For a fairer fight against pandemics, ensure universal internet access
This essay is part of a PIIE series on Economic Policy for a Pandemic Age: How the World Must Prepare.
Distributing hundreds of millions of newly developed vaccines to US citizens in a matter of months was bound to produce disparities, especially in a society rife with inequality across different income, racial, and ethnic groups. But one, perhaps less appreciated, factor driving inequities in the fight against COVID-19 is persistently unequal access to the internet. US counties with the highest share of vulnerable residents are also places where fixed residential internet service is least common. This link between poor health and digital isolation underscores the challenge faced by US localities struggling to provide equal public services to all their residents. We now know that failure to provide universal residential broadband access, in addition to skewing access to remote work and distance learning opportunities, raises the mortality risks of the pandemic and reinforces existing social cleavages.
The pandemic has brought into sharp relief the growing reliance of governments on delivering services through the internet and the social costs of unequal broadband access. People without in-home internet service face high hurdles to obtain current information about pandemic risks, local virus prevalence, and necessary precautions. Public health authorities in counties on the wrong side of the digital divide face greater difficulty and expense reaching and maintaining contact with those most in need. Not only rural areas but also places with larger concentrations of poor, minority, and older residents lack an essential tool available to “well-connected” jurisdictions. These disparities have arisen dangerously in the rollout of vaccine appointments, where a place in line is often secured only by navigating maze-like online registration websites. Lack of internet access is frequently cited as one of the factors in the low vaccination rates among high-risk communities.
Many federal legislators recognize the heightened urgency of ensuring universal in-home broadband access and adoption in a pandemic age. The coronavirus relief plan passed early in 2020 included expanded funding for schools and libraries, to provide for distance learning. It also helped fund rural health care providers, to expand telemedicine services. But it was not until the Consolidated Appropriations Act, 2021 and the American Rescue Plan Act of 2021 that the US Congress agreed to provide money aimed at connecting people in their homes. The ongoing fight against the pandemic requires making such assistance permanent. And to help deal with wider issues of inequality, the United States needs to accelerate deployment of high-speed broadband infrastructure across the country.
More vulnerable counties are less connected counties
Due to residential sorting and the physical infrastructure links required to provide broadband service, the digital divide is a spatial divide. Jurisdictions vary widely in the health needs of their citizens and the degree to which local households are connected to the internet. Although broadband infrastructure has extended further into rural areas over time, service providers still find it unprofitable to set up networks in sparsely populated areas. Even within otherwise well-served urban and suburban areas, service providers skip over particular neighborhoods. Indeed, current federal regulations do not require providers to meet the needs of their entire service areas or to offer equal availability of speed tiers.
Moreover, even if providers were required to provide equal access, affordability will be an ongoing challenge for disadvantaged households, as is acquiring the skills necessary to navigate government websites. These service disparities are pronounced among US counties, which play a key role in the US public health response to the pandemic.
Data from the Mapping Broadband Health in America project of the Federal Communications Commission (FCC) allows us to see how population health needs and internet connectivity are correlated across counties. The dataset includes a variety of county health conditions, including the share of residents who have been diagnosed as obese, diabetic, or who smoke, or report being in fair or poor health. These data show that counties where residents are more likely to have health conditions associated with COVID-19 mortality are also places where a larger share of homes lack a fixed internet connection. The FCC lists a household as having a wired connection if it has service above a very modest quality threshold, including dial-up modem connections. So, the analysis we present below, based on their measures, may understate the extent to which online government services are skewed away from those most at risk.
Figure 1 illustrates the share of county households with or without home internet connection across four quartiles sorted by the share of county residents diagnosed with obesity, a significant predictor of COVID-19 mortality rates. Counties in the top quartile for obesity prevalence are places where, on average, 37 percent of households lack internet access. In contrast, counties in the lowest quartile have, on average, 19 percent of households without home internet connection. Thus, the likelihood that a resident lacks internet access is twice as large in counties with the highest prevalence of obesity than in counties with the lowest obesity rates.
Figure 1 similarly displays the relationship between the prevalence of diabetes and internet connectivity. Again, we find a significant relationship between county health conditions and fixed residential internet. Lack of a home connection is almost twice as common, on average, in counties with the highest levels of diabetes compared with those with the lowest prevalence. Similar correlations can be found between internet connections and the share of residents claiming poor or fair health or the share who smoke.
The elderly are most at risk and least connected
Death rates from COVID-19 are higher for the elderly than for any other demographic group. Public health authorities have struggled to connect elderly residents living in the community to information, services, and vaccination sites. A major concern is the relatively low adoption of in-home internet service by older Americans. This worry is well founded: The Pew Research Center finds that in 2019 only 59 percent of people aged 65 and older were home broadband users compared with at least 77 percent of those in younger age groups.
When viewed from a county-level perspective, however, the picture is complicated by important differences among elderly populations. Wealthier seniors may easily afford the expense of home internet service while less-well-off seniors struggle to pay for monthly utilities. Some may find it difficult to navigate the complications of purchasing and installing necessary equipment. Elderly living in congregate settings, such as nursing homes, are not included in the FCC’s data on residential connections. These factors, among others, produce a low correlation between a county’s elderly share and the share of households lacking internet connection (the correlation coefficient across counties is only 0.05).
Like the elderly, Black and Hispanic Americans across the United States have been disproportionately affected by COVID-19, facing higher risk of infection and higher mortality rates if infected. Yet the vaccination rate for Black people in the United States is only half that of white people, and the gap for Hispanic people is even larger, according to data compiled by the New York Times. Compared with their white counterparts, Black and Hispanic people are less likely to have internet access reliable enough to access health information online and make vaccination appointments and have dependable transportation to vaccine sites, among other factors. Pew Research Center data supports these concerns, reporting that in 2019 79 percent of white survey respondents claim to be home broadband users, but only 66 percent of Black and 61 percent of Hispanic respondents do.
Such disparities do appear at the county level, but they intersect with racial differences in urban vs. rural locations. Among counties sorted into quartiles by share of households with Black, African American, or Hispanic residents, counties with the highest minority share have the lowest level of connectivity: On average, 33 percent of households in these counties lack home-based internet service. But connectivity is also low in counties with the smallest nonwhite shares (on average 29 percent of households in this group lack home internet), reflecting the disproportionately rural status of this population and the greater likelihood that the local area has no broadband infrastructure.
To delve more deeply into the observed relationships for both residents’ age and race/ethnicity, we use the FCC dataset mentioned earlier to further divide counties into two bins. The first bin contains “younger counties”—jurisdictions with an elderly share below the national median for all counties. The second bin contains “older counties”—jurisdictions with an elderly share above the national median.
Figure 2 displays the average share of households with or without internet connection, by nonwhite household quartiles, for these two groupings. Among younger counties, those with the smallest and the largest shares of nonwhite households have higher than average shares of households without home internet connection, 31 percent. The middle quartiles of this “young” county group have lower than average service gaps.
Turning to the “older” county grouping, we see that households in the first three quartiles have roughly similar levels of lack of internet connectivity, close to the nationwide county average of 28 percent. The quartile with the largest shares of nonwhite households, however, exhibits the largest digital gap—the average share of households without internet connection in this group of counties is 39 percent. Thus, the data show that counties with higher shares of older, minority residents face greater difficulties in reaching and serving their most vulnerable citizens.
Federal efforts to fill the gaps
The US Congress has long recognized the need for universal access to broadband internet service, but progress toward closing gaps has been slow. The COVID-19 pandemic dramatically heightened this concern as American schools, businesses, and governments turned to remote work and providing services online. Recent legislation addresses two needs—making high-speed service available to all locations and getting households connected to the internet.
Prior to the passage of the 2020 Coronavirus Aid, Relief, and Economic Security (CARES) Act, the FCC relied mainly on the Universal Service Fund to address pandemic-related challenges. Using this authorization, the commission took steps to maintain and modestly expand enrollment in its Lifeline Program for Low-Income Consumers, which partners with broadband providers to offer subsidized service to eligible households. The FCC also eased rules restricting the use of federally funded equipment for schools and libraries (but stopped short of permitting home use). Addressing health care needs directly, the FCC rolled out the Connected Care Pilot Program, which provides subsidies to eligible health care providers to expand internet-connected services to low-income households and to veterans at their residence or mobile location.
The CARES Act took aim at discrepancies in broadband access hindering remote work and distance learning. It also addressed health care, but only with temporary funding to help health care providers purchase telecommunications devices and services needed to expand telehealth services. These funds target areas of the United States hardest hit by COVID-19.
The Consolidated Appropriations Act, 2021 (CAA 2021) provides additional funding for telehealth programs but importantly also tackles broadband availability and affordability for underserved areas and populations. Several provisions seek to expand broadband infrastructure and access to areas lacking service, with specific appropriations for programs that connect minority communities and tribal lands.
Notably, CAA 2021 provides significant new funding to subsidize internet connections for low-income or job-displaced families. The Emergency Broadband Benefit program reimburses service providers up to $50 each month for qualifying households, or up to $75 for those on tribal lands. It also provides up to $100 if a household purchases a connected device, excluding smartphones. Addressing incomplete uptake by target populations, the legislation also directs the FCC to raise program awareness and promote consumer outreach.
The American Rescue Plan Act of 2021 (ARP) further recognizes the importance of broadband access and internet adoption for economic recovery. With the Emergency Connectivity Fund, Congress dramatically expanded existing programs for schools and libraries to provide free broadband service and connected devices to students and patrons for use in their homes. The ARP also includes enhanced assistance to homeowners who fall behind on mortgages and utility bills, including internet service. Recognizing that households can connect only where there are “pipes,” this new legislation provides funds to states, territories, and tribal lands for local recovery, which may include broadband infrastructure investment. Additional infrastructure funding may come from another pot, the Coronavirus Capital Projects Fund.
These various programs significantly expand federal efforts to close remaining infrastructure and connection gaps. But serious shortcomings remain. The new assistance is temporary, at least for now. For example, the Emergency Broadband Benefit program, which is key to connecting low-income families to the internet, expires six months after the termination of the COVID-19 public health emergency or when appropriated funds are exhausted. The Accessible and Affordable Internet for All Act, introduced in the House by Representative James Clyburn (D-SC) and in the Senate by Senator Amy Klobuchar (D-MN), would go further. It proposes $94 billion to support construction of broadband infrastructure when it does not exist, improve speeds where service is slow, and continue discounts to eligible families past the recovery. It also would establish grants to support digital skills training. All three forms of assistance—infrastructure, connection subsidies, and training—are needed if the United States is to achieve universal access and adoption.
According to the 2020 United Nations E-Government Survey, almost all governments responded to the pandemic by deploying new digital tools, such as dedicated COVID-19 information portals, e-services for supply of medical goods, virtual medical appointments, self-diagnosis apps, and e-permits for curfews. Many countries were quick to deploy tracking and tracing apps and apps for working and learning from home. Not all nations, however, entered the pandemic age equally prepared to deliver services to their citizens digitally. In 2019, the United States ranked 26th worldwide in fixed broadband subscriptions per 100 residents, based on a low minimum service quality standard. Despite differences in physical terrain and institutions, the United States may find it useful to consider how Switzerland, France, Denmark, South Korea, Norway, Canada, and the United Kingdom, among others, overcame rough terrain, affordability problems, and digital skills scarcities to achieve higher rates of fixed broadband adoption.
As shown earlier, public data from the FCC indicate that US counties where residents are less healthy and older are more likely to be on the wrong side of the digital divide. When COVID-19 appeared, the past failure in connecting all US households to the internet made America less prepared to ensure effective and equal public health services to all. The pandemic has made clear the danger of unequal private access to public information and the new Congress has responded with greatly enhanced, but temporary, public support for infrastructure expansion and household internet adoption. The gaps will widen substantially when funding provided by these new programs is exhausted. Because internet access will remain essential for education, employment, and government service provision well beyond the current crisis, it is time to build broadband better—elevating universal service provision to a national commitment for all Americans.
1. Smartphones are another way to access the internet and some households without broadband access do use them. However, it is difficult to navigate government health department websites via smartphone, especially for older people.
2. COVID-19 has been deadlier for people of color, yet a New York Times investigation found that in all reporting states, except Oregon, Black and Hispanic Americans had been vaccinated at lower rates than the general population by late February 2021. See Amy Schoenfeld Walker et al., Pandemic’s Racial Disparities Persist in Vaccine Rollout, New York Times, March 5, 2021.
3. The FCC data we use provide the percentage of households in a county with residential fixed internet connection over 200 kilobits per second (kbps), or 0.2 megabits per second (Mbps), in at least one direction. In 2015, the FCC defined high-speed internet as a connection over 25 Mbps download speed and at least 3 Mbps upload speed. With today’s greater download demands, a commonly cited minimum download speed for working from home or attending school remotely is 50 Mbps.
4. Analysis of over 17 million health records in England found that risk of death related to COVID-19 rose with obesity and most comorbidities, including diabetes. See Williamson, Walker, Bhaskaran et al., “Factors associated with COVID-19-related death using OpenSAFELYWalker,” Nature 584, July 8, 2020, pp. 430–36.
5. The Pearson’s r, a measure of a linear relationship between two variables, lies in the range of 0.34–0.37 for each of the four health characteristics mentioned.
6. Studies confirm that age is the strongest predictor of an infected person’s risk of dying from COVID-19. See Smriti Mallapaty, “The coronavirus is most deadly if you are older and male—new data reveal the risks,” Nature, August 28, 2020.
7. Data suggest that these disparities cannot be explained by differences in age or occupation. See Amy Schoenfeld Walker et al., Pandemic’s Racial Disparities Persist in Vaccine Rollout,New York Times, March 5, 2021.
8. We use “nonwhite” share here to refer to the share of households that identify at least one member as Black, African American, or Hispanic in the US Census.
9. The Lifeline Program, part of the FCC’s Universal Service Fund, is the only permanent federal program focused on telephone and broadband adoption for low-income households. Internet service providers opt in to offer eligible households discounts of $9.25 per month, a subsidy most households apply to monthly wireless bills.
10. Details on broadband provisions of the Act can be found in Congressional Research Service, The Consolidated Appropriations Act, March 2, 2021: Broadband Provisions in Brief.
11. Congress appropriated $3.2 billion for this Emergency Broadband Benefit program. The program wraps around the existing Lifeline Program.
12. For a detailed discussion of the American Rescue Plan’s broadband provisions, see Kevin Taglang, American Rescue Plan: Broadband and the Social Safety Net, Benton Institute, March 12, 2021.
13. Kevin Taglang provides more details in Emergency Broadband Benefit Program: From Here to Launch in 60 Days, Benton Institute, March 5, 2021.
14. Among those connected to the internet, the quality of service varies widely across households. By 2018, approximately 89 percent of residential fixed connections had a speed of at least 10 Mbps downstream, while 76 percent had a speed of at least 25 Mbps downstream. Only about 50 percent of all residential fixed connections had a downstream speed of at least 100 Mbps. See Federal Communications Commission, Internet Access Services: Status as of December 31, 2018, Industry Analysis Division, Office of Economics & Analytics, 2020.
15. Not just availability but also a minimum service quality is needed to ensure that all Americans can participate in the digital economy. In a letter dated March 4, 2021, four US senators (Michael Bennet [D-CO], Angus S. King, Jr. [I-ME], Rob Portman [R-OH], and Joe Manchin III [D-WV]) urged the Biden administration to set a goal of symmetrical speeds of 100 Mbps, with only limited variation across the United States, arguing that this service quality is required for equal economic opportunity.
16. This ranking is based on data from the International Telecommunication Union.