Other Resources

In an effort to further understand and gather relevant information concerning the benefits of formally recognizing broadband connectivity as a social determinant of health (SDOH) domain, the C2H Task Force provides below links and information to other sources (i.e., outside the FCC) relevant to the issue.  These references and other information on this page should serve as a convenient tool or resource for stakeholders and researchers interested in this topic.  (NOTE:  This listing is for educational and research purposes only; it should not be construed as endorsement of the information and content from other websites, organizations, or publications.)     

General Information about SDOH   

• Centers for Disease Control and Prevention, Social Determinants of Health: Know What Affects Health.  This CDC website connects you to CDC resources for SDOH data, research, tools for action, programs, and policy. They may be used by people in public health, community organizations, research organizations, and health care systems to assess SDOH and improve community well-being.
• HHS, Office of Disease Prevention and Health Promotion, Healthy People 2030, Social Determinants of Health (identifies and describes the 5 “domains” that currently comprise SDOH;  provides relevant information, resources, summaries, etc.; provides national guidelines for improving the health of the Nation).
• World Health Organization, Social Determinants of Health.  According to the WHO, social determinants of health are the non-medical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.  These forces and systems include economic policies and systems, development agendas, social norms, social policies, and political systems.
• Rural Health Information Hub, Defining Social Determinants of Health  (providing information and links to other relevant resources) (“SDOH are closely linked with health outcomes. Research suggests that the number of deaths in the U.S. due to social factors — such as a lack of education, racial segregation, discrimination, and poverty — may be comparable to the number resulting from heart disease, lung cancer, and other leading causes of death.  In addition, SDOH can influence and contribute to chronic health conditions, such as obesity, diabetes, and heart disease.”)
• The County Health Rankings & Roadmaps program is a collaboration between the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute, which compares the health of counties in the U.S. to others within the state and provides strategies that communities can use.  This program compares the health of nearly all counties in the United States to others within its own state.  The annual rankings provide a revealing snapshot of how health is influenced by where we live, learn, work and play. 

External Research and Papers on Broadband as a Social Determinant of Health

• Digital Access: A Super Determinant of Health, Substance Abuse and Mental Health Services Administration (Turcios, Y., March 22, 2023) (Examining the impact of the digital divide on health, including behavioral health, and contends that there is a strong relationship between broadband access and health outcomes and that such relationship is linked to health equity. Argues for expanding efforts to bridge the digital divide as a way to reduce health disparities.).
   
• Internet Access, Social Risk Factors, and Web-Based Social Support Seeking Behavior: Assessing Correlates of the “Digital Divide” Across Neighborhoods in The State of Maryland, Journal of Medical Systems (Hatef, E., et al, Sept. 2021) (Contending that more disadvantaged neighborhoods had higher demand for social services, but “[t]he digital divide and lack of internet access (to search for social services) in disadvantaged neighborhoods might have masked the actual demand for such services.”  Asserts that “[c]alling [the] digital divide a ‘super-determinant of health’ shows its impact on the health of individuals and populations as without internet access a number of health and social services would be inaccessible to those in need.”).
   
• Disparities in Internet Access and COVID-19 Vaccination in New York City, Preventing Chronic Disease (Michaels, I.H., et al, Aug. 2021) (Finding that “COVID-19 vaccination was significantly associated with household internet access in New York City at the zip code level.”  Contends that “Internet access is a known social determinant of health.”).
   
• Digital Disenfranchisement and COVID-19: Broadband Internet Access as a Social Determinant of Health, Health Promotion Practice (Early, J. & Hernandez, A., May 2021) (Asserting that “[t]he COVID-19 pandemic has underscored the strong link between digital equity and health equity” by highlighting the critical importance of broadband access “not as a luxury but as an essential utility such as water and electricity.”  “Now more than ever, health advocacy to promote digital equity and inclusion is critical to our meaningful progress toward health equity.”).
   
• Telehealth and the Digital Divide as a Social Determinant of Health During the COVID-19 Pandemic, Network Modeling Analysis in Health Informatics and Bioinformatics (Clare, C.A., April 2021) (Contending that “[t]elemedicine and digital-based prenatal care are strategies that have been successful in reducing in-person visits for routine questions and concerns,” but issues such as “decreased internet connectivity and a lack of Wi-Fi and video chat/webcast in both urban and rural areas can hinder the effectiveness of telehealth to its full capability, especially among communities of color, the poor, and medically underserved.”).
   
• Digital inclusion as a social determinant of health, npj Digital Medicine (Sieck, C.J., et al, March 2021) (Stating: “Digital literacies and Internet connectivity have been called the
  ‘super social determinants of health’ because they address all other social determinants of health (SDOH). . . . For example, applications for employment, housing, and other assistance programs, each of which influences an individual’s health, are increasingly, and sometimes exclusively, accessible online.”  Cautioning that “greater reliance on digital tools has the potential to increase disparities between those who have skills and access to digital tools and those who do not.”).

• Broadband Internet Access Is a Social Determinant of Health!, American Journal of Public Health (Benda, N.A., et al, Aug. 2020) (Contending that “[n]ow, more than ever, broadband Internet access (BIA) must be recognized as a social determinant of health. Disparities in access should be treated as a public health issue because they affect ‘the health of people and communities where they live, learn, work and play.’”).
   
• Digital Divide: Marked Disparities in Computer and Broadband Internet Use and Associated Health Inequalities in the United States., International Journal of Translational Medical Research and Public Health (Singh, G. K., et al, June 2020) (Examining socioeconomic, demographic, and health characteristics associated with computer and Internet use in the United States.  Asserts that both "have profound effects not only on individual empowerment, educational attainment, economic growth, and community development, but also in accessing health care, health-related information, and health education and health promotions efforts, and, are seen as an important social determinant of health.").
   
• Digital Prosperity: How Broadband Can Deliver Health and Equity to All Communities, Brookings (Tomer, A., et al, Feb. 27, 2020) (“Broadband is so influential on society that we would now call it essential infrastructure. That means affordable subscription prices, universal access to connected devices, and a population equipped with digital skills are now vital characteristics of a healthy neighborhood, city, state, or country. Broadband’s applications are so far-reaching that these physical networks directly and indirectly affect a wide range of conditions that impact health and life outcomes, known as social determinants of health (SDOH).”).
   
• Broadband Access as a Public Health Issue:  The Role of Law in Expanding Broadband Access and Connecting Underserved Communities for Better Health Outcomes (Bauerly, B.C., et al, 2019) (Contending that broadband internet access is a “super-determinant of health” that plays an important role in healthcare and public health outcomes.  Argues that laws and policies play an important role in facilitating broadband access necessary for solutions in those communities currently without high-speed internet access.).
   
• Addressing Social Determinants to Improve Patient Care and Promote Health Equity: An American College of Physicians Position Paper, Annals of Internal Medicine (Daniel, H., et al, April 2018) (Recognizing the growing role of broadband-enabled technologies such as medical portals and electronic health records in healthcare.  Contends that a lack of reliable Internet service “limits not only a person's ability to utilize technology for health-related purposes but also their ability to access other important services, such as emergency assistance or employment opportunities.”).
   
• Patient Portals and Broadband Internet in Equality, Journal of the American Medical Informatics Association (Perzynski, A.T., et al, March 2017) (Contending that “[i]ndividuals without internet access are systematically denied the benefits of patient portal use” because health information technologies like patient portals require reliable, high-speed broadband.  Argues that “internet access has emerged as an important social determinant of health.“).