In conjunction with the release of Mapping Broadband Health in America 2017, the Connect2HealthFCC Task Force conducted a series of data analyses around the premise that a data-driven approach can systematically reveal gaps, needs, and opportunities in the broadband and health space. This effort began in 2016 with the initial launch of the broadband health mapping platform and the inaugural versions of the Priority 100 and Rural 100.
For 2017, the Task Force has again identified “critical need” counties at the intersection of broadband and health with the goal of driving better decision-making and creating a roadmap for private investment and coordinated public support. All counties in the U.S. were considered for inclusion in the nationwide priority list; only counties with majority rural population were considered for the rural priority list. For this year, we are no longer capping the lists at 100 counties. Instead, there are now 214 “critical need” counties, 96 counties on the Priority 2017 list and 175 counties on the Rural Priority 2017 list.
Also new this year is our Positive Trend Counties inventory. The counties included on this inventory were previously identified as having critical needs, but the recent data reflects some progress in either their broadband access metrics and/or health status. If positive trends continue, these counties would “graduate” from the lists altogether. See additional details.
Identifying critical need counties
As summarized in the chart below, in order to identify counties with the most critical needs in broadband and health and create the Priority 2017 list, we used national estimates for various broadband and health metrics as thresholds and inclusion criteria.
- Population data: Counties had to have a “significant” population indicated by population counts above the national median for counties (i.e., >= 25,000). We considered “significant” population as an inclusion criterion in order to identify counties, and clusters of counties, that would be ripe for the development of a business case for private and public sector engagement in connected health.
- Health data: As to health outcomes, we focused on chronic disease metrics for diabetes and obesity, identifying counties with very high health needs – specifically, diabetes and obesity prevalence greater than or equal to the national averages of 9.9% and 27.8%, respectively.
- Connectivity data: Similarly, the broadband access threshold was set at equal to or below 50% and the Internet adoption threshold at equal to below 60% (corresponding to the middle quintile of 40-60% subscription).
We also generated a Rural Priority 2017 list with inclusion criteria based on “rural-specific” thresholds. For inclusion on this “rural” list, the county had to have a majority of its population residing in rural areas and the total population had to equal or exceed the median population for rural counties (i.e., >= 15,000). The health inclusion thresholds were also normalized to rural metrics. Counties in the Rural Priority 2017 also had to have obesity and diabetes prevalence greater than or equal to the mean of all majority rural counties (12.1% and 32.2%, respectively). We used the same broadband thresholds as with the Priority 2017.
|Population||Broadband Access||Internet Adoption||Diabetes||Obesity|
|Priority 2017||>= 25,000
(natl avg. 9.9%)
(natl avg. 27.8%)
|Rural Priority 2017||>= 15,000
(rural county median)
(natl avg. 12.1%)
(natl avg. 32.2%)
We anticipate that once a county makes it onto one of the priority lists, it remains on the list until its broadband access or health metrics improve above the applicable thresholds (which are updated annually). To help identify changes in broadband access in these priority counties year on year, the priority lists also indicate whether the current broadband access figure has increased, decreased or remained unchanged since the platform’s 2016 release. We denote these changes using the following symbols: ↑ ↓, ↔.
In order for counties to move to the Positive Trend Counties inventory, the counties must have originally appeared on the 2016 Priority 100 and/or Rural 100 lists. In addition, they had to experience a positive shift in their broadband access levels and/or health status – namely, broadband access levels must have increased above the 50% threshold or both of the health metrics (i.e., diabetes and obesity prevalence) improved to below the national average, indicating a diminishing health need in the relevant county. In addition, these positive trends must have occurred in both the rural and non-rural portions of the county, if applicable.
Take for example, Wharton County, Texas, one of 21 Texas counties highlighted last year. Based on 2014 data, Wharton County had 19% broadband access; while as of December 2015, broadband access had increased to 52% (above the 50% threshold for the priority lists). Similarly, broadband access in Delaware County, Oklahoma shifted from 25% to 55%.
To provide some broader context, the lists also indicate whether a county has: (a) Primary care physician shortage areas as defined by HRSA; (b) Census Bureau-designation as Persistent Poverty; and (c) above national average percentages of veterans, Native Americans, and people over 65 years of age.