Lack of internet connections deepen inequity in education and health care during COVID-19

COVID-19 Zoom
A teacher giving a lesson to her students over Zoom. Source: Phil Roeder

By Liam Bohen-Meissner
Medill Reports

Access to virtual education and telehealth underscore the digital divide in Chicago and elsewhere exacerbated by the onset of the COVID-19 pandemic. When coupled with limited in-person activity, a lack of broadband internet potentially forces millions of students to fall behind in school and millions of people to forgo medical treatment. Some 3.7 million households in the United States lack consistent and/or stable internet connection.

Bridging the digital divide will take time, resources, and a partnership between the private and public sectors. This podcast looks at the needs and solutions to optimize digital learning as viewed by policymakers, nonprofits, teachers, doctors, internet users and game changers such as Chicago Connected.

Public-private partnerships bridge the digital divide in education

COVID Learning
A student learning online during the COVID-19 pandemic. (Daniel Foster)
Chicago Neighborhoods NO Broadband
An infographic of the 10 neighborhoods in Chicago with the most children who do not have access to broadband internet.


Resources and Information for Meeting the Digital Divide Challenge







The jury is still out on the impact of the digital divide on telemedicine.

Medical personnel demonstrating a specific medical exam through telehealth. (Army Medicine)

COVID-19 not only revealed the damage caused by the digital divide in education but demonstrated how the digital divide can impact medical care as well. Doctors and experts are divided on whether telemedicine, lauded as a safe and reliable option for in-person visits, leads to greater inequity because of the digital divide. Telemedicine became popular during the COVID-19 pandemic. It is the use of a phone call or video chat in lieu of attending an in-person doctor’s appointment.

Some practitioners such as Dr. David Ansell of Rush University Medical Center believe telemedicine has the potential to reduce inequities among patients. The increased accessibility of a phone call or video chat can eliminate other obstacles such as taking time off of work or traveling long distances for an in-person visit.

Other medical experts like Dr. Srinath Adusumalli of Penn Medicine at the University of Pennsylvania, however, published research that highlights the digital divide and the inequities it creates in telehealth.

“I do think that care via this modality [telehealth]…are the way of our health care delivery systems future,” Adusumalli said. “But it’s the work of our time, so to speak, right now and in the health care field to be able to think about how best to integrate those into the care delivery process.”

Telehealth less of an option for some communities

The Pew Research Center’s 2019 data shows that 96% of Americans own a cell phone and 81% have a smartphone. This means telehealth via phone calls and phone apps are an option for most Americans. But to access video chat appointments via services like Zoom or a provider’s mobile app, patients need a computer or smart device that can connect to the Internet through WIFI or data.

Yet it is estimated that approximately 42 million Americans do not have access to broadband internet according to an article from the American Heart Association. An observational study conducted in 2019, and research from the Pew Research Center show that communities generally most impacted by the digital divide are women, older people, people with disabilities, lower income individuals, people of color, immigrants, and those residing in rural areas.

A lack of digital literacy or technological literacy can hinder patient’s ability to access telehealth as well. People may have difficulty navigating a medical system’s app or website making telehealth a difficult option, Adusumalli explained.

He co-authored a study out of the University of Pennsylvania last year that examined 148,402 patients scheduled for primary care or medical specialty ambulatory telemedicine visits. Examples of primary care visits include annual check-ups or physicals while specialty ambulatory care are visits with medical specialists such as cardiologists or neurologists.

He found during the early part of the pandemic that older people and those who do not use English as their first language tended to complete fewer telemedicine appointments. Patients who were older, female, Black, Latinx, and of a lower household income tended to use video less for their telemedicine appointments.

A lack of or lower rate of access for particular communities can impact the quality or type of care they receive. While a phone call for example, can suffice for certain routine visits, a video chat can provide a greater array of services.

Adusumalli said video visits allow clinicians to see how a patient is doing physically. Clinicians have developed creative ways to conduct portions of a physical exam as well. But video chats also provide a window into a patient’s home life which can be helpful in identifying safety issues or reviewing how to take medications.

“So I’ve had a number of opportunities where being able to review that with patients and identify either medication errors or missing medications, for example,” he said. “So that’s where video, I think adds to the conversation.”

Telehealth as a means to eliminate certain inequities

Overall, Ansell said that for visits with many of his patients, telehealth, even via a phone call, is a great alternative.

“Except for looking at someone in the eye, it’s not like you could do a physical exam over a video, you may be able to look at a rash, but someone can send you a picture of that as well,” he said. “So I actually think that the inequities are actually reduced.”

He acknowledges that these visits are mainly for check-ins and other low stakes visits but emphasized the ease of access for patients.

“I mean, rather than looking at it as a barrier, which I understand your questions, what about a great door opener?” he said. “Cause in the reach of your phone is your doctor.”

Adusumalli agreed, saying that because people often have to take time and resources to travel to an appointment, telehealth could cut that out of the equation.

“There are lots of barriers for a patient coming to meet us where we’re at,” he explained. “That could range from transportation issues, having to take time off from work, child care, all of these are real barriers to accessing care and coming to scheduled appointments, some of which can be averted by using telehealth.”

Both Adusumalli and Ansell believe telehealth will become more common in the future. While the jury is still out on whether telehealth reduces or creates more inequities, ensuring it is accessible to all will become far more necessary in the future.

Liam Bohen-Meissner is a health and politics reporter at Medill. You can follow him on Twitter at @lbmeissner.