Sir Michael Marmot to expand the Whitehall Study to look at why we “age” differently

Marmot’s Whitehall Study is a longitudinal study that has studied the effects of social status on health.

He used as his sample a large number of well educated British Civil Servants – Hence “Whitehall”. A key finding has been the steep gradient in health outcomes that are formed by where you are in the power hierarchy. In short the less control and status you have – the more likely you are to be ill and even die early.

This insight fits well with Michael Rose’s research where our optimal health is found the closer we live in accordance with our evolved design. This fit is a broad one and includes not only what we eat and what we do but our social environment as well.

The way we design the industrial workplace itself is a factor in poor health just as industrial food is.

We are not “employees”.

We spent millions of years in small tribal groups that had very flat hierarchies, high personal interaction where all had a place and value. The bureaucratic norms of today represent a novel environment that does not fit our evolved design. This distance and estrangement drives high levels of social stress that releases constant high levels of cortisol. This is turn, like a poor diet that drives too much insulin, damages our immune system over time. Here is a link to Dr Robert Sapolsky’s epic lecture on how this works. If you find the science a bit dull then fast forward to the last 1/3rd where he brings in the baboons.

70% of the participants in the study are still involved and this now after so many years offers the opportunity for us to see why we age so differently. For as Marmot and Michael both know – there is no aging process per se.  Here is the outline of the work to come:

Participants in the Whitehall II study have now been followed for a quarter of a century. During this time they have taken part in nine data collection phases, five of which have included a medical screening.

Participation continues to be high at 70% of those alive. Aged 35-55 on enrolment into the study in 1985, those who took part in our latest clinical data collection phase (Phase 9 clinic, 2007-2009) were aged 58-78. Our recent publications and findings reflect this ageing of the cohort and mark a change of direction for the study.

Ageing is not characterised by universal decline. Rather variations in the speed of ageing result in people of the same age becoming increasingly dissimilar in terms of cognitive capability, mental and physical health and functioning over time.

Understanding the causes of this age-related individual heterogeneity and its distribution by social group will be the core focus of our future work.

Using some of our existing self-reported measures we have shown physical functioning to decline faster with age in low socio-economic groups, suggesting that inequalities in functioning will become an important public health issue as the population ages.

At the time of our proposed next medical screening (2012-13), our eleventh wave of data collection, Whitehall II will be optimal for studying outcomes in the elderly. Ninety percent of participants will be 65+, more than 30% 75-85, and our data will span an age range of 50 years.

By combining our existing 25 years of data on social inequalities and chronic disease with new clinical measures of cognitive function, mental disorders and physical functioning we will transform Whitehall II into a world-class, interdisciplinary study of ageing.

In addition to providing insights into individual and social differences in the development of frailty, disability, dependence, and dementia, our work will enable the determination of optimal time windows and targets for interventions that maximize the potential for healthy-ageing and independent living.

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