Justice at workplace associated with reduced risk of coronary heart disease

October 24, 2005

CHICAGO - A sense of fair treatment in the workplace was associated with a reduced risk of coronary heart disease in a large long-term study of British office workers published in the October 24 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

People feel a sense of justice at work when they believe their supervisor considers their viewpoint, shares information concerning decision-making and treats individuals fairly and in a truthful manner, according to background information in the article. An earlier study had shown that employees had lower blood pressure on days spent working with a supervisor they perceived as fair. The authors suggest that it is plausible to connect a high level of justice with a reduction in chronic stress and its attendent association with coronary heart disease (CHD).

Mika Kivimaki, Ph.D., of the Finnish Institute of Occupational Health, Helsinki, Finland, and colleagues analyzed data from 6,442 male office staff in 20 civil service departments in London, England. Justice at work was measured at phase one (1985-1988) and two (1989-1990). Each participant was given a score based on a self-reported justice scale. They were divided into three groups based on their average score. Participants were followed for incidence of coronary heart disease from 1990 to 1999. Conventional risk factors for coronary heart disease were measured at phase one.

"These data enable us to determine whether the addition of justice would add to risk estimates based on other risk factors," the researchers write. "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."

"In men who perceived a high level of justice, the risk of incident CHD was 30 percent lower than among those who perceived a low or an intermediate level of justice," the researchers report. "This finding was not accounted for by baseline factors such as age, ethnicity, marital status, educational attainment, socio-economic 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 two leading stress models, job strain and effort-reward imbalance."

"Most people care deeply about just treatment by authorities," the authors conclude. "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."
(Arch Intern Med. 2005; 165:2245-2251. Available pre-embargo to the media at www.jamamedia.org.)

Editor's Note: This study was supported by the Health and Safety Executive, London; projects from the Academy of Finland and the Finnish Environmental Foundation, Helsinki; grants from the Medical Research Council, London, and the British Heart Foundation, London; and a research fellowship from the Medical Research Council. Complete funding information is available in the article.

For more information, contact JAMA/Archives Media Relations at 312-464-JAMA (5262) or email mediarelations@jama-archives.org.

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