Broadband and Rural Population

Rural counties in total in the US gained 33,000 people in 2017, the first overall increase in rural population since 2011. But the gains came entirely to rural counties adjacent to metropolitan areas and highlights that remote rural counties continue a long-term trend of losing population. Nationwide, counties not next to metropolitan areas lost 24,000 people in 2017.

Further, within that global number, there is a different by the primary economic drivers in each county. Farming counties lost the most population, rural counties with manufacturing only lost a little population, and counties that rely on recreation and tourism gained population, attributed mostly to in-migration of retirees.

The loss of population is one of the primary reasons that rural counties are looking for better broadband. Rural counties don’t have to peer to far into the future to see a bleak picture. Their counties are often rapidly aging as young people move away to find employment. They are already seeing houses abandoned and foresee a shrinking property tax base. Farm counties continue to see the consolidation of farms and the loss of the family farmer.

Rural counties have different goals from broadband than more urban areas. They foremost hope that better broadband can mean more jobs and more employment. Many rural counties are not naïve enough any more to think they are going to attract factories or other businesses to their county. Some get lucky occasionally, but the country as a whole has lost an astonishing 60,000 factories since 2001. And even when new factories arise, they are largely automated and support far fewer jobs than factories in the past.

Rural counties care more about finding ways for residents to supplement incomes, and better broadband brings the chance to work from home. I was working with a rural county in Minnesota last year where I noticed that almost every farm in the county was operating a non-farming business along with farming as a way to supplement income – and this was in a county where the farms had practically no broadband at all and many homes relies on their cellular data for extremely expensive broadband connections. These counties want broadband so that the people living there can make enough money to stay.

Rural counties also need broadband for education. I rarely visit a rural county where there are not a few places in the county where rural residents drive their kids a few night each week to use WiFi in order to do their homework. It’s disheartening to see a parking lot full of cars at a library after it’s closed sitting and doing homework on the slow WiFi leaking out through the library walls.

Earlier I mentioned counties that rely on recreation for their economy. These counties desperately want broadband because they are finding that urban tourists don’t want to visit places that don’t have good internet connectivity and cellphone coverage. And businesses in these counties who rely on tourism have a hard time making it without broadband. Something as simple as offering on-line reservations requires a decent broadband connection, and lack of broadband puts counties at a disadvantage compared to similar areas with broadband.

Finally, rural counties want broadband to help keep the elderly in their homes longer. As hard as it is to be elderly in an urban area it’s much harder in a rural area where something as simple as seeing a doctor can mean a long trip. Rural areas also have a hard time attracting doctors and as rural clinics and hospitals continue to close it will become even harder to get basic healthcare. So rural counties are relying more and more on telemedicine and providers like the Mayo Clinic are embracing the technology to help rural America – but telemedicine require decent broadband including good upload speeds.

The skeptics of any government push to improve broadband often use the excuse that people just want broadband to watch TV, and that broadband is just for entertainment. And when people get broadband they take advantage of the wonderful world of entertainment now available on the Internet. But I can’t recall ever having seen entertainment on the list of reasons why rural counties want better broadband – they want it so that their counties survive as viable communities.

Telemedicine Needs Big Bandwidth

Medical_Software_Logo,_by_Harry_GouvasThe Federal Government is a big believer in telemedicine and there are several branches of the government that have been vigorously pursuing it as a way to better treat patients. Some of these initiatives include:

  • The Department of Veterans Affairs kicked off their telehealth program in 2011 named Special Care Access Network – Extension for Community Healthcare Outcomes (SCAN-ECHO). This program is aimed at providing care to veterans without requiring them to travel to a VA hospital. In some parts of the country VA hospitals are widely scattered and the VA knows that a lot of doctor visits are routine and can be handed adequately through telemedicine links.
  • The Department of Defense started working on a telemedicine program almost two decades ago for use on the battlefield. Their telemedicine links allow specialists to weigh in on battlefield injuries along with field medics, and they had great results in Iraq and Afghanistan. The DoD has named their system ECHO and has recently licensed it to Kaiser Permanente. The hospital chain sees use of the technology to field triage accident victims and to use for their patients who can’t make it to a hospital.
  • The Air Force has been working on a focused telemedicine program for the last four years. Instead of working on remotely treating patients, which is being pioneered by others, they have been focused on four specific areas within teleimaging: teleradiology, telecardiology, tele-endoscopy and telepathology. In a nutshell they are working with field devices that can create the diagnostic images that telemedicine doctors need to better treat field injuries. This would provide more detailed diagnostics for accident victims and remote patients who can’t easily get to a hospital.

Telemedicine is a priority for the Veterans Administration which reports that they are today treating 380,000 vets who live in rural areas. They have nearly 11,000 veteran patients now using the VA’s tele-audiology system, but they would like to greatly expand their telemedicine capabilities.

What all of these programs have come to realize is that the broadband in rural America is not adequate for what they are trying to do. One thing every one of the above efforts needs is big broadband capacity to connect to patients through video links or to transmit gigantic imaging files.

The military is used to having big broadband on the battlefield. We tend to think of satellite data links as small bandwidth and slow connections, but satellites can download significant bandwidth pipes with the right receivers and at the right price. I would assume (but don’t know) that the military has their own data satellites in orbit to provide bandwidth on the battlefield.

So these agencies are adding their voice to the cry for better rural broadband, which is the primary place where intensive telemedicine technologies are most needed. As these agencies are moving battlefield-tested technology into the civilian world they are bumping up against the same rural bandwidth limits that others have been seeing for years.

Just last week the FCC boldly increased the definition or broadband in the country to 25 Mbps download and 4 Mbps upload. According to the FCC’s numbers this means that 55 million Americans, or 17 percent of the population do not have access to broadband.

If you have followed my blog you know that I think the number is even higher than that since the FCC’s estimate is based upon a very flawed National Broadband Map, which is populated by the carriers. But one can be pretty certain that the vast majority of the people who can’t get the FCC’s newly defined broadband live in rural areas.

I have worked for years with rural communities and the lack of broadband has some real life repercussions for the people living there. There are numerous rural communities without hospitals, without doctors and without universities, and the people who live in these remote places have to undertake long drives to do things the rest of us consider as routine like see a doctor or take a class.

Telemedicine has a huge potential for diagnosing and treating rural patients. It is already being used worldwide to bring modern healthcare into remote communities. But I find it sad that many places in our own country can’t have this great technology due to the lack of broadband infrastructure.