Whitehall II - Social and Occupational Influences On Health and Illness

BACKGROUND:

One of the major health problems facing industrialized countries is the persisting social class differences in the rate of occurrence of the major chronic diseases. It is true in the United States as it is in the United Kingdom, Scandinavia, Japan, and other countries. The advantage of investigating these social differences in the United Kingdom is that they have been most extensively documented, but findings are likely to be generalizable. The Black Report comprehensively reviewed the persisting social inequalities in health and concluded that the reasons were not completely understood. The Whitehall Study of the British civil service confirms the social gradient in mortality.

In the British civil service studies, as in the country as a whole, social class is defined on the basis of occupation. This raises the question as to whether the observed differences in morbidity and mortality are due to factors related to occupation or the general way of life. In many countries there are well documented social class differences in aspects of life-style: smoking, leisure-time physical activity, obesity, diet. Such differences were confirmed in civil servants studies, but these were insufficient to account for differences in mortality. There are thus two types of question: what accounts for the differences in smoking and other aspects of life style among men and women in different occupations? and; to what extent may the unexplained social differences in disease rates be related to factors associated with work as distinct from way of life?

DESIGN NARRATIVE:

There was a cross-sectional study and a short-term longitudinal study linking baseline data with morbidity based on sickness-absence records collected over an eighteen month period. Each subject was screened in an on-site work clinic. Questions were included on birthdate, civil service grade, marital status, family history of cardiovascular disease, occupation, car and house ownership, ethnicity, medical history of cardiovascular and respiratory problems, smoking, coffee and alcohol use, dietary intake, physical activity, work characteristics, social support, life satisfaction, life events, and mental illness. Type A behavior was assessed by the Framingham Type A Scale. A separately funded physical exam was conducted and included data on blood pressure, height, weight, pulse, ECG, blood clotting factors, and serum cholesterol. Initial analysis included calculation of prevalence rates of ischemic heart disease by age, sex, and social class as measured by employment grade. Dependent variables were crosstabulated for various categories of independent variables. The independent variables consisted of measures of psychosocial stress arising from work and personal situations.