Digital Literacy Surprisingly Important to Health Care Access

Late summer to early fall is one of the best times of the year to drive through New Mexico. The two central highways that bisect Albuquerque, Interstate 40 and Interstate 25, offer breathtaking views of red rocks, high deserts and the tiniest communities that are a blip on a map before, whoosh, they're gone in the rearview mirror.

But this empty, enchanting feeling underscores one of the state's most pressing challenges for residents: quality internet access. And as time goes on, it becomes harder to ignore how literal health deserts across the state could be largely eradicated with quality, consistent and affordable internet service.

In a health desert, it can be difficult to find a medical provider without driving for hours round trip to do so. Even booking a medical appointment can take months, and the wear of these physical limitations has shown for years.

For nearly 20 years, the state has doubled the national average of deaths related to drugs, alcohol and suicide. In 2017, New Mexico eclipsed national averages of obesity rates and has been steadily increasing since, according to the Trust for America's Health. As of 2022, the state sits at a low tier of preparedness for a public health emergency. Not unlike the rest of the Mountain West region, New Mexico is in the top 10 states most severely touched by teen suicide with 20.4 suicides per every 100,000 teens aged 15-19.

But what could change the face of these outcomes are upcoming federal investments in broadband infrastructure. Each state's $675 million cut of the $42.45 billion in Broadband Equity, Access, and Deployment (BEAD) funding was announced in 2023 as a part of the larger Infrastructure Investment and Jobs Act (IIJA). With that money, states can now begin to plan how to build out internet access to homes that are unserved and underserved alike.

"[New Mexico] is the fifth-biggest state in land area and one of the smallest by population. That's something BEAD is looking to tackle, to serve those unserved populations," says Alison Riley, the public information officer for the New Mexico Office of Broadband Access and Expansion.

But beyond access, digital literacy is the next hurdle that broadband leaders need to contend with because one can have access to the fastest internet on the market, but if they don't know how to use a computer, that investment makes no difference. That means health deserts, even with strong internet connections that connect people in ways they were not before, will remain.

"It's a domino effect — one thing leads to another," Riley says. "Internet access is important to social determinants of health with education and employment. It's all connected."

According to Riley, building out internet infrastructure across New Mexico is estimated to cost between $2 billion to $4 billion. While BEAD awards won't cover the entire state, it's plenty to get started. Across the country, there is a consensus as to what type of broadband technology is preferred with these massive pots of money: fiber-optic internet.

"We encourage states and partners to push fiber as far into the network as possible," says Kathryn de Wit, project director for the Broadband Access Initiative with Pew Charitable Trusts. "Although it has high upfront costs, it has a longer lifespan and capacity to serve more customers at higher speeds than any other form of technology."

But community organizers, like Maria Chaparro, argue that communities, especially the older population, need much more than a lightning-fast fiber connection.

Chaparro is a stay-at-home mother and independent consultant for Mamacítas Cibernéticas, a local grassroots organization based in southern Doña Ana County, New Mexico. The county seat for the area, Las Cruces, is the second-largest city in New Mexico by population. The region is a stone's throw from El Paso, Texas and Ciudad Juarez in Chihuahua, Mexico.  

In 2023, Chaparro's team embarked on a Comprehensive Needs Assessment to learn about how digital literacy impacted the daily life of people in the community. The results were striking.

"One thing that surprised me was the demographics of the participants," Chaparro says. "I thought it would be mothers and school-age children, [but] the people that came to the focus group were women 55 years and older."

A lack of digital literacy stood in the way of respondents being able to utilize telemedicine appointments, manage prescription drugs or register for social programs they were eligible for, like food stamps. Respondents stated that investments into their digital literacy could help them become more self-sufficient, especially for older adults and those with limited mobility.

Over 85% of participants already had internet service in their home, but more than 70% stated that they could not afford a laptop. Nearly 60% replied that there was no one that could help them in their home if they needed technological troubleshooting, and over 85% said that they did not have the money to fix their laptop or upgrade their internet service if a problem arose. About 80% also replied that their fears of online scams made them hesitant to use the internet at all beyond checking Facebook.

"Access was not the No. 1 barrier that they faced," Chaparro says. "Access came in at 36%, versus 92% of people saying they lacked skills."

Right now, the organization is working on launching a training program for future Spanish-speaking digital navigators who, upon certification, can provide hands-on digital literacy training in community hubs across the region.

Hand-in-hand with the Sunland County Community Library, Chaparro presented her findings before the city manager to justify the municipality hiring another librarian solely focused on digital literacy programming. When Chaparro wrapped up her presentation, she noticed that most of the city leadership, including the mayor, were stunned by the depth of digital literacy needs just outside of their front door. One of the city councilmembers in particular was almost brought to tears, Chaparro says.

"He said, 'I look at this [focus] group and see my grandmother. I see my aunt. And wow, no one is helping them. Who is helping them?'"

To Chaparro, this needs assessment is indicative of the fact that plenty of rural communities across the country, from Washington to Georgia, are facing the same challenges that aren't talked about, because most young people who grew up with technology can't exactly wrap their heads around what a challenge it is for older generations. A lack of digital literacy can also stem from what language trainers speak.

"The institutions we're working with now [do] not even have a bilingual instructor to train the digital navigators to deliver digital navigation services," Chaparro says. "These services need to be culturally competent in order for digital literacy to take root and thrive. If not, the barriers will continue. It's just going to be a cycle."

It's going to take substantial time, even if ground broke on the tiniest town today, for rural, spread-out states to see the effects of BEAD funding. But it's coming.

"What I'd like to see the most is the elimination of health deserts," Riley says. "Telehealth is such an advantage and in many situations, a doctor doesn't need to be in your presence to help out."

For De Wit, in order to improve public health outcomes from BEAD investments, health care systems need to be in conversation with their respective states from the start.

"States need input from health care experts — not just on the barriers to access for patients, but how digital equity can play a meaningful role in improving health care outcomes across the country," De Wit says.

As for Mamacítas Cibernéticas, it may not seem like training older generations to use the internet will be a game-changer for public health, but to really make these federal investments stretch as far as possible and increase quality of life for all, that is what needs to be done.

"Digital literacy has been on the backburner because there has been no awareness," Chaparro says. "[Think about] how horrible it would be to just ignore that need of our elders. We need to really be proactive."

Karen Fischer is an independent writer. You can find her bylines in CQ Researcher, The Verge, EATER, and other publications on her website at kfischerwrites.com. Read More