How social inequalities lead to heart disease

Heart diseases used to be thought of as a problem for stressed-out executives. But a world-renowned study that the BHF has helped to fund for decades started to reveal the real picture. 

The Whitehall study, set up in 1967, was a long-term research programme to track the health of around 18,000 UK male civil servants. A major finding of the study, published in 1978, was that those in the ‘lowest employment grade’ were more likely to develop heart disease and die prematurely when compared to their bosses. The studies have also shown that this inequality can’t just be attributed to risk factors such as smoking and obesity. After taking those risk factors into account, people in the lowest employment grade were still twice as likely to die from heart diseases compared to those in the highest grade. Researchers suggested other parameters to be at play and suspected an influence of the psycho-social environment.

That’s what the team aimed to find out in a follow on study, called Whitehall II. Conducted from 1985 to 1988, it followed a further 10,000 civil servants, of whom one third were women. The results of this study published in 1991 showed that psychosocial factors, like work stress, perceived unfairness and how much control you have over your work can increase a person’s risk of developing heart disease.

The lead author of the Whitehall Study, Professor Sir Michael Marmot, expanded on these findings in a 2010 report called the Marmot Review. This stemmed from pivotal BHF-funded research and proposed new ways of reducing health inequalities. It showed the need to address differences in the social determinants of health (the conditions in which people are born, grow, live, work and age, which can lead to health inequalities), and helped to shape the UK Governments’ public health policies. In 2020 Professor Marmot co-authored an updated Marmot Review, which found that health inequalities remain a profound issue in UK society. 

The findings of the Whitehall studies, and the subsequent Marmot Reviews of health inequalities in England, underpin the work we and others are doing to address the impact health inequalities have on heart and circulatory diseases in the UK. 

First published 1st June 2021