Mapping Broadband Health in America is a customizable data visualization platform that depicts the intersection of broadband connectivity and health data for states and counties in the U.S. The 2024 release of the mapping platform now includes health data on key maternal health risk factors (e.g., pre-pregnancy or gestational diabetes, pre-pregnancy or gestational hypertension, and pre-pregnancy obesity), cancer data, and new demographic, socioeconomic and community health filters (e.g., veteran status, food insecurity). The platform also now incorporates broadband access and adoption data collected from the Commission’s Broadband Data Collection, along with mobile broadband access and device ownership data. Users can also filter data by counties that have received funding from the Commission’s Rural Health Care Program.
The mapping platform uses color-coding, filtering, and data overlays to allow users—from the casual observer to the sophisticated researcher—to create customized maps intersecting the broadband and health variables of interest. With these design features, users can explore gaps and opportunities in the broadband health space, the status of broadband or health across levels of the other, as well as the characteristics and context of these areas by selecting relevant demographic, socioeconomic, and access variables. It is also open data so that users can download the data and conduct their own analyses that addresses their specific needs and priorities, or utilize the data in their own platforms. This section describes the methodology underlying the mapping platform, including the variables, data sources, calculations, and design features.
Visit www.fcc.gov/health/maps/developers and https://c2h-prod.fcc.gov/bh-data.html for more information.
Broadband
The broadband variables were chosen to provide insights on what can be enabled and delivered through the broadband health ecosystem of network, devices, and applications, and to identify exactly where gaps and opportunities exist. The selected variables fall under four primary dimensions of broadband connectivity: availability (access), subscription (adoption), digital device ownership, and funding (for rural health care facilities).
The platform uses data from the FCC’s Broadband Data Collection (BDC) program (as of December 2022), the FCC’s Form 477 data program (2022), Universal Service Administrative Company (USAC) Rural Health Care Commitments and Disbursements program (2018–2023), and the U.S. Census Bureau’s American Community Survey (2016–2020). The map uses data on fixed broadband at download speeds of 100 Mbps and upload speeds of 20Mbps, the current minimum broadband speed thresholds set by the FCC, and data on mobile 5G-NR service at download speeds of 35 Mbps and upload speeds of 3 Mbps. 5G-NR service at 35/3 Mbps speeds or greater is the highest speed that the Commission collects for mobile data and is the threshold speed used by the Commission for analyzing mobiles service availability. The fixed broadband and mobile data in the current mapping platform come from the FCC’s BDC program released in 2024 and covering data as of 2022. BDC data is collected at the broadband serviceable location level. Broadband availability data (e.g., Fixed Broadband Access, Mobile Access, and Fixed Broadband and Mobile Access) shows what broadband services, if any, are available at locations included in the Fabric, as reported by internet service providers every six months. These access metrics are also available for the rural population specifically (e.g., Rural Fixed Broadband Access, Rural Mobile Access, and Rural Fixed Broadband and Mobile Access). Metrics on Internet adoption of any speed come from the FCC’s Form 477 data released in 2024, which covers data as of 2022.
In addition, the platform also uses self-reported data from the American Community Survey released in 2023, and covering data from 2016–2020. This includes high-speed Internet adoption data and device ownership data, including data on the percentage of households with only a desktop or laptop, the percentage of households with no device, and the percentage of households with only a smartphone.
Finally, the platform also incorporates funding data for the Commission’s Rural Health Care (RHC) Program. Data is from USAC’s Rural Health Care Commitments and Disbursements dataset. The platform aggregates the available funding data from Funding Years 2018–2023. Each funding year begins on June 1 and ends on July 30 of the next year, so the data year range covers June 1, 2018, to July 30, 2024. To create the RHC funding variables, committed funding amounts were aggregated across all eligible entities from 2018–2023, as well as aggregated by nine entity types (community health centers, community mental health centers, consortia, dedicated emergency rooms, educational institutions, local health departments, not-for-profit hospitals, rural health clinics, skilled nursing facilities, and other entities).
Maternal Health
In the Phase 1 (2023) update to the platform, the approach to intersecting broadband and maternal health reflected an initial focus on two outcome variables, severe maternal morbidity and maternal mortality up to one year postpartum. As a complement to that outcome data, the Task Force also consulted with the Centers for Disease Control and Prevention (CDC) and reviewed the available literature to identify relevant risk factors and social determinants of health (i.e., the conditions in the places people live, learn, and work, affect a wide range of health, functioning, and quality-of-life outcomes and risks) that influence maternal health outcomes and where broadband-enabled interventions might help bridge the gaps. Information on the resulting conceptual model and the measures that were included in the Phase 1 and Phase 2 (2024) updates can be found in this Methodology document with a brief summary below.
Data on maternal mortality comes from death certificates submitted to the National Vital Statistics System and is accessed through CDC WONDER—the Online Data for Epidemiologic Research. The platform incorporates three measures related to maternal mortality. The first is the Maternal Mortality Rate, which is defined as “the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.” The second is the Late Maternal Death Rate, which includes deaths that occur after 42 days but up to one year postpartum. Both rates are calculated per 100,000 live births, also using data from CDC WONDER. The third is “Maternal Deaths,” which reflects counties reporting maternal deaths (up to 42 days postpartum) or no maternal deaths. The CDC does not report mortality data when there are between one and nine deaths in a particular geographical location for privacy and confidentiality reasons; these counties are marked as “suppressed” in the platform. The CDC also does not report rates when there are fewer than 20 deaths due to statistical unreliability.
Data on severe maternal morbidity come from the Healthcare Cost and Utilization Project’s Fast Stats, which are sponsored by the Agency for Healthcare Research and Quality (AHRQ). They reflect the number of women experiencing unexpected outcomes of labor and delivery (21 indicators) per 10,000 in-hospital deliveries. For the initial effort, data for this measure are available at the state-level for intersection with broadband. This information on maternal mortality and severe maternal morbidity can be intersected with broadband to show areas where broadband can be leveraged through telehealth and other broadband-enabled solutions to improve health outcomes and address disparities.
Additional data on risk factors, maternal health care, and social determinants of health come from various sources, including from the Health Resources and Services Administration (HRSA), the March of Dimes, and the U.S. Census Bureau. These data are available for intersection with broadband or as filters that can be applied to explore disparities in the broadband health picture in specific areas and populations.
Telehealth and other broadband-enabled solutions and technologies offer new and exciting opportunities to help address the maternal health crisis. Remote monitoring, telesonography, self-operated ultrasound and robotic sonography are all emerging broadband-enabled technologies that show promise in this area. The March of Dimes observed that, “In obstetrics, telehealth exists in nearly every aspect of care from remote observation of ultrasound recordings to postpartum blood pressure tracking, however, development of evidence-based practices may lag with technology uptake.” For example, broadband can be leveraged in:
- Providing preconception, prenatal, and postnatal care to reproductive age and pregnant women through telehealth, when appropriate, particularly in maternity care deserts or to women who experience limited access to care due to geographical, financial, physical, cultural/social, or other reasons. Studies show that fewer prenatal care visits are associated with increased maternal mortality;
- Providing telehealth services for mental health and substance use prior to, during, and following pregnancy, especially where access to mental health providers is limited;
- Remote monitoring of chronic conditions and other risk factors for reproductive age and pregnant women;
- Facilitating participation in childcare education classes, maternal health support groups, and community services or networks;
- Enabling access to online information and resources on family planning, pregnancy, childbirth, and the postpartum period.
However, the success of these solutions relies on available broadband at adequate speeds in the areas where women of reproductive age who are at-risk of poor maternal health outcomes.
In the Phase 2 (2024) update, the Task Force incorporated infant health outcomes and maternal risk factors as proxy variables to take a more nuanced look at maternal health. Poor infant health outcomes have profound impacts on the mother’s physical and mental health, so data on infant mortality rate, low birth weight, and preterm birth were included. Risk factors like pre-pregnancy or gestational diabetes, pre-pregnancy or gestational hypertension, or pre-pregnancy obesity can also lead to increased risk of maternal morbidity or death. Additional risk factors added to the platform for Phase 2 include smoking during pregnancy and breastfeeding initiation. Smoking during pregnancy can lead to low birth weight, preterm birth, stillbirth, birth defects, sudden infant death syndrome (SIDS) and abnormal maternal bleeding. It can also cause fertility problems for future pregnancies. For mothers, breastfeeding is associated with lower risk of Type 2 diabetes, breast, and ovarian cancer. This new data comes from HRSA’s Maternal and Infant Health Mapping Tool. HRSA obtains data from sources such as Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System, Linked Birth / Infant Deaths on CDC WONDER Online Database, Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System, Natality on CDC WONDER Online Database, and U.S. Census Bureau postcensal estimates of the July 1 resident population.
Chronic Disease
The data on chronic disease reflect four critical dimensions of health (i.e., population health outcomes, access to care, quality of care, and health behaviors) where broadband connectivity may be used to enable effective and cost-saving interventions. Population health outcomes include adult obesity and diabetes prevalence, health-related quality of life measures (such as self-reported poor/fair health and sick days in the past month), and premature death. Access to care is represented by the number of primary care physicians per 100,000 population, as well as the total number of primary care physicians, dentists, and mental health providers in each county. Quality of care is represented by preventable hospitalizations. These are hospitalizations for diagnoses that are usually treatable in an outpatient setting, indicating that the quality of care in these settings was sub-optimal. Relevant health behaviors include adult smoking, excessive drinking, and physical inactivity. We also include variables on selected risk factors—injury deaths and severe housing—that provide insight on the physical and safety environment in a county.
These data sets are drawn from the 2024 release of the County Health Rankings & Roadmap program—a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Initiative. They reflect the most recent data on the metrics of interest from the Centers for Disease Control and Prevention, Health Resources and Services Administration, Centers for Medicare and Medicaid Services, and American Medical Association, among others.
In Phase 2, the Task Force incorporated breast cancer incidence and mortality, as well as hospitals with mammography services and mammography screening. Cancer is the second leading cause of death in the United States. In terms of access to cancer care, people living in rural areas tend to have limited access to cancer care. Breast cancer incidence and mortality variables were obtained from U.S. Cancer Statistics, and the original data sources are CDC's National Program of Cancer Registries (NPCR) and NCI's Surveillance, Epidemiology, and End Results (SEER) Program, and CDC's National Center for Health Statistics (NCHS) National Vital Statistics System (NVSS). Hospitals with mammography services data was obtained from HRSA’s Area Health Resource File. Mammography screening prevalence was obtained from CDC PLACES, and the original data source is the Behavioral Risk Factor Surveillance Survey.
Opioid-Related Mortality and Prescription Rates
Pursuant to a congressional request that the FCC measure the potential impact of broadband access on the opioid crisis and that we utilize the Mapping Broadband Health in America platform to “overlay[ ] drug abuse statistics with the level of Internet access to help address challenges in rural areas,” the platform includes variables on both health outcomes and risk factors for drug surveillance. It also reflects the first phase of a planned multi-phase effort to add drug abuse data to the platform. This initial phase focuses on a subset of variables that provide critical, baseline information for policymakers, namely opioid-related mortality rates, opioid prescription rates, and trends in each.
The opioid-related mortality data are based on death certificates for U.S. residents and reflect an average, age-adjusted mortality rate over a five-year period (2015-2019) accessed using CDC WONDER—the Wide-ranging Online Data for Epidemiologic Research. The CDC does not release mortality data when there are fewer than 9 deaths for privacy reasons or fewer than 20 deaths because of statistical unreliability. Given the large amount of suppression in the county-level data on mortality from the CDC, especially when a single year is selected, our approach uses a five-year average. We also include data on the broader category of all drug mortality given that more than 70% of drug overdose deaths involve opioids. These approaches have the effect of increasing the number of counties that meet the minimum death counts for data to be released and displayed in the mapping platform, while still providing a current snapshot of the situation. We identify counties where the CDC does not release mortality data as “Not Reported” in the mapping platform.
The CDC also recognizes three distinct waves in the opioid epidemic. Starting in 1990, the first wave of the epidemic reflected an increasing number of overdose deaths involving prescription opioids. A second wave of the epidemic began in 2010 with a spike in overdose deaths involving heroin. The current wave began in 2013 with a rapid increase in overdose deaths due to synthetic opioids, notably fentanyl. In recognition of these distinct waves, the mapping platform now includes several sub-categories of opioid-related mortality. Users can select specific data on overdose mortality related to prescription opioids, heroin, or synthetic opioids.
Given the role of prescription opioids in driving the opioid epidemic, we also include data on the opioid prescription rate. While deaths due to prescription opioids may no longer be the most common cause of opioid-related mortality, the prescription rate provides an important measure of risk due to the level of exposure to opioids that exists in a community as a potential gateway to opioid abuse or other opioids use. Thus, this data may provide an early indicator of potentially emerging areas of need and targets for prevention efforts. Data on opioid prescription rates for 2019 come from the CDC’s U.S. Opioid Dispensing Rate Maps accessed in 2023.To help users assess trends over time and identify potentially emerging hotspots, we also calculate a percent change in the mortality and prescription rates. To calculate the percent change for the mortality data, we compare two consecutive, five-year periods (2015-2019 and 2010-2014). The percent change in opioid prescription rate reflects the most current data (2020) compared to the previous year (2019). Trends are calculated by subtracting the value for the baseline period from that for the current period and dividing by the baseline period to produce a percent change. If either or both values for the baseline or current period are missing, a percent change cannot be calculated; and we depict this in the mapping platform as “Unavailable.”
Finally, in Phase 2, we incorporated opioid use disorder data. This data measures the prevalence of overarching Opioid Use Disorder (OUD) among Medicare (dual and non-dual) beneficiaries and is based on Centers for Medicare & Medicaid Services’ administrative enrollment and claims data for Medicare Part A and Part B beneficiaries enrolled in the fee-for-service program. The data identifies OUD based on procedure and diagnosis codes, hospitalization and emergency department visits due to opioid-related overdoses and poisoning events, and/or the utilization of FDA approved drugs for the treatment of OUD.
Demographic and Socioeconomic Determinants
To provide characterizations and context for visualizations of the intersection between broadband and health, the mapping platform also includes other relevant demographic information and socioeconomic determinants, including population, rurality, education, and income (with different variables applicable to certain disease states). This information comes from various publicly available sources, including the U.S. Census Bureau, the FCC’s, the County Health Rankings & Roadmaps, and the Agency for Healthcare Research and Quality (AHRQ)’s Social determinants of Health Database.
Population size is a critical variable underlying the demographic information and calculations in the mapping platform. We use the values for population from the U.S. Census Bureau as the primary source for population estimates. In addition to providing information on population statistics, the mapping platform also enables users to overlay population data in certain visualizations. We also use this data to calculate the number of people living in urban or rural areas and identifying as male or female for display in the chronic disease and opioids modules.
Given the importance of rurality to better understand the broadband health space, we also include information and functionality on rurality. The U.S. Census Bureau is also the primary data source, and they define an urban area as a “densely settled core of census tracks and/or census blocks that meet minimum population density requirements, along with adjacent territory containing non-residential urban land uses as well as territory with low population density included to link outlying densely settled territory to the densely settled core” and encompass at least 2,500 people. Rural areas are all those not identified as urban areas. Users can filter by quintiles of rural population (0-20%, 20-40%, etc.) or by areas where 50% or more of their population live in rural areas vs. areas where less than 50% of the population live in rural areas.
In acknowledgment that social determinants of health affect a wide range of health, functioning, and quality-of-life outcomes and risks, in Phase 2, the platform incorporated additional community factors and socioeconomic metrics. Community factors include transportation, represented through the “percentage of households with no vehicle” as well as “distance to ER” filter; housing, represented through the “severe housing”; “poor mental health days”; and injury deaths variable. Social and economic metrics include food insecurity, or the estimated percentage of the population who lack adequate access to food, and the Social Vulnerability Index, a composite measure of social vulnerability based on 16 demographic factors collected in the American Community Survey, including poverty, unemployment, housing cost burden, education, health insurance, age, disability status, single-parent households, English language proficiency, racial and ethnic minority status, housing type and transportation.
Geographic Zoom Levels
Map features are available at the state and county zoom levels. We chose to focus on counties for several reasons: (1) county level data are available across most health measures (e.g., diabetes, obesity, preventable hospitalizations) and connectivity variables; (2) counties are a discrete geographic unit with community governance that can potentially drive broadband economies and local health policy (i.e., they are neither too broad such as a state level geography nor too granular such as neighborhood level geography); and (3) counties are the building blocks for publishing many types of data (e.g., economic data) and for tracking progress and regional population and economic trends.
Open Data
The map platform allows the user to conduct further analysis by downloading the data in a number of formats including CSV. It also allows developers to integrate the data into their own platforms using JSON data download formats. We encourage developers to leverage the platform for their own use. Please use the Community Engagement tab to share efforts in analysis and development using the platform and to identify other data or features that would be useful.