult or impossible to establish. Barriers range from outright bans on municipal networks, to financial or regulatory requirements that make the establishment of such networks prohibitively expensive. These state laws are often enacted in response to lobbying from large telecommunications companies with the sole purpose of limiting competition in the private broadband market. Consequently, 45% of households have only a single broadband provider that offers 25 Mbps download and 3 Mbps upload speeds. By limiting competition from public ISPs, states are disincentivizing private ISPs from improving their broadband connection, which contributes to the unreliable and unaffordable broadband connections available in rural communities. States can promote access to broadband and improve the quality of existing broadband connections in rural areas by repealing laws that limit or prohibit municipal broadband or by passing legislation that promotes municipal broadband. For example, in 2022, Maine and New York enacted bills that created new funding streams for the establishment of municipal broadband networks.
Community Spotlight on Broadband Connection
While many rural communities are experiencing broadband connection issues, a number of rural communities are showing that fast, affordable internet is possible. One great example is Greenlight, North Carolina’s first community-owned fiber-to-home network, located in the small rural city of Wilson. Greenlight is a municipal network that is operated by the City of Wilson. Greenlight demonstrates how municipal networks can provide reliable broadband and enhance the lives of residents and the local economy. For instance, to ensure equitable access to broadband, Greenlight provides low-cost internet services to residents living in public housing as well as providing 100 Mbps speeds to all after-school programs, libraries, and community centers. In addition, Greenlight has expanded its broadband service into other rural communities, including Pinetops and Vick Family Farms. And to support economic development efforts in Wilson, Greenlight staff offered a 10-week “Fiber Optics Basics” course that provided hands-on training to local residents, aiming to build a strong and economically resilient workforce. Greenlight is an example of how municipal networks can provide reliable access to broadband in support of their local economy.
How Dedicated Investment is Improving Broadband Access for All
Federal grants and programs play a critical role in addressing the digital divide in rural communities. Previous federal grants and programs for broadband infrastructure have been ineffective because some have lacked enforcement mechanisms, failed to prioritize funding to rural communities, or had overly restrictive eligibility criteria. Current programs such as the ReConnect loan and grant program have been successful because the funding is dedicated to rural communities and some application requirements have been lifted to allow for more participation. In addition, programs such as the Tribal Broadband Connectivity Program and the Rural Health Care Program have been even more focused on addressing local community needs. The Tribal Broadband Connectivity Program dedicates funding for broadband implementation for tribal nations, and the Rural Health Care Program provides funding to eligible health care providers to improve broadband services and the quality of health care available for rural residents. Lastly, the Broadband, Equity, Access and Deployment (BEAD) program provides $42 billion dollars in grant funding to plan, deploy, map, and adopt broadband. The BEAD program maintains equity at the core of the program by prioritizing “unserved and underserved areas” and ensuring collaboration between state, local, and tribal entities; community organizations; and others. In 2022, Louisiana received $2.9 million to provide affordable and reliable high-speed internet for all residents. These dedicated investment streams have been successful thus far but must continue to address the digital divide and improve the quality of life for all rural communities.
This blog post is the fourth in our Toward Better Rural Futures series, which highlights the unique assets of rural communities as well as the challenges they face. Access our collection of resources for rural policymaking to read the other installments in the series.
This blog series is part of the Toward Better Rural Futures project, which participates in the Aspen Institute’s Thrive Rural Initiative and is funded by the Robert Wood Johnson Foundation. Toward Better Rural Futures aims to foster greater collaboration and alignment across local, regional, and state levels of government, equipping leaders with the tools and knowledge to fundamentally shift power, opportunity, and resources in order to create healthy rural places where everyone can thrive.
Cover image: US Department of Agriculture