The FCC is currently underwriting $7 billion worth of broadband and leading digital technology for two critical anchor institutions – libraries and schools. The funding window closes on August 15, 2021.

Earlier in June, three US Senators launched a bill to bring $40 billion to these and other anchor institutions. Finally, in March the American Rescue Plan Elementary and Secondary School Emergency Relief Fund (ARP ESSER) opened a $122 billion grab bag of tech and non-tech funds.  

This trifecta of federal government largess could mean Christmas will come early for rural public health. Just as we are attacking the homework gap by pouring billions of dollars into anchor institutions, we should simultaneously attack the healthcare gap.

For 20 years, libraries, schools, local government buildings, healthcare facilities, and other anchor institutions have been critical elements of community broadband network design, partly because these institutions can help finance (through fees) many network buildout costs. But institutions’ key value is driving people (subscribers and users) to the network. Today, these institutions still drive telehealth access and adoption.

Telehealth may or may not be the silver bullet for public health. But it is a powerful tool to attack the healthcare gap between those who can access affordable, quality healthcare, and those who cannot, especially, rural populations, seniors, immigrants, the unemployed, and the working poor.

Building the Telehealth Hub

In order to create a working hub, you need to combine two or three anchor institutions to collectively facilitate telehealth access and adoption. The essence of broadband adoption is 1) daily access to the Internet at speeds, quality, and capacity necessary to accomplish common tasks, 2) the digital skills and training necessary to fully participate online, 3) access on a personal device and secure, convenient network.

By swapping in “equitable” for “daily,” we now have a definition of telehealth adoption.

Libraries are the vanguard of broadband access and adoption within communities. In many rural communities, libraries are the fastest and sometimes the only Internet access that residents have. A library can partner with the county health department (another key anchor) or local family practice to provide telehealth services via library kiosks.

“ECF’s main focus is on providing Internet service to homes and remote locations within the community,” said Debra M. Kriete, South Dakota E-rate Coordinator. “The library is reimbursed 100% up to $400 for each computing device, $250 for a hotspot, and the ISP’s monthly Internet service. If there’s no Internet service at all in a segment of the library’s region, the library can build network infrastructure in the area.” School districts taking ECF have the same option.

While putting laptops, hotspots, digital skills, and networking gear into the hands of tens of thousands of library patrons and even more K-12 students, give them telehealth software, digital stethoscopes, and other digital devices, digital navigators assess patrons’ Internet needs, baseline digital skills and advise on free or affordable solutions to improve their digital literacy.

One challenge that anchor institutions may have is a lack of health literacy by all involved. “Nine out of 10 people actually lack the skills needed to maintain, manage and prevent disease,” said Jessica Maack Rengal, Senior Vice President of Clinical Innovation at University of North Texas Health Science Center. “And even when we send people home with medical literature, we have it at such a high level with regard to the words we choose that people just throw it away.” Digital navigators do a great job at improving people’s digital literacy, but health literacy may need a special kind of navigators.

Getting Schooled in Telehealth

Telehealth can certainly benefit K-12 elementary and secondary children in rural communities because, on average, there are several areas where physical and mental healthcare is lacking. At the same time, don’t expect schools to carry the full administrative burden of managing telehealth.

The National Survey of Children’s Health (NSCH), funded and directed by the Health Resources and Services Administration’s (HRSA) Maternal and Child Health Bureau (MCHB), provides information on the health and well-being of children ages 0-17 years in the United States.

Having a usual source of care or a particular place to go for health care leads to better health outcomes for children. In 2017-18, children in small rural areas were less likely (71.4%) than urban children to have a usual source of sick and preventive care (75.8%). Receiving preventive dental care was less common in small rural areas (74.0%) compared to urban areas (80.2%)

Children ages 10-17 who lived in small rural areas were more likely to be affected by overweight (19.5%) and obesity (22.1%), relative to children in urban areas (15.1% and 14.6%, respectively). At the same time, there are some positive health stats. Children ages 10-17 in small rural areas were more likely to meet the recommended 60 minutes of daily physical activity (25.8%) compared to urban children (18.9%).

$122 Billion in Bonus Funds

While there has been a lot of attention given to the ECF and the FCC by way of media articles, and webinars there is one particularly large pot of cash that has gotten a relatively small amount of attention – the ARP ESSER. A part of the American Rescue Plan (ARP) Act of 2021, it’s a $122 billion grant fund for just about anything that schools may need or want.

These grants are available to all school districts and are given quite broad discretion for their uses. As it was framed in the Act, the money is going to help schools reopen after the Covid-19 shutdowns.

“I think school districts can definitely make the case that, in order for them to safely reopen, districts need to have options for robust telehealth solutions in place,” said Evan Shea, manager for policy and strategic partnerships at the technology firm, Education Superhighway. “If a student gets sick, they would be able to learn from home, and also receive the benefits of healthcare.”

Even with this much money, the program has a lot fewer strings attached and it has a longer funding horizon. The ECF runs through the end of June 2022. The ESSER funds are available through September 2023.

Craig Settles, saved from a stroke by telehealth, pays it forward by uniting community broadband teams and healthcare stakeholders through telehealth initiatives. He provides additional insights to libraries as anchor institutions.

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