And just like that, telehealth is a technology superstar. Recognition of telehealth’s potential to transform healthcare is one of the few silver linings in the COVID-19 cloud. But COVID-19 also ripped open a gaping wound within our healthcare system – a deadly inequity for African-American and other people of color.  

“Systemic racism and bad policy over the years created situations where African-Americans and other people of color are more susceptible to hypertension, diabetes, and the like,” said Philadelphia Mayor Jim Kenny on CNN. “We need solutions that treat everybody equitably when it comes to access to healthcare.”

Black and Brown people don’t want to hear “We have to research the problem.” We know why, for instance, African Americans can have 32% of louisiana’s population but have more than 70% of the COVID-19-related deaths. It’s poor health and poor access to healthcare.

Telehealth can narrow the heathcare gap. But does the U.S. have the political will to make change happen?

Strategy for beating the “Healthcare Gap”

Telehealth isn’t just chats with physicians. Telehealth means using intranets and Internet networks to observe, diagnose, initiate or otherwise medically intervene, administer, monitor, record, and/or report on the continuum of care (CoC) – everything that’s done to get you healed.

The “healthcare gap” is that very real divide between those who have access to affordable, quality healthcare, and those who do not. To close the gap requires the full range of telehealth, lots of broadband, political willpower, and money.

There are six targets, or medical disciplines, to impact:

1. General practice
2. Specialized care
3. Chronic care 
4. Emergency response and trauma care
5. Mental health care
6. Senior care

In these six disciplines, huge numbers of people can be impacted, telehealth has proven effective, and both rural and urban communities are underserved or unserved. Investment in telehealth could impact broadband deployment.

General practice

Twenty-eight of U.S. men and 17% of women don’t have a personal doctor or healthcare provider. But an analysis by the Kaiser Family Foundation shows higher rates for minorities, such as 33% of Hispanic women and 31% of African-American men. What’s more, the healthcare industry has a decades-long history of bias against and abuse of people of color.

I started a 10-city pilot in which barbershop and hair salon owners check customers’ blood pressure levels and healthcare providers respond to the data via telehealth. The Wilson County [NC] Department of Health is partnering with DiFrent Level Barber Studio.

Owner Kahmahl Simmons says, “Telehealth brings insight on common health issues that a lot of people in my community may overlook.” The pilots’ third phase explores ways to get broadband in neighborhoods surrounding the barbershops and salons.

Specialized care

According to the Association of American Medical Colleges, there’s a need for an estimated 24,800 - 65,800 medical specialists – orthopedic doctors, neurologists, etc by 2032. Rural and historically underserved areas may feel this pain more.              

COVID-19 shows that, with wireless networks, wired broadband, and the ability to build or commandeer a structure, a city or county can make hospital magic. Nonprofit Partners Healthcare System, Boston, and Massachusetts built a full-blown, fully-functional, 1,000-bed field hospital with all the digital trimmings - in just 7 days! Mayor Kenny oversaw a similar buildout to house 200 patients in Temple Arena in Philadelphia.          

We have been marinated in the belief that only a corporate hospital can deliver healthcare well. Think outside of that box, too!

Chronic care 

According to the Centers for Disease Control and Prevention (CDC), six out of ten people in the U.S. suffer from a chronic disease. Four out of ten people suffer from two. Chronic diseases -- such as heart disease, cancer, and diabetes -- are normally the leading causes of death and disability in the U.S. Diabetes is 60% more common in African Americans; African American men are 50% more likely to get lung cancer.

Given how pervasive chronic illnesses are, unserved communities should have the power to negotiate deals with hospitals, insurers, and economic development groups in which these entities underwrite broadband and telehealth infrastructure that the communities own. Many broadband grant programs are well-intentioned but moderately effective for closing the broadband gap. No broadband, no telehealth!

Emergency response and trauma care

When I had a stroke five years ago, my remote neurologist and the stroke team had to wait for me to arrive before telehealth started. What if I had faced a 3-hour rural ride? Since then, more hospitals are equipping first responder vehicles with wireless hotspots and trauma equipment such as portable CT scans, ultrasounds, and EKG machines so hospital physicians can deliver treatment even before leaving patients’ homes or accident scenes.

Local governments should consider strategically deploying high-powered wired and wireless hot spots in case patients need immediate medical attention while still en route to the hospital. These spots should be on ambulance routes, but in places where people may be isolated during natural disasters. Mobile satellite hotspots configured for telehealth could be helicoptered in to areas where communities may be isolated following natural disasters. Remember those traumatic pictures from New Orleans after Hurricane Katrina?

Mental health care

“There are 65 million Americans that have diagnosable mental health illness but we have less than half of the psychiatric providers needed to meet that demand,” says Encounter Telehealth CEO Jennifer Amis. “When you look at many of the rural areas, we may have less than 20% of the number of providers needed.” Approximately 30% of African American adults for with mental illness receive treatment each year, compared to the U.S. average of 43%, says the National Alliance on Mental Illness.

Here is another discipline in which need clearly outstrips available professionals, and telehealth doesn’t give overworked professional too many more hours in the day. Any telehealth strategy has to have a plan for doubling the pool of professionals.

Senior Care

Approximately 75 million Americans make up the baby boom generation, and every year for the next 20 years roughly 3 million baby boomers will reach retirement age.  From a different perspective, 14.1% of adults ages 65 and older (7.2 million souls) lived in poverty in 2017 based on the Supplemental Poverty Measure.

We’re going to need a lot of partnerships between Internet of Things (IoT) manufacturers and broadband because that will help seniors stay in their homes longer. Furthermore, many seniors barely scrape by financially, so their broadband has to be affordable and the bandwidth capacity plentiful.

Being clear on the goal of telehealth is the easy part. Now it’s time to stand and deliver – or get out the way.   

Craig Settles assists cities and co-ops with business planning for broadband and telehealth. He can be reached at: craig@cjspeaks.com

The Benton Institute for Broadband & Society is a non-profit organization dedicated to ensuring that all people in the U.S. have access to competitive, High-Performance Broadband regardless of where they live or who they are. We believe communication policy - rooted in the values of access, equity, and diversity - has the power to deliver new opportunities and strengthen communities.

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