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Health selection in the Whitehall II study, UK


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  • Chandola, Tarani
  • Bartley, Mel
  • Sacker, Amanda
  • Jenkinson, Crispin
  • Marmot, Michael
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    There has been considerable debate over the importance of the health selection hypothesis for explaining social gradients in health. Although studies have argued that it may not be an important explanation of social gradients in health, previous analyses have not estimated, simultaneously, the relative effect of health on changes in social position and of social position on changes in health (social causation). Cross-lagged longitudinal analyses using structural equation models enable the estimation of the relative size of these pathways which would be useful in determining the relative importance of the health selection hypothesis over the social causation hypothesis. Data from four phases of the Whitehall II study (initially consisting of 10,308 men and women aged 35-55 in the British civil service) were collected over a 10 year period. There was no evidence for an effect of mental (GHQ-30 and SF36) or physical health (SF-36) on changes in employment grade. When financial deprivation was used as a measure of social position, there was a significant effect of mental health on changes in social position among men although this health selection effect was over two and a half times smaller than the effect of social position on changes in health. The results suggest that the development of social gradients in health in the Whitehall II study may not be primarily explained in terms of a health selection effect.

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    Bibliographic Info

    Article provided by Elsevier in its journal Social Science & Medicine.

    Volume (Year): 56 (2003)
    Issue (Month): 10 (May)
    Pages: 2059-2072

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    Handle: RePEc:eee:socmed:v:56:y:2003:i:10:p:2059-2072

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    Keywords: Health selection Social causation Health inequalities United Kingdom;


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    Cited by:
    1. Anne Case & Christina Paxson, 2010. "The Long Reach of Childhood Health and Circumstance: Evidence from the Whitehall II Study," NBER Working Papers 15640, National Bureau of Economic Research, Inc.
    2. Aittomäki, Akseli & Martikainen, Pekka & Laaksonen, Mikko & Lahelma, Eero & Rahkonen, Ossi, 2012. "Household economic resources, labour-market advantage and health problems – A study on causal relationships using prospective register data," Social Science & Medicine, Elsevier, vol. 75(7), pages 1303-1310.
    3. Case, Anne & Fertig, Angela & Paxson, Christina, 2005. "The lasting impact of childhood health and circumstance," Journal of Health Economics, Elsevier, vol. 24(2), pages 365-389, March.
    4. Anne Case & Christina Paxson, 2010. "Causes and consequences of early-life health," Demography, Springer, vol. 47(1), pages S65-S85, March.
    5. Billingsley, Sunnee, 2012. "Intragenerational mobility and mortality in Russia: Short and longer-term effects," Social Science & Medicine, Elsevier, vol. 75(12), pages 2326-2336.
    6. Buhong Zheng, 2011. "A new approach to measure socioeconomic inequality in health," Journal of Economic Inequality, Springer, vol. 9(4), pages 555-577, December.
    7. Elovainio, Marko & Pulkki-Råback, Laura & Jokela, Markus & Kivimäki, Mika & Hintsanen, Mirka & Hintsa, Taina & Viikari, Jorma & Raitakari, Olli T. & Keltikangas-Järvinen, Liisa, 2012. "Socioeconomic status and the development of depressive symptoms from childhood to adulthood: A longitudinal analysis across 27 years of follow-up in the Young Finns study," Social Science & Medicine, Elsevier, vol. 74(6), pages 923-929.


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