A NEW FRAMEWORK FOR HOW THE PHYSICAL AND BUILT ENVIRONMENT AFFECTS STROKE CARE AND RECOVERY

The built environment is a well-described component of the social determinants of health. We understand the built environment to be an intermediate determinant of health when pairing this understanding with the National Institute of Neurologic Disorders and Stroke (NINDS) framework. The built environment, influenced by upstream structural racism, plays a direct mediating role on stroke risk, evident by increased stroke risk in areas heavily historically affected by redlining or slavery. When elements of the built environment are curated to promote social and physical activity, inpatient rehabilitation centers may have a more positive effect on physical and psychological recovery following a stroke. Lastly, the physical environment in a home or community setting has tremendous influence on a stroke survivor’s ability to adapt to their new motor abilities. The foundational principles of bioethics (autonomy, justice, non-maleficence and beneficence) are driven by four themes across the spectrum of stroke risk and recovery affected by the built environment: access, physical safety, health promotion and psychosocial behavior. It is therefore imperative that clinicians and scholars continue to leverage their expertise to advocate for meaningful changes specifically regarding the built environment in order to effectively tackle stroke risk and outcomes.