I recently identified the possibility that without positive intervention, the growth of broadband internet could mean that more than three million Australians would be left on the wrong side of the digital divide, and that this would have significant public health implications.
There is a great deal which we do not yet know or understand about what impacts broadband will have on our lives. A report on broadband adoption and economic benefits for the Australian Communications and Media Authority (ACMA) notes (p. 18) that:
The adoption of generic new technologies such as broadband creates a multitude of economic effects that ripple through markets and communities, potentially for many years. Their cumulative effects are complex, often profound and have the potential to change work patterns, social relationships, economic activity and settlement patterns.
Despite the optimistic forecasts of the July 2010 Access Economics Telehealth report, it is also important to recognise that the use of broadband for Australian consumer applications is still in its infancy.
A 2009 article by University of Miami academic María E. Davalos and colleagues warns that telehealth evaluation studies to date may not be reliable because of their small sample sizes, lack of uniform methodologies, scant use of randomised control trials, lack of long-term impacts and disparate estimation methods.
Health is clearly not a top driver of broadband take-up: the ACMA internet service market report of July 2011 does not specifically mention health matters as part of the listing of most popular activities which people do online.
The evaluation of a ground-breaking pilot digital inclusion initiative undertaken in a Melbourne public housing estate by the non-profit organisation Infoxchange does indicate positive benefits for health, although the main direct economic benefits were in education and employment.
A number of Australian pilot broadband health consumer applications are currently underway, including a Western Australian CSIRO rural and remote eye screening project, falls prevention, chronic illness monitoring in the Hunter Valley and a Townsville diabetes management project.
Although we do not yet have much data, this does not mean that broadband for health is not important: clearly it is, if for no other reason that there is now a widespread assumption (and thus a de facto requirement) that we will all access information online.
The free information services of the past are gradually being eliminated or reduced…. Telephone books are disappearing because they are an environmental nuisance. Telephone information calls can now cost up to $2. The assumption is that shifting material onto the Internet seems to be cost-free, when in fact we are paying the telecommunications providers whatever price they set. The move to digital communications — with all the benefits we attribute to the process — is irreversible, and the costs have been accepted by those who can afford the changes with barely a ripple.
Osnos goes on to write that his monthly household “spend” for two adults living in Connecticut on telephone (two mobiles, two landlines), broadband and cable TV was US$487 per month, plus electricity (estimated at $40/month) to power it all.
This pattern is being replicated in Australia. My Sydney household’s adult monthly “spend” for a similar pattern (two landlines and two mobiles, plus broadband) averages about Aus$350 – without the cable TV, plus electricity – and thus is reasonably equivalent. That’s $4200/year, which would be a very significant sum for a low income family. And just this week I went through the exercise of attempting to obtain my family’s Medicare and private health insurance statements for the last financial year: the assumptions were that it would all happen online.
Positive trends are evident, with the current Australian Government paying particular attention to what is broadly termed “digital inclusion”. On 1st July, the NBN Co launched an interim broadband satellite service for residents, small businesses and Indigenous communities in rural and remote Australia who can’t currently access broadband services comparable to those available in metropolitan areas.
And on 7th July, The Minister for Broadband, Communications and the Digital Economy, launched the 2011-12 Regional Telecommunications Review, that will examine telecommunications services in regional, rural and remote parts of Australia.
All of this attention is great, but it is early days yet, and the Government can still get distracted by other – and more pressing – political matters (carbon tax, anyone?).
As Osnos warns, “redress(ing) the digital divide was an early agenda item for the Obama administration, but (with) so much else to grapple with now, little momentum seems left for that effort.”