Health Affairs posted a report on digital inclusion and health equity. Here are the key points…

• Digital inclusion is considered a super social determinant of health and rests on four pillars: available and affordable broadband service, quality devices, digital skills and training, and technical support for using accessible applications.
• Evidence suggests two pathways through which digital inclusion and health equity are connected. The direct pathway is through increasing access to health care services. This brief focuses on the indirect pathway, through which people can use the internet to address health-related social needs such as education, employment, and social This pathway is strongly influenced by neighborhood characteristics, where historic patterns of neighborhood racial and socioeconomic segregation influence both the availability of high-quality, affordable internet services and the availability of health-supporting social resources, such as good schools and jobs.
• To date, the internet has mostly benefitted people who already had more education and income. Because of residential sorting by education and income, federal funding that prioritizes rural broadband expansion over affordability and skills training for urban and low-income populations contributes to unequal internet benefits for members of racial and ethnic minority groups compared with White people.
• To support digital inclusion and improve health equity, broad policy and structural reforms are needed to eliminate geographically based segregation by race and income and create conditions for people and communities to use the internet to thrive. The health sector can contribute through advocacy, outreach, digital health skill training, and data analytics.

The emphasis above is mine, because it calls out rural broadband and that is a focal point of the blog. Here’s part of what they say about that rural/urban comparison…

Most federal broadband funding has focused on closing rural versus urban availability disparities, compensating for the high cost of connecting rural homes. Reports showing persistent gaps for tribal, rural, and some low-income urban areas refute FCC reports issued before 2024 noting that most locations can access broadband service.

Prepandemic, 75 percent of households without internet subscriptions were located in and around cities, with lower subscription rates in central cities and low-income suburbs than elsewhere in metropolitan areas. Notably, 46.7 percent of Black people live in central cities compared with 25.0 percent of White people. Regardless of income, majority Black and Hispanic neighborhoods across 905 cities had lower subscription rates compared with majority White or Asian neighborhoods. In rural Southern counties with 35 percent or more Black residents, limited or costly internet service resulted in lower subscription rates for Black compared with White residents. Home and mobile internet speeds are slower and of poorer quality in rural areas with higher concentrations of Black and Brown people and lower median income levels.

A recommendation to intentionally compare those areas…

A stronger digital equity lens must be applied to federal broadband policies and funding. Independent researchers should be engaged to assess intervention results, including claims that rural broadband investments are racially discriminatory. Broadband Equity, Access, and Deployment Program funds slotted for further rural broadband deployment should be matched with commensurate resources benefitting urban and minority populations.

They seem to pit rural access with urban usage. It shines a light on a positive aspect of federal BEAD funding, which strives to address both access and use and gives more agency to States to make investment decisions.