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Re: Justice and fairness in the workplace

The work by Kivimäki et al (64:659-665) is part of an important tradition that aims to expand understanding of occupational psychosocial stressors to include issues of justice and fairness in the workplace, complementing the two most well-known models, demand-control and effort- reward. We applaud this work, while we also agree with the commentary by Renée Bourbonnais (64:640-641) that the existing conceptual frameworks for identifying job stressors are simultaneously overlapping and incomplete. Further, we echo her point that the conceptual basis of relational justice needs to be more fully examined to clarify how it goes beyond existing models – since, as Kivimäki and coworkers acknowledge, the concept of equity is related to but not totally subsumed under the construct of effort-reward imbalance. We also believe that apparent unavailability of measures to examine workplace injustice has delayed examination of its importance for mental and other health outcomes.

Discriminatory treatment within the workplace is a clear example of injustice that negatively impacts the three dimensions of self esteem, self-efficacy, and belonging cited by Bourbonnais. The current focus on procedural and relational injustice is perhaps not so much new as a reframing, in that there is already a substantial literature addressing the adverse health effects of gender and racial discrimination. For example, racism in the United States has been documented to have negative associations with psychological well-being [1-5] and physical health [5-9] and is increasingly recognized as accounting directly for some of the differences in psychological and physical health between whites and people of color [9-13]. For example, a thirteen-year panel study conducted by Jackson and colleagues [5] demonstrated that racial discrimination affected both the physical and mental health of African Americans. Krieger and Sidney [6] showed that experiences of racial discrimination, as well as acceptance of unfair treatment as inevitable, were associated with higher levels of blood pressure in African American participants.

The literature is still rather sparse on the specific health effects of racial discrimination in the work environment. Mays and co-workers [14] reported that perceived race-based discrimination in the labor market affected advancement, skill development, and interpersonal relationships with coworkers among African American women. Similarly, Hughes and Dodge [15] found that both interpersonal and institutional racism at work, especially interpersonal prejudice, were significant predictors of job satisfaction.

With regard to gender issues, sexist treatment of women at work – discrimination, negative sex stereotyping, isolation and sexual objectification - has been associated with adverse mental and physical health conditions, including high blood pressure, ulcers, tension, and insomnia [16-18]. Women who reported gender discrimination in their workplace also had lower levels of job satisfaction and organizational commitment, as well as more negative relations with coworkers and supervisors [19-21]. The effects of sexual harassment at work are similar: negative psychological outcomes such as anxiety, depression, alienation, and lower self-esteem [22-24]; smoking and alcohol abuse [25]; and negative somatic outcomes such as gastrointestinal disturbances, headache, and insomnia [16, 26-29].

While we agree with Bourbonnais that the pathways through which organizational practices are linked to individual health outcomes are not clear, we would argue that organizational issues are indeed important to explore. Like the other models of job stress, workplace discrimination can be defined both at the level of the organization and at the level of the individual, and these are clearly correlated with each other. For example, the frequency of sexual harassment behavior by individuals has been shown to be higher in work climates where sexist stereotypes and attitudes are tolerated [21, 30-32] and where an organization is unresponsive to employee concerns and complaints [20, 28]. Furthermore, experiences of discrimination are distributed differentially by socioeconomic position [33]. Incidents of injustice affect not only those immediately targeted; even sexual harassment directed at someone else in the workplace can cause lower job satisfaction, job withdrawal, psychological distress and somatization [34]. Additionally, job segregation plays a role as women and people of color are often relegated to jobs with less control, high stress, and low influence [35], which then translates into poor health outcomes [36]. Interestingly, we found that perceived sexism in an academic workplace was associated with lower job satisfaction for women and men [19].

It is unfortunate that time pressure and disciplinary gaps tend to keep researchers unaware of relevant research methods and findings in fields other than our own that could expand our understanding of the impact of equity at work. With an eye to rectifying this omission, and with the support of the U.S. National Institute for Occupational Safety and Health, we have recently compiled a large set of survey measures on sex and race discrimination, sexual harassment, and work-family balance, with detailed examination of the psychometric properties of each one. Most of these measures were found in the psychology literature, but it is our hope that occupational health researchers will now have easier access to them and thus will broaden their investigations of job stress. This measures compendium will be forthcoming this fall from NIOSH [37].

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