Monday, March 17, 2014.  Here is a small part of what I have accumulated during my online studies that began last Friday and continued today.  I am not finished by any means.  The bulk of what I have on file now would not be of interest to many readers but I did think perhaps what follows might interest some.

“Medical Sociology” is not a combination of words I have ever thought about until this afternoon when I encountered this article during an online research investigation I am working on to assist my daughter as she prepares to write papers and do several presentations around the country on the topic of health disparities and American Indian people.

Social Conditions As Fundamental Causes of Disease

Bruce G. Link; Jo Phelan

Journal of Health and Social Behavior, Vol. 35, Extra Issue: Forty Years of Medical Sociology:

The State of the Art and Directions for the Future. (1995), pp. 80-94.

Stable URL:


Journal of Health and Social Behavior is currently published by American Sociological Association.


This is the bio information on Link & Phelan from the 1995 article:

Bruce G. Link is associate professor of public health at Columbia University and research scientist at New York State Psychiatric Institute. His interests lie in understanding the sources of particular types of inequality, its legitimation, and its consequences as these bear on the social patterning of health and illness. This interest is reflected in his work on the association between socioeconomic status and major mental disorders and the possible role that occupational conditions may play in this association, research on the health and well-being of homeless people, and research on the social and economic adversities engendered by the stigma of mental illness.

Jo Phelan is assistant professor of sociology at the University of California, Los Angeles. Her research interests include homelessness, social stigma, the impact of social conditions on health and illness, and attitudes concerning inequality and its legitimacy.

CONCLUSION to the 1995 article

The dominant focus in epidemiology and perhaps the American culture in general is on individually-based risk factors that lie relatively close to disease in a causal chain. But this focus overlooks important sociological processes and, as a result, could lead us to actions that limit our ability to improve the nation’s health. We have focused on two concepts — contextualizing risk factors and fundamental causes — that direct our attention to precisely those factors that are left unexamined in the currently dominant orientation to research on risk factors for disease. If future research by medical sociologists and social epidemiologists increases our understanding of the processes implied by these concepts, we will be better positioned as a society to further improve the nation’s health.”  – page 90


I also located this book chapter of more recent writing by the authors Link & Phelan:

Fundamental sources of health inequalities

BG Link, JC Phelan – Policy challenges in modern health care, 2005 – books.google.com

 argued that new mechanisms arise because persons higher in socioeconomic status enjoy
a wide range of resources—including money, knowledge, prestige, power, and beneficial social
connections—that they can utilize to their health advantage (Link and Phelan 1995).

Link to their chapter is also here:  http://homeoint.ru/pdfs/socialconditions.pdf in the book Policy Challenges in Modern Health Care edited by Lynn B. Rogut, James R. Knickman, David Mechanic, David Colby – 2005


This is the most important main body of statistical information currently available in the United States on this topic:

CDC Health Disparities and Inequalities Report — United States, 2013


This is the most current information specific to American Indian health:

Trends in Indian Health and Regional Differences in Indian Health

…. Part 5: Patient Care Statistics (PDF – 1.9MB)

…. Brochure (PDF – 667KB)


And this from the Office of minority health – US dep’t of health and human services


Also on this site

Cultural Competency

15 National StandardsWhat’s Cultural Competency?

Training Tools | Continuing Education

There is also HHS disparities action plan at this site


American Indian health profiles are at this link per 12 regional divisions for data collection nationwide outside of Alaska:


  1. Aberdeen Area
  2. Alaska Area
  3. Albuquerque Area
  4. Bemidji Area
  5. Billings Area
  6. California Area
  1. Nashville Area
  2. Navajo Area
  3. Oklahoma Area
  4. Phoenix Area
  5. Portland Area
  6. Tucson Area


I also found these two concepts intriguing although more work to ferret out the meaning and significance of these terms will be required:

Social resistance framework” (3/17/14) and “nondominant minorities


Roni  Factor, David R.  Williams, Ichiro  Kawachi. (2013) Social Resistance Framework for Understanding High-Risk Behavior Among Nondominant Minorities: Preliminary Evidence. American Journal of Public Health 103:12, 2245-2251
Online publication date: 1-Dec-2013.



Objectives. The recently developed social resistance framework addresses a widespread pattern in which members of some nondominant minorities tend to engage in various risky and unhealthy behaviors more than the majority group. This pilot study tested the core hypotheses derived from this innovative framework.

Methods. We conducted in 2011 a nationally representative Web-based survey of 200 members of a nondominant minority group (African Americans) and 200 members of a majority group (Whites).

Results. The preliminary findings supported the main premises of the framework and suggested that nondominant minorities who felt discriminated and alienated from society tended also to have higher levels of social resistance. Those with higher levels of social resistance also engaged more in risky and unhealthy behaviors—smoking, drinking, and nonuse of seat belts—than did those with lower levels of social resistance. These associations were not found in the majority group.

Conclusions. These preliminary results supported the framework and suggested that social resistance might play a meaningful role in risky and unhealthy behaviors of nondominant minorities, and should be taken into account when trying to reduce health disparities.


Understanding high-risk behavior among non-dominant minorities: A social resistance framework

R Factor, I Kawachi, DR Williams – Social Science & Medicine, 2011 – Elsevier

Across different societies, non-dominant minority groups, compared to the dominant group,
often exhibit higher rates of involvement in high-risk behaviors, such as smoking, drug and
alcohol use, sexual risk behaviors, overeating, and unsafe driving habits. In turn, these

HARVARD EDU – PDFharvard.edu [PDF]


I have also located and sent to my daughter all the United Nations links to current reports and centers that collect information about and work to serve the needs of Indigenous People the globe over.


I can simply state that severe infant and child abuse survivors are, in my thinking, members of a “nondominant minority.”  We survivors, as the CDC-ACE study has shown, thoroughly live with risk factors for low health standards often because of the risky behaviors we are most likely to engage in.  We are probably very similar to the groups that could be identified as fitting within a “social resistance framework” for many reasons.  (I suggest doing a Google Scholar search for the term “cdc ace pyramid” – the results that will come up are incredible indicators of the lifelong serious consequences of severe trauma in the early years of life for ANYONE.)

I fortunately do not have to think my way through any of the resources I am accumulating.  That is my daughter’s professional job as she works with 200 responses to a local survey with American Indian and Non-American Indian respondents.

I have taken on a simple but complex part of the job to find resources embedded within resources about disparities in health between minorities and non-minorities.  A very clear pattern is emerging in America as the data shows.  At present 50% of all girls age 15 and under in the United States are “minorities.”  It is suspected that by 2050 50% of the population in America will be “minorities” while 50% will be what many consider to be “white.”

Times are changing.

I have come across valid research articles that suggest that the widening gap in all forms of health disparities between the “dominant majority” and the minorities in America may well never be closed.  I cannot imagine the tragedy of such a continuing pattern. 

I don’t have to do anything more right now than to voluntarily accumulate resources that will help light my daughter’s pathway as she pursues this important current research work – which in actuality is a sideline to her main employment tasks.  I LIKE doing the internet research part.  I would NOT LIKE to have to integrate this information into a coherent whole!  That is my daughter’s gift.

I send her related articles and reports, each individually notated in emails that will be printed on her end to be used in an index for the emails themselves – and some collected documentation in WORD – that contain live links.  When I do this kind of study I am reminded of what a miracle the internet is!!  Awesome in ways that probably only later generations will recognize.

Let us all make the very best use possible of all helpful information OUT THERE.  We need one another’s help.  Of that much I am certain.

Meanwhile I realize that as I do this kind of online research I feel as close to flying as I ever will in my lifetime.  I get lost to real time for hours and hours.  I absolutely love it!


HERE ARE SOME INTERESTING FINDINGS from my flying.  I haven’t yet gone to see if I can access whole articles or even abstracts for these but the titles intrigue me!

Braveman PA, Cubbin C, Egerter S, Williams DR, Pamuk E. Socioeconomic disparities in health in the United States: what the patterns tell us. Am J Public Health 2010;100(Suppl 1):S186–96. DOI:10.2105/AJPH.2009.166082.   Sent to ramona


Objectives. We aimed to describe socioeconomic disparities in the United States across multiple health indicators and socioeconomic groups.

Methods. Using recent national data on 5 child (infant mortality, health status, activity limitation, healthy eating, sedentary adolescents) and 6 adult (life expectancy, health status, activity limitation, heart disease, diabetes, obesity) health indicators, we examined indicator rates across multiple income or education categories, overall and within racial/ethnic groups.

Results. Those with the lowest income and who were least educated were consistently least healthy, but for most indicators, even groups with intermediate income and education levels were less healthy than the wealthiest and most educated. Gradient patterns were seen often among non-Hispanic Blacks and Whites but less consistently among Hispanics.

Conclusions. Health in the United States is often, though not invariably, patterned strongly along both socioeconomic and racial/ethnic lines, suggesting links between hierarchies of social advantage and health. Worse health among the most socially disadvantaged argues for policies prioritizing those groups, but pervasive gradient patterns also indicate a need to address a wider socioeconomic spectrum—which may help garner political support. Routine health reporting should examine socioeconomic and racial/ethnic disparity patterns, jointly and separately.

Read More: http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2009.166082http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2009.166082


Adler NE, Stewart J. Health disparities across the lifespan: meaning, methods, and mechanisms. In: Adler NE, Stewart J, eds. The biology of disadvantage. New York, NY: New York Academy of Sciences; 2010;1186:5–23. 

Ohlshansky SJ, Antonucci T, Berkman L, et al. Differences in life expectancy due to race and educational differences are widening, and may not catch up. Health Aff 2012;31:1803–13. 


Independent research supporting the CDC-ACE study findings —

Cathy Spatz  Widom, Sally J.  Czaja, Tyrone  Bentley, Mark S.  Johnson. (2012) A Prospective Investigation of Physical Health Outcomes in Abused and Neglected Children: New Findings From a 30-Year Follow-Up. American Journal of Public Health 102:6, 1135-1144
Online publication date: 1-Jun-2012.



We investigated whether abused and neglected children are at risk for negative physical health outcomes in adulthood.


Using a prospective cohort design, we matched children (aged 0-11 years) with documented cases of physical and sexual abuse and neglect from a US Midwestern county during 1967 through 1971 with nonmaltreated children. Both groups completed a medical status examination (measured health outcomes and blood tests) and interview during 2003 through 2005 (mean age=41.2 years).


After adjusting for age, gender, and race, child maltreatment predicted above normal hemoglobin, lower albumin levels, poor peak airflow, and vision problems in adulthood. Physical abuse predicted malnutrition, albumin, blood urea nitrogen, and hemoglobin A1C. Neglect predicted hemoglobin A1C, albumin, poor peak airflow, and oral health and vision problems, Sexual abuse predicted hepatitis C and oral health problems. Additional controls for childhood socioeconomic status, adult socioeconomic status, unhealthy behaviors, smoking, and mental health problems play varying roles in attenuating or intensifying these relationships.


Child abuse and neglect affect long-term health status-increasing risk for diabetes, lung disease, malnutrition, and vision problems-and support the need for early health care prevention.

Read More: http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2009.166082


Rosenthal L, Caroll-Scott A, Earnshaw VA, et al. The importance of full-time work for urban adults’ mental and physical health. Soc Sci Med 2012;75:1692–6. 

Leach LS, Butterworth  P, Strazdins L, et al. The limitations of employment as a tool for social inclusion. BMC Public Health 2010;10:621


Woolf SH, Johnson RE, Phillips RL, Philipsen M. Giving everyone the health of the educated: an examination of whether social change would save more lives than medical advances. Am J Public Health 2007;97:679–83


Now I am going to sit down and read more of my junk mystery crime thriller!  VEG TIME!

NOTE:  I am running Windows XP on this old slow laptop which is threatening me with a major crash even as I work to get this posted first!  I am a techno phobe who is being forced to upgrade to a new computer – hopefully it can be ordered soon so I don’t loose online time as I learn to manage Windows 8.1 (with the handy help of my new nearly 1000 page help manual!)

OOPS!  It crashed first.  Big time.  Good thing I put this in Word and saved it in time!  It’s just not up to the work I’m loading on it.  I will be glad once I have a new computer.  Just have to learn how to manage in Tile World as they call Windows 8.1!  I learn do it.  I can do it……


Here is our first book out in ebook format.  A very kind professional graphic artist is going to revise our cover pro bono (we are still waiting to hear that he has accomplished this job) – what a gift and thank you Ben!  Click here to view or purchase: 


It lists for $2.99 and can be read by Amazon Prime customers without charge.  Reviews for the book on the Amazon.com site are WELCOME and appreciated!


Please click here to read or to Leave a Comment »


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