Report: The “Double Burden” of Chronic Conditions, Poor Broadband Access

A recently released study from the Federal Communications Commission (FCC) is shedding new light on health care disparities in the United States—specifically, between patients residing in rural and urban counties when it comes to the prevalence of chronic disease. As Health Data Management and others first reported, the report, Mapping Broadband Health in America, from the FCC’s Connect2Health initiative found an increase in the number of Americans residing in so-called “double burden” counties, where people experience both limited access to high-quality broadband Internet and significant prevalence of chronic disease. “The picture of health remains vastly different in connected communities and digitally isolated communities,” the researchers explained. “This holds true across access to care, quality of care and health outcome metrics.”

The report, which was prepared with the help of the Robert Wood Johnson Foundation, notes that “the least connected counties generally have the highest rates of chronic disease.” Such counties—which the researchers classify as those where 60 percent of households do not have access to broadband, and where more than 60 percent of residents do not have basic Internet in their homes—tend to have obesity rates that are 25 percent higher than those that are better connected, along with 41 percent higher rates of diabetes. Also common in these “double burden” counties: limited access to primary care physicians, and higher rates of preventable hospitalizations than their better-connected counterparts. Throughout the country, Connect2Health researchers estimated, more than 36 million people live in these counties, many of which are located in “clusters of five or more.” Notably, they also identified an increase in the “rural/urban gap” in recent years; between 2014 and 2015, for example, the number of Americans living in double burden counties increased by about one million. What’s more, conditions in many of those counties have worsened—almost 45 percent of what the researchers deem “critical need” counties, with fewer than 50 percent of households having broadband access and higher-than-average diabetes and obesity rates, saw these metrics deteriorate in the past year. The high closure rate of rural hospitals is one potential explanation for these changes.

The report’s findings echo recent statements from the American Medical Informatics Association (AMIA), the American Telemedicine Association (ATA), and other organizations that had urged the FCC to prioritize the expansion of broadband access as a way of addressing health care disparities. As we noted at the time, AMIA encouraged the agency in a letter to consider broadband access “a social determinant of health,” given its importance to telehealth and other mobile health technologies, as they craft broadband policy. While studies have shown that telehealth and mHealth have tremendous potential when it comes to treating and preventing chronic health conditions, high-quality broadband infrastructure is (of course) crucial to bringing the technologies to patients who need them. For their part, Connect2Health staff sounded an optimistic note about the work ahead of them. As Mignon Clyburn, one of the FCC commissioners, told Health Data Management: “Armed with the robust input from stakeholders across the country along with the data and information that is pouring into the Commission in response to the recent Connect2Health Public Notice, the Task Force staff are working to make recommendations to the Commission about how best to architect broadband health policy to meet the needs of rural and underserved Americans.”

Click here to read the Health Data Management article on the FCC report.

Click here for key findings from the FCC report. 

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