Organisational Justice and
workers’ health
Findings from Whitehall II and other studies
Jane E. Ferrie
Department of Epidemiology and Public Health
University College London
Social Justice or Fairness
the quality of treating people
equally or in a way that is right and
reasonable
Fundamental behaviour?
Early evolutionary origin of
aversion to injustice?
published in Nature 2003
the brown capuchin monkey
(Cebus apella)
Experiment
Monkeys were taught in pairs to give a token to the
experimenter. In return they were given a reward of food. The
food could be highly prized (high reward) or less exciting (low
reward).
When the monkeys saw that both monkeys in the pair got the
same reward in exchange for their token, 95% happily
exchanged their token for the reward.
When the monkeys witnessed their partner get a high value
reward for equal effort over half of them refused to participate
and would not hand in their tokens for exchange.
The refusal rate increased to 80% if the monkeys witnessed
their partner get high value reward without handing the token to
the experimenter at all.
Brosnan & de Waal. Nature 2003
Experiments in humans
Using neoroimaging studies have
shown that unfair transactions
activate the bilateral anterior
insula, areas of the brain
associated with negative
emotional states.
Sanfey et al
Science 2003
Anterior insula activation is
consistently seen in neuroimaging
studies of pain and distress,
hunger and thirst, and autonomic
arousal – one of the responses to
stress.
General unfairness or injustice
Odds ratio*
Justice
1.55
1.60
1.54
1.40
No
injustice
1.32
High
injustice
1.20
1.00
1.00
1.00
1.00
0.80
0.60
0.40
0.20
0.00
New heart attack
Poor physical
functioning
De Vogli et al (2007) J Epidemiology and Community Health
Poor mental functioning
*adjusted for socio-demographic, psychosocial and
behavioural risk factors and health at baseline
Organisational justice
refers to the extent to which
workers or employees are
treated with justice at their
workplace
Organisational Justice
Components
• Procedural component
– decision-making procedures include input from
affected parties, are consistently applied, open
and ethical
• Relational component
– respectful and considerate treatment of workers
and employees by their supervisors
Early work
Rate*/ odds ratio*
1.00
1.00
1.00
1.00
Organisational
justice
1.00
0.87
0.77
0.80
0.60
Bottom
quartile
Top
quartile
0.60
0.48
0.40
0.20
0.00
Poor self-rated
health
Poor mental health
Elovainio, Kivimäki, Vahtera (2001) Am J Public Health
Long-term
Short-term
sickness absence sickness absence
*adjusted for demographic and
behavioural risk factors
Depressive disorders
The leading cause of YLD
(years of healthy life lost as a result of disability)
in high-income countries
Lopez et al. Global burden of disease and risk factors WHO 2006
10 leading causes of YLD* (millions of years)
in high-income countries (WHO 2006)
Cause
YLD (millions of
years)
Percent of total
YLD
1. Unipolar depressive disorders
8.4
11.8
2. Alzheimer's and other dementias
6.3
8.9
3. Hearing loss, adult onset
5.4
7.6
4. Alcohol use disorders
3.8
5.3
5. Osteoarthritis
3.8
5.3
6. Cerebrovascular disease
3.5
4.9
7. Chronic obstructive pulmonary disease
2.9
4.0
8. Diabetes mellitus
2.3
3.2
9. Endocrine disorders
1.7
2.4
10. Vision disorders, age-related
1.5
2.1
*Years of healthy life lost as a result of disability
Lopez et al. Global burden of disease and risk factors 2006
Organisational justice, other work stressors
and newly diagnosed depression
Odds ratio
1.60
1.40
1.20
Low stress
High stress
1.01
1.43
1.27
1.13
1.00
0.80
0.60
0.40
0.20
0.00
Lack of control Job demands
Job strain
Injustice
Source of stress
Ylipaavalniemi, Kivimäki et al. Soc Sci Med 2005.
Does self-reported justice reflect actual
managerial treatment
... or the characteristics of the worker?
Individual and work unit level assessment of
organisational justice
Odds ratios (95% confidence intervals) for new doctor-diagnosed depressive disorders for levels of
procedural justice.
Adjusted for
Characteristic*
Unadjusted
age and salary
+mental distress at baseline†
Organisational justice (individual score)
high
low
1.00
1.91 (1.14 to 3.19)
1.00
1.90 (1.14 to 3.17)
1.00
1.73 (1.02 to 2.93)
1.00
1.73 (1.48 to 2.03)
1.00
1.77 (1.52 to 2.07)
1.00
1.65 (1.36 to 2.00)
Organisational justice (work unit mean
score‡)
high
low
*High and low levels of procedural justice refer to +1 SD and –1 SD, respectively.
†The 12-item General health questionnaire score four or more
‡The work unit mean score of procedural justice applied to all members of the
work unit.
Source: Kivimäki et al. (2003). Psychological Medicine
Cardiovascular disease
The leading cause of premature death
in high income countries
Organisational justice and cardiovascular
disease in the Whitehall II study
Longitudinal study of 6,442 men, British civil servants aged 35
to 55 years who had no prevalent CHD at baseline
1985 – 1988 Baseline screening (Phase 1)
CHD risk factors, organizational justice & work stress
1989
Questionnaire only (Phase 2)
Organizational justice & work stress
1990 – 1999 Follow-up, clinical records (after Phase 2)
Clinical records of CHD death, first non-fatal myocardial
infarction or definite angina (250 incident CHD cases
during the mean follow-up of 8.7 years)
Kivimäki et al. Arch Intern Med. 2005;165:2214-2220.
Hazard Ratio
Risk for Coronary Heart Disease
1
1.00
1.05 (95% CI 0.78, 1.41)
0.75
0.65 (95% CI 0.47, 0.91)
0.5
0.25
0
Low
Intermediate
High
Organizational Justice
Kivimäki et al. Arch Intern Med. 2005;165:2214-2220.
Unfair supervisors can raise your blood pressure
Systolic BP
1
140
140
120
120
Experimental
group
Control group
100
Experimental
group
Control group
100
80
80
Non-work day
Work day, non-favoured
supervisor
2140
12 mm Hg higher increases in systolic BP
during workdays under less favoured
supervisor than those of the control group
(p=0.001).1
120
Experimental
group
Control group
100
15 mm Hg higher systolic BP during
workdays under a less favoured supervisor
compared to a favoured supervisor
(p=0.001).2
80
Work day, favoured
supervisor
Wager et al. Occup Environ Med 2003;60:468-474
Relational justice and CVD death
or hosptiatisation for back disorders
Hospitalization for back
disorders (not intervertebral disc
disorders)
Cardiovascular mortality
Hazard Ratio (adj. for age, sex, job strain, ERI)
1.2
Hazard Ratio
1.2
1.0
1
1
0.8
0.8
1.0
0.6 (0.3-0.9)
0.6
0.4
0.6
1.0
1.0 (0.5-2.3)
0.4
0.2
0.2
0
0
Seldom
Often/ always
0.4 (0.2-0.8)
Low
High
"My supervisor treats me fairly"
Supervisory support
Elovainio, Leino-Arjas, Vahtera, Kivimäki.
the Valmet Study. J Psychosom Res 2006
Kaila-Kangas, Kivimäki et al.
the Valmet Study. Spine 2005
Does a change in organisational
justice lead to a change in health?
Change in Organisational Justice
Odds of new-onset minor psychiatric morbidity
1.75
Men
Women
1.50
1.25
Odds of poor physical health
1.5
1.23 (1.01-1.49)
1.25
1.00
1
1.00
0.61 (0.50-0.74)
0.75
0.75
0.5
0.50
0.25
0.25
0.00
0
Adverse
change
No change Favourable
change
Ferrie et al. Occup Environ Med 2006
Adverse
change
No change
Favourable
change
Kivimäki et al. J Epidemiol.Comm.Health 2004
Other effects of organisational justice
High justice ------------- Low Justice
•
•
•
•
•
•
Commitment
Don’t leave job
Job performance
Conflict resolution
Decision acceptance
Job satisfaction
•
•
•
•
•
Retaliation
Withdrawal
Theft
Stress
(C) overt
disobedience
Greenberg & Cropanzano 2001
Summary
• Organisational injustice is a workplace stressor
• It has been shown to be associated with
minor psychiatric disorder and depression
poor physical health
coronary heart disease
hospitalisation for back problems
sickness absence
premature cardiovascular death
poor organisational outcomes
• Levels of organisational justice can be improved
• Higher levels of justice improve health, decrease
sickness absence and improve organisational outcomes