Variations in self-reported health by occupational grade in the British Post Office: the Q-health project

Between 1995 and 1998 a national sample of 58,501 (42,885 males, 15,616 females) Post Office employees (29%) completed and returned a postal questionnaire survey providing information on demographic characteristics, physical and psychological health, health and lifestyles and health screening behaviour. Response rates by occupational grade were as follows: manual (male 69.3%, females 43.6%); clerical (male = 11.8%, female, 42.3%); middle management (males 15.5%, females 10.7%) and senior management (males 3.4%, females 3.3%). A number of differences in health status occurred with occupational grade. Angina, high blood pressure, obesity, smoking, arthritis, disability, GP consultations and abnormal smears were all more prevalent in lower occupational grades. Height, job satisfaction, seat belt use and breast self-examination were also lower in lower status jobs. Some findings were unexpected: GHQ scores indicated better mental health in lower grades, whilst knowledge and frequency of testicular self-examination and attendance for mammograms were higher in lower grades. Self-reports for asthma, diabetes and family history of bowel cancer were also greater in higher grades. These findings are considered in terms of response bias, health selection, the psychosocial work environment, occupational health interventions and the nature, meaning and organization of social position within the Post Office.