Digital divide increases impact on health care in rural Georgia and South, new study reveals – The Current

Telehealth has seen a surge in popularity in recent years, thanks in part to the COVID-19 pandemic; however, a recent study published by in Mayo Clinic Proceedings: Digital Health shows that there is a large gap between rural and underserved communities and other parts of the country in access to high-speed internet, making it difficult for people living in those areas to access health care services online.

It’s a problem compounded by the fact that rural and underserved communities also tend to have less access to regular health care and are at higher risk for many diseases and other health conditions.

The study had Neil J. MacKinnon, PhD, executive vice president for academic affairs and president of Augusta University, as senior author along with first author Diego Cuadros, PhD, a research scientist and University of Cincinnati epidemiologist. The team also included researchers from the University of Washington, the University of Hawaii and Hoakkaido University in Japan.

Telemedicine has huge merit, but the challenge is that telemedicine assumes that a person has access to high-speed internet. If someone doesn’t have that access, he can create difficulties for both patients and doctors. This study shows that due to the digital desert concept, the technology divide could indeed have health consequences by contributing to a greater health gap in the country, MacKinnon said.

The team conducted a county-level data visualization and spatial analysis of more than 3,100 counties in the contiguous United States to assess the geospatial association between digital wastelands without broadband Internet and three measures of health care and social vulnerability. The study highlighted disparities in access to digital technology that could widen the gap in access to healthcare.

Maps showing broadband access and healthcare systems in the United States
Figure 1. Spatial distribution of the variables included in the study, broadband access, resource-limited healthcare system index (RCHSI), healthcare accessibility barriers index (HABI), and social vulnerability index (SVI). A high RCHSI or HABI value indicates weak health system capacity, while a low value indicates a strong county health system. Similarly, a high SVI value indicates a more vulnerable community.

We’ve identified parts of the country that have poor access to high-speed internet and attempted to determine if there’s a relationship between that and three different indices, two related to the type of health care available and one based on social vulnerability, MacKinnon said.

We found that there is a strong relationship between parts of the country in digital deserts that also have limited access to regular healthcare and are at high risk for many health problems. Through this analysis, we have been able to divide the country into four clusters. Cluster 1 is concerning because that’s where people lack access to high-speed internet and are most at risk for health factors with less access to regular healthcare, and that’s where we find most of Georgia, plus some Atlanta and a few other select counties.

Maps and graphs showing broadband Internet access in the United States
Figure 2. A, Bivariate spatial associations between broadband access and resource-limited healthcare system index (RCHSI), healthcare accessibility barriers index (HABI), and social vulnerability index (SVI) . Dark green areas indicate counties with low broadband access and high index associations. B, Multivariate clustering analysis including all 4 variables, with dark purple areas (cluster 1) indicating counties with low broadband access and high values ​​for all 3 indices. A high RCHSI or HABI value indicates weak health system capacity, while a low value indicates a strong county health system. Similarly, a high SVI value indicates a more vulnerable community.

Unsurprisingly, much of the rural southern United States, which stretches from Texas down to North Carolina, is in Cluster 1. This is where high-speed broadband Internet access is lowest, but health systems with limited resources they are more focused. There are also numerous barriers to the accessibility of healthcare and high social vulnerability.

The point is, telehealth isn’t going to be helpful for everyone. It will be extremely helpful for people who already have good access to health care, but it won’t be very helpful for those who don’t, Cuadros said. The digital divide is already here. But we will rely even more on these technologies in the future, so the gap will only grow. The pandemic has been a game changer for us. These technologies are here to stay. Here’s how to live many aspects of our lives well, from education to relationships to health care.

Map showing high-speed Internet coverage in the United States
Figure 3. High-speed Internet coverage in the contiguous United States by county. White areas represent counties with broadband coverage of less than 65% of the population. Darker purple areas illustrate counties with greater than 80% broadband coverage.

While the United States is a global telecommunications leader, according to a 2023 Statista survey it can’t even decipher a list of the top 20 nations in terms of wireless coverage per capita. Part of that is due to the size in square miles of the United States.

The Biden administration announced in March that it will invest $73 million in outreach grants to provide affordable high-speed Internet to more Americans. The program is designed to address a growing healthcare access gap created during the COVID-19 pandemic, as providers began offering more healthcare services over the web.

Augusta University announced earlier this year that U.S. Representative Buddy Carter has secured $1 million in federal funding to help support the recently established Medical College of Georgia Center for Telehealth.

The funding will support Augusta University’s mission to improve health care access and outcomes for all Georgians, especially those in rural and underserved parts of the state. The center will also train future doctors and prepare them to provide telehealth-related patient care.

We’re not identifying individual patients with this analysis, but it lets you see the power in population health and paints a bigger, higher-level picture, MacKinnon said. If you score lower on these two health indices and then on social vulnerability indices as well, it shows a lot about an area. High-speed internet is no longer just something that’s nice to have, it’s a necessity. You can even go so far as to see how this affects education and how that in turn can affect change and policy.

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