The Whitehall Studies investigated social determinants of health, specifically the cardiovascular disease prevalence and mortality rates among British civil servants. The initial prospective cohort study, the Whitehall I Study, examined over 17,500 male civil servants between the ages of 20 and 64, and was conducted over a period of ten years, beginning in 1967. A second cohort study, the Whitehall II Study, was conducted from 1985 to 1988 and 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 studies, named after the Whitehall area of London and originally led by Michael Marmot, found a strong association between grade levels of civil servant employment and mortality rates from a range of causes: the lower the grade, the higher the mortality rate. Men in the lowest grade (messengers, doorkeepers, etc.) had a mortality rate three times higher than that of men in the highest grade (administrators). This effect has since been observed in other studies and named the "status syndrome".
Whitehall I The first Whitehall Study compared mortality of people in the highly stratified environment of the British Civil Service. It showed that among British civil servants, mortality was higher among those in the lower grade when compared to the higher grade. The more senior one was in the employment hierarchy, the longer one might expect to live compared to people in lower employment grades. The first of the Whitehall studies, or Whitehall I, found higher mortality rates due to all causes for men of lower employment grade. The study also revealed a higher mortality rate specifically due to coronary heart disease for men in the lower employment grade when compared to men in higher grades. The initial Whitehall study found lower grades, and thus status, were clearly associated with higher prevalence of significant risk factors. These risk factors include obesity, smoking, reduced leisure time, lower levels of physical activity, higher prevalence of underlying illness, higher blood pressure, and shorter height. Controlling for these risk factors accounted for no more than forty percent of differences between civil service grades in cardiovascular disease mortality. After controlling for these risk factors, the lowest grade still had a relative risk of 2.1 for cardiovascular disease mortality compared to the highest grade. Whitehall I was carried out by the Department of Medical Statistics & Epidemiology at the London School of Hygiene & Tropical Medicine and published in 1987. The Whitehall Study papers are available to view at the School's archives.
Whitehall II Twenty years later, the Whitehall II study documented a similar gradient in morbidity in women as well as men. The name Whitehall II was derived from the previous Whitehall study. The Whitehall Studies revealed this social gradient for a range of different diseases: heart disease, some cancers, chronic lung disease, gastrointestinal disease, depression, suicide, sickness absence, back pain and general feelings of ill-health. A major challenge, and a reason for the importance of these studies, was to understand the causes of this social distribution of so many disorders. Whitehall II is a longitudinal, prospective cohort study of 10,308 women and men, all of whom were employed in the London offices of the British Civil Service at the time they were recruited to the study in 1985. The Study is led by Professor Mika Kivimaki at University College London. The initial data collection included a clinical examination and self-report questionnaire. Since then, thirteen waves of data collection have been completed: phase 1 (1984-1985; age 35 to 55), phase 2 (1989-1990), phase 3 (1991-1993), phase 4 (1995-1996), phase 5 (1997-1999), phase 6 (2001), phase 7 (2002-2004), phase 8 (2006), phase 9 (2007-2009), phase 10 (2011), phase 11 (2012-2013), phase 12 (2015-2016), phase 13 (2019-2022). The thirteenth wave began in February 2019 and finished in January 2023. It took longer as usual due to the Covid-19 pandemic.
More information about this table at the Data Collection (external link) page of the project. Research continues to explore the pathways and mechanisms through which social position influences health. The research group aims to build a causal model leading from social position through psychosocial and behavioural pathways to pathophysiological changes, sub-clinical markers of disease, functional change, and clinical disease. The Whitehall II study began as a study of working age people and investigated the relationships between work, stress, and health. Whitehall II found that the way work is organised, the work climate, social influences outside work, influences from early life, and health behaviours all contribute to the social gradient in health. As participants in this study continue through adult life, the research focuses on inequalities in health and functioning in an aging population. With an increasingly large population of older citizens in the UK, there is an urgent need to identify the causes of social inequalities and to study the long-term effects of previous circumstances on people's ability to function and stay healthy during retirement. Researchers in the Whitehall II team are also considering the role of social inequalities in relation to dementia risk.
Data sharing The Whitehall II team have a data sharing policy, allowing researchers from other institutions to use data from the Whitehall II cohort. There is a slightly different data sharing policy for projects that involve genetic information. This policy suggests that the team are engaging with the open access movement, a social movement which is gaining momentum in academia.
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