Cardiac Arrest and the Built Environment: What’s Space-Time Got to Do with It?

The Backstory

When a new admit comes to the Cardiac ICU, the flight nurses hoist the patient onto the unit bed with the coordinated synchronicity of military pallbearers lowering caskets into the ground. Unfortunately, cardiac arrest patients are a mainstay on this unit, and though each patient outcome is different—some make it, some don’t—the underlying causes are the same: some breakdown in the patient’s built environment contributed to these consequences. The problem of how we got to this point can’t be answered without assessing the systems that got us here in the first place. I say “us”, because this is an “everyone” problem.

Decentralization Contributes to Poverty Concentration

The social determinants of health are themselves determined by the planning practices that created the inequities experienced across both rural and urban spaces: that’s right, no one is excluded, and that is why this is everyone’s problem. After the second World War, the United States needed housing within financial reach for veterans returning home, and suburbia was born. Neighborhoods were designed away from the city center, as people with money (mostly white, middle class individuals and families) purchased homes; in this regard, car and home ownership became a privilege of the wealth-building class. Low-income earners (mostly black and brown people) became concentrated in urban areas, and this systemic class divide shaped how resources and amenities were distributed. With that decentralization came marginlization.

Ribbons of highway and seas of asphalt parking lots carved out distance between vital services, rendering the space-time continuum heavy on the space and light on time. In other words, the distance between amenities increased, and so did the time it took to access them. For rural dwellers, that means it takes more time to access advanced medical care…at at time when seconds matter. That also looks like increased vehicular dependency and inconsistent access to fresh, whole foods as grocery stores became scattered across sprawled communities.

How Sprawl Contributes to Cardiovascular Disease

So what does this have to do with cardiac arrest? Though there are many risk factors of cardiovascular disease (CVD), when assessed through a systems lens, we can understand how they contribute to acute cardiac events. Obesity is a chronic illness with behavioral, environmental, genetic, and physiological etiologies. Concentration of poverty within communities with little access to fresh whole foods and clean water (whether in urban food deserts or rural communities) contributes to imbalanced nutrition. A culture of vehicular dependence breeds a sedentary lifestyle. Not to mention increased vehicular dependence means increased likelihood of vehicle accidents, a factor that further contributes to the morbidity and mortality that can be tracked back to conventional planning practices. The pressures of participating in an economic system designed to reward hard work with more work and marginal gain keep people laser focused on doing the next best thing for their pockets and not always their physiology. The systems that designed the built environment encoded inequity into its culture—not as a byproduct, but as a feature, and intentional element of its architecture.

How to Buy Time? Use Space More Efficiently

If we were to take half of one strip mall parking lot, place a clinic in it, build a grocery store on it and add some housing units over it, we not only reduce the space we must negotiate but the time it takes to negotiate it. We have now created opportunity for pedestrianism to flourish, encouraging mobility and promoting cardiovascular health. Vehicular dependency is reduced, and fresh food becomes more accessible. Mixed-use zoning creates space for innovations like this, that allow us to increase access to prompt medical care, and work to reduce both food and medical deserts. Though this is no substitute for emergent care, it places preventative care within reach and promotes the incremental activities, that over time, improve health outcomes.