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and Stansfeld, 1997). Something else had to be going on. We hypothesized that the social gradient in disease occurrence could be attributed to psychosocial factors. In order to test this hypothesis, we set up the Whitehall II study: a longitudinal study of 10,308 men and women working in the British Civil Service ages 35-55 at baseline in 1985. Participants were recruited from the entire range of occupational grades, from senior civil servants responsible for large government programs to clerical workers, porters, and messengers.

In the biomedical world, the idea of social causation sounds mystical. How, a biomedical scientist wants to know, can someone’s socioeconomic position get “under the skin” to cause disease (Adler and Ostrove, 1999)? Or, as a senior medical colleague put it to us, you will never convince medical scientists that people’s social circumstances, and particularly psychosocial factors, influence health unless you have a biological pathway. An important part of the research agenda for Whitehall II is therefore to show how social and psychosocial factors influence biological pathways to cause social inequalities in disease.

Epidemiological studies are one, but not the only, research strategy to target this goal. Development and testing of hypotheses linking psychosocial factors to biological pathways come also from psychobiological studies (see below) in which smaller numbers of individuals are studied intensively, either in the laboratory or under naturalistic conditions, to link changes in emotion and behavior with changes in relevant biological markers. This is closely integrated with our overall scientific aim of understanding inequalities in health by studying civil servants from different levels of the hierarchy. There is thereby a conceptual link from Whitehall II to the psychobiology studies.

We also have a keen scientific interest in linking health, well-being, social participation, and economic and social circumstances in older people. To this end we set up ELSA, the English Longitudinal Study of Ageing (British spelling), very much influenced by, and modeled on, the Health and Retirement Study (HRS) in the United States (Marmot, Banks, Blundell, Lessof, and Nazroo, 2003). The sampling frame for ELSA was nationally representative surveys of the English population: the Health Surveys for England 1998, 1999, and 2001. The sample in ELSA comprises 11,392 men and women ages 50-72, with an additional 636 partners under 50, and 72 new partners were interviewed, leading to a total sample size of 12,100. The plan is to interview them at home every two years, and every second interview (i.e., every four years) will include a nurse visit in addition to the face-to-face interview. The nurse visit will allow physical function to be measured by a trained observer and blood samples to be drawn for biochemical analysis. One major difference from HRS is that the Health Survey data set contains biomarkers relevant to monitoring



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