Australian Journal of Public Administration, vol. 77, no. 4, pp. 829–842 doi:10.1111/1467-8500.12323
Research and Evaluation Digital Infrastructure as a Determinant of Health Equity: An Australian Case Study of the Implementation of the National Broadband Network
Ashley Schram and Sharon Friel The Australian National University
Toby Freeman, Matthew Fisher, and Fran Baum Flinders University
Patrick Harris University of Sydney
Inequities in access to fast and reliable internet connections, essential for digital access to services and information that are important for health, can exacerbate social inequalities in health. We evaluated the social equity of the rollout of the National Broadband Network (NBN) in Australia based on the type of digital infrastructure delivered to areas of varying socioeconomic status. We found that areas of greater socioeconomic disadvantage were significantly less likely to receive the highest quality infrastructure, controlling for level of remoteness. These social inequities in provision of quality infrastructure will shape and possibly exacerbate inequities in health. In our discussion we consider how political decisions have obstructed equitable implementation of the policy. Lessons from the Australian case study may be valuable for other countries investing in public digital infrastructure who want to ensure equity of provision and can also inform Australian policy in the NBN’s remaining rollout.
Key words: health inequalities, social inequity, social determinants of health, digital infrastructure, policy implementation
Introduction Cave and Martin 2010; Willson et al. 2009). The US Broadband Opportunity Council de- Affordable quality broadband technology has clared in 2015 that broadband is ‘taking its been noted as a key component of effective place alongside water, sewer and electricity national telecommunication infrastructure. Ev- as essential infrastructure for communities’ idence has accumulated for its role as a vital en- (Middleton 2015). The growing acknowledge- abler of economic growth, social inclusion, and ment of broadband as a critical infrastructure environmental protection (Broadband Com- service is reflected in the increased prioriti- mission for Sustainable Development 2016; sation and investment from national govern- ments in telecommunication infrastructure, an area that has traditionally been the domain of No conflict of interest declared. private enterprise. A recent analysis found that Accepted for publication: March 26, 2018 151 out of 189 countries reviewed have adopted