This story was originally published by North Carolina Health News.
Internet dead zones are as much a staple of Appalachia as the mountains, lakes and rivers that have made the region so popular among tourists.
The pandemic — and the lack of broadband infrastructure in some of these areas — has pushed North Carolina’s mountain people to embrace short-term solutions, including Wi-Fi hot spots at library parking lots and grocery stores. At the height of the pandemic, Gov. Roy Cooper even initiated a program that dispatched just under 300 Wi-Fi-enabled school buses to rural communities in need, alongside limited investments in rural infrastructure.
As life returns to some semblance of normalcy with the vaccine rollout, North Carolina’s mountain region continues to lag behind other rural areas in the state in internet access, recent data from the Appalachian Regional Commission shows. Roughly 22% of North Carolina’s mountain households lack an internet connection at home, compared with 18% of the state’s rural areas outside of Appalachia, according to the study.
Within the mountain region, the disparities grow even more stark, where sparser counties such as Graham and Swain have 30 to 40% of households without broadband access.
Rural broadband in these areas is an issue of volume and feasibility, according to the report. Much of the mountain region is far too sparse for internet service providers to want to expand there. And ISPs who do want to expand may find it difficult because of the exorbitant cost of laying fiber in the mountains.
Telehealth Unavailable
When it comes to health care, the lack of broadband can mean anything from not being able to offer telemedicine appointments to doctor’s offices using fax instead of email for prescription requests, referrals and other routine tasks. Several physician offices even asked NC Health News to fax questions, rather than email them.
In other instances, physicians such as Steve Crane in Hendersonville said that the lack of reliable internet meant they could not pivot to telehealth during the pandemic because some payers would only reimburse if a telehealth visit included both audio and video, something that was impossible in places with no broadband.
Such challenges affect people’s access to care, Steve Heatherly, who heads Harris Regional Hospital and Swain Community Hospital, wrote.
There are workarounds, he noted, but these solutions are far from perfect. For example, hospital staff has worked with community partners to offer Wi-Fi hubs through which patients can access telehealth services. Paramedics in Swain and Jackson counties may also bring Wi-Fi hot spots to patients who can’t otherwise travel to facilitate online consultations with hospital staff.
Bryan Hodge, director of rural initiatives at the Asheville-based Mountain Area Health Education Center, has seen these issues again and again in health care. During the pandemic, for instance, MAHEC created a virtual coronavirus vaccine outreach campaign, but it became clear early on that this information wouldn’t reach rural residents. MAHEC opted for the costlier, slower method of reaching residents with information, including billboards, radio and television ads, and printed materials.
For a short time, it seemed as though the renewed focus on telemedicine would bring the funds and public attention that would eventually connect more rural residents to the internet. Late last year, Cooper announced a $30 million investment in roughly 70 rural broadband projects, at least seven of which would benefit rural households in the mountain region of the state.
Pricier Work
Drilling through the granite of the Appalachians is far more expensive than burying internet lines in the sandy coastal plains, or even the rocky soil of the Piedmont. Data from the state shows that the cost of hooking up 300 homes and businesses at Haywood County, just west of Asheville, is estimated to cost $2 million.
A project of roughly the same size in Lenoir County to the east got just over $135,000 in last year’s grant cycle. The project cost roughly $200,000 with matching funds, data from the state shows.
Despite these long-standing issues and the urgency of the pandemic, the spotlight on rural broadband needs is perhaps fading somewhat, said Sarah Thompson, executive director of the Southwestern Commission Council of Governments, a Sylva-based organization that helps internet service providers find the funds for rural broadband.
Nonetheless, the need remains urgent.
“We’ve been beating this drum for years before the pandemic,” Thompson added. “For the people who live in rural communities, the pandemic was an example for everyone else, but we (rural residents) always knew it. I don’t think it’s going away.”
There’s at least some signs that federal and state lawmakers have taken that to heart. President Joe Biden’s American Rescue Plan — of which North Carolina received $5.7 billion — earmarks significant funds for rural broadband improvements. The state’s exact allocation to the rural broadband infrastructure remains to be determined, but Cooper said last March that more than $1 billion could be allocated.
The final tally, of course, is up to the lawmakers in Raleigh to work out, Thompson said. That decision will likely come after the state budget negotiations between the North Carolina House of Representatives and the state Senate. While the Senate unveiled its proposal, lawmakers in Raleigh said the House’s proposal likely won’t be released until next month and a consensus budget may be even farther off, if previous budget talksare any indication.
Some county governments received additional support from the Biden administration, but they likely won’t use it for broadband improvements, at least not until the state clarifies its spending priorities for the rural broadband money.
“The silver lining of the crisis of the pandemic,” Thompson added. “Is that we’re going to have a lot more money to throw at the problem than we did before.”
North Carolina Health News is an independent, non-partisan, not-for-profit, statewide news organization dedicated to covering all things health care in North Carolina. Visit NCHN at northcarolinahealthnews.org.
This article first appeared on North Carolina Health News and is republished here under a Creative Commons license.