# data[].attributes.body
What did I learn about health? - I learned about multiple different injuries & the affects they can have on the body

What did I learn about healthcare? - I learned about many different ways to treat injuries & the options you have to recover from something. I also learned more about healthcare career options which interests me.

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health : i learned about minimizing the risks of developing and preventing different injuries

healthcare:i learned a little bit more about how much insurance can benefit people . and how much bills can be without it.

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Rotator cuff injuries are also commonly seen in athletes, especially in baseball, tennis, swimming, golf, and basketball. They are typically overuse injuries.

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Rotator Cuff Tear | Orthopedics & Sports Medicine

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Shoulder Rotator Cuff Tear Rotator cuff tears get a lot of attention. They’re relatively common in people over 40 and can result from overuse or a single tr…

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Mackenzie Liebau - Population most at risk? 

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Mackenzie Liebau - Population most at risk? 

# data[].attributes.body
Rotator cuff injuries are the most common tendon injuries seen and generally affects the older population

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A rotator cuff injury may develop overtime due to overuse from repetitive activities.

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Shoulder Sports Injuries Shoulder Surgery

What is a rotator cuff injury?

Your rotator cuff consists of muscles and tendons that hold your shoulder in place. It is one of the most important parts of your shoulder.

Your rotator cuff allows you to lift your arms and reach upward. Each year, millions of people in the United States go to their healthcare providers because of a rotator cuff problem. A rotator cuff tear is a common cause of pain and disability among adults.

What are the symptoms of a rotator cuff tear?

The following are the most common symptoms of a rotator cuff tear. However, you may experience symptoms differently. Symptoms may include:

Recurrent pain, especially with certain activities

Pain that prevents you from sleeping on your injured side

Grating or cracking sounds when moving your arm

Limited ability to move your arm

Muscle weakness

The symptoms of a rotator cuff tear may resemble other conditions or medical problems. Always talk with your healthcare provider for a diagnosis.

How is a rotator cuff injury diagnosed?

In addition to a complete medical history and physical exam, diagnostic procedures for a rotator cuff injury may include the following:

X-ray. A diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.

Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.

A rotator cuff may tear partially or fully. Partial-thickness tears do not completely sever the tendon from the shoulder.

What causes a rotator cuff injury?

There are 2 main causes of rotator cuff tears: injury and degeneration. An injury to the rotator cuff, such as a tear, may happen suddenly when falling on an outstretched hand. It may also develop over time due to repetitive activities. Rotator cuff tears may also happen due to aging, with degeneration of the tissues.

How is a rotator cuff injury treated?

Treatment may include:

Nonsteroidal anti-inflammatory medicines

Strengthening and stretching exercises

Ultrasound therapy

Corticosteroid injection

Surgery (for severe injuries)

Johns Hopkins Shoulder and Elbow Surgery

When should I call my healthcare provider?

Notify your healthcare provider if:

Key points about rotator cuff injury

Your rotator cuff allows you to lift your arms and reach upward.

There are 2 main causes of rotator cuff tears: injury and degeneration.

The symptoms of a rotator cuff tear may resemble other conditions or medical problems. It is important to talk with your healthcare provider for a diagnosis.

Your healthcare provider will determine specific treatment for your rotator cuff injury.

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An injury to the rotator cuff, such as a tear, may happen suddenly when falling on an outstretched hand or develop over time because of repetitive activities.

# data[].attributes.body
Another common cause of rotator cuff injuries can be aging. It is a result of degeneration of tissues

# data[].attributes.attachment_link.readable_text
Shoulder Sports Injuries Shoulder Surgery

What is a rotator cuff injury?

Your rotator cuff consists of muscles and tendons that hold your shoulder in place. It is one of the most important parts of your shoulder.

Your rotator cuff allows you to lift your arms and reach upward. Each year, millions of people in the United States go to their healthcare providers because of a rotator cuff problem. A rotator cuff tear is a common cause of pain and disability among adults.

What are the symptoms of a rotator cuff tear?

The following are the most common symptoms of a rotator cuff tear. However, you may experience symptoms differently. Symptoms may include:

Recurrent pain, especially with certain activities

Pain that prevents you from sleeping on your injured side

Grating or cracking sounds when moving your arm

Limited ability to move your arm

Muscle weakness

The symptoms of a rotator cuff tear may resemble other conditions or medical problems. Always talk with your healthcare provider for a diagnosis.

How is a rotator cuff injury diagnosed?

In addition to a complete medical history and physical exam, diagnostic procedures for a rotator cuff injury may include the following:

X-ray. A diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.

Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.

A rotator cuff may tear partially or fully. Partial-thickness tears do not completely sever the tendon from the shoulder.

What causes a rotator cuff injury?

There are 2 main causes of rotator cuff tears: injury and degeneration. An injury to the rotator cuff, such as a tear, may happen suddenly when falling on an outstretched hand. It may also develop over time due to repetitive activities. Rotator cuff tears may also happen due to aging, with degeneration of the tissues.

How is a rotator cuff injury treated?

Treatment may include:

Nonsteroidal anti-inflammatory medicines

Strengthening and stretching exercises

Ultrasound therapy

Corticosteroid injection

Surgery (for severe injuries)

Johns Hopkins Shoulder and Elbow Surgery

When should I call my healthcare provider?

Notify your healthcare provider if:

Key points about rotator cuff injury

Your rotator cuff allows you to lift your arms and reach upward.

There are 2 main causes of rotator cuff tears: injury and degeneration.

The symptoms of a rotator cuff tear may resemble other conditions or medical problems. It is important to talk with your healthcare provider for a diagnosis.

Your healthcare provider will determine specific treatment for your rotator cuff injury.

# data[].attributes.attachment_link.description
An injury to the rotator cuff, such as a tear, may happen suddenly when falling on an outstretched hand or develop over time because of repetitive activities.

# data[].attributes.body
Recurrent pain, especially with certain activities

Pain that prevents you from sleeping on your injured side

Grating or cracking sounds when moving your arm

Limited ability to move your arm

Muscle weakness

# data[].attributes.attachment_link.description
An injury to the rotator cuff, such as a tear, may happen suddenly when falling on an outstretched hand or develop over time because of repetitive activities.

# data[].attributes.headline
Natalie Montenegro :anatomy visual structures

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Natalie Montenegro :anatomy visual structures

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Gabriella Pola-Cadena- What Processes Cause this Condition?

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Gabriella Pola-Cadena- What Processes Cause this Condition?

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The processes that can cause this condition would be the two types of rotator cuff tears: injury and degeneration. Repetitive overhead activities such as tennis, trauma, aging, and bone spurs.

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An injury to the rotator cuff, such as a tear, may happen suddenly when falling on an outstretched hand or develop over time because of repetitive activities.

# data[].attributes.headline
Mackenzie Liebau - Anatomical Structures involved

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Mackenzie Liebau - Anatomical Structures involved

# data[].attributes.body
A rotator cuff tear involves the tearing of one or multiple tendons of the rotator cuff muscles. This includes supraspinatus, infraspinatus, teres minor, & subscapularis.

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Tayla Young- Processes  are affected by this a torn rotator cuff. 

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Tayla Young- Processes  are affected by this a torn rotator cuff. 

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Because your rotator cuff is made up of tendons that connect your shoulder, if you have a rotator cuff injury your shoulder will become very weak. This means doing things like brushing your hair or getting dressed becomes very hard and even painful. Anything including lifting or raising your arm will be very very challenging.

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Your arm is kept in your shoulder socket by your rotator cuff. The rotator cuff is a group of four muscles that come together as tendons to form a covering around the shoulder. When one of these tendons is torn, it may be painful to lift or rotate your arm.

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The Teres Minor is one of the four main muscles. This muscle helps rotate the arm outward. The muscles stretches from the lateral border of the scapula to the greater tubercle of the humerus. The Teres Minor involves lateral and external rotation of the arm.

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Anatomy, Shoulder and Upper Limb, Arm Teres Minor Muscle - StatPearls - NCBI Bookshelf

# data[].attributes.attachment_link.description
The teres minor is a narrow, intrinsic shoulder muscle that extends from the lateral border of the scapula to the greater tubercle (or tuberosity) of the humerus.[1] It contributes to the “rotator cuff,” a capsule of muscles and tendons that collectively stabilize the glenohumeral joint. The teres minor is responsible for lateral, or external, rotation of the arm at the shoulder.[2][3]

# data[].attributes.body
The most common rotator cuff injury is falling on a outstretched hand, this can cause a tear. The stress of the fall can over limit the strength of the tendons and create a small tear or larger tear.

# data[].attributes.attachment_link.readable_text
Shoulder Sports Injuries Shoulder Surgery

What is a rotator cuff injury?

Your rotator cuff consists of muscles and tendons that hold your shoulder in place. It is one of the most important parts of your shoulder.

Your rotator cuff allows you to lift your arms and reach upward. Each year, millions of people in the United States go to their healthcare providers because of a rotator cuff problem. A rotator cuff tear is a common cause of pain and disability among adults.

What are the symptoms of a rotator cuff tear?

The following are the most common symptoms of a rotator cuff tear. However, you may experience symptoms differently. Symptoms may include:

Recurrent pain, especially with certain activities

Pain that prevents you from sleeping on your injured side

Grating or cracking sounds when moving your arm

Limited ability to move your arm

Muscle weakness

The symptoms of a rotator cuff tear may resemble other conditions or medical problems. Always talk with your healthcare provider for a diagnosis.

How is a rotator cuff injury diagnosed?

In addition to a complete medical history and physical exam, diagnostic procedures for a rotator cuff injury may include the following:

X-ray. A diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.

Magnetic resonance imaging (MRI). A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.

A rotator cuff may tear partially or fully. Partial-thickness tears do not completely sever the tendon from the shoulder.

What causes a rotator cuff injury?

There are 2 main causes of rotator cuff tears: injury and degeneration. An injury to the rotator cuff, such as a tear, may happen suddenly when falling on an outstretched hand. It may also develop over time due to repetitive activities. Rotator cuff tears may also happen due to aging, with degeneration of the tissues.

How is a rotator cuff injury treated?

Treatment may include:

Nonsteroidal anti-inflammatory medicines

Strengthening and stretching exercises

Ultrasound therapy

Corticosteroid injection

Surgery (for severe injuries)

Johns Hopkins Shoulder and Elbow Surgery

When should I call my healthcare provider?

Notify your healthcare provider if:

Key points about rotator cuff injury

Your rotator cuff allows you to lift your arms and reach upward.

There are 2 main causes of rotator cuff tears: injury and degeneration.

The symptoms of a rotator cuff tear may resemble other conditions or medical problems. It is important to talk with your healthcare provider for a diagnosis.

Your healthcare provider will determine specific treatment for your rotator cuff injury.

# data[].attributes.attachment_link.description
An injury to the rotator cuff, such as a tear, may happen suddenly when falling on an outstretched hand or develop over time because of repetitive activities.

# data[].attributes.body
During arm movements, the rotator muscles contract and prevent the sliding of the head of the humerus, allowing full range of motion and providing stability.

Additionally, rotator cuff muscles help in the mobility of the shoulder joint by facilitating abduction, medial rotation, and lateral rotation.

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Mackenzie Liebau: Symptom of rotator cuff injury

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Mackenzie Liebau: Symptom of rotator cuff injury

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Limited Movement- Difficulty raising arm above the shoulder or reaching behind the back

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Symptoms of a Rotator Cuff Injury- Tayla Young

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Symptoms of a Rotator Cuff Injury- Tayla Young

# data[].attributes.body
One symptom of a rotator cuff injury is weakness in the arm when trying to lift it. This can also affect trying to rotate your arm and move objects.

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A rotator cuff tear causes shoulder pain and makes arm movements difficult. Learn more about the symptoms and treatment.

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Symptom of Rotator Cuff Injury-Gaby Pola-Cadena

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Symptom of Rotator Cuff Injury-Gaby Pola-Cadena

# data[].attributes.body
One symptom commonly seen in a rotator cuff tear is swelling and inflammation around the rotator cuff near the shoulder blade.

# data[].attributes.body
Popping or Cracking- When moving your arm you will hear a popping or cracking sound. This sound is from the muscle or tendon moving over the bone in the shoulder.

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Steroid Injections : Such shots often provide temporarily relief. The injections can ease pain and swelling. It also may make daily activities like sleeping , or moving the arm easier .

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Surgery: Most rotator cuff surgeries take place arthroscopically through small incisions. Occasionally, the surgeon will use an open approach when needed.The surgery is an outpatient procedure. Overall recovery after this surgery is very substantial and can take up to a year or more.

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Diagnosis of a Rotator Cuff injury- Tayla Young 

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Diagnosis of a Rotator Cuff injury- Tayla Young 

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One way a rotator cuff injury can be diagnosed is through imaging such as MRIs or X-rays. X-rays help rule out other types of injuries such as bone spurs. MRIs help doctors tell if it's a full tear or a partial tear.

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Diagnosis of a Rotator Cuff Injury- Olivia Locklin

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Diagnosis of a Rotator Cuff Injury- Olivia Locklin

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Physical Exam- One example of a diagnosis of a rotator cuff injury is a physical exam. During this exam the doctor will check on mobility and range of motion by moving your shoulder in different positions asking questions throughout the process.

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Rotator cuff injury - Diagnosis and treatment - Mayo Clinic

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This common shoulder disorder is often caused by repetitive overhead motions in jobs or sports. Extensive rotator cuff tears may require surgery.

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After one rotator cuff injury, it is definitely possible to re hurt the affected area especially because overtime a partial tear can progress to a complete tear. After surgery the rate of re-tearing can be up to almost 95%. The size of the original tear is the most important factor because the larger it was, the more prone to re-injury.

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Untreated chronic inflammation due to a partially torn rotator cuff tendon could lead to a full-thickness tear and eventually progress to shoulder arthritis at which point you may not be able to raise your arm overhead due to shoulder weakness and pain

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Rotator cuff injury - Symptoms and causes

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This common shoulder disorder is often caused by repetitive overhead motions in jobs or sports. Extensive rotator cuff tears may require surgery.

# data[].attributes.body
When we sleep for prolonged periods on our shoulders specifically after a rotator cuff injury, this can cause abnormal loading pressures on the bones, cartilage, ligaments, and tendons. Interrupted sleep or morning shoulder soreness – This can be a sign that you are injuring your shoulder during sleep.

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After the injury, people may find that their arm is incredibly stiff and there is a loss of motion when trying to lift their arm above their head. It also may become hard to reach behind one's back. They will also find that lifting heavy object with the injured arm is quite challenging.

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A tear in the rotator cuff can lead to diseases such as: degenerative joint disease, hypertension and other tendon conditions. Tendonitis can also be formed from a rotator cuff injury. Re-tear is also another possibility.

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Prevalence and risk factors of a rotator cuff tear in the general population - PubMed

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Surgery, physical therapy and rest are the 3 long term treatments to a rotator cuff injury. Surgery is made for a tear that is extreme and rest will be the treatment for not as extreme. Usually with an injury in the rotator cuff you will need physical therapy no matter what.

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Rotator cuff problems: MedlinePlus Medical Encyclopedia

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The rotator cuff is a group of muscles and tendons that attach to the bones of the shoulder joint, allowing the shoulder to move and keep it stable.

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Surgery: Cost varies on the intensity of the tear and which state you live in, but the price typically falls between 10,000-15,000 dollars. It can be lower and higher though.

Physical Therapy: PT for a rotator cuff typically costs about 50-100 dollars per session and can last up to 6 months making the total around 3,000-4,000 dollars.

Rest: Rest doesn't cost anything, however, if people have to take time off work to rest their arm it can result in a loss of income.

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How Much Physical Therapy Costs Without Insurance in 2024 | Miracle Rehab Clinic

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If you do not have insurance you might be worried about going into physical therapy. Here are the costs you should expect in 2022.

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Mackenzie Liebau - Does insurance cover these treatments?

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Mackenzie Liebau - Does insurance cover these treatments?

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Surgery: Yes, insurance typically covers the cost of rotator cuff surgery when the surgery is medically necessary for the patient

Physical Therapy: Generally insurance will cover the cost to attend physical therapy but if the patient fails to show progress or the extent of injury doesn't necessarily require PT, insurance may not cover it.

Rest: Since rest is done on your own, you clearly don't need to pay for anything. Over time, the injury should hopefully get better

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Surgery: If the injured person does not proceed with surgery, they may have permanent weakness or full loss of motion in the shoulder, depending on the severity of the injury.

Physical Therapy: Shoulder arthritis may occur if the injury is not worked on in physical therapy. This includes chronic inflammation, possibly leading to the need for surgery.

Rest: If the injured person does not rest, there is a very likely reason that the injury will become worse. This could lead to the need for surgery and/or physical therapy.

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Example of long term treatment scenario- Natalie Montenegro 

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Example of long term treatment scenario- Natalie Montenegro 

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The goal of this study was to estimate the short-term ,healthcare costs of failed primary arthroscopic rotator cuff repair (RCR) in the United States.And it provides examples of the costs

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Healthcare costs of failed rotator cuff repairs

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The goal of this study was to estimate the short-term (∼2 years) healthcare costs of failed primary arthroscopic rotator cuff repair (RCR) in the United States.A review of current literature was performed to estimate the number of RCR performed…

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If one obtains a rotator cuff injury, Cognitive Behavioral Therapy can help manage psychological factors that can affect recovery from this type of injury. There are many ways to help a patient who requires this therapy.

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The influence of a cognitive behavioural approach on changing patient expectations for conservative care in shoulder pain treatment: a protocol for a pragmatic randomized controlled trial - BMC Musculoskeletal Disorders

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Background Despite similar outcomes for surgery and conservative care, the number of surgeries to treat rotator cuff related shoulder pain has increased. Interventions designed to enhance treatment expectations for conservative care have been shown to improve patient expectations, but no studies have yet explored whether such interventions influence patient decisions to pursue surgery.

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After a rotator cuff injury, emotional support may be necessary to uplift the patient going through a rough time. Injuries often prevent you from doing day-to-day activities which can be upsetting so accepting your emotions, talking to friends/family, & communicating with healthcare providers can be beneficial.

https://www.nimh.nih.gov/health/topics/coping-with-traumatic-events#:~:text=Spend%20time%20with%20trusted%20friends,activities%20that%20help%20reduce%20stress

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Emotional support can be used long term due to psychological issues. For example, therapy is progressive help over time. A therapist is a professional who would be able to give emotional support to someone who is struggling with an injury.

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Top Quality medical devices to help Heal your Rotator Cuff Injury quickly

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Cognitive Behavioral Therapy: What effects of the condition is CBT designed to treat and what professional delivers this treatment. -Tayla Young

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Cognitive Behavioral Therapy: What effects of the condition is CBT designed to treat and what professional delivers this treatment. -Tayla Young

# data[].attributes.body
Cognitive behavioral therapy may be necessary to manage pain or anxiety related to the injruy. Attending therapy may also be necessary for depression.

Many different professions can deliver CBT including, psychologists, therapists, counselors, mental health social workers, and psychiatrists.

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Anxiety and Depressive Symptoms Correlated to Patient-Reported Outcome Measures after Rotator Cuff Repair: A Prospective Study in the Perioperative Period

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Anxiety and depressive symptoms adversely affect surgical outcomes in patients with rotator cuff tear (RCT) undergoing surgical repair. Patients without a diagnosis of mood disorders, such as anxiety and depression, before rotator cuff repair (RCR)…

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Speech, Hearing, & cognitive rehabilitation are unrelated to Rotator Cuff Injuries (Natalie , Mackenzie, Tayla, Gabriella,Olivia)

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Speech, Hearing, & cognitive rehabilitation are unrelated to Rotator Cuff Injuries (Natalie , Mackenzie, Tayla, Gabriella,Olivia)

# data[].attributes.body
Unless the incident impacts other parts of body such as the head ,the injuries only effect shoulders not speech, hearing and or cognitive rehabilitation.

# data[].attributes.headline
Olivia Locklin: Short term treatment OT 

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Olivia Locklin: Short term treatment OT 

# data[].attributes.body
Sort term treatment for occupational therapy includes: goal setting, transition plan, and outcome evaluation. A short term plan includes a daily routine.

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Role of Occupational Therapy in Short-Term Rehabilitation | Avon Health Center

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Occupational therapy is an essential component of short-term rehabilitation. Learn what to expect during this segment of your care.

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Natalie Montenegro: Occupational therapy 

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Natalie Montenegro: Occupational therapy 

# data[].attributes.body
Since occupational therapy is helpful for getting back into every day activities these exercises may include things like for shoulder pain may include: stretching, strengthening, and joint mobilization/stabilization. something like practicing lifting everyday items like pots and pans

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Long term physical therapy treatment for a rotator cuff injury generally includes stretching, strengthening, & range of motion. Long term rehabilitation helps an individual progress after an injury prevents them from participating in daily activites.

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Short term treatment for a torn rotator cuff would include things like ice therapy, heat therapy, electrical stimulation, and stretching. These are all thing that provide relief for pain and start to make movement easier; however, treatment for a torn rotator cuff is typically long term.

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Rotator cuff injury - Diagnosis and treatment - Mayo Clinic

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This common shoulder disorder is often caused by repetitive overhead motions in jobs or sports. Extensive rotator cuff tears may require surgery.

# data[].attributes.headline
Gabriella Pola: What type of professional is required?

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Gabriella Pola: What type of professional is required?

# data[].attributes.body
In order to deliver these treatments, a Physical or Occupational therapist is required

# data[].attributes.headline
Changing actions in day to day activities:Natalie Montenegro

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Changing actions in day to day activities:Natalie Montenegro

# data[].attributes.body
One can adjust the way they may lift or carry items, reach overhead and even sleep at night to reduce stress on their shoulder. For example instead of holding boxes above one's head , the person could hold them in front of their body to reduce tension on shoulder.

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A diet is a specific course of food that is healthy to help someone loose weight or become healthier. Diets can help with mood changes and overall health. A health diet can help with growth and nutrients needed.

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A diet is the combination of foods typically eaten by a specific group of people or other organisms.

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On a scale of 1-10, I would rank it to be about a 5 for how hard it may be for a patient to make diet changes. This is because it won't necessarily have any effects on their rotator cuff injury but it can be a struggle to make changes since they're already going through other areas of difficulty such as pain or negative mental health while dealing with their injury.

In order to make this lifestyle change, a nutritionist would be helpful.

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Types of Actions to Avoid - Gabriella Pola-Cadena

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Types of Actions to Avoid - Gabriella Pola-Cadena

# data[].attributes.body
Any physical activity that requires movement of the rotator cuff may not be a good idea as it may damage it more. Activities such as playing tennis, swimming, pickleball, etc.. These activities should be avoided if one has an injury.

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Why these support systems are important? -Natalie Montenegro

# data[].attributes.subject
Why these support systems are important? -Natalie Montenegro

# data[].attributes.body
Emotional support is crucial after a rotator cuff injury because the recovery process can be physically and mentally challenging. Pain, limited mobility, and the inability to perform everyday tasks or engage in favorite activities can lead to feelings of frustration. Having a strong support system provides encouragement, and motivation to stick with the rehabilitation process. Emotional support can also help reduce stress and provide a sense of connection that fosters overall well-being during recovery.

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Being educated on how you can prevent injuries like a rotator cuff is crucial especially if you are in a career that involves heavy lifting or throwing. Staying educated can help you protect yourself and continue what you love doing. Several people may not be educated on safety because they might not think it'll happen to them so they don't care to be educated. This is how injuries occur.

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Abstract

Health disparities research in the United States over the past 2 decades has yielded considerable progress and contributed to a developing evidence base for interventions that tackle disparities in health status and access to care. However, health disparity interventions have focused primarily on individual and interpersonal factors, which are often limited in their ability to yield sustained improvements.

Health disparities emerge and persist through complex mechanisms that include socioeconomic, environmental, and system-level factors. To accelerate the reduction of health disparities and yield enduring health outcomes requires broader approaches that intervene upon these structural determinants. Although an increasing number of innovative programs and policies have been deployed to address structural determinants, few explicitly focused on their impact on minority health and health disparities.

Rigorously evaluated, evidence-based structural interventions are needed to address multilevel structural determinants that systemically lead to and perpetuate social and health inequities. This article highlights examples of structural interventions that have yielded health benefits, discusses challenges and opportunities for accelerating improvements in minority health, and proposes recommendations to foster the development of structural interventions likely to advance health disparities research.

Reducing health disparities to improve health outcomes is a complex challenge that extends far beyond the reach of traditional health care settings. Increasingly, the structural conditions in which people are born, live, learn, work, worship, play, and age are recognized as critical determinants of health and health disparities. Minority populations often face multiple levels of mutually reinforcing structural disadvantage that contribute to poor health. Although many promising health interventions have targeted individual-, interpersonal-, and, to some extent, community-level factors, the evidence on how enduring these interventions are in supporting sustained improvements in population health and reducing health disparities is limited. Inherent in the challenge to support individual behavioral change is the dynamic interplay of risk and protective factors that cut across social and environmental contexts that can help individuals and their communities attain the highest level of health. Take, for example, the case of obesity disparities: interventions that improve nutrition and physical activity at the individual level are unlikely to succeed when the food and social environments (e.g., unsafe and limited recreational space, ready access to low-cost, calorie-dense food options) and high rates of poverty present severe barriers to maintaining healthy diets and active lifestyles.

Despite increasing national recognition of the relationship of structural determinants to health and health disparities, the majority of health disparities interventions have focused primarily on behavior change at individual and interpersonal levels, which have had limited impact on sustained improvements in health or reductions in health disparities. The vision for health disparities research is to promote intervention science that addresses the structural drivers of health disparities through multisectoral collaborations. This article highlights examples of major national efforts focused on structural determinants that have yielded reductions in health disparities. These examples illuminate common themes inherent in successful interventions that tackle structural drivers of health and challenges to deploying structural interventions that improve minority health and health equity. We conclude with recommendations to advance the science of health disparities research.

DEFINITION AND CONCEPTUAL FRAMEWORK

Structural interventions attempt to change the social, physical, economic, or political environments that may shape or constrain health behaviors and outcomes, altering the larger social context by which health disparities emerge and persist. They target factors such as economic instability, limited educational and employment opportunity, societal racism, systemic discrimination, and lack of resources, which limit neighborhoods' access to healthy food, clean water, physical activity spaces, transportation, and health care. It has long been argued that to effect population-level change and reduce health disparities, multilevel structural interventions are needed.

The National Institute on Minority Health and Health Disparities (NIMHD) Minority Health and Health Disparity Research Framework can guide structural interventions by emphasizing multiple domains of conceptual constructs that may be relevant to the development of structural interventions such as physical and built environments, sociocultural determinants, and multiple levels of influences in addressing health disparities. Furthermore, the most promising interventions should involve diverse stakeholders from multiple sectors, such as criminal justice, education, transportation, housing, business, and other social services, in addition to the health care system. For more information on designing, conducting, and analyzing multilevel structural interventions, see the multilevel intervention analytic essay by Agurs-Collins et al. (p. S86) in this special issue.

EVIDENCE-BASED STRUCTURAL INTERVENTIONS

A few promising interventions have addressed structural determinants of health disparities, intervening at the intersection of behavioral, sociocultural, physical and built environment, and policy domains. However, there is a dearth of evidence on effective structural interventions focused explicitly on health disparity outcomes. This is not a systematic review article, but an analytic essay to share themes common to nationally recognized structural interventions that reduce health disparities, describe challenges in designing and implementing these programs, and discuss lessons learned toward advancing the science of making meaningful and sustainable improvements in minority health and reductions in health disparities.

We identified common themes that provide key insights for researchers interested in advancing the science of health disparities research. These examples also illustrate the need for more such programs, common frameworks, and measures to fill the knowledge gap.

Context

The importance of integrating the geographic context in health is exemplified by the Moving to Opportunity study, a randomized housing mobility trial that offered housing vouchers to low-income families who resided in public housing in high-poverty communities to encourage them to move to lower-poverty neighborhoods. After 10 to 15 years of follow-up, the intervention group had improvements in physical and mental health, including reductions in rates of extreme obesity, diabetes, psychological distress, and major depression.

Authentic Engagement

Authentic community and stakeholder engagement is critical to the development, implementation, and sustainability of interventions to tackle structural drivers of health disparities. Community-based participatory research manages power imbalances, ensures transparent access to resources, and fosters shared decision-making to support genuine and lasting partnerships across sectors, researchers, community members, and policymakers. Successful structural interventions demonstrate that in populations affected by disparities, community stakeholders can be active equal partners in designing and evaluating structural interventions and in the advocacy and policy translation processes needed to sustain and scale these efforts.

Disease-Agnostic Interventions

Timing and Location

A crucial challenge is optimizing the timing and location of structural interventions to have the largest impact on reducing disparities. The Moving to Opportunity housing mobility experiment found that children from low-income and minority families who relocated to low-poverty areas had better long-term outcomes if the move occurred before age 13 years. Both Moving to Opportunity and the Earned Income Tax Credit demonstrated the profound effect of prenatal and childhood interventions on life course social, economic, and health trajectories. Similarly, identifying geographic risks associated with residential neighborhood factors can inform local-area capacity building and propel cross-sectoral interventions that directly or indirectly reduce health disparities and improve health outcomes.

Unintended Consequences

CHALLENGES

We identified several challenges to developing and deploying structural interventions that have the potential to reduce disparities. To fill knowledge gaps, new research and policies are needed in several domains, including theoretical frameworks, measurement, study design, funding, evaluation, and dissemination.

Common Framework and Research on Mechanisms

The task of identifying the distinct social-ecological factors that contribute to health risks and disparities and targeting these multiple contexts and levels of influence can be complex and pose several challenges to developing, implementing, and evaluating structural interventions. The domains and levels of influence are often dynamic, juxtaposed, and interact with one another, resulting in synergistic intervention effects. These interacting factors complicate the measurement of individual and collective impacts, particularly over short timeframes, and potentially hinder the ability to prioritize meaningful solutions. Standard epidemiologic methods may not adequately measure the outcomes and the impact on disparities. For naturally occurring social experiments, such as universal pre-K in poor neighborhoods, tax credits, and food environment interventions, this challenge of attribution remains salient despite the emerging science in this area. Better understanding of the mechanisms through which structural interventions succeed or fall short in improving minority health and reducing disparities is critical to informing and advancing the development, scalability, and sustainability of these programs and policies.

Improved Measurement and Methods

Measurement and methodological issues are critical to narrowing the evidence gap and elucidating the role of structural interventions in reducing and eliminating health disparities. The literature reviewed for this article revealed that interventions targeting social and, specifically, structural determinants represent a broad class of strategies and approaches that cut across multiple sectors and domains of influence. As described in the previous section, these interventions target a range of issues, from early childhood education, fiscal and tax policies, housing access, and neighborhood environments, to structural racism. Although individual interventions may have positive effects, the lack of standardized definitions of structural factors and consistent criteria for classifying different sets of relevant interventions and the limited inclusion of process and outcome measures related to health in many of these interventions impede opportunities to compare and evaluate their impact on a range of health disparities.

Despite opportunities for analyzing and linking existing data across systems, such as electronic health records, registry data, and non-health sector data, there are limitations in utilizing these data for evaluating structural interventions. Investigators and evaluators may not have contributed to intervention design, implementation, or evaluation; therefore, the measures needed to determine causal inferences are lacking or unavailable. Consistent and valid measurement across different sectors is also a concern if, for example, important variables such as race or ethnicity are inadequately measured or specified.

Rigorous Study Designs

There is limited capacity and technical expertise for linking large data sets across multiple sectors to evaluate the impact of structural interventions. Related to this issue is the need for greater interoperability and harmonization across different data systems and for a common set of minority health and disparities-related data elements that can be captured across health and nonhealth sectors. In this era of big data, a number of challenges continue to impede the culling of disparate data sets to meaningfully analyze community-wide and system-level interventions.

Limited Funding for Structural Interventions

Tackling structural determinants, such as a lack of affordable housing, poverty, and limited educational attainment, requires substantial investment from the national to the local community level across health and nonhealth sectors. However, funding is often siloed within sectors and allocated in tightly restricted ways that limit innovation and collaboration, even when organizations recognize the value of working collectively around shared goals and strategies.

Changing Priorities and Longer-Term Investment

Structural interventions often evolve in response to emerging policy, funding, or political priorities, and thus may be implemented in an iterative, discontinuous manner. Another challenge is the long follow-up periods required to observe and measure health outcomes, and especially to document decreases in health disparities, thus necessitating prolonged, multilevel evaluations that extend far beyond typical funding cycles. Structural interventions may require years, sometimes decades, of follow up before improvements in health outcomes can be observed. Most research grants are between 3 and 5 years, a timeline too short to assess long-term impact on reducing health disparities. The examples of ParentCorps and the Earned Income Tax Credit illustrate the need in disparities research for long-term interventions to understand downstream effects of these structural interventions on minority health and health disparities.

Dissemination and Implementation Gaps

Although the evidence base for structural interventions to address health disparities is growing, evaluation data are still lacking on sustainability, scalability, and replicability of successful interventions. Furthermore, the growth of evidence-based strategies has not been matched by data that inform understanding of the processes that lead to adoption and implementation in different geopolitical contexts and resource environments. The costs of structural interventions pose additional challenges as communities determine which interventions may offer the best return on investment in population health improvement and reduction in health disparities. There is a lack of clarity of the trade-offs for choosing one set of interventions versus another and how much those strategies cost per person in different communities.

FUTURE DIRECTIONS

Structural interventions are fundamentally rooted in understanding, and often altering, the contexts through which health disparities emerge and persist. They tackle complex combinations of structural determinants of health, including culture, social position, racism, environmental settings, and policies. Their common features that have successfully mitigated or eliminated disparities include accounting for the social and physical contexts that produce or perpetuate disparities, authentic engagement and integration of community and other stakeholders in all phases of the research process, and taking a disease-agnostic approach to promote disparities reduction across different conditions and at multiple levels. Furthermore, effective implementation and evaluation require close attention to the timing and location of the intervention and both intended and unintended outcomes. However, significant gaps remain in our knowledge. The following sections and the box on this page present recommendations for reducing these knowledge gaps and advancing the science of health disparities research.

Key Recommendations for Structural Interventions to Reduce Health Disparities.

* Promote the science of community and stakeholder engagement in assessing structural determinants of health and designing meaningful relevant interventions to reduce health disparities.

* Strengthen scientific frameworks to evaluate long-term impact of structural interventions on health disparities.

* Develop robust methods and measures to evaluate structural intervention impact in reducing disparities.

* Support dissemination and implementation science research for structural interventions on health disparities to enhance understanding of what strategies work across different populations, disease conditions, and geographic settings.

* Harness innovative and evidence-based approaches to addressing disparities.

* Support multilevel and multisectoral interventions that tackle structural determinants with rigorous evaluation methods and population-level data infrastructure building to assess changes over time in reducing health disparities.

Promote Community and Stakeholder Engagement

A key element of successful structural interventions is the critical role of community and stakeholder engagement in identifying the needs of disparity populations and communities, developing shared goals, and supporting meaningful, sustainable, and scalable interventions. The development, implementation, evaluation, translation, and dissemination of structural interventions require early and continuous input by the communities who bear the disproportionate burden of disease and by the stakeholders who are instrumental in efforts to sustain and scale successful practices. Community-engaged approaches result in the development of strategies that have direct relevance and practical benefits to local communities, leading to better integration of science, practice, and policy. Stakeholder engagement also informs the development of strategic partnerships across a range of sectors (such as housing, food systems, transportation, criminal justice, and health care) to address domains that contribute to health disparities at each level of influence.

Strengthen Scientific Frameworks

As noted earlier, few interventions aimed at structural determinants are guided by scientific frameworks. The effectiveness of these real-world efforts may be influenced by intersecting political, legal, economic, cultural, and biomedical factors that should be considered and accounted for in their design and evaluation. A critical step in addressing the inherent complexity of structural interventions is developing and adopting a scientifically credible conceptual framework or theory of change that incorporates these diverse factors and the roles they are anticipated to play in health disparities.

Develop Robust Methods and Measures

Robust evaluation designs and measures-derived from a broad range of disciplines and capable of harnessing big data across sectors-are needed to address the evidence gap in our understanding of the impact and reproducibility of structural interventions developed to reduce health disparities. Big data science is rapidly evolving and should engage health disparities researchers who have expertise in social and structural determinants of health. Addressing measurement and data collection challenges requires broad-based strategies, among them, mixed-method evaluation, stakeholder involvement in designing the intervention and evaluation, multisector agreement on common nomenclature and measurement, standardized measurement systems, effective methods to harmonize disparate data, and novel modeling strategies

Some structural interventions may not be suited to traditional research designs because of cost and time constraints, ethical considerations, an inability to randomize sites or individuals, or the continually evolving nature of the intervention. Robust and validated approaches, such as stepped-wedge or staggered interventions, interrupted time-series, quasi-experimental designs, and cluster or group-randomized trials can facilitate rigorous evaluation at the individual, interpersonal, community, and societal levels.

Construct and Analyze Connected Data Sets

Optimally, studies should be prospective and should include data from multiple sectors that allow examination of the impact of structural interventions on population health and health disparities. Historical data from various sectors may provide important insights into the development and evaluation of long-term impact of structural interventions by identifying simultaneous changes in social and health indicators over time that are associated with health disparities. Predictive analytics and other robust methods can inform decision-making on the nature and scope of various structural interventions and strategies to optimize health impact and disparities reduction.

Support Research

Understanding how structural interventions that were successfully developed in one community might be adapted, scaled up, and transferred to another setting is of critical importance. Promising and evidence-based structural interventions do not easily translate into improved health and reduced health disparities because it takes time, resources, and multidisciplinary teams to improve the relevance, uptake, and implementation of evidence-based interventions in real-world settings. Dissemination and implementation research training has great potential to improve the reach and impact of structural interventions on minority health and health disparities.

Harness Innovation

Advances in several disciplines are rapidly changing the ability to design, implement, and evaluate structural interventions. Technological advances, including big data science, can be mobilized to explain and address disparities. Many health system interventions have made innovative use of electronic health records as tools to characterize social and structural characteristics of populations, identify targets for intervening, and deploy interventions. Geographic information system platforms can link individuals to social and structural risks and resources. Similarly, advances in fields such as personalized medicine, personalized public and population health, systems science, and computational biology may result in powerful predictive tools to identify those at highest risk for disparities and link them to appropriate structural interventions.

Fund Cross-Sector Interventions

To conduct well-designed structural interventions and robust evaluations, resources are needed to promote interactions among stakeholders from disparate sectors to plan and develop large-scale meaningful structural interventions that can effectively reduce health disparities in populations and communities. Trans-federal agency collaborations and public-private partnerships may be promising approaches to intervening on health disparities. Standardizing approaches for motivating multistakeholder collaborations is a critical need in disparities research. Future efforts should focus on building partnerships among sectors in the earliest phases of intervention design by providing resources to support multisector partners. These early partnerships can plan effectively by using a collective impact framework and group facilitation to support consensus building that effectively translates evidence into practice. In addition, these collaborations should have an explicit emphasis on informing the collection of shared metrics and facilitating opportunities to support interoperable data systems to access large classes of epidemiological, environmental, social, and biological data to determine the impact on advancing health equity and improving population health.

Develop Decision-Making Tools

Many local communities recognize the role of structural determinants on health and social outcomes but face the challenge of identifying the interventions most likely to influence their populations' social and health outcomes. An emerging solution is the collation of evidence-based interventions in registries and reports, among them the National Registry of Evidence-Based Programs and Practices, the What Works Clearinghouse, and the Community Guide, along with an increasing number of databases that aim to help local communities examine health and social indicators at the state, county, and local level, such as the 500 Cities: New Data for Better Health and County Rankings Projects and The Opportunity Atlas. NIMHD is currently developing an Intervention Portal to serve as a repository for interventions that have successfully improved minority health or reduced health disparities. This portal is part of HD Pulse ( https://hdpulse.nimhd.nih.gov), an ecosystem that provides access to data and resources to design, implement, and evaluate evidence-based interventions to improve minority health and reduce health disparities. There is potential to harness expertise in predictive modeling and analytics to help local communities and states determine which structural interventions may yield the most meaningful reductions in health disparities.

CONCLUSIONS

Health and health disparities are the result of more than individual, interpersonal, or biological factors. Social, economic, environmental, and policy drivers also determine the health status of individuals and populations. Structural determinants play a vital role in health outcomes and the ability to seek preventive and treatment services or support for quality of care. Structural interventions should seek to change the social and environmental contexts that yield and perpetuate social and health inequalities. They can advance health equity by changing the conditions in which people live, work, learn, and play, and the community norms that influence and derive from these conditions. To tackle health disadvantage and gradients in populations, researchers must build the scientific base for multisector stakeholder engagement; extend beyond individual outcomes to community and system-level outcomes; expand methods for implementing, evaluating, and disseminating multilayered, multifaceted interventions; support the data science and infrastructure for more robust evaluations of social and health indicators; and prioritize funding for well-designed structural interventions and rigorous evaluations.

ACKNOWLEDGMENTS

This work was supported in part by the following institutes of the National Institutes of Health (NIH): National Institute on Minority Health and Health Disparities (NIMHD) and National Center for Advancing Translational Science (NCATS). A. F. Brown was supported by National Institute of Neurologic Disorders and Stroke under award U54NS081764 and NCATS award UL1TR001881. G. X. Ma was supported by National Cancer Institute award U54 CA153513 and Centers for Disease Control and Prevention (CDC) award U58DP005828. C. Trinh-Shevrin was supported by NIMHD award U54 MD000538 and CDC award U48 DP005008.

The authors wish to acknowledge Rina Das, PhD, program director of the Division of Extramural Scientific Programs at NIMHD, for her significant contributions to the conceptualization, development, and editorial comments on the article.

Note. This trans-NIH work resulted from an NIMHD-led workshop, including external experts, to address Intervention Science for Health Disparities Research. The final content of the analytic essay is the responsibility of authors and does not necessarily represent the perspective of the US government.

CONFLICTS OF INTEREST

The authors declare no conflicts of interest.

HUMAN PARTICIPANT PROTECTION

Human participant protection was not required because this work did not involve human participants.

REFERENCES

6. Black D. Inequalities in health: report of a research working group. London, England: Department of Health and Social Security; 1980.

9. Kreisel W, von Schirnding Y. Intersectoral action for health: a cornerstone for health for all in the 21st century. World Health Stat Q. 1998;51(1):75-78. [PubMed] [Google Scholar]

42. Bachrach D, Pfister H, Wallis K, Lipson M. Addressing patients' social needs: an emerging business case for provider investment. New York, NY: The Commonwealth Fund; 2014.

Articles from American Journal of Public Health are provided here courtesy of American Public Health Association

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Structural Interventions to Reduce and Eliminate Health Disparities

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Health disparities research in the United States over the past 2 decades has yielded considerable progress and contributed to a developing evidence base for interventions that tackle disparities in health status and access to care. However, health ...

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Physical Conditioning and Exercise Program Advertising- Gabriella Pola-Cadena

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Physical Conditioning and Exercise Program Advertising- Gabriella Pola-Cadena

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Stretching and flexibility exercises: Encourage stretching of the shoulder muscles, focusing on the pectorals, deltoids, and upper back to improve flexibility and range of motion.

Balance training: Include exercises to improve body control and shoulder stability to prevent sudden, awkward movements that may stress the shoulder joint.

Group exercise sessions, online classes, or local community programs. Encourage local gyms, sports clubs, and rehabilitation centers to offer rotator cuff prevention programs.

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Changing training techniques- Tayla Young

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Changing training techniques- Tayla Young

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Athletic rotator cuff injury are especially common because they're a repeated use of your shoulder when there's strain on it; however, lots of the time the strain is caused because the sport movement isn't being executed. In sports like baseball, tennis, and swimming coaches could be trained in how their athletes can have proper technique that minimizes shoulder strain. They could also be trained in certain shoulder stretches and use of resistance bands because this can help stretch the shoulder out which decreases the injury risk after a long practice. This would be aimed at individual coaches and could be implemented as a policy for training new coaches. This could possibly be challenging because it might cost money and be hard for all coaches in those sports to change how they coach.

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Prevention exercises to avoid rotator cuff tears - BSM Foundation

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Tears to the rotator cuff muscles in your shoulder are a common injury of the upper body.

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When professionals teach how to prevent a rotator cuff injury, they should focus on the little things that could help the person like focusing on maintaining good posture, regularly strengthening your shoulder muscles through targeted exercises, warming up before activity, avoiding repetitive overhead motions, and stopping any activity that causes shoulder pain immediately.

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Why it would be difficult to change daily activities- Tayla Young

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Why it would be difficult to change daily activities- Tayla Young

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One a scale of 1-10 it might be around a 5 for people to change there daily activities. This might depend on the persons job, if it involves heavy lifting. It could also depend on where they have items in their house, if they're in hard to reach places or not. The profession that would help would be an occupational therapist.

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Prevention of rotator cuff injuries - Mackenzie Liebau

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Prevention of rotator cuff injuries - Mackenzie Liebau

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A common determinator of rotator cuff injuries is overuse. Therefore a public health intervention that should be used is terminating any use of the shoulder as soon as pain appears. By doing so, a person is less likely to overwork that area which can prevent further damage such as a rotator cuff tear. Public health measures that can be taken are promoting the avoidance of overuse of a body part. For example, signs that state "Know when enough is enough for your body" could encourage people to be more aware of how they treat their body. Preventative exercises such as good posture and stretching are also very important.

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Rotator cuff injuries are common, and everyone is susceptible. Simple exercises can prevent rotator cuff injuries.

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For health I learned about the different ways you can improve you health and prevent certain injures. Especially ways to treat and prevent rotator cuff injuries and TBI's.

For healthcare I learned that there are so many different career options in healthcare. I also learned about the price of healthcare and the accessibility.

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One of the many things I have learned about health in my focus problem is how the levels of severity affect the type of treatment required for a rotator cuff injury. Lastly, I have learned about the many causes, effects, and treatments of my focus problem.

In terms of healthcare, I have learned about the careers available in the field. I have also learned about healthcare affordability for people with certain types of incomes.

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What did I learn about health?

Staying healthy can significantly impact your lifestyle and daily activities. When it comes to injuries, you are less likely to Gert injured if you keep your body healthy.

What did I learn about healthcare?

I learned that there are several careers the you can go into. Throughout the class the surveys mentioned several different career ideas and opportunities. This gave me an idea on what I'm interested in.