Whitehall Study

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The original Whitehall Study investigated social determinants of health, specifically the cardiorespiratory disease prevalence and mortality rates among British male civil servants between the ages of 20 and 64. The initial study, the Whitehall I Study, was conducted over a period of ten years, beginning in 1967. A second phase, the Whitehall II Study, examined the health of 10,308 civil servants aged 35 to 55, of whom two thirds were men and one third women. A long-term follow-up of study subjects from the first two phases is ongoing.

The Whitehall studies found a strong association between grade levels of civil servant employment and mortality rates from a range of causes. Men in the lowest grade (messengers, doorkeepers, etc.) had a mortality rate three times higher than that of men in the highest grade (administrators).

Contents

[edit] Whitehall I

The first phase of the Whitehall studies, or Whitehall I, found there were higher mortality rates in men of lower employment grade specifically due to coronary heart disease, as well as increased mortality rates due to all causes for lower status men.

The initial Whitehall study found lower grades, and thus status, were clearly associated with greater propensities for significant risk factors, including obesity, smoking, reduced leisure time and physical activity, more baseline illness, higher blood pressure, and shorter height. Controlling for these risk factors accounted for no more than 40% of grade differences in cardiovascular disease mortality. Even after these standard risk factors were controlled for, the lowest grade still had a relative risk of 2.1 for cardiovasular disease mortality compared to the highest grade.

[edit] Whitehall II

The second phase, or Whitehall II, sought to examine the association between the psychosocial work environment and subsequent rates of absenteeism due to illness. Two controlled trials were conducted for high-risk subjects: one trial examined anti-smoking counseling, while the other trial examined preventative treatment for those found to be at risk because of impaired glucose tolerance. Besides smoking and glucose intolerance, civil servant grade was also found to be associated with other specific causes of death.

Among the conclusions drawn from the second phase were that stress due to the psychosocial work environment factors predicts rates of sickness absenteeism, and that enhanced control of task management and support "could have beneficial effects," such as increasing productivity and improving employee health and well-being.

[edit] Health risks associated with disparities of wealth and power

By design, the Whitehall studies have been focused upon a single swath of related occupations, wherein relatively little heterogeneity exists within occupational grades, yet clear social distinctions between grades are inherent. The studies were designed in this manner as an attempt to avoid certain research drawbacks associated with generalized social class groupings, drawbacks that otherwise would result from the diversity of occupations within social classes, which in turn would tend to reduce the potential objectivity of analyses.

The primary health risks under investigation in the Whitehall studies include cardiovascular function, smoking, car ownership, angina, leisure/hobbies, ECG measurements, and diabetes. The name for the Whitehall Study derives from a road in London, the capital of the United Kingdom, where a vast number of British civil servants work. The road takes its name from the vast Palace of Whitehall, which runs between Trafalgar Square and Parliament Square.

High blood pressure at work was associated with greater 'job stress', including 'lack of skill utilization', 'tension', and 'lack of clarity' in tasks assigned. The higher blood pressure among the lowest grade servants was found to be related to the highest job stress score, whereas blood pressure at home was not related to job stress level.

According to Whitehall study researches, "a steep inverse association between social class, as assessed by grade of employment, and mortality from a wide range of diseases" has been demonstrated. Summing up the moral of the Whitehall studies, the researchers concluded that "more attention should be paid to the social environments, job design, and the consequences of income inequality."

[edit] Direction

The study is directed by Professor Michael Marmot of the Department of Epidemiology and Public Health at University College London. Marmot is currently the commissioner of the World Health Organization's Commission on Social Determinants of Health.[1]

[edit] External links

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