The first Whitehall study made clear that inequalities in health were not limited to the health consequences of poverty. Important as that issue remains, the Whitehall question was why there should be a social gradient in disease in people above the poverty threshold. This forms the premise of the Whitehall II study, a longitudinal study of British civil servants, with the explicit intention of examining reasons for the social gradient in health and disease in men and extending the research to include women.
Since this first wave of data collection, self-completion questionnaires and clinical data have been collected from the Whitehall II cohort every two to five years with a high level of participation. The study is now a study on ageing, with the 30 year follow-up allowing research on multimorbidity, functional decline, frailty, disability, and dementia.
To date twelve data collections (“Phases”) have been completed. Phase 10 acted as a pilot carried out in February and March 2011; a small group of Stress and Health participants were selected randomly and invited to attend the Phase 10 clinic. This enabled Whitehall II to successfully pilot new measures for mental well-being introduced at Phase 11. The latest round of data collection for 2019-20, Phase 13, is underway.
Self-completed questionnaires include a wide range of topics covering family history, health, health behaviours, personality, mental health, and wellbeing as well as psychosocial and socioeconomic measures. Clinical measurements collected in clinic cover anthropometry, blood analysis, cardiovascular measures, cognitive function, cortisol and physical functioning.
The Whitehall II study has shown the importance of psychosocial factors such as work stress and work-family conflict in heart disease and diabetes. These are in addition to the contribution of unhealthy behaviours and traditional risk factors (such as high blood pressure).
More recently, Whitehall findings on long-term associations of cardiometabolic and lifestyle factors with old age functioning and chronic diseases have provided primary evidence for clinical guidelines and policy statements, including the European Guidelines on Cardiovascular Disease Prevention, the American Heart Association Guidelines for the Prevention of Stroke, NICE prevention guideline on disability, dementia and frailty in later life (NG16), and the 2020 Lancet Commission on Dementia Prevention and Care.
Whitehall II study was all civil servants (men and women) aged 35–55 years working in the London offices of 20 Whitehall departments in 1985–88. The achieved sample size was 10 308 people: 3413 women and 6895 men. The participants were from clerical and office support grades, middle-ranking executive grades, and senior administrative grades.
The whole cohort is invited to the research clinic at 5-year intervals, and a postal questionnaire is sent to participants between clinic phases. Home visits by nurses were offered for the first time to participants unwilling or unable to travel to the Phase 7 clinic. A brief telephone questionnaire is administered to those who decline clinic and full questionnaire participation at each phase.
Follow-up for morbidity and mortality through the NHS Central Registry provides date and diagnoses of hospitalisations and cause of death. Self-reported non-fatal coronary events and those identified by research clinic ECG are verified through primary care and hospital records. NHS-Wide Clearing Service notifications provide further information on incident disease and hospital procedures.
Participants of the Whitehall II study are linked to records of the UK National Health Service’s Hospital Episode Statistics (HES) database and ONS death register.
Management and funding
The study has been funded by major grants from the
- Medical Research Council (MRC, UK)
- British Heart Foundation (BHF, UK)
- National Heart, Lung and Blood Institute (NHLBI, US)
- National Institute on Aging (NIA, US)
- Economic and Social Research Council (ESRC, UK)
- Horizon 2020 (EU)
- European Research Council (ERC, EU)
The study is hosted at the UCL Department of Epidemiology and Public Health.
Accessing the data
Whitehall II welcome proposals for collaborative and external projects for bona fide research. Data are made as widely available as possible while strongly protecting confidentiality, and making sure that the reputation of the study, its funders and its participants are maintained. All proposals are reviewed by the data sharing committee. Visit the Whitehall II website for further information.
Whitehall II data can also be accessed via the Dementia Platform UK data portal which allows analysis of our data in relation to multiple other cohorts. Visit THE Dementia Platform UK website for further information.
In addition, release of the Whitehall II data to the UK Data Archive, the UK’s largest collection of social, economic and population data, is in progress.
Michael Marmot, Eric Brunner, Cohort Profile: The Whitehall II study, International Journal of Epidemiology, Volume 34, Issue 2, April 2005, Pages 251–256.