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Sampling and Population Risk: The Whitehall Studies

PUBH6005: Epidemiology

This assessment addresses the following learning outcomes: 

2. Recognise the role of exposure to biological, behavioural, social and environmental risks in disease patterns. 

4. Assess levels of evidence and make recommendations. 

6. Understand the difference between association and causation, statistical and public health significance 

8. Critically evaluate epidemiological studies, including potential for bias, confounding and chance errors 

9. Identify key health indicators and sources of data

Instructions: The Whitehall study is a ground-breaking longitudinal (prospective cohort) study that clearly demonstrated the association between social determinants of health (the social gradient) and morbidity and mortality (cardiovascular disease) in a population of British civil servants (Breeze et al., 2001; Chandola et al., 2008; Marmot et al., 1978)

In no more than 1,000 words please address the following short-answer questions:  What is the sampling frame for each phase of the Whitehall study (Whitehall I and II)?  How was disease risk assessed (both in data collection and analysis) in each of the three studies, and why?  To what extent can the results of each of the three studies can be generalised to other populations (include reasons for your answer)?  Would it be feasible to conduct a similar study in Australia using an existing cohort such as the 45 and up study cohort, or the Australian Women’s longitudinal study cohort? Why or why not?

Assessment criteria  Knowledge and understanding of prospective cohort studies  Knowledge and understanding of social determinants of health  Knowledge an understanding of the concepts of sampling and bias  Use of mathematical concepts to describe sampling frame and disease risk  Interpretation of the findings of the Whitehall study and its generalisability to other populations  Academic presentation including accurate referencing using APA style

University Graduate Attributes: 1. Distinguishing between ethical and unethical practice, and articulating the impact of their discipline or profession on local and global communities. PUBH6005_Assessment Brief 2 Page 6 of 6 2. Describing their discipline or profession in the contemporary global environment, including the forces that have shaped the past, are driving innovation today and are taking it into the future. 3. Applying research skills appropriate to the level of the qualification. 4. Applying cognitive skills and dispositions necessary to be perceptive, analytical and creative in identifying and solving problems. 5. Demonstrating the interpersonal skills and dispositions of an effective team member and leader in complex situations. 6. Communicating effectively across diverse cultural groups. 7. Displaying leadership qualities to be a future leader committed to social justice and human rights.




The Whitehall studies are the investigations carried on British servants to determine social determinants of health it speaks mainly about cardiovascular disease prevalence and mortality rates. The study has been carried out in two phase, one was conducted over period of 10 years started in year 1967. The second study had been conducted in-between 1985 and 1988. In this paper, the three studies have been considered Whitehall Studies 1&2, Morbidity and mortality in a population of British civil servants for the purpose. In the paper, sampling frame in each phase of Whitehall has been discussed. The risk asset and results portrayed in all three studies have been discussed. The feasibility study of the Australian population has also been discussed.

Sampling frame of Whitehall Study in each phase

The Whitehall study is conducted in two parts, on  is conducted in 1967 taking 18000 male civil servants falling in the age groups of 20 to 64. The second study  had been conducted in-between 1985 and 1988, taking 10,308 civil servants aged in between 35 to 55 where two- thirds of the samples were men and one third of the sample were women (Hinnouho et al. 2014). The study has been conducted in 9 phases. The phase 1 is conducted in 1984-1985 taking age 35 to 55. The second phase has been conducted in 1989-1990 assuming a sample age in-between 37 to 60. The third phase is conducted in 1991-1993 age between 39 and 64. The fourth phase has been conducted in 1995-1996 taking age of 42 to 65. The fifth phase was conducted in 1997-1999 taking age of 45 to 69. The sixth phase was conducted in 2000 taking sampling age of 48 to 71. The seventh phase had been conducted in 2002-2004 taking a sample of 50 to 74. The eighth phase had been conducted in 2008 taking age of 53 to 76. The ninth and the final phase had been conducted in 2007-2009 taking age of 55 to 80. The above phase had been conducted in order to determine the cardiovascular diseases in the servants (Lahti et al. 2016). 

Disease risk assessed in each of the three studies

The three different studies are conducted in the population of the Britain for determining the diseases in the servants working for the higher authority people. In each study, the diseases associated to the servants lead to higher mortality rate. The morbidity rate is higher in the servants when the study is conducted. When the first study is conducted among the servant the major disease cause death of servants risk is coronary heart disease. The reason for the higher mortality rate is the lower employment grade among the servant. The servant which has lower employment grade has more death rates (Brunner, 2017). Due to the lower employment grade the servants are unable to treat their diseases. In the second study of Whitehall, the disease which caused most death had been identified, high blood pressure and cardiovascular diseases were predominantly the cause behind them. The reason was similar to first study that cause of death is unable to treat the diseases due to lower employee grade of servant. Due to that the mortality rate is higher in lower employment grade servants. In the third study the diabetes and cardiovascular disease is the highly found disease in the servants. The servants are mainly facing the morbidity and mortality due to diseases (Jackson, 2016). The lower payment and lack of cheap facility causes more death to the civil servants.    

The results of each of the three studies can be generalized to other populations 

The each study conducted was aimed towards  reaching the conclusion. The study focuses the civil servants of the Britain. The outcomes of the each study come to be diseases causing mainly cardiovascular disease, high blood pressure and diabetes in the servants. The disease caused more deaths to the civil servants which has lower employment grade. Due to less income the servants are unable to bear the cost of treatment. In such case the mortality rates has increased. The result generalized in the three studies has given the conclusion that the lack of time to take rest and less money cause more disease in the person. The person suffers from the dieses then the person will able to pay for the treatment of disease (Vistisen et al. 2018). The results can be applied in other population such as labors, workers, drivers etc. The wages of these populations are also less. The time for resting and employment grade is low in these above mentioned population. The high blood pressure, cardiovascular disease is common among these people. If the person fall suffer from any major disease then due to low wage the person can approach to doctor for the better treatment (Stamatakis et al. 2018).  

The feasibility of similar study in the Australian Women’s longitudinal study cohort

The study is feasible in context to the question of Australian Women working as servant or in any other profession. In the study it has been found that major cause of the death in Australia are the cardiovascular diseases. The most of the people suffer from heart diseases. In recent studies it has been found that the 43,963 deaths has been caused due to the cardiovascular disease in 2016 (Foundation, 2018). In considering the results, the death due to the heart disease is more than other diseases. In such case the similar study can be conducted in the population of the Australia. The study helps in finding the reason for causing the death due to the heart diseases. The people are suffering from disease due to unhealthy lifestyle or due to lack of money for the treatment of the dieses. It will be clear from the study conducted on the different population (Persson, Lingfors, Nilsson & Mölstad, 2015).


The above study is based on the study of Whitehall Study 1 and 2. In this paper, the morbidity and mortality study in the population of British servant is conducted. In the above study, the cause higher mortality rate is discussed. The risk of disease and results of the study is discussed. It also discussed about the feasibility of study in Australia. The conclusion which can be drawn from the study is that the major cause of death in British servant is due to cardiovascular disease and lower employment rate among servant. Due to low income, the servants are unable to consult good doctor for treatment.

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