Connecting health: How broadband influences health outcomes and provider recruitment in Michigan

By: David Nunnally

Lansing, Mich. (April 14, 2026) - On Friday, March 27, I gave an oral presentation titled “Connecting Health: How Broadband Influences Health Outcomes and Provider Recruitment in Michigan” to the annual meeting of the Michigan Academy of Science, Arts, and Letters (MASAL). The project explored how internet and device adoption can impact various health outcomes at the county level across Michigan, with an emphasis on the role of provider recruitment.

The presentation drew on the social determinants of health literature to frame the argument. Scholars typically identify five social determinants of health: economic stability, access to and quality of education, access to and quality of health care, neighborhood and built environment, and social and community context. However, leading medical agencies have since argued that internet and device adoption are more like “super determinants” of health, in that they affect many of the other determinants. Internet adoption affects economic stability by providing individuals with opportunities to find and sustain work. It also impacts education access because many programs (K-12 and post-secondary) require the internet for homework and test preparation. Moreover, the internet has transformed social communication over the past two decades – making it easier to connect with people across the country and the world.

The MASAL presentation analyzed another pathway connecting internet and device adoption to health outcomes – health care provider recruitment as a function of health care access and quality. I proposed a potential indirect link, whereby internet adoption affects provider recruitment because of what it represents: community institutional capacity. Achieving high adoption requires the simultaneous presence of infrastructure, human capital, and institutional investment – many of the same ingredients that support the primary health care workforce supply. In addition, internet adoption assumes internet access, which bolsters community livability – an amenity that may drive physician location decisions. For these reasons, I expected a positive association between internet and device adoption and primary physician rates, which would then positively impact several health outcomes.

Data for this endeavor came largely from the 2025 County Health Rankings and Roadmaps, a combined initiative between the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation that uses data and evidence to build healthier communities. This source compiles data from many federal initiatives, including the American Community Survey (ACS) and the Behavioral Risk Factor Surveillance System (BRFSS), and surveys from the Center for Medicare and Medicaid Services (CMS), the Health Resources and Services Administration (HRSA), and the National Center for Health Statistics (NCHS). The following table details the variables explored in this study, as well as their original data sources.

The analyses relied on mediation models that estimate both the direct effect (from adoption to health outcomes) and the indirect effect (from adoption to health outcomes, mediated by provider availability) for all counties in Michigan. I found significant direct effects of adoption on all health indicators in the full-sample models. In other words, internet and device adoption is associated with fewer days of fair or poor health, fewer years of potential life lost, fewer physically or mentally unhealthy days, higher PCP and mental health provider rates, and lower injury death rates.[1] However, the indirect relationships through provider availability did not achieve significance. This means that while internet and device adoption meaningfully impact health outcomes, they affect outcomes through other mediating factors, such as increased income, information, and ability to rely on telehealth.

A forthcoming report will expand upon these findings, showing the impact of internet and device adoption on health outcomes at the county level nationwide.

Everyone belongs in a Connected Nation.