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The Whitehall II study of British civil servants was set up with the explicit purpose of testing hypotheses as to the causes of the social gradient in cardiovascular and other diseases (Marmot and Brunner, 2005; Marmot et al., 1991). The scientific questions arose from key findings of the first Whitehall study: health followed a social gradient (Marmot, Shipley, and Rose, 1984). That is to say, the lower the position in the social hierarchy, the higher the mortality from cardiovascular disease and from a range of other major causes of death. Although the social gradient was defined in the Whitehall study by grade of employment, similar patterns emerge with classification on the basis of income or education (Mensah, Mokdad, Ford, Greenlund, and Croft, 2005). This gradient provided a particular challenge to explanation. One could not invoke the old notion of "executive stress" because people with more responsibility at work were at lower risk of disease. One could not look to poverty as an explanation because people second from the top of the hierarchy had worse health than those at the top-and so on all the way down the hierarchy-and it is an untenable hypothesis that higher executive officers in the British Civil Service, men (Whitehall II included women but the original Whitehall study was a women-free zone) with stable white-collar jobs, are somehow materially deprived.

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