Combating digital redlining is imperative for advancing health equity, say researchers

Broadband plays a critical role in most aspects of modern-day life, yet over 42 million Americans still lack access to high-speed Internet. This digital divide is driven by "digital redlining"—discriminatory disinvestment in broadband infrastructure that disproportionately affects people of color, low-income communities, and rural populations, worsening disparities in access to health care, social services, education, and employment for these populations.

Addressing digital redlining and the digital divide is imperative for advancing health equity, write three Boston University School of Public Health researchers in a new commentary published in JAMA.

"Digital redlining drives and widens existing disparities in access to health care, education, employment, and social services," write Dr. Monica Wang, associate professor of community health sciences; Dr. Cristina Gago, assistant professor of community health sciences; and Master of Public Health student and Dean's Scholar Kate Rodriguez.

This deliberate underinvestment by Internet companies in marginalized communities refers to practices such as tier flattening—charging those with slow or nonexistent internet the same rates as those with better access—as well as lack of availability of online delivery services based on neighborhood income, race, or rurality. As a result, affected communities experience limited access to telehealth or other online health services and, thus, are unable to reliably obtain important health information and other services they need.

"The Internet is a basic utility, yet the historic systems designed to prevent marginalized communities from accessing home loans are limiting access to broadband today," Rodriguez says.

Ending this discriminatory practice requires a comprehensive strategy involving health care systems, research initiatives, public outreach, and policymakers, the authors write.

Central to this effort is the need to standardize social determinants of health (SDOH) screenings to include questions about broadband and digital device access. Health care providers conduct these screenings to identify and provide support to patients experiencing issues such as unstable housing or food insecurity, but screening tools for digital access remain underutilized.

"With patients relying on the Internet to connect with critical health information, medical care, and social services, screening for digital access is urgently necessary. Amidst striking inequities in access, we can't assume every patient has the tools they need to identify and connect with resources," says Dr. Gago.

Incorporating broadband access questions into SDOH screenings will not only identify people and support patients lacking these resources, it will also provide necessary data to better inform research efforts that can continue to identify and document these communities most in need.

"By including broadband and device access in coordinated screening efforts, data can be aggregated to systematically identify patterns at the local, state, and national levels, enabling researchers to tailor interventions and identify policies that address diverse needs," the authors write.

As the Biden administration ambitiously aims to achieve universal broadband access by 2030 with a $42 billion pledge, the researchers urge continued public awareness about digital redlining, as well as outreach about the financial and educational digital resources currently available to people who fall into this digital access gap—such as the federal Affordable Connectivity Program, which provides $30–$75 broadband discounts to eligible low-income households.

"Digital redlining is a modern manifestation of historical injustices that perpetuates unequal access to essential resources. Integrating broadband questions into health screenings and advocating for policies to bridge the digital divide are crucial to optimize health and well-being for all," Dr. Wang says.