Around 3 million Americans residing in predominantly rural areas where access to both healthcare and reliable high-speed internet is scarce often experience poorer health outcomes and shorter lifespans, compared with people who live in other parts of the country.

This was the conclusion reached through analysis done by KFF Health News in a recent study. These populations “live sicker and die earlier on average in more than 200 counties nationwide,” wrote Sarah Jane Tribble and Holly K. Hacker in KFF’s article, “Dead Zone: Millions in U.S. Live in Places Where Doctors Don’t Practice and Telehealth Doesn’t Reach.”

The authors described how these “dead zone” counties share three defining characteristics: limited access to high-speed, reliable internet or what’s called a broadband desert; an absence of primary care providers; and a shortage of behavioral health specialists.

To identify which counties meet the definition of a dead zone, KFF Health News used data from the Federal Communications Commission (FCC) and George Washington University’s Mullan Institute for Health Workforce Equity.

It analyzed U.S. Census Bureau, the Centers for Disease Control and Prevention (CDC), and other data as well. Primary care deserts are those with 281 or more Medicaid enrollees per provider (the national median is 218); behavioral health deserts have 1,680 or more residents per provider (the national median is 1,119).

High rates of chronic illness and longstanding inequities are defining features of these counties with inadequate services, the article purported. People in the medical community who were consulted for the article unanimously agreed that limited internet access severely disrupts medical care and availability.

A preponderance of dead zone counties was determined to be in the rural South, Appalachia, and remote West. Residents there face greater challenges than people living in other regions when it comes to making video calls with doctors or accessing patient portals — both critical tools for engaging with the U.S. medical system.

Diabetes is one of the chronic illnesses adversely affecting these communities. The analysis revealed that least-served counties have higher rates of diabetes than most-served counties. U.S. counties with the highest level of internet connectivity and healthcare access are “profoundly different from those that lack services,” the authors said.

For example, in Greene County, Alabama, approximately one-fourth of adults have diabetes, which is double the national average. It has among the highest rates in the country for high blood pressure, stroke, and obesity, based on Centers for Disease Control and Prevention data analyzed by KFF.

Black residents in the rural South are disproportionately likely to lack home internet access, based on information from the Joint Center for Political and Economic Studies cited by the article.

However, counties with the utmost access to both internet and healthcare providers tend to have higher life expectancy, lower rates of chronic illness, and factors such as greater income and educational levels, the analysis showed.

For example, in Howard County, Maryland, virtually every home has access to fast, reliable internet. With a median household income of approximately $147,000, residents enjoy an average life expectancy of more than 82 years — 10 years longer than residents of Greene County. Far fewer individuals in this area are affected by chronic illnesses, the article noted.

Despite the fact that U.S. lawmakers have allocated over $115 billion to address inequities in connectivity, dead zones remain a significant issue. Federal broadband initiatives are disjointed and redundant, as illustrated in a 2023 federal report that indicates there are 15 agencies overseeing more than 133 funding programs, the article said.

“The analysis confirmed that internet and care gaps are ‘hitting areas of extreme poverty and high social vulnerability,’” the article quoted Clese Erikson, deputy director of the health workforce research center at the Mullan Institute, as saying. Diabetic patients who use telemedicine are more likely to get the care they need to manage their blood sugar, said another medical professional.

So what speeds are required for effective telehealth applications? KFF’s analysis reported that adequate speeds are 25-100 Mbps download and 5-100 Mbps upload; while optimal speeds are greater than 100 Mbps both download and upload.

Inadequate speeds were identified in the article as less than 25 Mbps download and less than 3 Mbps upload.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF, an independent source for health policy research, polling and journalism.