3 Reasons Why Mobile Will Not Reduce Health Disparities for Underserved Communities
Part of the reason we’re seeing health disparities persist despite advances in health information technology, is because underserved communities don’t have access to sustainable broadband connectivity at home.
As a result, mobile devices, which have higher adoption and usage rates among vulnerable populations, have become a natural medium for mhealth programs targeting these communities.
Unfortunately, mobile is not the answer – at least not entirely. Here are three reasons why.
#1. LIMITATIONS OF MOBILE INTERNET
There’s only so much you can do on a smartphone, considering you’re working from a really, tiny screen. You can’t research, study, explore, or read anything for a long period of time.
So for example, you’ve got Inner City kids (who own smartphones, by the way) that have to go to McDonalds after school to do their homework, because that’s where broadband can be found in their community.
For one, that doesn’t do anything for their health because while they’re accessing the Internet, they’re munching McNuggets from the Dollar Menu. But again, if the local library is closed, or all the terminals are taken, McDonalds is the only place for them to access the Internet.
Secondly, the mobile Internet experience isn’t equivalent to a computer with wired or Wi-Fi broadband access. Amy Gahran, writing for the Knight Digital Media Center in May 2013 highlighted the major limitations of mobile Internet:
“Even with faster 4G mobile networks, smartphones and tablets tend to lack memory and processor capacity compared to laptop and desktop computers. They also present more challenges for typing, printing, saving files for offline use, and variable connection speed. Plus, since most U.S. carriers no longer offer unlimited wireless broadband plans, data charges have become a constraining factor for some of the most compelling high-bandwidth mobile Internet uses such as streaming video. (Unless users have easy access to cheap or free Wi-Fi.)
Therefore, it’s important to understand what’s easy to do online via mobile devices, and which use cases really do require a computer with a broadband connection. Then, target your mobile initiatives, training, and services accordingly.
For instance, the Grand Rapids Community Foundation encourages community members to use computers to fill out complex scholarship applications — but sends text message reminders about finishing pending applications before the deadline.”
#2. POOR COMPUTER SKILLS AND LITERACY
According to the Mobile Leapfrogging and Digital Divide Report, research in several countries has shown that people tend to use the mobile Internet more, if they have some prior experience with computers (especially going online from a computer) and if they have at least basic literacy.
This is the second-level digital divide: “The gaps in relevant technology usage skill sets that can persist even after disparities in technology access have been addressed.”
Since computer skills and literacy are lagging in underserved populations, it would make sense to address those gaps first — and later move on to showing people how to do more with their phones.
#3. CONTROLLED MOBILE INTERNET ACCESS
The other problem with mobile is that access to the Internet is controlled by phone companies like AT&T and Verizon Wireless, and the rules are different for phone companies than they are for broadband providers. Phone companies have a lot of control over what you can or cannot access on your device.
So the notion that underserved communities can just jump onto their mobile devices to access health information is not only inaccurate, it can actually make things worse. Here’s why.
THE TALE OF TWO INTERNETS
We know from experience that there are huge differences between mobile Internet and broadband Internet.
In fact, a few years ago, Jamilah King, wrote a brilliant article for Colorlines.com, where she discussed her observations about the “Two Internets” emerging in the U.S.
The first one – the Open Internet – is driven by innovation and commerce, allowing users to work, play and explore freely from the comfort of their homes.
That Internet, King argued, “is regulated by the federal government, which has issued rules that prohibit Internet service providers from interfering with their users’ online access. Those rules exist as an implicit acknowledgement that the Internet isn’t just fun and games, but rather the central communication platform of the 21st century.”
The second one comprises of mobile wireless, which people of color, or users with low incomes depend entirely upon – and by default the cell phone companies that provide it – for Internet access. That Internet is unregulated and cell phone companies can do whatever they want, including controlling what users see.
So even though underserved communities have closed the ‘digital divide’ with mobile devices, the truth is they have only moved into another realm of uncertainty, where these companies not only control how they access the Internet, but also the actual content in their cell phones.
Case in point. In 2007, Verizon Wireless stated, they had a right to block “controversial or unsavory” text messages, when they rejected a request by Naral Pro-Choice America, the abortion rights group, to make Verizon’s mobile network available for a text-message program. A week later, they reversed the decision. More than anything, this incident proved the need for a neutral Internet, free from interference or arbitrary judgments by phone companies.
For sure, mobile has been very effective in disseminating important information about pertinent health programs and outreach efforts. However, disparities in health IT adoption among underserved communities will not go away until sustainable and affordable broadband Internet is available to them, as it is to the rest of America.
THE ECONOMICS OF HEALTH IT ADOPTION
The issue of Health IT adoption among underserved communities is closely tied with economics – the economics of broadband connectivity, which, by the way is a complicated matter.
Even if you have access to broadband Internet at home, it doesn’t mean you can afford to own a computer, or a laptop. It also doesn’t mean, (as mentioned in point #2), that you have the literacy to use an HIT device that’s powered by at-home broadband. Of course literacy is just a learning curve that can be overcome, but economics is the bigger problem.
So if you’re on a fixed income for example, and you’re struggling to pay your bills, then most likely the $19.99 Wi-Fi bill will go unpaid in order to keep the lights on. These are some of the reasons why underserved communities aren’t able to adopt Health IT and instead find themselves ‘banished’ to mhealth.
BUT…BECAUSE THERE’S ALWAYS A “BUT”
There are several organizations trying to bring free broadband connection to traditionally underserved areas. Google pioneered this effort with their Google Kansas City Fiber Project. Another example is Connecting for Good, and there are many, many others.
As these programs expand around the country, hopefully we will begin to see underserved communities taking advantage of the opportunities that broadband connectivity affords, not just in accessing health and medical information, but also for online job applications, online education and so on.
Thoughts? The question of reducing health disparities for underserved communities using mobile devices is a complex and multilayered issue. But I’d love to hear your take on it.
is the CEO at the Institute for eHealth Equity & Advisory Board Chair at eHealth Equity.