David Raths

“Social determinants of health” is a hot topic among government and health system executives. The phrase usually refers to basic food, housing and transportation disparities that can lead adjoining ZIP codes to have drastically different life expectancies. But could lack of broadband Internet access also be considered a social determinant of health?

Mark Myers remembers his very first day on the job in January 2015 as the state of Arkansas’ CIO and director of the Department of Information Systems (DIS). “I was with Gov. [Asa] Hutchinson in the mansion, and he said, ‘Hey, Mark, you have got to get this K-12 broadband thing fixed,’” he recalled. Myers admits that at the time he knew very little about the Arkansas Public School Computer Network (APSCN), which provides connectivity to all of the state’s K-12 classrooms. He did some research and found that APSCN was averaging a pokey 5 kilobits per second (Kbps) per user. In contrast, the Federal Communications Commission (FCC) has set a K-12 Internet access target of 100 Kbps per student.

In 2014, the FCC made resources available to close the connectivity gap across the country by increasing its investment in K-12 broadband by $2.5 billion per year to a total of $3.9 billion annually. This should be sufficient funding to connect every public school classroom in America to high-speed broadband. With a goal of increasing the number of state school districts meeting the FCC Internet access target of 100 Kbps per student to 100 percent, Hutchinson directed DIS to upgrade APSCN to an all-fiber network.

One of the central themes of the fifth annual Health Datapalooza conference in Washington, DC was how innovative approaches to data can help local public health agencies better target their limited resources.

Two panels of public health experts described some creative solutions they have developed to work around the fact that data coming from federal and state sources is often years old and not geographically meaningful enough.

Brian Castrucci, program director for the de Beaumont Foundation, which seeks to catalyze new thinking about public health innovation, said his organization has surveyed local public health officials in 18 cities and found a strong desire for more local data. “They need neighborhood-level data to inform policy,” he said. “It has to have the right level of geographic aggregation.” The data they get now to help target chronic conditions such as diabetes is not granular enough, he added. It doesn’t help them to have state-level data that is two years old.

Barbara Ferrer, executive director of the Boston Public Health Commission, said one of the biggest issues for her department right now is dealing with an opioid overdose epidemic. “The data we get from the state is three years old, and from the medical examiner confirming deaths is two years old,” she said. “I am looking for real-time data. We need it to influence programming dollars.” She added that there isn’t agreement on the need of public health departments at the local level having good access to data.

There is no reason those electronic media record feeds couldn’t happen simultaneously if there is agreement on which data should be sent where. “It is wasteful but better than no data access at all,” she said, “or waiting for others to decide when we are going to get access.”