Broadband initiatives for unserved and underserved areas
Broadband is high-speed internet access that is faster than dial-up and ready for use immediately. Broadband speed and bandwidth vary1 but can be measured as download/upload speed in megabits per second (Mbps)2. Broadband transmission technologies include digital subscriber line (DSL), cable modem, fiber, wireless, satellite, and broadband over powerlines (BPL)3. Comprehensive broadband initiatives consider geographic, social, and economic factors to improve broadband infrastructure and increase broadband adoption, including the cost of internet service, devices, and digital literacy skills4. There are many ways for states to increase broadband availability and adoption in unserved and underserved areas, such as grants and loans to internet service providers, nonprofit utility cooperatives, and local governments5. Definitions of unserved and underserved areas vary by state6. In the U.S., approximately 24 million people live in digital deserts without broadband access, including approximately 19 million people in rural areas and 1.4 million people living on Tribal lands7.
What could this strategy improve?
Expected Benefits
Our evidence rating is based on the likelihood of achieving these outcomes:
Increased broadband adoption
Increased labor force participation
Potential Benefits
Our evidence rating is not based on these outcomes, but these benefits may also be possible:
Increased access to care
Increased access to mental health services
Increased financial stability
Improved health outcomes
Improved mental health
Improved well-being
Increased social connectedness
What does the research say about effectiveness? This strategy is rated some evidence.
There is some evidence that broadband initiatives for unserved and underserved areas increase broadband adoption and can increase labor market participation, with larger effects for people living in rural areas8, 9 and for women, especially those with college educations10. Moving to higher speed broadband (100 Mbps) may have a greater positive effect on employment rates than lower speeds8. Additional evidence is needed to confirm effects.
Broadband initiatives for unserved and underserved areas are a suggested strategy to support equitable access to health-promoting services, including telemedicine, online social services, distance education, online groceries, ecommerce, online social support, civic engagement opportunities, and more3, 4, 7, 11. Increased broadband access is associated with improved health outcomes, including reduced rates of smoking and diabetes diagnoses and increased consumption of fruits and vegetables12. Experts suggest broadband access increases access to health care via telemedicine, improves economic stability through opportunities for telework and the ability to search for jobs and file for unemployment benefits, increases food access with online grocery shopping and the ability to see food pantry hours or mobile market schedules, increases social support with videoconferencing opportunities for family, friends, faith groups, and support groups, and increases education providing access to online classes and virtual learning opportunities11. One study associates broadband access with increased telemedicine use in rural counties13. For adults in urban settings, limited neighborhood broadband internet access is associated with lower likelihood of using hospitals’ patient portals14.
Experts suggest broadband access is a super determinant of health7 because disparities in access to broadband exacerbate economic, social, education, and health inequalities3, 4, 11. Surveys identify significant existing disparities in broadband access across the U.S. by age, gender, income, and geography and in overall internet access (which includes dial-up and cell phone access) by race and ethnicity, education, age, gender, and income15. A strong digital divide exists between urban and suburban areas with high incomes and rural and urban areas with low incomes3, 4. The digital divide also appears to include a connectivity gap, where rural users experience lower speed internet connections than more urban users16. Residents of Tribal lands report predominantly using smart phones to access the internet, as well as using public Wi-Fi or by going to a friend or relative’s house17.
A report on broadband access in Wisconsin finds that household income may affect access more than rurality18. Nationally, households earning less than $20,000 have a broadband adoption rate of 62%, lower than the average state broadband adoption rate of 84%. State by state broadband adoption rates vary; states with the lowest adoption also have populations with the lowest median incomes, many communities of color, and high percentages of their populations living in rural areas. In general, the average majority white neighborhood has a broadband adoption rate of almost 84%, while the average majority Black neighborhood has a broadband adoption rate of just over 67%19.
Broadband initiatives can support digital inclusion with efforts to provide low-cost broadband, to promote digital literacy and offer digital software and hardware training at convenient locations for community members, to support the availability of low-cost computers and technical support, and to establish public access computing centers. Providing access to low-cost internet is the necessary first step for increasing adoption and meaningful broadband use in most unserved or underserved communities20. Broadband access initiatives can also include fiber, high-capacity fixed wireless to the home, and affordable high-speed mobile to improve connection options in underserved areas17.
In some areas, internet service may be widely available; however, the affordability of service and devices, device maintenance, and skills for older residents and those with lower incomes remain challenges to meaningful broadband adoption. Discounted internet service plans from private providers may also be underutilized by eligible community members21. Efforts to expand broadband access can be coupled with broadband adoption initiatives to strengthen digital literacy and raise awareness of broadband’s benefits. Experts suggest collaborating with university extension programs, churches, libraries, nonprofits, and other groups with strong on-the-ground networks2. Prioritizing equity and universal access in initiatives can limit the negative effects of competing political, social, and commercial priorities on implementation efforts22.
State-level funding programs have a positive significant impact on general and fiber broadband availability while municipal or cooperative restrictions have a negative impact on availability, in urban and rural areas23. An analysis of state-level policies regulating municipally owned networks finds that such policies may erect significant barriers to entry and recommends public-private partnership in building networks and offering service24. One comparison finds municipally owned networks offering fiber-to-the-home service had lower pricing when the service costs and fees were averaged over four years, compared to private competitors25.
How could this strategy impact health disparities? This strategy is rated likely to decrease disparities.
Implementation Examples
As of 2020, all 50 states have a task force, commission, or other authority to coordinate broadband expansion26. The Purdue Center for Regional Development describes models for broadband expansion, including municipally owned broadband, public-private partnerships, private sector efforts, and co-operative models, each with different costs and benefits2. As of 2021, 17 states have preemption laws or other barriers to municipal broadband; Arkansas and Washington are the most recent states to remove legislative barriers27, 28. The National Association of Counties (NACo) recommends that federal policy promote competition, incentivize modern services to underserved communities and prohibit state preemption of municipal investments and partnerships, including with the private sector, to enable community broadband networks to operate29.
Many states use broadband service maps from the Federal Communications Commission (FCC) to inform broadband expansion efforts30, though additional data is often considered. For example, the FCC’s Mapping Broadband Health in America tool illustrates the intersection of broadband access and health31. As of 2021, a new federal Broadband Data Task Force is charged with updating the FCC broadband data and mapping tools32. The FCC also maintains the Lifeline Program for Low-Income Consumers, which offers eligible households a monthly discount on broadband service and support for first-time connection charges33. Additional funding is available to households on specific Tribal lands33, 34.
Non-profit organizations can support efforts to increase broadband access in underserved areas around the country. For example, in the Greater Cleveland area, DigitalC is working to increase broadband infrastructure in underserved residential areas, provide affordable services and devices, and improve digital literacy among residents addressing basic to intermediate skills for both hardware and software35. Some cities have developed community broadband networks. Chattanooga has a high-speed, community-wide fiber optic network that provides high speed internet access to residents throughout the city36. A study of the network finds its value exceeds the project cost by more than $2.2 billion dollars in terms of economic development, job creation, reduced carbon emissions and more37. Several counties across the country are seeking to expand and improve the quality of broadband access in their communities, for example, Boone County, Kentucky; Elmore County, Alabama; Erie and York Counties, Pennsylvania; Huron County, Michigan; Kitsap County, Washington; Mitchell and Yancey Counties, North Carolina; Mono County, California; and Warren County, New York29.
Minnesota is one of the states at the forefront of innovative broadband development. The Minnesota Office of Broadband Development contracts with an independent organization, Connected Nation38, to develop broadband service maps, including for Tribal areas39. The office also offers resources for digital inclusion, to help with the cost of broadband services and devices40. The state is on track to meet broadband speed goals exceeding the federal standard, and 88% of Minnesotans already have access to 100/20 Mbps41. To further support these efforts, the Minnesota Office of Broadband Development conducts crowd-sourced speed tests42. A recent digital equity community needs assessment for the Minnesota Department of Education recommends funding a digital navigator program at community-based organizations, libraries, and other trusted organizations to provide community members with one-on-one digital literacy instruction43.
The annual Indigenous Connectivity Summit brings together community network managers and operators, Indigenous-owned internet service providers, community members, researchers, policy makers, and leaders to address the need for affordable, high-quality, and sustainable internet access for Alaska Native, American Indian, Inuit, Native Hawaiian, First Nations, and Métis communities44. The National Telecommunications and Information Administration operates the Tribal Broadband Connectivity Program, a $1 billion program to increase broadband access on Tribal lands that supports telehealth, distance learning, broadband affordability, and digital inclusion45.
Implementation Resources
BroadbandUSA-SBLN - BroadbandUSA, National Telecommunications and Information Administration. State Broadband Leaders Network (SBLN) and state broadband programs.
BroadbandUSA-TBCP‡ - BroadbandUSA, National Telecommunications and Information Administration. Tribal Broadband Connectivity Program (TBCP).
Pew-Broadband policy map 2021 - The Pew Charitable trusts (Pew). State broadband policy explorer: Laws governing high-speed internet access. 2021.
NACo-Broadband 2021 - National Association of Counties (NACo). Broadband Task Force: High-speed internet is essential for all counties. July 2021.
NDIA-Digital navigators - National Digital Inclusion Alliance (NDIA). The digital navigator model.
FCC-Lifeline Consumers - Federal Communications Commission (FCC). Consumer Guides. Lifeline support for affordable communications. Last updated/reviewed June 29, 2021.
Purdue-Gallardo 2019 - Gallardo R, St. Germain B. Southeastern Indiana Regional Planning Commission: State of broadband. Purdue Center for Regional Development. 2019.
Footnotes
* Journal subscription may be required for access.
1 FCC-Speed - Federal Communications Commission (FCC). Consumer Guides. Broadband speed guide.
2 Purdue-Gallardo 2019 - Gallardo R, St. Germain B. Southeastern Indiana Regional Planning Commission: State of broadband. Purdue Center for Regional Development. 2019.
3 CRS-Rachfal 2020 - Rachfal CL. State broadband initiatives: Selected state and local approaches as potential models for federal initiatives to address the digital divide. Congressional Research Service (CRS) R46307; 2020.
4 CRS-Kruger 2019 - Kruger LG, Gilroy AA. Broadband internet access and the digital divide: Federal assistance programs. Congressional Research Service (CRS) RL30719; 2019.
5 Pew-Broadband 2019 - Pew Research Center (Pew). How states support broadband projects: Lawmakers use a variety of funding sources and mechanisms to meet expansion goals. 2019:1-6.
6 Pew-Urahn 2020 - Urahn SK, Irwin M, Stauffer A, et al. How states are expanding broadband access. The Pew Charitable Trusts (Pew); 2020.
7 Bauerly 2019 - Bauerly BC, McCord RF, Hulkower R, Pepin D. Broadband access as a public health issue: The role of law in expanding broadband access and connecting underserved communities for better health outcomes. Journal of Law, Medicine and Ethics. 2019;47(2_suppl):39-42.
8 Lobo 2020a - Lobo BJ, Alam MR, Whitacre BE. Broadband speed and unemployment rates: Data and measurement issues. Telecommunications Policy. 2020;44(1):101829.
9 Atasoy 2013 - Atasoy H. The effects of broadband internet expansion on labor market outcomes. Industrial and Labor Relations Review. 2013;66(2):315-345.
10 Dettling 2017 - Dettling LJ. Broadband in the labor market: The impact of residential high-speed internet on married women’s labor force participation. Industrial and Labor Relations Review. 2017;70(2):451-482.
11 Benda 2020 - Benda NC, Veinot TC, Sieck CJ, Ancker JS. Broadband internet access is a social determinant of health! American Journal of Public Health. 2020;110(8):1123-1125.
12 Whitacre 2014 - Whitacre B, Brooks L. Do broadband adoption rates impact a community’s health? Behaviour and Information Technology. 2014;33(7):767-779.
13 Wilcock 2019 - Wilcock AD, Rose S, Busch AB, et al. Association between broadband internet availability and telemedicine use. JAMA Internal Medicine. 2019;179(11):1580-1582.
14 Perzynski 2017 - Perzynski AT, Roach MJ, Shick S, et al. Patient portals and broadband internet inequality. Journal of the American Medical Informatics Association. 2017;24(5):927-932.
15 Greenberg-Worisek 2019 - Greenberg-Worisek AJ, Kurani S, Finney Rutten LJ, et al. Tracking Healthy People 2020 internet, broadband, and mobile device access goals: An update using data from the Health Information National Trends Survey. Journal of Medical Internet Research. 2019;21(6):1-10.
16 Whitacre 2017 - Whitacre BE, Wheeler D, Landgraf C. What can the national broadband map tell us about the health care connectivity gap? Journal of Rural Health. 2017;33(3):284-289.
17 AIPI-Howard 2019 - Morris T, Howard B. Tribal technology assessment: The state of internet service on Tribal Lands. American Indian Policy Institute, Arizona State University; 2019.
18 UW Ext-Conroy 2021 - Conroy T, Deller S, Kures M, et al. Broadband and the Wisconsin economy. University of Wisconsin-Madison Extension. Study Series No. 7. 2021.
19 Brookings-Tomer 2020 - Tomer A, Fishbane L, Siefer A, Ballahan B. Digital prosperity: How broadband can deliver health and equity to all communities. Washington, DC: Metropolitan Policy Program, Brookings Institution; 2020.
20 Benton-Rhinesmith 2016 - Rhinesmith C, Barton A. Digital inclusion and meaningful broadband adoption initiatives. Wilmette, IL: Benton Institute for Broadband & Society; 2016.
21 CTC-Cambridge 2021 - Columbia Telecommunications Corporation (CTC). Digital equity in Cambridge: Data and strategic recommendations. Kensington, MD: CTC Technology & Energy, for the City of Cambridge, MA; March 2021.
22 Freeman 2019 - Freeman T, Fisher M, Baum F, Friel S. Healthy infrastructure: Australian National Broadband Network policy implementation and its importance to health equity. Information Communication and Society. 2019;22(10):1414-1431.
23 Whitacre 2020 - Whitacre B, Gallardo R. State broadband policy: Impacts on availability. Telecommunications Policy. 2020;44(9):102025.
24 Landgraf 2020 - Landgraf SW. Entry threats from municipal broadband Internet and impacts on private provider quality. Information Economics and Policy. 2020;52.
25 Talbot 2018 - Talbot D, Hessekiel K, Kehl D. Community-owned fiber networks: Value leaders in America. SSRN Electronic Journal. 2018.
26 NCSL-State broadband - National Conference of State Legislatures (NCSL). State broadband task forces, commissions or authorities and other broadband resources. Updated June 2020.
27 LawAtlas-State preemption - LawAtlas. State preemption laws in 12 domains.
28 CN-Kienbaum 2021 - Kienbaum K. Preemption detente: Municipal broadband networks face barriers in 19 states. Community Networks (CN). 2019; Updated May 2021.
29 NACo-Broadband 2021 - National Association of Counties (NACo). Broadband Task Force: High-speed internet is essential for all counties. July 2021.
30 FCC-Maps - Federal Communications Commission (FCC). Reports and Research: Maps.
31 FCC-Broadband health - Federal Communications Commission (FCC). FCC Initiatives: Connect2HealthFCC. Mapping Broadband Health in America platform.
32 FCC-Broadband Task Force - Federal Communications Commission (FCC). Broadband Data Task Force.
33 FCC-Lifeline Consumers - Federal Communications Commission (FCC). Consumer Guides. Lifeline support for affordable communications. Last updated/reviewed June 29, 2021.
34 USAC-Tribal lands - Universal Service Administrative Co (USAC). Lifeline support: Additional support for Tribal lands.
35 DigitalC - DigitalC. DigitalC, a non-profit empowering Greater Cleveland to achieve success through technology, innovation, and connected community.
36 CN-Gonsalves 2021 - Community Networks (CN). Study finds Chattanooga fiber networks 10-year ROI: $2.69 billion. Posted by Sean Gonsalves. February 1, 2021.
37 Lobo 2020b - Lobo BJ. Ten years of fiber optic and smart grid infrastructure in Hamilton County, Tennessee. 2020.
38 Connected Nation-Mapping - Connected Nation. What we do for you: Mapping & analysis.
39 MN OBD-Maps - Minnesota Office of Broadband Development (MN OBD). Maps and data.
40 MN OBD-Inclusion - Minnesota Office of Broadband Development (MN OBD). Digital inclusion.
41 MN Broadband Task Force 2020 - Minnesota (MN) Broadband Task Force. Annual report of the Governor’s Task Force on Broadband. 2020.
42 MN OBD-Speed - Minnesota Department of Employment and Economic Development, Office of Broadband Development (OBD). Broadband speed tests.
43 Literacy MN-Digital equity 2020 - Literacy Minnesota (MN). Digital equity community needs assessment report. 2020.
44 IS-Connectivity summit - Internet Society (IS). Indigenous Connectivity Summit 2020.
45 BroadbandUSA-TBCP - BroadbandUSA, National Telecommunications and Information Administration. Tribal Broadband Connectivity Program (TBCP).
Related What Works for Health Strategies
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