Reader, you’re about to read a post that is decidedly pro-internet. Like Nixon in China, we at KBGH feel we have particularly powerful priors to make this pro-internet argument. We’ve posted in the past on the potential ill health effects of social media, which, along with Amazon commerce, is maybe the leading driver of internet activity in 2021. And we freely acknowledge all the other bad things that come with internet use, like leaky personal data, mean anonymous messages, poor interoperability of electronic health records, and the general time-suck of streaming services. So we’re not coming from a magical internet land of digital butterflies and rainbows when we tell you that access to the internet is good.

With access to the internet, you can see pictures of your grandkids now, for almost free. You can push a few buttons, drive to the airport, and fly, float, or bus anywhere in the world. We gaze in wonder at the seemingly impossible tasks made possible by internet connectivity and its associated computing power, like the recent news of AlphaFold2 (part of Google/Alphabet’s DeepMind) outdoing legions of human biologists by solving the problem of protein folding and publicly releasing 350,000 protein structure predictions, more than double the number that have been determined in all of human history by traditional methods, and including nearly every protein expressed in the human body. We all have access to our doctors’ notes now, thanks to the internet.

So the internet is increasingly seen not as a luxury, but as a utility, like electricity or city water. Access to cheap electricity undoubtedly increases your risk of being electrocuted. But it also increases your likelihood of having heat in the winter. We take the bad with the good. And a new tool from the Agency for Healthcare Research and Quality shows that access to the internet, in spite of all its flaws, may be valuable to your health. The effect is so powerful that many believe that internet access–which 25 million Americans lack–should be considered a “social determinant of health,” just like income or education level.

The new tool looks at years 2014 to 2018 and shows that internet access, both in terms of broadband and internet-connected devices, is unequally distributed. In the darkest blue counties, between 22% and 62% (!) of homes have no computing devices:

Here is Kansas, with data from Sedgwick County:

The darkest blue counties align closely with counties with the highest poverty rates and highest levels of chronic disease. People on Medicaid and Medicare make up about two-thirds of those without home internet, and around a fifth of Americans under the poverty line lack internet. So a skeptic might say that the lack of internet access is just a proxy for poverty. But other studies show an independent effect, even after controlling for income and other determinants of health. It does not take a huge leap of the imagination to see how internet access may improve health outcomes, given our recent history of a global pandemic and forced entry into telemedicine. And with more social distancing likely on the horizon this fall (*gentle reminder: update your vaccines*), we are likely to get another heapin’ helpin’ of telemedicine as 2021 turns into 2022. But the benefit of internet access likely extends far beyond simple access to a physician. Less than 20% of health outcomes are directly attributable to the care of a physician and his care team, after all.

We don’t know the exact mechanism by which internet access may improve health outcomes. Caregivers may have more informal access to health information. It may give people access to their physician’s electronic health record portal. It may simply lead to more economic opportunities, like the gig economy. Regardless, we believe that it may be helpful to determine which of your employees lack home internet access. For those that do, it may be beneficial to their health to assist them in getting access. I can’t find any good studies of specific strategies, but off the top of my head, we could make sure access to broadband is widely available at the workplace so that they can take advantage of breaks in the day. We could instruct employees on local sources of free broadband like the public library. We could coach them on using publicly available apps like WiFi Maps or the Facebook mobile app to find wifi hotspots (and coach them on the potential data insecurity of public wifi while we’re at it; this is not an endorsement of WiFi Maps, and Lord knows it’s not an endorsement of Facebook). If any of your employees are taking continuing education courses, there is a chance the course vendor or institution offers free internet access for the duration of the course.

Has your company taken steps to increase broadband access? What potential interventions have we overlooked? We’d love to hear from you.

As the Medical Director of the Kansas Business Group on Health, I’m sometimes asked to weigh in on hot topics that might affect employers or employees. This is a reprint of a blog post from KBGH.