The Whitehall study is a ground-breaking longitudinal (prospective cohort) study
ID: 95204 • Letter: T
Question
The Whitehall study is a ground-breaking longitudinal (prospective cohort) study that clearly demonstrated the association between social determinants of health (the social gradient) and morbidity and mortality (cardiovascular disease) in a population of British civil servants (Breeze et al., 2001; Chandola et al., 2008; Marmot et al., 1978).
In no more than 1,000 words please address the following short-answer questions:
What is the sampling frame for each phase of the Whitehall study (Whitehall I and II)?
How was disease risk assessed (both in data collection and analysis) in each of the three studies, and why?
To what extent can the results of each of the three studies can be generalised to other populations (include reasons for your answer)?
Would it be feasible to conduct a similar study in Australia using an existing cohort such as the 45 and up study cohort, or the Australian Women’s longitudinal study cohort? Why or why not?
Additional Resources for Assessment 2
SAX Institute. (n.d.). 45 and up study. http://www.saxinstitute.org.au/our-work/45-up-study/
Australian Longitudinal study on Women’s Health. http://www.alswh.org.au/
Whitehall II (also known as the Stress & Health Study). Retrieved from http://www.ucl.ac.uk/whitehallII
Assessment criteria
Knowledge and understanding of prospective cohort studies
Knowledge and understanding of social determinants of health
Knowledge an understanding of the concepts of sampling and bias
Use of mathematical concepts to describe sampling frame and disease risk
Interpretation of the findings of the Whitehall study and its generalisability to other populations
Academic presentation including accurate referencing using APA style
Explanation / Answer
Whitehall study I : The first Whitehall Study I 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.
Whitehall study II :
After 20 years 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 Whitehall studies have been focused upon a single set of related occupations, where the people within each occupational grade tend to be socially similar, yet clear social distinctions between grades are inherent.
The primary health risks under investigation in the Whitehall studies include cardiovascular function, smoking, car ownership, angina, leisure and hobbies, ECG measurements, and diabetes.
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 issues.
According to Whitehall study researchers, "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.
Whitehall II confirmed some of the results of Whitehall I, especially the finding that the lower the job status, the higher the prevalence of ischemic heart disease. New, landmark findings revolved around gender differences and isolation as possible causes of this inverse relationship. In general, women had greater morbidity than men in all grades of employment.
The Australian Longitudinal Study on Women's Health,has its history in the women's movement of the 1980s. At that time, activists successfully pressured governments in Australia, at both the State and Federal levels, to develop women's health policies. Part of the development process of the National Women's Health Policy, which was launched in 1989, involved a national consultation with women's organizations representing more than a million women.From this consultation the idea of a national longitudinal study on women's health emerged. As with the National Policy generally, the longitudinal study was to be premised on a social rather than a narrowly focused medical approach to health. The study was envisaged as a strategy to enable women to gain greater power over shaping the nature of health care. This was given impetus by studies at the time showing that it was not major medical conditions that were of most concern to most women. Studies asking women to rate their main health concerns found these concerns to be tiredness, menstrual difficulties, overweight, depression, and anxiety.
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