Better Community Health Depends on Broader Digital Access
By Amy R. Sheon, Ph.D., M.P.H., Executive Director, Urban Health Initiative, Case Western Reserve University School of Medicine
—In his recent blog series on “Leadership and the Future,” OneCommunity CEO Lev Gonick put forth a bold vision for designing and implementing Northeast Ohio’s digital infrastructure to fuel economic development and social justice.
I am pleased to have been invited, through my position as Executive Director of the Urban Health Initiative at Case Western Reserve University School of Medicine, to help the community leverage this tremendous resource to improve the health of the local population.
I agree with Lev that there is a broad imperative to leverage digital infrastructure to ensure equal opportunity for all to achieve and maintain health. Whether the expanded digital capacity of our region exacerbates the digital divide or serves as a gateway to opportunity is up to all of us.
Before we can consider how digital capacity can contribute to health, it’s worth a moment’s digression to consider the “true causes” of health and illness. In 1993, McGinnis and Foege published a now classic paper that attributed 400,000 deaths to tobacco and 300,000 to poor diet and lack of physical activity.
Since then, health policy experts have increasingly focused on the relationship between social factors and health. Attention now focuses on factors even more removed from health to “social determinants of health.” In 2000, an estimated 245,000 U.S. deaths were associated with low education, 176,000 with racial segregation, 162,000 with low social support, 172,000 with poverty, and 119,000 with inequality.
The Cleveland metropolitan area is, unfortunately, near the bottom of major metropolitan areas in several of these measures.
Could Internet Access be a New Social Determinant of Health?
In 2012, OneCommunity commissioned a survey to report on Internet access and use for Cuyahoga County and for areas with high rates of poverty. Whereas 74% of residents in wealthier areas had home access to high-speed broadband, only 55% of residents in the poorer areas did. While mobile Internet access was nearly the same at just over one-third of the population, residents of wealthier areas were more likely to have at least one or the other (88% vs. 76%). More residents of poorer areas had only mobile access 8% vs 3%). Limits on data usage is one significant drawback of mobile-only access. A summary and the complete results of the 2012 Cuyahoga County Internet Survey are available on the Connect Your Community web site.
New Opportunities for Expanding Digital Access Need Public Support
Bold plans such as the recently-announced PRE4CLE—to expand availability of high-quality preschool—and the new Upper Chester Development represent real opportunities for addressing root causes of health and wellness.
The federal E-Rate Program provides discounts for eligible K-12 schools and public libraries to ensure affordable access to modern telecommunications and information services. Unfortunately, at present, Ohio pre-schools are not eligible for this discount rate.
And, while some express concern about excessive screen time among youth, the value of Internet access must be seen more broadly. For example:
- We could offer online training for preschool teachers in nutrition and physical activity.
- What about offering a physical activity channel that would offer interactive activities led by training a remote instructor?
- Enhancing parent-teacher communication by improved online access is an additional benefit to consider.
Internet access should be among factors considered from the outset when planning any new building or neighborhood redevelopment. The Health Impact Assessment is a tool offered by the national Health Impact Project to help policymakers consider the impact on health of decisions made in other sectors such as transportation, agriculture and energy.
The Cleveland City Planning Commission and the Cuyahoga County Place Matters team are promoting use of Health Impact Assessments for development and redevelopment projects in our region. For example, the Upper Chester Development project has received a grant to use the HIA tool to consider factors such as access to quality food, green space, proximity to education, air quality and access to jobs in the neighborhood’s design.
Let’s hope that equal opportunity for Internet access is also being considered for this exciting redevelopment plan.
The six-step HIA process encourages public input at each step. Over the coming weeks and months, watch for opportunities to give your input and feedback on ways we can optimize establishment and use of the region’s growing digital infrastructure for health improvement in our community’s redevelopment plans.
McGinnis, J. A. (1993). Actual causes of death in the United States. JAMA, 2207-2212.
Galea S, T. M. (2011). Estimated Deaths Attributable to Social Factors in the United States. Am J Public Health, 1456-1465.
Cuyahoga County Survey of Internet Access and Use. University of Illinois; University of Iowa, 2012.