The Growing Role of Digital Health

As healthcare continues to move into the digital age, millions of Americans are being left behind—not due to a lack of motivation to manage their health, but because they lack something more basic: reliable internet access. The digital divide, especially in low-income, rural, and historically marginalized communities, has become a key driver of health disparities. 

 

For people living with chronic conditions like diabetes, this divide can mean the difference between manageable care and serious, long-term complications.

Technology has become central to the modern healthcare experience. Patients are now expected to access lab results through patient portals, schedule appointments online, meet with providers via telehealth, and use apps to manage their medication, blood glucose, and nutrition. 

But for individuals without internet access or digital skills, these innovations are not only inaccessible—they reinforce existing inequities.

COVID-19 and the Acceleration of Digital Disparities

The COVID-19 pandemic accelerated the healthcare system’s digital transformation. Telehealth, once a niche service, became the primary method for delivering care during lockdowns. While this shift offered convenience and safety for many, it also revealed a stark reality: not everyone could participate.

 

Patients without broadband, smartphones, or digital literacy were left with few or no alternatives. Routine appointments were missed, chronic conditions went unmanaged, and opportunities for early intervention slipped away. In diabetes care, this often meant unchecked blood sugar levels, missed prescriptions, and an increased reliance on emergency departments for conditions that could have been managed through regular, proactive care.

 

The pandemic made it clear that digital access is not a luxury—it is essential infrastructure. And when it is lacking, the cost is measured in human health and lives.

 

The Impact of the Digital Divide on Diabetes Care

Diabetes is a condition that requires constant monitoring, learning, and communication. Patients must regularly track their blood glucose, understand how to adjust their diet and activity, manage stress, and maintain close contact with healthcare providers. For many, digital tools are indispensable in this process. 

 

They provide: real-time glucose monitoring apps, medication and appointment reminders, telehealth consultations with primary care and endocrinologists, and educational resources on nutrition, exercise, and complication prevention

 

When patients lack access to these tools, they are left to manage a complex disease without guidance. This can lead to delays in recognizing warning signs, increased difficulty adhering to treatment plans, and reliance on outdated or inaccurate information from non-medical sources. The consequences are serious: poorly managed diabetes significantly increases the risk of heart disease, nerve damage, kidney failure, vision loss, and even premature death.

Broadband as a Social Determinant of Health

The concept of social determinants of health refers to the conditions in which people live, work, and access resources—factors like housing, education, income, and transportation. Increasingly, internet access must be added to this list.

 

Broadband enables access to telehealth, online support groups, digital literacy tools, and health education. Without it, people are effectively shut out of modern healthcare. Recognizing broadband as a social determinant of health reframes internet access as a public good, not a private privilege. Just as we invest in clean water or public transportation to support community health, we must invest in digital infrastructure to ensure equitable care.

Infrastructure, Affordability, and Community Solutions

Improving digital access requires investments on multiple fronts. First and foremost, rural and underserved urban communities need expanded broadband infrastructure. Many areas still lack high-speed internet entirely, while others offer limited service at high cost. Bridging this infrastructure gap is essential to connecting patients with their providers and care teams.

Affordability is another barrier. Even where internet service is available, many low-income households cannot afford monthly fees or the cost of a device. Programs that subsidize broadband and provide low-cost or donated tablets and smartphones are critical to ensuring access.

 

Community institutions such as public libraries, schools, and health centers can serve as digital health hubs. By offering Wi-Fi, loaner devices, and on-site support, these spaces can help patients engage with telehealth platforms, attend virtual appointments, and learn how to use digital health tools effectively.

Bridging the Digital Literacy Gap

Access is only the first step. Once a patient is connected, they need the skills to navigate digital platforms, understand health information, and communicate effectively online. Digital literacy training is therefore a vital part of chronic disease prevention and management—especially for older adults, immigrant communities, and individuals with limited formal education.

 

Diabetes education programs should incorporate technology training that is hands-on, culturally competent, and linguistically inclusive. Tutorials on using patient portals, apps, or virtual appointment systems should be available in multiple languages and delivered in plain language. 

Peer-led workshops, tech navigators, and community health workers can play an important role in building comfort and confidence.

 

Digital literacy is not about mastering every app or device—it’s about ensuring that patients can access and understand the information they need to make informed decisions about their health.

 

The Role of Care Coordination in a Digital Era

Models like the Patient-Centered Medical Home (PCMH) emphasize coordinated, comprehensive, and accessible care. In theory, this approach can help bridge communication gaps and provide holistic support for patients with complex needs. But in a digital-first system, coordination is only possible when patients are connected.

 

When a patient lacks internet access, the benefits of the PCMH model—such as remote monitoring, virtual care team collaboration, and follow-up via patient portals—are diminished. Embedding digital access and literacy into PCMH implementation is essential to make sure the model works in practice, not just on paper.

 

Healthcare teams should screen patients for digital access in the same way they assess housing, food security, or transportation. When digital gaps are identified, providers should be prepared to offer alternatives—like printed materials, phone-based check-ins, or referrals to tech assistance programs.

 

Policy Implications and the Path Forward

Health equity in the digital age requires more than just well-meaning initiatives—it demands bold, coordinated policy action that addresses the root causes of digital exclusion. Internet access, digital literacy, and culturally competent tech support are now essential to equitable healthcare delivery, particularly for chronic disease management. Federal and state governments have a key role to play in leveling the playing field.

They can expand funding for broadband infrastructure, support digital inclusion grants for community organizations, require healthcare systems to report on digital equity metrics, and incentivize the integration of digital literacy into chronic disease programs. Each of these strategies can help dismantle structural barriers and ensure that digital tools reach the people who need them most.

• Expand Funding for Broadband Infrastructure

To close the digital divide, robust and sustained investment in broadband infrastructure is essential—particularly in rural, tribal, and underserved urban areas where access is sparse or unreliable. Federal programs like the FCC’s Affordable Connectivity Program and the Infrastructure Investment and Jobs Act have laid critical groundwork by funding internet expansion projects and offering subsidies to low-income households. However, these efforts must be scaled and maintained long-term.

Future investments should prioritize “last-mile” infrastructure—the final stretch of internet delivery that often prevents rural homes and clinics from getting connected. Funding should also be allocated for public Wi-Fi networks in community centers, housing developments, and healthcare facilities. Without physical access to the internet, efforts to improve health equity through digital tools remain out of reach. Policymakers must treat broadband as they would any public utility—necessary for participation in society and health systems alike.

• Support Digital Inclusion Grants for Community Organizations

Community-based organizations are on the front lines of health and social services. They understand the specific needs of the populations they serve, whether that’s seniors in public housing, low-income families, or recent immigrants. By offering targeted digital inclusion grants, governments can empower these organizations to build local capacity and provide hands-on support.

These grants could fund programs that distribute loaner laptops or tablets, host multilingual tech literacy workshops, and create “digital health navigators”—staff trained to help community members access patient portals, telehealth platforms, and disease management apps. For example, a community health center in a predominantly Spanish-speaking neighborhood might use a grant to develop culturally tailored tutorials for managing diabetes online. Digital inclusion doesn’t just happen through policy—it happens through partnerships with trusted, grassroots institutions.

3. Require Healthcare Systems to Report on Digital Equity Metrics

What gets measured gets managed. Currently, few healthcare systems systematically track patients’ digital access, internet availability, or comfort using online health tools. Requiring providers to collect and report on digital equity metrics would offer critical visibility into who is being left behind.

 

These metrics could include: patient-reported internet access at home, availability of devices (e.g., smartphone, computer), preferred method of communication (portal, phone, text), patient portal usage rates disaggregated by language, race/ethnicity, age, and income, and completion rates of telehealth visits vs. in-person appointments

 

Tracking these indicators helps identify disparities and monitor the effectiveness of interventions over time. It also pushes institutions to take accountability for ensuring their digital care delivery is accessible to all, not just the digitally fluent. Public reporting requirements—similar to those used for quality measures or health outcomes—could further drive transparency and improvement.

4. Incentivize the Integration of Digital Literacy into Chronic Disease Programs

Digital literacy is essential for patients managing chronic diseases like diabetes, hypertension, and heart disease. Yet, most chronic disease programs don’t include tech training as a core component. By tying funding or reimbursement incentives to the inclusion of digital skill-building, public and private insurers can encourage more holistic, future-ready care models.

 

For instance, federally qualified health centers (FQHCs) or Medicaid managed care organizations could receive enhanced payments for offering digital literacy modules as part of diabetes self-management education. These could include live or recorded tutorials on: logging into and navigating patient portals, attending virtual appointments, using mobile health apps for blood glucose tracking or nutrition, and communicating securely with care teams via text or video

 

Programs should also prioritize culturally and linguistically appropriate delivery, including support in patients’ preferred languages and materials designed with different literacy levels in mind. By building digital literacy into care—not treating it as an afterthought—we make it easier for patients to engage fully in their health.

 

Healthcare institutions can also contribute by integrating digital access assessments into patient intake, training staff to assist with technology onboarding, and partnering with libraries and schools to deliver digital health resources.

 

Efforts must also center equity. Solutions should be tailored to the unique needs of communities, rather than adopting one-size-fits-all approaches. Marginalized populations—such as Black, Indigenous, Latinx, rural, immigrant, and low-income communities—must be included in the design and implementation of digital health initiatives.

 

Conclusion: Connection as a Foundation for Health

Health equity in the digital age begins with connection—not just between patients and providers, but between people and the tools they need to stay well. The digital divide is no longer just a technological issue; it’s a public health crisis. And for patients with diabetes, who require ongoing education, monitoring, and care coordination, the stakes are especially high.

Internet access, affordability, and digital literacy are foundational to chronic disease management. Without them, even the most advanced healthcare tools remain out of reach. 

Recognizing broadband as a social determinant of health and acting accordingly is key to closing the gap.

 

As healthcare continues to evolve, equity must be at its core. That means ensuring no one is left behind—not because of where they live, what language they speak, or whether they can afford Wi-Fi. In the fight for better diabetes care, digital access is not a convenience. It’s a necessity.