Whitehall Study

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 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 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'. 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. The Whitehall Study papers are available to view at the School's archives. 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 initial data collection included a clinical examination and self-report questionnaire. Since then, nine 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) and phase 10 (2011). The tenth wave began in January 2011, with wave 11 due to begin in January 2012. The study continues to release findings.