Technology has come so far in such a short time, giving us access to more than we could ever imagine, so quickly, conveniently, and comprehensively. We have never been more reliant on technology than during the COVID-19 pandemic. In order to practice social distancing, we have converted most of our lives into a virtual format. Thankfully, technology has made it possible for most of us to spend time with friends, celebrate special occasions with family, work, learn, engage with our religious communities, attend health and wellness classes, and have appointments from the comfort and safety of our own homes without fear of contracting or spreading the virus. But not all of us. Because the pandemic has lasted longer than any of us had ever imagined, and we do not know when, or even if, our lives will ever get back to the way it was pre-pandemic, lack of access to the technology needed to engage in a virtual world will inevitably exacerbate existing socioeconomic, health, and behavioral health disparities.
Brett R. Harris, DrPH
Up to 42 million people lack broadband internet access and are left on the outside of this virtual world looking in (L. Ayre, What More Can We Do to Address Broadband Inequity and Digital Poverty? – 2020). Individuals living in rural areas are at heighted risk, as isolation, lack of access to services, and stigma associated with behavioral health services – already present pre-pandemic – are greatly exacerbated for those in the most remote areas that lack access to broadband. Even if public institutions such as local libraries offer free Wi-Fi hotspots, they do not offer the privacy required for telehealth appointments, and sudden closures due to safety regulations leave people who are reliant on those hotspots to find other means to access the internet. Already at significantly greater risk of suicide and other behavioral health issues than their urban or suburban counterparts, the COVID-19 pandemic has impacted a larger proportion of the everyday lives of rural residents than the population as a whole, further increasing risk. Implications are even greater for people with pre-existing chronic illnesses or behavioral health conditions who no longer have access to the routine care they need.
Moreover, college students who come from remote rural areas, traditionally on more equal footing when taking classes on campus, are at a disadvantage taking classes remotely from their hometowns without access to the same resources as their urban and suburban peers. Academic success in college is dependent on internet access, and issues with connectivity can make engaging in synchronous virtual classes, discussions, and group meetings difficult (M. Bekalu et al., Association of Social Media Use, 2019). In addition, students are reliant on online connections for social support and behavioral health care. Though colleges and universities have made behavioral health services available via telehealth, they cannot be accessed without proper internet connectivity, not giving at-risk students an outlet for coping with stress and addressing behavioral health issues. Moreover, for students who just started college this fall, traditional in-person functions such as orientation and other activities that help freshman meet their peers and develop social networks have happened only in virtual formats. This is far from the typical college experience, and many students are left feeling isolated and lonely. With limited internet access, students cannot even benefit from online interactions, having a major impact on mental wellbeing. High levels of stress and poor mental health impact academic success, and inability to succeed academically hinders students’ abilities to get internships, jobs, or entrance into graduate school, exacerbating disparities and leaving many students behind in ways that may impact the entire trajectory of their lives, particularly through health, behavioral health, and socioeconomic status.
Not only is internet connectivity an issue but so is access to electronic devices with which to successfully navigate our virtual world. Remote learning, work, social connection, and access to services require computer and digital technology. Though many of us take for granted the possession of a laptop, desktop, tablet, and cell phone, not everyone has them, particularly within low-income and/or rural communities. K-12 schools are desperately trying to be the equalizers, providing laptops and wireless hotspots to students who need them, but, unfortunately, they often do not have the resources to provide for everyone. If students cannot regularly engage with teachers or with their coursework, how can they succeed? How far will they fall behind? Similarly, schools are trying to offer continuity to students with behavioral health issues, often making home visits to check on those who are struggling when virtual connections are not available. Yet again, however, they do not have the resources to meet the needs of all students, leaving many at-risk students to fall even further behind their classmates.
Prolonged remote education in K-12 schools that has resulted from the COVID-19 pandemic may have major unforeseen consequences that will be hard to reverse. Remote learning is not ideal for many young people regardless of access to internet and computers, particularly those with behavioral health conditions; how will they make up for the deficits that are likely to result? In addition to internet, computers, and cell phones, students whose parents are not able or available to help reinforce what they learn, those who experience or witness domestic violence in the home, those who are homeless, and those who do not have the quiet or privacy to fully concentrate on their studies are at a further disadvantage.
One example of a population that is at a disadvantage in this environment is recent immigrants, refugees, and their families. Many immigrant or refugee heads of household struggle with the English language, relying on their children to translate for them, making the mastering of virtual technology extremely difficult. Often, children must help teach their parents as well as their younger siblings, taking away from the time they spend on their own virtual studies. Furthermore, children struggle without everyday face-to-face interaction with teachers or specialized instruction for English language learners. With large families, there are multiple children engaging in remote learning on multiple devices in one home, putting a strain on their internet connection and increasing distractions in the home. Being far from their home countries, they feel detached from their culture of origin and increasingly isolated.
While the disparities created by transitioning our lives into a virtual format – for social interaction, school, work, management of chronic conditions and behavioral health concerns, health and wellness, and entertainment – might have been negligible had this crisis been short-term, it is likely to cause long-lasting socioeconomic, health, and behavioral health consequences for already disadvantaged groups. Once we successfully combat this pandemic and hopefully go back to our pre-pandemic ways of life, we will still have a lot of work ahead of us to address the disparities that were created as a result of the pandemic. A critical first step is to increase access to and utilization of behavioral health services, expand broadband access, provide schools with funding to ensure all students have access to the technology they need for optimal learning, and offer adult continuing education programs in the use of technology.
For questions or comments related to this article, please address correspondence to Brett Harris, DrPH at bharris@albany.edu.
