Millions in US Live in Places Where Doctors Don’t Practice and Telehealth Doesn’t Reach

Introduction to the Issue

Green lights flickered on the wireless router in Barbara Williams’ kitchen. Just one bar lit up — a weak signal connecting her to the world beyond her home in the Alabama Black Belt. Next to the router sat medications, vitamin D pills, and Williams’ blood glucose monitor kit. “I haven’t used that thing in a month or so,” said Williams, 72, waving toward the kit. Diagnosed with diabetes more than six years ago, she has developed nerve pain from neuropathy in both legs.

The Problem of Limited Access

Williams is one of nearly 3 million Americans who live in mostly rural counties that lack both health care and reliable high-speed internet, according to an analysis by KFF Health News, which showed that these people tend to live sicker and die younger than others in America. Compared with those in other regions, patients across the rural South, Appalachia, and remote West are most often unable to make a video call to their doctor or log into their patient portals. Both are essential ways to participate in the U.S. medical system. And Williams is among those who can do neither.

Efforts to Address the Issue

This year, more than $42 billion allocated in the 2021 Infrastructure Investment and Jobs Act is expected to begin flowing to states as part of a national “Internet for All” initiative launched by the Biden administration. But the program faces uncertainty after Commerce Department Secretary Howard Lutnick last week announced a “rigorous review” asserting that the previous administration’s approach was full of “woke mandates.”

Impact of Limited Internet on Healthcare

High rates of chronic illness and historical inequities are hallmarks of many of the more than 200 U.S. counties with poor services that KFF Health News identified. Dozens of doctors, academics, and advocates interviewed for this article unanimously agreed that limited internet service hinders medical care and access. Without fast, reliable broadband, “all we’re going to do is widen health care disparities within telemedicine,” said Rashmi Mullur, an endocrinologist and chief of telehealth at VA Greater Los Angeles. Patients with diabetes who also use telemedicine are more likely to get care and control their blood sugar, Mullur found.

Personal Stories of Struggle

Williams, who sees a nurse practitioner at the county hospital in the next town, said she is not interested in using remote patient monitoring or video calls. “I know how my sugar affects me,” Williams said. “I get a headache if it’s too high.” She gets weaker when it’s down, she said, and always carries snacks like crackers or peppermints. Williams said she could even drink a soda pop — orange, grape — when her sugar is low but would not drink one when she felt it was high because she would get “kind of goozie-woozy.”

‘This Is America’

Connectivity dead zones persist in American life despite at least $115 billion lawmakers have thrown toward fixing the inequities. Federal broadband efforts are fragmented and overlapping, with more than 133 funding programs administered by 15 agencies, according to a 2023 federal report. “This is America. It’s not supposed to be this way,” said Karthik Ganesh, chief executive of Tampa, Florida-based OnMed, a telehealth company that in September installed a walk-in booth at the Boligee Community Center about 10 minutes from Williams’ home.

Digital Haves vs. Have-Nots

Just over half of homes in Greene County have access to reliable high-speed internet — among the lowest rates in the nation. Greene County also has some of the country’s poorest residents, with a median household income of about $31,500. Average life expectancy is less than 72 years, below the national average. By contrast, the KFF Health News analysis found that counties with the highest rates of internet access and health care providers correlated with higher life expectancy, less chronic disease, and key lifestyle factors such as higher incomes and education levels.

Paying More for Less

Rural residents like Williams paid nearly $13 more a month on average in late 2020 for slow internet connections than those in urban areas, according to Brian Whitacre, an agricultural economics professor at Oklahoma State University. “You’re more likely to have competition in an urban area,” Whitacre said. In rural Alabama, cellphone and internet options are limited. Williams pays $51.28 a month to her wireless provider, Ring Planet, which did not respond to calls and emails.

‘That Hurt’

Over a lunch of tortilla chips with the savory sauce that had been simmering on the stove, Williams said she hadn’t been getting regular checkups before her diabetes diagnosis. “To tell you the truth, if I can get up and move and nothing is bothering me, I don’t go to the doctor,” Williams said. “I’m just being honest.” Years ago, Williams recalled, “my head was hurting me so bad I had to just lay down. I couldn’t stand up, walk, or nothing. I’d get so dizzy.”

Conclusion

The lack of access to healthcare and reliable internet in rural areas of the US is a pressing issue that affects millions of Americans, leading to poorer health outcomes and reduced life expectancy. Efforts to address this issue, such as the “Internet for All” initiative, are crucial but face challenges and uncertainties. It is essential to prioritize the needs of these communities and work towards providing them with the necessary resources and infrastructure to access quality healthcare and high-speed internet.

FAQs

1. What is the main issue faced by rural areas in the US?
   The main issue faced by rural areas in the US is the lack of access to healthcare and reliable internet, leading to poorer health outcomes and reduced life expectancy.
2. How many Americans are affected by this issue?
   Nearly 3 million Americans live in mostly rural counties that lack both health care and reliable high-speed internet.
3. What is being done to address this issue?
   The Biden administration has launched a national “Internet for All” initiative, which includes allocating over $42 billion to states to improve internet access.
4. What are the challenges faced by this initiative?
   The initiative faces uncertainty after Commerce Department Secretary Howard Lutnick announced a “rigorous review” asserting that the previous administration’s approach was full of “woke mandates.”
5. How does limited internet access affect healthcare?
   Limited internet access hinders medical care and access, making it difficult for patients to participate in telemedicine and access necessary healthcare services.