Health selection in the Whitehall II study, UK

Area of Science:

• Public Health
• Epidemiology
• Sociology

Background:

• Social gradients in health are a persistent public health concern.
• The relative importance of health selection versus social causation in explaining these gradients remains debated.
• Previous analyses have not simultaneously estimated both pathways.

Purpose of the Study:

• To estimate the relative effects of social position on health (social causation) and health on social position (health selection).
• To determine the primary driver of social gradients in health within the Whitehall II study.

Main Methods:

• Utilized cross-lagged longitudinal analyses with structural equation models.
• Analyzed data from four phases of the Whitehall II study over 10 years.
• Assessed mental and physical health (GHQ-30, SF-36) and employment grade/financial deprivation.

Main Results:

• No evidence found for mental or physical health influencing changes in employment grade.
• A significant, but smaller, effect of mental health on changes in financial deprivation was observed among men (health selection).
• The effect of social position on health was substantially larger than the effect of health on social position.

Conclusions:

• Social causation appears to be a more significant factor than health selection in developing social gradients in health in this cohort.
• Findings suggest that interventions targeting social determinants of health may be more effective.
• The health selection hypothesis is unlikely to be the primary explanation for observed health inequalities in the Whitehall II study.