It’s been way too long since I’ve posted a blog on digital inclusion.  Simply, I’ve been too busy!  Which, when you’ve taken the leap to quit your job for full time consulting, is an unexpected, if not entirely unwelcome situation.

Quite frankly, organizations are starting to “get it.”  What are they getting?  How and why digital inclusion is essential to their mission.  Dynamics that are so fundamental to society, and have been so central to my work, my values, my mission in life—that I am always continuing to be surprised to find this to be news to anyone.  MUCH better late than never!

What are Organizations Understanding about Digital Inclusion?

That poor health is not caused by lack of health care, and that even good health care will hardly “move the needle” on creating measurable improvements in health of the entire population.

And why is that?  Because conditions that create poor health are due to social and environmental factors.  Yes, health care can give someone insulin to fix their elevated blood sugar, but it’s the wrong cure for the wrong disease.

At the first level, the causes of disease are poor nutrition and lack of exercise.

Social Determinants Cause Diseases

But at a deeper level are the causes of the causes of disease.   So, health care has discovered the “social determinants of health.”   Education.  Jobs.  Access to healthy food.  Even health care.  That’s a start, and great that health systems are now routinely screening and referring patients to community organizations to address the gaps.

And some health systems are looking beyond to realize that the distribution of people living in neighborhoods is not random.  And the distribution of parks and grocery stores is not random either.  As you know, I started a website in 2015 with hyperlocal mapping of health and social disparities.  At the time, I had a hard time explaining the value to others, which was my bad.  I merely needed to say “a picture is worth a thousand words” and show maps of segregation, health outcomes and determinants of health side by side.  Yet now, I don’t need to explain what geospatial epidemiology is.

Looking at the “causes of the causes,” there is growing (although hardly universal) recognition that larger forces shape whether everyone truly has equal opportunity in life.  Starting from pre-prenatal—when moms bodies already bear the legacy of stresses borne by their mothers.  Through pregnancy when BIOPIC and people of color experience overt racism, institution biases and structural inequality that lead to worse outcomes and higher rates of infant mortality.  Through schooling where property-tax-based funding traps Blacks and low-income populations into intergenerational poverty. Compounded, as so many are now recognizing, by lack of quality affordable internet access that reflects digital redlining and government policies that have been shaped by the telecommunications industry.  Thus, they have been allowed to bypass poor communities with high-speed internet.

So what are the signs that people are “getting it?”

Health Systems and Communities Becoming Digitally Inclusive

One nationally known health system has engaged me to help build metrics for determining whether their provision of telehealth services is equitable.

Another engaged me to train clinical research staff on how to teach patients to use telehealth.

I’m working with a non-profit organization that received funding from U.S. Ignite to bring high-speed internet to underserved neighborhoods.  One novel thing about this program is that we will train people to use the internet for improving their health, education and economic stability.

I’ve co-led a group of leaders from local health systems, non-profits, telecommunications and others to agree to use a common instrument to screen all patients to determine their needs for devices, connectivity and digital skill training. 

Digital Navigators: A New Profession!

Locally and nationally, the concept of digital navigators is gaining great traction. Some local libraries were funded to engage digital navigators, and I’m encouraging our local health systems to collaborate on creation of a training pipeline where they can upskill them to be digital health coaches.

Digital Inclusion is gaining acceptance as a social determinant of health  

Recently, I noticed a spike in LinkedIn connection requests.  I quickly ascertained that someone I didn’t know wrote a glowing post about a paper I recently co-authored—Digital Inclusion as a Social Determinant of Health.  I’ve been using this language for so long that I’m surprised to learn that the concept is, apparently, still novel to many!

And, I’ve had greatly enjoyed serving as the Research Director for the National Telehealth Equity Coalition.  Click on the “Stories” link to see the four I’ve written, including the most recent, “Solutions for Connectivity and Hardware Barriers to Telehealth Equity.”

This week, I will be leading a half-day workshop on digital inclusion for leaders of Jewish Social Service organization, and will be interviewed for a story on HIMSS Media.  That came about after I complained that one of their stories failed to give adequate attention to digital disparities.  In fact, the story gave it no attention whatsoever.  Six months ago, I wouldn’t have even bothered to send a snarky email to the writer!

How Public Health Innovators can help you

Start with developing a shared vision for your organization.  Looking at who can’t use virtual health is a start, but what is your objective?  Do you want to just make it available to those who can use it, or help those who can’t to be able to?  What about broader digital engagement, e.g., through the patient portal?  Is everyone aligned?  Or do some units encourage patients to message through the portal when others see that as cutting into revenue?

Then, strategies.  PLEASE start digital inclusion screening and referral.  But only after you know what you’re screening for, and what you will do when you have someone with a need.  You don’t want a patient to say, “yes”, they have internet when their internet access consists of borrowing their ex-sister in law’s cell phone if they run into each other at the grocery store.  Are you going to give away devices?  Tell patients to call the FCC to get their broadband benefit?  Or do you want strategies that will work?

Training, Coaching and Technical Support….Next steps.  Stay tuned for the next post!

 So solidarity hugs to all of my digital inclusion compatriots.  My Cleveland friends and National Digital Inclusion Alliance colleagues know who you are.  I’m glad the rest of the world is meeting you, too!