This commentary originally ran in the Kansas Reflector on June 23, 2022. About the authors: Dr. Tiffany Anderson, superintendent of Topeka USD 501, and Dr. Shannon Portillo, associate dean and professor at the University of Kansas, served as co-chairs of the Governor’s Commission on Racial Equity and Justice; David Jordan, president and CEO of the United Methodist Health Ministry Fund, chaired the subcommittee on healthcare.
Dependable internet access is not an amenity — it’s essential for accessing services today, including health care, work and school. In Kansas, a digital divide separates the “haves” from the “have nots” in terms of devices, digital literacy, and access to high-speed internet. The COVID-19 pandemic highlighted digital gaps across our state, especially in internet access in rural and low-income communities and communities of color.
Digital equity is more than a quality-of-life issue; it plays a role in health care. A Federal Communications Commission task force is studying whether broadband connectivity should be considered a social determinant of health. Social determinants of health are the conditions where people live, work, and play that affect their health, such as transportation, neighborhood crime and education. Social determinants account for as much as 80% of a person’s health status. Digital equity may even be a “super” determinant because it affects other determinants — people search online for housing, transportation, and employment.
The Governor’s Commission on Racial Equity and Justice examined digital equity, seeking to understand how to address systemic issues that affect health outcomes, community vitality, and access to information and human services. Broadband recommendations to address racial equity were included in the commission’s final report. As we consider broadband policies and investments, we should treat broadband connectivity as a social determinant of health.
In 2020, the state established the Kansas Office of Broadband Development. This department focuses on connecting Kansans, with several investment programs focused on unserved and under-served areas. Multiple programs have been made possible through federal dollars. The commission recommended the state should maximize federal dollars to support broadband development and to increase access for hard-to-reach and vulnerable communities.
Kansas should support and invest in broadband access for all Kansans, but access is not enough. As state and local governments invest in broadband, they should also ensure their work is focused on digital equity.
To bridge the digital divide, Kansans need affordable broadband and appropriate devices, outreach to learn about available programs and digital literacy skills built with the help of culturally competent navigators.
Funds should be used to support digital navigators who help Kansans use online services and set up devices and home internet. The National Digital Inclusion Alliance provides a digital navigator toolkit designed with libraries, health care and other social service agencies in mind.
A major shift during the pandemic has been the increase in accessing health care online.
Many Kansans travel to receive care, must take off work for appointments, or have caregiving duties that make it difficult to visit the doctor. During the pandemic, telehealth services were expanded. Kansans were able to see their providers and specialists remotely, and providers were reimbursed for telehealth visits similarly to in-person visits.
In a statewide voter poll conducted for the REACH Healthcare Foundation and the United Methodist Health Ministry Fund, most Kansans (86%) said they support expanding or maintaining telehealth options after the pandemic ends. The poll oversampled Black and Hispanic voters. The study found that when it comes to accessing care, 71% of Kansans of color would prefer to see a doctor or health care professional who comes from their community, speaks their language and looks like them. Telehealth can help bridge that gap.
In a related consumer focus group survey, some patients shared that telehealth allows them to receive care they otherwise would not be able to access, including patients in rural areas who live hours away from specialists. However, others found internet connectivity to be a barrier.
“What frustrated me was the internet connection. While I’m at my parents’ I can FaceTime my son in Saudi Arabia, but I can’t talk to a local doctor 30 miles away. … So that is very frustrating to me to be talking to someone on the other side of the world and I’m not able to contact my local doctor,” said one focus group participant.
Community health workers or other care coordinators can serve as culturally competent digital navigators, helping patients set up their internet and teaching them how to use their personal devices to access telehealth appointments.
Interviews and a survey of Kansas health care providers and administrators found that for telehealth to remain viable, future financial support is needed for system upkeep and visit reimbursement. As a health equity strategy, Kansas should expand telehealth access and codify the regulations that expanded telehealth services.
As a state, we must continue removing barriers to ensure we’re reducing the digital divide, so that more Kansans can access information, health and human services, civic engagement, and educational and employment opportunities.
About this series
In June 2020, Gov. Laura Kelly signed Executive Order 20-48, forming the Governor’s Commission on Racial Equity and Justice. The Commission studied issues of racial equity and justice across systems in Kansas, focusing first on policing and law enforcement and then on economic systems, education, and health care. The Commission developed recommendations for state agencies, the Legislature, and local governments. Through the end of 2022, commissioners will dig deeper into the recommendations in a monthly series.