When coronavirus caused over 1.5 million people in Ohio to file for unemployment benefits, many did not have a computer or access to the internet in order to apply for benefits. “Several residents came to my house to have me walk them through getting unemployment because they didn’t have a computer, and they didn’t know how to use the internet,” said Jones Home Neighbor Association President Rodney Lewallen. With people in need of internet access to stay afloat and receive necessary benefits during the pandemic, Lewallen allowed his Clark Fulton neighbors in Cleveland, Ohio to use his internet connection and computer to apply for the benefits that would keep them afloat.
Lewallen was unsurprised at the need to provide this service, because in Cleveland, 27.4% of households do not have any home Internet or mobile data plans, and up to 50% of households lack broadband internet access. Having previously developed a rapport with many community residents who did not have access to the internet while he was working at the local library, Rodney is now helping these residents access subsidized, low-cost, high speed broadband internet for $10 a month through a multi-partner Digital Connectivity initiative convened by The MetroHealth System.
One of the challenges of our current digital infrastructure system is that it is oriented primarily around profit maximization. In places deemed unprofitable by the small oligopoly of large telecommunications corporations, tens of millions of people are left without high speed internet access. Even where modern digital infrastructure exists, it is often not affordable to large swaths of our population. These problems create a digital divide between the internet haves and the internet have nots.
Unsurprisingly, in this digital divide the data shows that the have nots are often the same people that face other staggering inequalities in healthcare throughout America. That is, predominantly communities of color, low income communities, and rural communities. One in five White people don’t have high-speed internet at home, but for Black people the ratio is roughly one in three, and only one in 2.5 for Latinx people. Similarly, non-metropolitan households are 11% less likely to have broadband than their metropolitan neighbors, and 65% of households that make under $25,000 have access to broadband internet, compared to over 93% of households that make $50,000 a year or more.
Access to the Internet, and knowledge of how to use it, are critical components of one’s ability to find a job and to work many professions in the modern economy (to say nothing of today’s COVID-19 world). And employment is critically important to ensuring one’s health, especially when it can mean the difference between having health insurance or being uninsured during a global pandemic; the difference in being able to afford healthy, nutritious food or only being able to afford fast food; and the difference in one’s ability to access high-quality housing or to live in moldy, lead filled homes or go homeless. Moreover, in many communities — especially smaller towns and rural areas — affordable high speed internet access is critical to attracting and retaining businesses. It is therefore no surprise that equitable internet access is a growing concern amongst health systems in the United States.
The internet also provides access to healthcare providers and telemedicine, educational programs, and information on social services when, either due to COVID-19 or regular market forces, many physical locations for medical offices, schools and universities, and community service providers are shut down. Internet service can be a necessity in order to pay your bills on time (especially when the Post Office is facing unprecedented backlogs due to political interference and privatization efforts), to participate in workforce development trainings and complete certifications if you were laid off and need to change career paths or build a new skill set, to access bus or public transportation schedules when services are irregular, and to order groceries safely via pickup or delivery if you are high risk for catching COVID-19. The internet is, like electricity and indoor plumbing, an essential part of life and being able to participate in our economy.
In order to address the digital divide, some health systems are taking the internet or technological devices to the households that need it the most in their communities.
In Cleveland, over a fourth of all households do not have access to internet or mobile data at home, as many as half of all households lack broadband internet access. In 2019, HAN member The MetroHealth System, made a commitment to addressing this deep digital divide in Cleveland, acknowledging that digital connectivity is necessary to create good health and equity in MetroHealth’s local community. Leading the project, MetroHealth’s Institute for H.O.P.E.™ is convening DigitalC, Dollar Bank, AT&T, and a plurality of community partners, to work to connect up to a thousand households to low-cost, reliable, broadband internet, and to provide households with devices to connect to these internet services. MetroHealth has worked with DigitalC to place two internet antennas to help provide coverage for nearby neighborhoods so far, including one on MetroHealth’s main campus hospital towers, and hopes to place more antennas on other MetroHealth buildings throughout Cleveland. For around $20 a month, residents in the Greater Clark Fulton neighborhood can receive access to this internet, and with a grant from Dollar Bank, qualifying low income residents are eligible for further subsidies to reduce this price to $10/month.
“I already see that [this service] is going to make a big impact with education, but also job searching, applying for jobs, making resumes, and social service agencies. Instead of having to go to the library to use these services, these residents can now do this from the comfort of their own home. Also with teenagers who are having to use a computer more and more often, they can do their homework at home. The other thing too is that many of the seniors and people who are unemployed need to get their child support payments online or they have to get their unemployment benefits online from the Ohio Bureau of Workers’ Compensation and the Ohio Department of Job and Family Services. And seniors, in fact, are really excited about it because it’s allowing them to connect with their family members who they cannot get a hold of or see in person because of COVID, that’s huge.” – Jones Home Neighborhood Association President Rodney Lewallen
Additionally, The MetroHealth System is using technology to connect patients to social care providers to address concerns such as food insecurity. By convening the Unite Ohio network and integrating the Unite Us platform into MetroHealth’s Electronic Health Records (EHRs), MetroHealth’s team can directly connect patients to social services they need to address the social determinants of health. This Unite Ohio platform, which is provided for free to local community partner organizations, allows for health care and social service providers to track patients, complete closed-loop communications, and provide them with wrap-around services that they may not have otherwise been able to find or access due to lack of internet access.
At HAN member Geisinger Health System, the digital divide has been a challenge for the northern portion of Montour County, Pennsylvania which historically has been under or unserved due to their rural location and challenging terrain for standard broadband infrastructure. Geisinger provided a $300,000 interest-free loan in 2018 to Driving Real Innovation for a Vibrant Economy (DRIVE) to help the organization develop and build high speed broadband infrastructure for Montour county’s population. The health system has allowed DRIVE to install microwave internet distribution technology on Geisinger’s Hospital for Advanced Medicine and USG in Washingtonville, and the initial loan provided funds for DRIVE to set up three other distribution sites, which are now up and running, and provide internet services in homes throughout Montour county and nearby areas. As COVID-19 has exacerbated the county’s need for the internet, Geisinger has also invested funds and employees’ efforts into continued work to help put technology in the hands of people that don’t already have it in their homes, including providing tablets to senior citizens.
Other health systems are getting creative and finding ways to adapt to provide resources and care for patients and community members who are disadvantaged by the digital divide.
At HAN member Rush University System for Health, addressing the digital divide is a component of their anchor mission hiring strategy. Rush identified a multitude of challenges COVID-19 has placed on unemployed community residents due to a shift towards digital reliance in a community in which the digital divide is a very present concern. Rush developed a multi-faceted approach to help this group find employment and services acknowledging the specific details of their population’s needs and minimal access to computers. With COVID-19 reducing the ability of the health system to host in person hiring training and interviews, Rush has taken advantage of the increase in usage of social media to address the decrease in local applicants. Within their community Rush has found that although portions of Rush’s local community may not have access to the in person recruiting events or to a computer to fill out applications, they saw opportunity in the fact that many do still have access to a phone as seen by an increase in usage of social media during the pandemic.
Taking advantage of this confluence of community members on social media, Rush partnered with YWCA on Facebook Live, and Skills for Chicagoland’s Future on Instagram Live, to disseminate information on how to be competitive in today’s job market, as well as resources such as information on how to participate in and prepare for employment opportunities at Rush. Additionally, Rush has used technology to spread their reach for local hiring by collaborating with their community partners who are still able to work with community members in person to share this information as well. Once connected with local community members, even if an appropriate position is not available for the applicant at Rush University System for Health, the health system is helping to address the digital divide’s impact on the job search by helping applicants find a job with one of their partners like UPS that may best fit the desires and needs of the candidate.
At HAN member UVA Health, bridging the digital divide is critical to providing health care. In order to facilitate telehealth activities UVA Health is partnering with social service providers and locations with vulnerable, at-risk populations to provide these populations with the opportunity to utilize UVA Health’s telehealth clinics. In one of these partnerships, UVA Health is working with the Virginia Department of Corrections to provide telehealth services to those within the prison system, noting that incarcerated individuals are highly at risk for COVID-19. Additionally, UVA Health has worked with hotels to provide people experiencing homelessness a device and access to the internet for these individuals to participate in telehealth appointments. Similarly, UVA Health has partnered with clinics for people experiencing homelessness to provide access to telehealth appointments from the clinic.
To address the rural digital divide, UVA Health is also active in advocacy efforts to install broadband infrastructure in rural Virginian communities. To further ensure patients are cared for without concerns for being able to connect virtually with providers, UVA Health has also initiated a program to send patients who have been hospitalized with COVID-19 home with an iPad loaded with a health platform called Locus that allows the patient to directly monitor their own health and digitally connect that information with their UVA Health providers. This also allows patients at home direct access to communicating with their physicians.
These HAN member hospitals and health systems are working to ensure digital equity and necessary healthcare services are available to vulnerable populations. Beyond delivering immediate health benefits, this crucial work starts to address some of the social determinants of health by connecting community members with the tools they need to succeed economically.
Health systems are not alone in anchor institution efforts to address the digital divide. Higher education systems like the University of Missouri System are also working on this issue to ensure access to equitable education and economic prosperity for all. The University of Missouri System Broadband Initiative is advising communities across Missouri to help them create action plans for implementing broadband access and connect to resources to make their plan feasible.
Thomas M. Hanna, Research Director at The Democracy Collaborative, urges that “it is time to stop treating high-speed internet like a luxury commodity and instead consider it public infrastructure. And as with other infrastructure, this means taking it out of the hands of corporations and putting it under democratic and public control.” In his report “Democratic Digital Infrastructure,” which focuses on this need to restructure the ownership of internet services and infrastructure, Hanna emphasizes that bridging the digital divide is critical to creating equity for all. “Connectivity is a basic need that should be met free at the point of use for all, with the foundational goods and services we all need to participate fully in society made universally accessible.”
The process of democratizing ownership and control of internet infrastructure is not just possible, but in many cases a proven successful strategy. Hanna’s report details localities such as Chattanooga, Tennessee and the city of Hull in the United Kingdom who have successfully developed publicly owned full fiber optic broadband internet.
In the meantime, HAN members and anchor institutions are helping to make sure that their communities are getting the access to and care from digital infrastructures necessary to uplift their vulnerable populations.