Reference No.: 59
Title: Health inequalities among British civil servants - the Whitehall II study
Author: M. G. Marmot, George D. Smith, Stephen Stansfeld, Chandra Patel, Fiona North, Jenny Head, Ian White, Eric Brunner, Amanda Feeney
Primary Topic: Health
Year: 1991
URL: https://doi.org/10.1016/0140-6736(91)93068-K
My notes on this reference #
Social Class and Health Outcomes
- There is a steep inverse association between employment grade and health outcomes, persisting over 20 years between Whitehall I and II studies.
- Lower employment grades are associated with:
- Higher prevalence of angina, ischaemia, and chronic bronchitis.
- Worse self-perceived health status and higher symptom reporting.
- Increased risk of cardiovascular disease due to workplace stress and low control.
Health-Risk Behaviours
- Clear employment-grade differences in behaviors:
- Smoking rates are higher in lower grades.
- Poor dietary patterns and less physical activity are more prevalent in lower grades.
- Higher grades demonstrate healthier behaviors, including more exercise and better diets.
Economic and Social Circumstances
- Lower-grade workers are more likely to:
- Experience economic difficulties, such as living in rented housing and financial stress.
- Have fewer opportunities for social support and meaningful relationships at work.
Psychosocial Factors
- Lower-grade jobs are characterized by:
- Low control, monotony, and low job satisfaction.
- Higher exposure to stressful life events and fewer coping resources.
- Poorer social support, with fewer confidantes or sources of practical support.
Biological and Behavioral Risk Factors
- Biological markers (e.g., obesity and blood pressure) show:
- Marginally higher prevalence of obesity in lower-grade workers.
- No significant differences in plasma cholesterol levels across grades.
- Behavioral risk factors such as smoking and low exercise levels are strongly linked to lower employment grades.
Implications for Policy
- Social and economic inequalities in health are not just limited to extreme poverty but exist across all employment grades.
- Healthy behaviors need promotion across society, focusing on:
- Improving workplace environments.
- Addressing income inequality and early-life disadvantages.
- Encouraging psychosocial support and job satisfaction.
Let me know if you’d like additional details or edits!