Experts in healthcare, broadband access, and rural community outreach discussed the digital divide and how it affects access to healthcare at the 2023 Alaska State of Reform Conference last month.
Christine O’Connor, executive director of the Alaska Telecom Association, emphasized how Alaska lacks access to fast internet speeds.
Due to the terrain and climate of Alaska, it is difficult and expensive to install fiber-optic cables (usually known as “fiber”), which are needed for a strong broadband connection. They are installed aerially, in the ground, or in water. In many rural communities there is no fiber closeby so their access to broadband connection is minimal or nonexistent.
This lack of connection causes a significant amount of people in Alaska to be unserved or underserved, O’Connor said.
According to Alaska Tribal Spectrum (ATS), about 60,000 people in Alaska are unserved, and around 200,000 people are underserved, meaning their internet connection is slower than 10 megabits per second (Mbps).
However, O’Connor has a hopeful outlook because of recent broadband funding Alaska has received.
“We are narrowing the digital divide. I think we could actually close it in a decade or so, largely due to [grant-funded] programs.”
— O’Connor
These programs include the Tribal Broadband Connectivity Program, ReConnect, and the Infrastructure Investment and Jobs Act. O’Connor said Alaska has about two billion grant dollars committed to narrowing the digital divide.
O’Connor said remaining challenges include coordination between agencies, implementation of the infrastructure, and sustainability: “How are they going to make sure it’s still operating in 20, 30, 50 years?”
Garret Spargo, director of enterprise architecture at the Alaska Native Tribal Health Consortium, said 75% of Alaska’s communities are not connected to a hospital by road systems. Rural residents, he said, have to travel 147 miles one way to gain access to care.
The Centers for Disease Control and Prevention says “telehealth technologies are less restricted by distance and time barriers, creating greater accessibility for rural and underserved populations.” Telehealth could provide more access to preventative or monitoring care to Alaskans living in rural areas, especially given the fact that travel in Alaska is more complex than it is in other states.
Spargo said the high cost of internet in Alaska is also an obstacle. He examined the Kusilvak Census Area in western Alaska, which has a population of a little over 8,200 people. There, the average annual per capita income in 2021 was $15,417, and the median household income was $37,975.
He said although Kusilvak has internet available, the cost is high and the connectivity speeds are slow. For $115 per month, residents can get internet with speeds of four Mbps downstream and one Mbps upstream, and for $315, the speeds are 10 Mbps down and two Mbps up.
“You don’t have [internet] access if you can’t afford it.”
— Spargo
The Federal Communications Commission (FCC) says basic broadband should have speeds of at least 25 Mbps down and three Mbps up. The Infrastructure and Investment Jobs Act has stricter guidelines than the FCC and ATS, considering communities with broadband speeds less than 100 Mbps down and 20 Mbps to be underserved.
Jacquie Braden, community development program manager at the Rural Alaska Community Action Program, said while there is a rural-urban digital divide, in Alaska, more urban areas still face connectivity issues, often due to affordability.
Braden spoke about digital equity, which aims to connect all people to the internet in order for them to have full access to jobs, healthcare, education, and government that might only be completely accessed online.
Without digital equity, people may get left behind the advancements in the digital world, which could worsen existing disparities between communities.
Ariel Burr, the senior manager of Government Programs at Quintillion—a broadband provider in Alaska—discussed the specifics of broadband connection and how it works.
“Telecommunications is like a road system,” Burr said. “… The middle mile is like the highway or freeway… [the last miles] are the streets and the neighborhoods that actually deliver the service to consumers in their residence, in the clinic, in the hospital, in the school, [or] in the business.”
Burr also spoke about the complications many people face when trying to access certain types of healthcare that is not offered in their communities. “Most communities are two plane rides away from Anchorage,” Burr said.
If they need to come to Anchorage for healthcare, they have to pay for plane tickets, a hotel, and take time off work, all to see a provider. She pointed out that people with complex illnesses living far from hub cities have to make those trips many times a year, which is unsustainable. This is where she feels telemedicine can help.
Quintillion, Burr said, wants to expand broadband access to lessen the travel burden so more people can access care through telemedicine. They will do so through a middle mile grant they recently received, which she said is the largest in the country.
Having expanded internet access could also help people suffering mental health issues, Burr said.
Alaska has the third highest suicide rate in the country, with 30.8 suicides per 100,000 people. Only Montana and Wyoming surpass Alaska.
In rural Alaska, suicide rates are even higher.
“Having an internet connection in your home so that you can have regularly scheduled appointments with a counselor to talk to about mental [health] would really help improve metal health issues and hopefully reduce rates of suicide in rural Alaska.”
— Burr