A Socio-Ecological Approach to Addressing Digital Redlining in the United States: A Call to Action for Health Equity

Abstract

Physical distancing requirements due to the coronavirus (COVID-19) pandemic has increased the need for broadband internet access. The World Health Organization defines social determinants of health as non-medical factors that impact health outcomes by affecting the conditions in which people are born, grow, work, live, and age. By this definition broadband internet access is a social determinant of health. Digital redlining—the systematic process by which specific groups are deprived of equal access to digital tools such as the internet—creates inequities in access to educational and employment opportunities, as well as healthcare and health information. Although it is known that internet service providers systematically exclude low-income communities from broadband service, little has been done to stop this discriminatory practice. In this paper, we seek to amplify the call to action against the practice of digital redlining in the United States, describe how it contributes to health disparities broadly and within the context of the COVID-19 pandemic, and use a socio-ecological framework to propose short- and long-term actions to address this inequity.

Telebehavioral health at a federally qualified health center pre- and peri-COVID-19.

“…Telehealth options that require data usage (e.g., Zoom) are less accessible to people without broadband. Until broadband internet is offered in more communities, and we overcome the effects of digital redlining (McCall et al, 2022), offering telephone sessions rather than video/internet sessions can increase minoritized people’s access to behavioral health services (Sachs et al, 2021). Finally, our finding that fewer older adults used telehealth compared to in-person services is consistent with both sensory difficulties that may be augmented with telehealth (e.g., difficulties with vision or hearing) and comfort with technology (Seifert et al, 2019).…”

Rural-Urban Disparities in Video Telehealth Use During Rapid Mental Health Care Virtualization Among American Indian/Alaska Native Veterans

“…For rural populations, geographic obstacles coupled with poor economic conditions can create infrastructural barriers that hinder access to regular broadband internet and telephone service and, thus, the adoption of VTH services. Additionally, inequities are further exacerbated 16 by reduced or absent broadband service and higher prices. Federal and local agencies should reduce this digital divide for already marginalized populations through policies and programs promoting increased broadband coverage.…”

Telehealth and pediatric care: policy to optimize access, outcomes, and equity

“…At the same time, designing applications with minimal bandwidth and memory requirements and for multiple operating systems may enhance the digital accessibility of the services. 9 Scheduling processes, timeliness of care, and usability of digital interfaces may impact clinician and patient satisfaction. 10 Ensuring cultural and linguistic appropriateness throughout intake, connection, encounter, and follow-up processes is essential for high-quality, equitable care.…”

“… Appropriate technology: the need for better availability of broadband is essential, particularly in rural, tribal, and other marginalized communities, including low-income urban areas experiencing “digital redlining”. 9 Financial access is needed as well, requiring ongoing support and expansion of the Affordable Connectivity Program. At the same time, there is a need for telehealth applications that are child/family friendly, HIPAA-compliant, and able to function in the context of the bandwidth available in the sizable percent of homes connected only via smartphone devices and mobile networks.…”