[Skip to Content]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address 54.161.216.242. Please contact the publisher to request reinstatement.
[Skip to Content Landing]
Download PDF
Table 1. 
Characteristics of Participants by Levels of Organizational Justice*
Characteristics of Participants by Levels of Organizational Justice*
Table 2. 
Associations of Conventional Risk Factors and Justice at Work With Incident CHD
Associations of Conventional Risk Factors and Justice at Work With Incident CHD
Table 3. 
Associations of Psychosocial Factors and Justice at Work With Incident CHD
Associations of Psychosocial Factors and Justice at Work With Incident CHD
Table 4. 
Associations of Psychosocial Factors at Work With Incident CHD by Level of Justice*
Associations of Psychosocial Factors at Work With Incident CHD by Level of Justice*
1.
Fehr  EFischbacher  U The nature of human altruism. Nature 2003;425785- 791
PubMedArticle
2.
Fehr  EGächter  S Altruistic punishment in humans. Nature 2002;415137- 140
PubMedArticle
3.
Johnson  DDPStopka  PKnights  S The puzzle of human cooperation. Nature 2003;421911- 912
PubMedArticle
4.
Marmot  M Status Syndrome: How Your Social Standing Directly Affects Your Health and Life Expectancy.  London, England Bloombury2004;
5.
Miller  DT Disrespect and the experience of injustice. Annu Rev Psychol 2001;52527- 553
PubMedArticle
6.
Brosnan  SFde Waal  FBM Monkeys reject unequal pay. Nature 2003;425297- 299
PubMedArticle
7.
Greenberg  J Organizational justice: yesterday, today, and tomorrow. J Manage 1990;16399- 432
8.
Moorman  RH Relationship between organizational justice and organizational citizenship behaviors: do fairness perception influence employee citizenship? J Appl Psychol 1991;76845- 855Article
9.
Tyler  TRBies  RJ Beyond formal procedures: the interpersonal context of procedural justice. Carroll  JSApplied Social Psychology and Organisational Settings Hillsdale, NJ Lawrence A Erlbaum Associates1990;119- 132
10.
Wilkinson  RG Unhealthy Societies: The Afflictions in Inequality.  London, England Routledge1996;
11.
Folger  RCropanzano  R Organizational Justice and Human Resource Management.  Thousand Oaks, Calif Sage Publications1998;
12.
Cropanzano  RFolger  R Procedural justice and worker motivation. Steers  RMPorter  LWMotivation and Work Behavior. Vol 5 New York, NY McGraw-Hill Co1991;131- 143
13.
Shapiro  DLBrett  JM Comparing three processes underlying judgements of procedural justice: a field study of mediation and arbitration. J Pers Soc Psychol 1993;651167- 1177Article
14.
Elovainio  MKivimäki  MHelkama  K Organisational justice evaluations, job control, and occupational strain. J Appl Psychol 2001;86418- 424
PubMedArticle
15.
McEwen  BSStellar  E Stress and the individual: mechanisms leading to disease. Arch Intern Med 1993;1532093- 2101
PubMedArticle
16.
Muldoon  MFHerbert  TBPatterson  SMKameneva  MRaible  RManuck  SB Effects of acute psychological stress on serum lipid levels, hemoconcentration, and blood viscosity. Arch Intern Med 1995;155615- 620
PubMedArticle
17.
McEwen  BS Protective and damaging effects of stress mediators. N Engl J Med 1998;338171- 179
PubMedArticle
18.
Brunner  E Stress mechanisms in coronary heart disease. Stansfeld  SAMarmot  MGStress and the Heart Psychosocial Pathways to Coronary Heart Disease London, England BMJ Publishing Groups2002;
19.
Wager  NFieldman  GHussey  T The effect on ambulatory blood pressure of working under favourably and unfavourably perceived supervisors. Occup Environ Med 2003;60468- 474
PubMedArticle
20.
Kikuya  MHozawa  AOhokubo  T  et al.  Prognostic significance of blood pressure and heart rate variabilities: the Ohasama Study. Hypertension 2000;36901- 906
PubMedArticle
21.
Marmot  MGDavey Smith  GStansfeld  S  et al.  Health inequalities among British civil servants: the Whitehall II Study. Lancet 1991;3371387- 1393
PubMedArticle
22.
Karasek  RA Job demands, job decision latitude and mental strain: implications for job redesign. Admin Sci Q 1979;24285- 307Article
23.
Karasek  RTheorell  T Stress, Productivity and Reconstruction of Working Life.  New York, NY Basic Books Inc Publishers1990;
24.
Siegrist  J Adverse health effects of high-effort/low-reward conditions. J Occup Health Psychol 1996;127- 41
PubMedArticle
25.
Kivimäki  MFerrie  JEHead  JShipley  MJVahtera  JMarmot  MG Organisational justice and change in justice as predictors of employee health: the Whitehall II Study. J Epidemiol Community Health 2004;58931- 937
PubMedArticle
26.
Rose  GABlackburn  HGillum  RFPrineas  RJ Cardiovascular Survey Methods. 2nd ed. Geneva, Switzerland World Health Organization1982;
27.
Tunstall-Pedoe  HKuulasmaa  KAmouyel  PArveiler  DRajakangas  AMPajak  A Myocardial infarction and coronary deaths in the World Health Organization MONICA project: registration procedures, event rates, and case-fatality rates in 38 populations in four continents. Circulation 1994;90583- 612
PubMedArticle
28.
House  JSLandis  KRUmberson  D Social relations and health. Science 1988;241540- 545
PubMedArticle
29.
Elovainio  MKivimäki  MVahtera  J Organizational justice: evidence of a new psychosocial predictor of health. Am J Public Health 2002;92105- 108
PubMedArticle
30.
Kivimäki  MElovainio  MVahtera  JVirtanen  MStansfeld  SA Association between organisational inequity and incidence of psychiatric disorders in female employees. Psychol Med 2003;33319- 326
PubMedArticle
31.
Stansfeld  SAFuhrer  RShipley  MJMarmot  MG Psychological distress as a risk factor for coronary heart disease in the Whitehall II Study. Int J Epidemiol 2002;31248- 255
PubMedArticle
32.
Kivimäki  MHead  JFerrie  JEShipley  MJVahtera  JMarmot  MG Sickness absence as a global measure of health: evidence from mortality in the Whitehall II prospective cohort study. BMJ 2003;327364- 368
PubMedArticle
33.
Vahtera  JPentti  JKivimäki  M Sickness absence as a predictor of mortality among male and female employees. J Epidemiol Community Health 2004;58321- 326
PubMedArticle
34.
Kivimäki  MHead  JFerrie  JE  et al.  Working while ill as a risk factor for serious coronary events: the Whitehall II Study. Am J Public Health 2005;9598- 102
PubMedArticle
35.
Stansfeld  SAFuhrer  RShipley  MJMarmot  M Work characteristics predict psychiatric disorder: prospective results from the Whitehall II Study. Occup Environ Med 1998;56302- 307Article
36.
Hemingway  HMarmot  M Psychosocial factors in the aetiology and prognosis of coronary heart disease: systematic review of prospective cohort studies. BMJ 1999;3181460- 1467
PubMedArticle
37.
Kivimäki  MLeino-Arjas  PLuukkonen  RRiihimäki  HVahtera  JKirjonen  J Work stress and risk of cardiovascular mortality: prospective cohort study of industrial employees. BMJ 2002;325857- 860
PubMedArticle
38.
Kuper  HMarmot  MG Job strain, job demands, decision latitude, and risk of coronary heart disease within the Whitehall II Study. J Epidemiol Community Health 2003;57147- 153
PubMedArticle
39.
Matthews  KAGump  BB Chronic work stress and marital dissolution increase risk of posttrial mortality in men from the Multiple Risk Factor Intervention Trial. Arch Intern Med 2002;162309- 315
PubMedArticle
40.
Kuper  HSingh-Manoux  ASiegrist  JMarmot  M When reciprocity fails: effort-reward imbalance in relation to coronary heart disease and health functioning within the Whitehall II Study. Occup Environ Med 2002;59777- 784
PubMedArticle
41.
Siegrist  J Effort-reward imbalance at work and health. Perrewe  PLGanster  CDHistorical and Current Perspectives on Stress and Health New York, NY Elsevier Science Inc2002;261- 291
42.
Rosengren  AHawken  SOunpuu  S  et al.  Association of psychosocial risk factors with risk of acute myocardial infarction in 11 119 cases and 13 648 controls from 52 countries (the INTERHEART Study): case-control study. Lancet 2004;364953- 962
PubMedArticle
43.
Belkic  KLLandsbergis  PASchnall  PLBaker  D Is job strain a major source of cardiovascular disease risk? Scand J Work Environ Health 2004;3085- 128
PubMedArticle
44.
van Vegchel  Nde Jonge  JBosma  HSchaufeli  W Reviewing the effort-reward imbalance model: drawing up the balance of 45 empirical studies. Soc Sci Med 2005;601117- 1131
PubMedArticle
45.
Macleod  JDavey Smith  GHeslop  PMetcalfe  CCarroll  DHart  C Psychological stress and cardiovascular disease: empirical demonstration of bias in a prospective observational study of Scottish men. BMJ 2002;3241247- 1251
PubMedArticle
46.
Power  CMatthews  S Origins of health inequalities in a national population sample. Lancet 1997;3501584- 1589
PubMedArticle
47.
Lynch  JDavey Smith  G A life course approach to chronic disease epidemiology. Annu Rev Public Health 2005;261- 35
PubMedArticle
48.
Cooper  WHRichardson  AJ Unfair comparisons. J Appl Psychol 1986;71179- 184Article
49.
Maurer  TJRaju  NSCollins  WC Peer and subordinate performance appraisal measurement equivalence. J Appl Psychol 1998;83693- 702Article
50.
Riggio  RECole  EJ Agreement between subordinate and superior ratings of supervisory performance and effects on self and job satisfaction. J Occup Organisational Psychol 1992;65151- 158Article
51.
Lazarus  RS Psychological Stress and the Coping Process.  New York, NY McGraw-Hill Co1966;
52.
van den Bos  KLind  EA Uncertainty management by means of fairness judgments. Zanna  MPAdvances in Experimental Social Psychology Orlando, Fla Academic Press Inc2002;1- 60
Original Investigation
October 24, 2005

Justice at Work and Reduced Risk of Coronary Heart Disease Among EmployeesThe Whitehall II Study

Author Affiliations

Author Affiliations: Finnish Institute of Occupational Health and University of Helsinki, Helsinki, Finland (Drs Kivimäki and Vahtera); and Department of Epidemiology and Public Health, International Centre for Health and Society, University College London Medical School, London, England (Drs Ferrie, Brunner, and Marmot and Mss Head and Shipley).

Arch Intern Med. 2005;165(19):2245-2251. doi:10.1001/archinte.165.19.2245
Abstract

Background  Justice is a fundamental value in human societies, but its effect on health is poorly described. We examined justice at work as a predictor of coronary heart disease (CHD).

Methods  Prospective occupational cohort study of 6442 male British civil servants aged 35 to 55 years without prevalent CHD at baseline in phase 1 (1985-1988). Baseline screening included measurements of conventional risk factors. Perceived justice at work and other work-related psychosocial factors were determined by means of questionnaire at phases 1 and 2 (1989-1990). Follow-up for CHD death, first nonfatal myocardial infarction, or definite angina occurring from phase 2 through 1999 was based on medical records (mean follow-up, 8.7 years).

Results  Cox proportional hazard models adjusted for age and employment grade showed that employees who experienced a high level of justice at work had a lower risk of incident CHD than employees with a low or an intermediate level of justice (hazard ratio, 0.65; 95% confidence interval, 0.47-0.89). The hazard ratio did not materially change after additional adjustment for baseline cholesterol concentration, body mass index, hypertension, smoking, alcohol consumption, and physical activity. Although other psychosocial models such as job strain and effort-reward imbalance predicted CHD in these data, the level of justice remained an independent predictor of incident CHD after adjustment for these factors.

Conclusion  Justice at work may have benefits for heart health among employees.

Some of the most fundamental questions concerning social relations and the organization of society have been suggested to be concerned with equity, altruism, and a sense of fairness.14 Negative reactions to injustice have been shown to prevail in human societies and even in cooperative nonhuman primates, such as monkeys.5,6 One line of research in this field focuses on workplaces and the concept of justice at work.7,8

Employees’ interactions with their supervisors, on whom they may be highly dependent for resources and rewards, can be important for well-being.911 An indicator of justice at work is whether people believe that their supervisor considers their viewpoints, shares information concerning decision-making, and treats individuals fairly and in a truthful manner.8 A high level of justice in such managerial treatment has been related to increased employee motivation and cooperation and decreased levels of psychological distress, negative emotions, and sickness absence (J.E.F., M.K., J.H., M.J.S., and M.G.M., unpublished data, December 2004).1214

There are plausible mechanisms connecting justice to CHD, as a high level of justice may reduce the risk of chronic stress characterized by adverse neuroendocrine changes, alterations of autonomic functioning, development of the metabolic syndrome and insulin resistance, and disturbances in coagulation and inflammatory and immune responses.1518 Indeed, data concerning employees with multiple supervisors show smaller blood pressure elevations on days worked under a supervisor perceived as fair as compared with days worked under one perceived as unfair.19 In addition, a cross-sectional observational study found reduced heart rate variability for those reporting a low level of justice at work (Marko Elovainio, PhD, M.K., Sampsa Puttonen, MA, Harri Lindholm, MD, Tiina Pohjonen, PhD, and Timo Sinervo, PhD, unpublished data, February 2004). Although high blood pressure and reduced heart rate variability are indicators of cardiac dysregulation,20 no previous study, to our knowledge, has examined whether justice at work is associated with the onset of CHD.

Data from the Whitehall II Study of British civil servants, an ongoing large-scale prospective occupational cohort study,21 have enabled our examination of the association between perceived justice and morbidity and mortality. A strength of the study is the possibility of determining incidence of CHD for the entire cohort based on comprehensive medical records of CHD death, nonfatal myocardial infarction (MI), and definite angina during a long period. A further advantage is that the data include measurements of conventional risk factors and major work-related psychosocial factors such as job strain and effort-reward imbalance.2224 These data enable us to determine whether the addition of justice would add to risk estimates based on other risk factors. In the present study, we examined whether justice at work predicted incidence of new CHD among employees and whether this association was independent of coronary risk factors, including cholesterol concentration, hypertension, body mass index (BMI), smoking, alcohol consumption, physical inactivity, and other psychosocial characteristics of the work environment.

METHODS
PARTICIPANTS

The target population of the Whitehall II Study was all office staff based in London, England, aged 35 to 55 years, in 20 civil service departments.21 With a 73% participation rate, the baseline cohort included 6895 men and 3413 women. The present study included those 6442 men (93% of all male participants) who responded to the justice questions at phase 1 or 2 and had no history of CHD at phase 2. All of these men were followed up for CHD after phase 2. The 453 men excluded were older (39.3% ≥50 years vs 23.1% among included men; P<.001), and they were more likely to be in the lowest employment grade (15.5% vs 8.9%; P<.001). We restricted the analyses to men, as there were insufficient incident CHD events among women (n = 85).

DESIGN

The Whitehall II Study is a prospective observational cohort study. Justice at work, job strain, and effort-reward imbalance were measured at phases 1 (1985-1988) and 2 (1989-1990). Follow-up for incident CHD was from 1990 (end of phase 2) to the end of 1999. Conventional risk factors for CHD, tested as potential confounders, were measured at phase 1.

ASSESSMENT OF JUSTICE AT WORK

We used a self-reported justice scale, which tapped the relational component of organizational justice8 (5 items; Cronbach α = .72 at phases 1 and 2), as in earlier studies using the Whitehall II Study cohort (J.E.F., M.K., J.H., M.J.S., and M.G.M., unpublished data, December 2004).25 The following items were included: (1) Do you ever get criticized unfairly (reverse scored)? (2) Do you get consistent information from line management (your superior)? (3) Do you get sufficient information from line management (your superior)? (4) How often is your superior willing to listen to your problems? and (5) Do you ever get praised for your work?

Participants rated their response to each of these items on a 4-point scale (1 indicates never; 2, seldom; 3, sometimes; and 4, often). For each participant, we averaged the scores of the 5 items at phases 1 and 2 and then calculated the mean of these averaged scores (Cronbach α for repeated measurements, .54). For those with missing justice scores in 1 of the 2 phases, we used information from 1 phase only. All participants were divided into 3 groups based on the distribution of the mean scores. The bottom third (mean scores 1.00-2.99) indicated a low level of justice; the middle third (3.00-3.39), an intermediate level; and the top third (3.40-4.00), a high level of justice.

ASSESSMENT OF INCIDENT CHD

The incidence of CHD was defined as a CHD death, a first nonfatal MI, or definite angina. To assess fatal CHD, participants were flagged at the National Health Service Central Registry, which provided information on the date and cause of death (of the 10 308 men and women employees in the Whitehall II Study cohort, 10 300 were successfully flagged). Coronary deaths were defined by the International Classification of Diseases, Ninth Revision, codes 410 through 414 as underlying causes of death. Potential new cases of nonfatal MI were ascertained by questionnaire items on chest pain26 and the physician’s diagnosis of heart attack. Confirmation of MI according to MONICA criteria (Multinational Monitoring of Trends and Determinants in Cardiovascular Disease)27 was based on electrocardiograms, markers of myocardial necrosis, and chest pain history from the medical records. Assessment of angina was based on the participant’s reports of symptoms with corroboration in medical records or abnormalities on a resting electrocardiogram, an exercise electrocardiogram, or a coronary angiogram.

ASSESSMENT OF RISK FACTORS

We measured the following demographic characteristics and conventional risk factors: age group (35-39, 40-44, 45-49, and 50-55 years), ethnicity (white vs other; missing values were replaced by data collected in 1997-1999), marital status (married or cohabiting vs other), educational level (aged <17, 17-18, and >18 years when left full-time education), employment grade (administrative, executive, or clerical), serum cholesterol concentration, BMI, hypertension (use of antihypertensive medication or systolic/diastolic blood pressure ≥140/90 mm Hg vs others), smoking (current smoker vs others), alcohol consumption (0, 1-21 and >21 U of alcohol per week), and physical activity (vigorous, moderate, or mild).21

Job strain and effort-reward imbalance were measured using self-reported job demands (4 items, Cronbach α = .67), job control (15 items; Cronbach α = .84), efforts (5 items; Cronbach α = .72), and rewards (7 or 10 items; Cronbach α = .78). Job strain is a continuous variable derived from the difference between the demand and control scores. Effort-reward imbalance is the ratio of effort (numerator) to reward (denominator). For each participant, we calculated the means of job strain (Cronbach α for repeated measurements, .64) and effort-reward imbalance scores across phases 1 and 2 (Cronbach α = .71). For those with a missing job strain or effort-reward score in 1 of the 2 phases, we used information from 1 phase only. All of the participants were divided into 3 groups in job strain and 3 groups in effort-reward imbalance based on the distributions of mean scores. The bottom third indicated a lowlevel and the top third a high level in job strain and effort-reward imbalance.

DATA ANALYSIS

We fitted Cox proportional-hazard models to study age- and employment grade–adjusted associations between conventional risk factors, psychosocial factors, and the level of justice and incident CHD. The time-dependent interaction terms between each predictor and logarithm (follow-up period) were all nonsignificant, confirming that the proportional hazards assumption was justified. For justice, we made additional adjustments for conventional risk factors and psychosocial factors. For the adjustments, cholesterol concentration and BMI were fitted as continuous variables, and the other covariates were fitted as categorical variables. The statistical significance of interactions among justice, psychosocial factors, and employment grade were tested by including interaction terms in the models. All P values are 2 tailed, and P values below .05 were considered to indicate statistical significance. All the analyses were performed using the SAS software, version 8.2 (SAS Institute, Cary, NC).

RESULTS

Table 1 shows characteristics of the participants by level of perceived justice. A higher level of justice was associated with older age. After adjustment for age, men who perceived higher levels of justice were more likely to be married and have a higher educational level, higher employment grade, and lower BMI compared with those who perceived lower levels of justice. A higher level of justice was also associated with lower job strain and lower effort-reward imbalance. The level of justice was not significantly associated with cholesterol level, hypertension, smoking, alcohol consumption, or physical activity.

Two hundred fifty employees had an incident CHD event during the mean follow-up of 8.7 years. Table 2 shows Cox proportional hazard models for associations between conventional risk factors, justice at work, and incident CHD among the 6128 men with no missing values. After adjustment for age and employment grade, higher cholesterol level, higher BMI, smoking, and hypertension were associated with higher incidence of CHD. For alcohol consumption and physical inactivity, the associations did not reach statistical significance. High justice was associated with a lower risk of incident CHD than low and intermediate justice before and after adjustment for risk factors, in addition to age and employment grade. Adjustment for ethnicity, marital status, and education had no effect on the association between justice and incident CHD (hazard ratio for high vs low justice, 0.67; 95% confidence interval [CI], 0.45-0.98 before and 0.46-0.98 after this adjustment; n = 4814 with 180 incident cases).

Table 3 shows Cox proportional hazard models for associations between incident CHD and psychosocial factors and justice at work. After adjustment for age and employment grade, higher job strain, and, to a lesser extent, higher effort-reward imbalance, were associated with higher risk of incident CHD. As previously shown, a high level of justice at work was associated with lower risk of incident CHD. This association remained in a model additionally adjusted for the other psychosocial work characteristics. For further analyses, we combined the categories of low and intermediate levels of justice, as these groups did not differ in terms of CHD risk. In a fully adjusted model including all conventional risk factors and psychosocial factors, a high level of justice at work, compared with low and moderate levels, remained a statistically significant predictor of incident CHD (hazard ratio, 0.70; 95% CI, 0.51-0.94 [data not shown]).

Table 4 shows the associations of job strain and effort-reward imbalance with incident CHD by level of justice. Job strain and effort-reward imbalance seemed to interact with the level of justice, although these interactions did not reach statistical significance (P = .06 and .26, respectively). Among employees with low or intermediate levels of justice, job strain and effort-reward imbalance were associated with a higher risk of CHD. In contrast, there was no association between job strain or effort-reward imbalance and incident CHD among employees with a high level of justice.

Finally, we studied whether the association between the level of justice and CHD was dependent on employment grade. This was not the case (P = .94 for interaction); the age-adjusted hazard ratios for incident CHD associated with a high level of justice were similar across the grades, ie, 0.64 (95% CI, 0.41-0.97) in the administrative grade, 0.67 (95% CI, 0.45-1.00) in the executive grade, and 0.54 (95% CI, 0.18-1.60) in the clerical grade.

COMMENT

This is the first study, to our knowledge, that demonstrates that justice at work may protect against CHD. In men who perceived a high level of justice, the risk of incident CHD was 30% lower than among those who perceived a low or an intermediate level of justice. This finding was not accounted for by baseline factors such as age, ethnicity, marital status, educational attainment, socioeconomic position, cholesterol level, obesity, hypertension, smoking, alcohol consumption, and physical activity. The association between the level of justice and CHD was also independent of other psychosocial factors at work, as indicated by the 2 leading stress models, job strain and effort-reward imbalance.2224 Our evidence was based on a large well-characterized cohort, a 9-year follow-up, and repeated measurements of justice. All components of the outcome, including CHD deaths, first nonfatal MIs, and definite angina, were confirmed by medical records.

The link between the level of justice and development of CHD was not unexpected, considering the strong associations between social relations and health4,10,28 and the central role of concerns about justice and equity in all societies.13 Furthermore, other studies suggest that a low or declining level of justice at work is associated with increased risk for subsequent psychological distress, nonoptimal health, and medically certified sickness absence,25,29,30 with all outcomes predictive of all-cause mortality and CHD incidence.3134 Our findings on justice and CHD are also compatible with small-scale studies on blood pressure and heart rate variability (Marko Elovainio, PhD, M.K., Sampsa Puttonen, MA, Harri Lindholm, MD, Tiina Pohjonen, PhD, and Timo Sinervo, PhD, unpublished data, February 2004).19

An important question is whether the addition of justice at work materially adds to a risk prediction based on the established theoretical models. The main theories in this field are the job strain model and the effort-reward imbalance model.2224 The job strain model posits that a combination of high work demands and low job control at work, ie, job strain, is a health risk for employees. The effort-reward imbalance model considers the impact of labor market conditions on health in addition to more proximal job conditions. According to this model, health risk derives from the mismatch between efforts expended at work and rewards received in the form of money, social approval, job security, and career opportunities. Both job strain and effort-reward imbalance have been shown to be the key psychosocial predictors of CHD and other health outcomes in the Whitehall II Study and a number of other investigations.3544

There is a large body of theoretical and empirical research on justice at work as a determinant of organizational behaviors,79,1113 but the association between justice and health has only recently been demonstrated.25,29,30 Unlike the job strain model and the effort-reward imbalance model, the justice approach is directly focused on managerial treatment and managerial procedures.7,11 Within this focus, it covers all kind of unfairness, not only that arising from disproportionate demands in relation to decision latitude and organizational rewards.5,7,11 We found that a high level of justice at work was associated with lower job strain and a more favorable match between efforts and rewards. Despite this, the association between justice and CHD was not explained by associations between these psychosocial factors, and the level of justice remained an independent predictor of CHD risk after adjustment for the other psychosocial factors. Moreover, there was an indication that a high level of justice might buffer part of the adverse effects of job strain and effort-reward imbalance. All these findings suggest that the addition of justice at work adds to a risk prediction based on the established theoretical models.

Questions have been raised regarding covariation between work perceptions and occupational position.45 Socioeconomic position is a major correlate of some psychosocial work characteristics and a marker of many risk factors across the life course.46,47 In the present study, a high level of perceived justice was more common among well-educated men and those in higher employment grades. However, adjustment for employment grade or education did not abolish the effect of the level of justice on CHD risk, and a subgroup analysis confirmed that the hazard ratios for administrative, executive, and clerical grades did not materially differ from each other. This evidence supports the possibility that the association between the level of justice and CHD is not due to socioeconomic confounding.

Several potential limitations merit careful consideration. First, as CHD develops during a long time span, long-term rather than short-term levels of justice are assumed to affect CHD incidence. We used averaged scores from repeated assessments during a 3-year period to determine levels of justice, job strain, and effort-reward imbalance. However, the stability of these measurements over time was only moderate and, despite use of the averaged scores, the observed effects of justice and other psychosocial factors might be underestimates. In addition, all comparisons in the predictive strength among the level of justice, job strain, and effort-reward imbalance should be interpreted cautiously, as the operationalization of these concepts may not be equally successful in every case.48

Second, as the level of justice was self-reported, it is unclear whether actual managerial treatment or the characteristics of the respondent determined it. Previous research suggests that self-reported justice levels reflect organizational reality, because there is a high degree of congruence between subordinates’ perceptions of their supervisors across multiple measurement points and between the perceptions of supervisors by their peers49 and superiors.50 Moreover, individual-level justice scores and more objective work unit aggregated scores have been shown to be equally predictive of health.30 Organizational reality may influence health through employees’ appraisal processes and perceptions,51 but increasing the level of justice with which organizational policies, practices, and procedures are applied may provide a more pragmatic way to influence health.

Third, although work is central in adult life, other social environments that people inhabit may also be important. Various positive aspects of society, family life, and relations with significant others have been found to be protective of health.4,10,28,39 It is possible that such health-promoting resources also mitigate the harm caused by a low level of justice at work. On the other hand, just treatment at work might be particularly important during times of uncertainty or for minority groups and vulnerable individuals with limited coping resources.36,52 Further studies with larger sample sizes are needed to examine these and other potential modifiers of the effects of justice on heart health.

Finally, as our evidence was based on male civil servants, further research is needed to determine whether the effect of justice on heart health is generalizable to women, in other contexts, and across ethnic groups.

CONCLUSIONS

Most people care deeply about just treatment by authorities. Just treatment may communicate status and value, whereas lack of justice may be a source of oppression, deprivation, and stress. Justice, equity, and altruism have been the drivers of benign developments in human societies according to a wide range of studies across a broad spectrum of disciplines. Our findings on CHD, the leading cause of death in all Western societies, suggest that organizational justice is also a topic worthy of consideration in health research.

Back to top
Article Information

Correspondence: Mika Kivimäki, PhD, Finnish Institute of Occupational Health, Topeliuksenkatu 41 aA, FIN-00250 Helsinki, Finland (mika.kivimaki@ttl.fi).

Accepted for Publication: June 8, 2005.

Financial Disclosure: None.

Funding/Support: This study was supported by the Health and Safety Executive, London; projects 104891 and 105195 from the Academy of Finland and the Finnish Environment Fundation, Helsinki (Drs Kivimäki and Vahtera); grant 47413 from the Medical Research Council, London (Dr Ferrie); a grant from the British Heart Foundation, London (Dr Shipley); and a research professorship from the Medical Research Council (Dr Marmot). The Whitehall II Study has been supported by grants from the Medical Research Council; the British Heart Foundation; the Health and Safety Executive; the Department of Health, London; grant HL36310 from the National Heart Lung and Blood Institute, National Institutes of Health (NIH), Bethesda, Md; grant AG13196 from the National Institute on Aging, NIH; grant HS06516 from the Agency for Health Care Policy Research, Rockville, Md; and the John D. and Catherine T. MacArthur Foundation Research Networks on Successful Midlife Development and Socioeconomic Status and Health, Vero Beach, Fla.

Additional Information: Dr Kivimäki has full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Acknowledgment: We thank all participating civil service departments and their welfare, personnel, and establishment officers; the Occupational Health and Safety Agency, London; the Council of Civil Service Unions, London; all participating civil servants in the Whitehall II Study; and all members of the Whitehall II Study team.

References
1.
Fehr  EFischbacher  U The nature of human altruism. Nature 2003;425785- 791
PubMedArticle
2.
Fehr  EGächter  S Altruistic punishment in humans. Nature 2002;415137- 140
PubMedArticle
3.
Johnson  DDPStopka  PKnights  S The puzzle of human cooperation. Nature 2003;421911- 912
PubMedArticle
4.
Marmot  M Status Syndrome: How Your Social Standing Directly Affects Your Health and Life Expectancy.  London, England Bloombury2004;
5.
Miller  DT Disrespect and the experience of injustice. Annu Rev Psychol 2001;52527- 553
PubMedArticle
6.
Brosnan  SFde Waal  FBM Monkeys reject unequal pay. Nature 2003;425297- 299
PubMedArticle
7.
Greenberg  J Organizational justice: yesterday, today, and tomorrow. J Manage 1990;16399- 432
8.
Moorman  RH Relationship between organizational justice and organizational citizenship behaviors: do fairness perception influence employee citizenship? J Appl Psychol 1991;76845- 855Article
9.
Tyler  TRBies  RJ Beyond formal procedures: the interpersonal context of procedural justice. Carroll  JSApplied Social Psychology and Organisational Settings Hillsdale, NJ Lawrence A Erlbaum Associates1990;119- 132
10.
Wilkinson  RG Unhealthy Societies: The Afflictions in Inequality.  London, England Routledge1996;
11.
Folger  RCropanzano  R Organizational Justice and Human Resource Management.  Thousand Oaks, Calif Sage Publications1998;
12.
Cropanzano  RFolger  R Procedural justice and worker motivation. Steers  RMPorter  LWMotivation and Work Behavior. Vol 5 New York, NY McGraw-Hill Co1991;131- 143
13.
Shapiro  DLBrett  JM Comparing three processes underlying judgements of procedural justice: a field study of mediation and arbitration. J Pers Soc Psychol 1993;651167- 1177Article
14.
Elovainio  MKivimäki  MHelkama  K Organisational justice evaluations, job control, and occupational strain. J Appl Psychol 2001;86418- 424
PubMedArticle
15.
McEwen  BSStellar  E Stress and the individual: mechanisms leading to disease. Arch Intern Med 1993;1532093- 2101
PubMedArticle
16.
Muldoon  MFHerbert  TBPatterson  SMKameneva  MRaible  RManuck  SB Effects of acute psychological stress on serum lipid levels, hemoconcentration, and blood viscosity. Arch Intern Med 1995;155615- 620
PubMedArticle
17.
McEwen  BS Protective and damaging effects of stress mediators. N Engl J Med 1998;338171- 179
PubMedArticle
18.
Brunner  E Stress mechanisms in coronary heart disease. Stansfeld  SAMarmot  MGStress and the Heart Psychosocial Pathways to Coronary Heart Disease London, England BMJ Publishing Groups2002;
19.
Wager  NFieldman  GHussey  T The effect on ambulatory blood pressure of working under favourably and unfavourably perceived supervisors. Occup Environ Med 2003;60468- 474
PubMedArticle
20.
Kikuya  MHozawa  AOhokubo  T  et al.  Prognostic significance of blood pressure and heart rate variabilities: the Ohasama Study. Hypertension 2000;36901- 906
PubMedArticle
21.
Marmot  MGDavey Smith  GStansfeld  S  et al.  Health inequalities among British civil servants: the Whitehall II Study. Lancet 1991;3371387- 1393
PubMedArticle
22.
Karasek  RA Job demands, job decision latitude and mental strain: implications for job redesign. Admin Sci Q 1979;24285- 307Article
23.
Karasek  RTheorell  T Stress, Productivity and Reconstruction of Working Life.  New York, NY Basic Books Inc Publishers1990;
24.
Siegrist  J Adverse health effects of high-effort/low-reward conditions. J Occup Health Psychol 1996;127- 41
PubMedArticle
25.
Kivimäki  MFerrie  JEHead  JShipley  MJVahtera  JMarmot  MG Organisational justice and change in justice as predictors of employee health: the Whitehall II Study. J Epidemiol Community Health 2004;58931- 937
PubMedArticle
26.
Rose  GABlackburn  HGillum  RFPrineas  RJ Cardiovascular Survey Methods. 2nd ed. Geneva, Switzerland World Health Organization1982;
27.
Tunstall-Pedoe  HKuulasmaa  KAmouyel  PArveiler  DRajakangas  AMPajak  A Myocardial infarction and coronary deaths in the World Health Organization MONICA project: registration procedures, event rates, and case-fatality rates in 38 populations in four continents. Circulation 1994;90583- 612
PubMedArticle
28.
House  JSLandis  KRUmberson  D Social relations and health. Science 1988;241540- 545
PubMedArticle
29.
Elovainio  MKivimäki  MVahtera  J Organizational justice: evidence of a new psychosocial predictor of health. Am J Public Health 2002;92105- 108
PubMedArticle
30.
Kivimäki  MElovainio  MVahtera  JVirtanen  MStansfeld  SA Association between organisational inequity and incidence of psychiatric disorders in female employees. Psychol Med 2003;33319- 326
PubMedArticle
31.
Stansfeld  SAFuhrer  RShipley  MJMarmot  MG Psychological distress as a risk factor for coronary heart disease in the Whitehall II Study. Int J Epidemiol 2002;31248- 255
PubMedArticle
32.
Kivimäki  MHead  JFerrie  JEShipley  MJVahtera  JMarmot  MG Sickness absence as a global measure of health: evidence from mortality in the Whitehall II prospective cohort study. BMJ 2003;327364- 368
PubMedArticle
33.
Vahtera  JPentti  JKivimäki  M Sickness absence as a predictor of mortality among male and female employees. J Epidemiol Community Health 2004;58321- 326
PubMedArticle
34.
Kivimäki  MHead  JFerrie  JE  et al.  Working while ill as a risk factor for serious coronary events: the Whitehall II Study. Am J Public Health 2005;9598- 102
PubMedArticle
35.
Stansfeld  SAFuhrer  RShipley  MJMarmot  M Work characteristics predict psychiatric disorder: prospective results from the Whitehall II Study. Occup Environ Med 1998;56302- 307Article
36.
Hemingway  HMarmot  M Psychosocial factors in the aetiology and prognosis of coronary heart disease: systematic review of prospective cohort studies. BMJ 1999;3181460- 1467
PubMedArticle
37.
Kivimäki  MLeino-Arjas  PLuukkonen  RRiihimäki  HVahtera  JKirjonen  J Work stress and risk of cardiovascular mortality: prospective cohort study of industrial employees. BMJ 2002;325857- 860
PubMedArticle
38.
Kuper  HMarmot  MG Job strain, job demands, decision latitude, and risk of coronary heart disease within the Whitehall II Study. J Epidemiol Community Health 2003;57147- 153
PubMedArticle
39.
Matthews  KAGump  BB Chronic work stress and marital dissolution increase risk of posttrial mortality in men from the Multiple Risk Factor Intervention Trial. Arch Intern Med 2002;162309- 315
PubMedArticle
40.
Kuper  HSingh-Manoux  ASiegrist  JMarmot  M When reciprocity fails: effort-reward imbalance in relation to coronary heart disease and health functioning within the Whitehall II Study. Occup Environ Med 2002;59777- 784
PubMedArticle
41.
Siegrist  J Effort-reward imbalance at work and health. Perrewe  PLGanster  CDHistorical and Current Perspectives on Stress and Health New York, NY Elsevier Science Inc2002;261- 291
42.
Rosengren  AHawken  SOunpuu  S  et al.  Association of psychosocial risk factors with risk of acute myocardial infarction in 11 119 cases and 13 648 controls from 52 countries (the INTERHEART Study): case-control study. Lancet 2004;364953- 962
PubMedArticle
43.
Belkic  KLLandsbergis  PASchnall  PLBaker  D Is job strain a major source of cardiovascular disease risk? Scand J Work Environ Health 2004;3085- 128
PubMedArticle
44.
van Vegchel  Nde Jonge  JBosma  HSchaufeli  W Reviewing the effort-reward imbalance model: drawing up the balance of 45 empirical studies. Soc Sci Med 2005;601117- 1131
PubMedArticle
45.
Macleod  JDavey Smith  GHeslop  PMetcalfe  CCarroll  DHart  C Psychological stress and cardiovascular disease: empirical demonstration of bias in a prospective observational study of Scottish men. BMJ 2002;3241247- 1251
PubMedArticle
46.
Power  CMatthews  S Origins of health inequalities in a national population sample. Lancet 1997;3501584- 1589
PubMedArticle
47.
Lynch  JDavey Smith  G A life course approach to chronic disease epidemiology. Annu Rev Public Health 2005;261- 35
PubMedArticle
48.
Cooper  WHRichardson  AJ Unfair comparisons. J Appl Psychol 1986;71179- 184Article
49.
Maurer  TJRaju  NSCollins  WC Peer and subordinate performance appraisal measurement equivalence. J Appl Psychol 1998;83693- 702Article
50.
Riggio  RECole  EJ Agreement between subordinate and superior ratings of supervisory performance and effects on self and job satisfaction. J Occup Organisational Psychol 1992;65151- 158Article
51.
Lazarus  RS Psychological Stress and the Coping Process.  New York, NY McGraw-Hill Co1966;
52.
van den Bos  KLind  EA Uncertainty management by means of fairness judgments. Zanna  MPAdvances in Experimental Social Psychology Orlando, Fla Academic Press Inc2002;1- 60
×