Organizational Injustice as an Occupational Health Risk

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Organizational Injustice as anOccupational Health RiskJerald Greenberg aa RAND CorporationPublished online: 26 May 2010.

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The Academy of Management Annals

Vol. 4, No. 1, 2010, 205–243

205

ISSN 1941-6520 print/ISSN 1941-6067 online© 2010 Academy of ManagementDOI: 10.1080/19416520.2010.481174http://www.informaworld.com

Organizational Injustice as anOccupational Health Risk

JERALD GREENBERG

*

RAND Corporation

Taylor and FrancisRAMA_A_481174.sgm10.1080/19416520.2010.481174Academy of Management Annals1941-6520 (print)/1941-6067(online)Original Article2010Taylor & [email protected]

Abstract

Content to conceive of inequity distress as a hypothetical construct instead ofan intervening variable, a half century of research inspired by equity theory haspaid little attention to measuring inequity distress. At the turn of the twenty-first century, however, European epidemiologists, interested in determinantsof ill health, found that injustice is a source of adverse emotional reactions thatput people at risk for mental and physical morbidity (e.g., depression and coro-nary heart disease). This research is reviewed here, along with studies identify-ing pathways accounting for these connections. Specifically, perceivedinjustices lead to negative emotional reactions and to unhealthy behaviors(e.g., being sedentary, smoking, and drinking excessively), both of which trig-ger various negative bodily reactions (e.g., elevated serum lipids). These, inturn, subsequently put people at risk of illness. Research has found that sucheffects are mitigated by organizational interventions that promote perceptionsof justice. Three limitations warranting consideration in future research arediscussed: (a) the need to address methodological concerns (e.g., reducingcommon method variance, improving efforts to determine causality), (b) the

*

Email: [email protected]

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• The Academy of Management Annals

need to assess the cultural generalizability of research findings, and (c) theneed to supplement the existing attention to disease with a new focus on healthand well-being.

Introduction

That work is a potential source of illness, both mental (Blustein, 2008) andphysical (Lax, Grant, Maanetti, & Klein, 1998), is well established. Most of thework-related illnesses studied focus on exposure to noxious environmentalconditions (e.g., miners suffering respiratory diseases caused by inhaling coaldust) and potentially debilitating repetitive motions (e.g., office workers atcomputer keyboards suffering the pain of carpal tunnel syndrome) (UnitedStates Department of Labor, 2007). Supplementing these physical sources ofoccupational illnesses, however, is an even broader range of maladies stem-ming from encounters with adverse psychosocial factors (e.g., chronic stres-sors, negative emotional states, absence of social ties). These constitute anadditional layer of risk that is at least as serious although understood less well(Everson-Rose & Lewis, 2004). This is likely because psychosocial variablescannot be observed directly, making their links to illness less obvious andthereby promoting less scientific scrutiny. Yet, these invisible threats are alltoo real, and according to the World Health Organization (2008), “psychoso-cial factors are now major occupational health concerns, joining the tradi-tional problems of unemployment and exposure to physical, chemical andbiological hazards.”

Among the most widely studied psychosocial determinants of employeehealth are workers’ feelings of injustice.

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This is the result of a surge ofresearch activity on this topic at the beginning of the twenty-first century, pri-marily by European scholars. Despite the relative newness of this line ofinvestigation, a considerable body of evidence already exists. Although newfindings are emerging on a regular basis, existing evidence has been suffi-ciently consistent and compelling to allow a conclusion to be drawn about therelationship between justice and health:

individuals who perceive injustice intheir workplaces are inclined to suffer mental and physical illness.

In thepresent paper, I examine the research bearing on this conclusion. I also dis-cuss the various theories that shed light on these findings, and propose anintegrated conceptualization of the underlying psychological and physiologi-cal processes involved.

Much has already been written about variables linked to perceived injustice(e.g., job performance, organizational commitment, absenteeism, dysfunc-tional behavior, and disruptive conflict) in the management literature, andresearch focusing on these dependent variables has been reviewed thoroughlyelsewhere (Colquitt, 2008; Greenberg, 2010; Greenberg & Colquitt, 2005).However, because most research linking workplace justice to health risks isrelatively new, and because it has been reported primarily in journals in the

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fields of medicine, epidemiology, and occupational sociology, it is unlikely toappear on the radar screens of most management scholars. Given the potentialimportance of this work to theory and practice in the field of management,however, its examination here is warranted strongly.

Background

Research linking organizational justice and occupational health has adoptedthree distinct professional orientations—sociological, psychological, andmedical.

Sociological Orientation: Inequalities in Distributions of Wealth

Although it is not my focus in this paper, intellectual completeness dictatesthat I acknowledge an established sociological literature linking health andjustice. Typically, this work operationally defines injustice in macro-levelterms as the unequal distribution of wealth within societies.

Adopting this approach, many researchers (e.g., Wilkinson, 1996) havereported that among developed nations, the healthiest populations arefound not in the wealthiest societies but in those with the smallest dispari-ties in income between its richest and poorest members. Highest death ratesoccur in societies with the widest inequalities in wealth. The best acceptedexplanation for this is offered by the so-called inequality hypothesis, whichclaims that the social fabric is weakened in societies that are highly strati-fied with respect to wealth, resulting in low levels of social cohesion and itscorrosive effects, including poor health (Raphael, 2003). Particularly atextreme levels, inequality and relative poverty are associated strongly withhigh mortality rates. Although this approach has not gone unchallenged(e.g., Eberstadt, 2004), it remains a popular doctrine among contemporarysociologists.

Interesting though it may be, this body of work fails to examine individual-level measures of injustice and, as a result, it is excluded from consideration inthis micro-oriented paper. Here, I focus instead on people’s perceptions offairness in organizations (i.e., organizational justice) (Greenberg, 1987). Thisorientation is adopted in the psychological and medical literatures, to which Inow turn.

Psychological Orientation: Role of Inequity Distress

For almost half a century, the dominant approach to distributive justice (i.e.,the perceived fairness of the distribution of valued resources) in the organiza-tional sciences has been Adams’ (1963, 1965) equity theory. According to thisconceptualization, individuals who feel overpaid (resulting from perceivingthat the ratio of their outcomes relative to their inputs is higher than thecorresponding ratios of comparison others) are said to experience guilt, and

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those who feel underpaid (resulting from perceiving that the ratio of theiroutcomes relative to their inputs is lower than the corresponding ratios ofcomparison others) are said to experience anger. These two manifestations ofinequity distress are negative emotional states that people are motivated toescape. They can do this by making behavioral and/or cognitive changes withrespect to their own outcomes or inputs (e.g., by working less hard or bydevaluing their contributions) or, when possible, those of focal comparisonothers.

Research testing equity theory generally has been supportive (Greenberg,1982). However, one aspect of the theory that has received little attention con-cerns the nature of inequity distress. As I have noted elsewhere (Greenberg,1984), a handful of studies have addressed this issue, but measurement short-comings make their findings inconclusive. Commenting on this literature adecade ago, Hegtvedt and Cook (2001) concluded that, “whether distress ormore specific emotions actually mediate reactions to inequity remainsunknown” (p. 107).

Whether or not this should be considered a limitation of equity theorydepends on the epistemological status accorded to inequity distress. Theinability to capture inequity distress empirically would be problematic ifone conceives of inequity distress as a mediator, an

intervening variable

thatleads the independent variable (i.e., inequitable states) to cause changes inthe dependent variable (i.e., changes in behavior or reported cognitions).However, equity theory implies that inequity distress is a

hypothetical con-struct

—that is, a construct that is not directly observable but whose existenceis inferred on the basis of theoretically predictable changes in behavior (learn-ing is a classic example).

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As such, directly measuring inequity distress, even ifpossible, is regarded to be unnecessary.

Traditionally, most social and organizational psychologists testing equitytheory have not been concerned about the unobserved nature of inequity dis-tress because they were interested primarily in antecedents and consequencesof inequity. This has left many content to attribute reactions to inequity to anapocryphal state whose existence was inferred rather than measured directly(Greenberg, 1984). As a result, a connection between the psychologicalconceptualization of equity (Adams, 1965) and the health of individuals inorganizations has not been established in the psychology literature. This isunfortunate given that stress and ill health have been linked strongly (e.g.,Warr, 2004), leaving open the possibility that because inequity triggers stress,it may be a risk factor contributing to health problems.

To a great extent, this state of affairs is the result of psychologists’ willing-ness to conceive of inequity distress as a hypothetical construct, thereby per-mitting them to leave on the table consideration of the possibility that theunmeasured concept of inequity distress may promote illness. This is surpris-ing when considered in light of two highly influential lines of research in the

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field of stress. First, Selye (1955) documented the unhealthy effects of stress afull decade before Adams (1965) developed equity theory. Thus, although thetable was set for psychologists studying inequity to feast on knowledge ofstress-induced illness, few took seats. Second, after Lazarus (1974) introducedthe notion that physiological stress reactions may be triggered by positivestimuli (i.e., eustress), as well as negative stimuli (i.e., distress), it is curiousthat psychologists failed to make the analogous connections to inequity dis-tress stemming from the ostensibly beneficial state of overpayment and thenegative state of underpayment.

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These unfulfilled opportunities notwithstanding, I should note thatbecause most of the early tests of equity theory were short-term laboratoryexperiments that were low in hedonic relevance, it is unlikely that the magni-tude of their inequity manipulations would have been sufficient to arousemuch distress, let alone trigger illness stemming from it. Furthermore, asuninformed as psychologists may appear for having failed to consider theunhealthy effects of injustice in the first few decades following the introduc-tion of equity theory, to their credit, this precedes today’s rapidly growingawareness of the role of emotions in perceptions of justice and reactions toinjustice (e.g., van den Bos, 2003). It also predates sophisticated physiologicalmeasures of emotional states (e.g., Abercrombie, Speck, & Monticelli, 2006)available to contemporary researchers.

Medical Orientation: Focus on Disease and its Causes

In contrast to psychologists’ seemingly naïve inattention to inequity as asource of illness, it probably comes as no surprise, given their focus, thatmedical researchers have been acutely aware of the unhealthy effects of ineq-uity distress. To them, however, what is interesting about inequity distress isthat it is regarded to be a “new psychosocial predictor of health” (Elovainio,Kivimäki, & Vahtera, 2002, p. 105). In contrast to organizational psycholo-gists, who traditionally are interested in perceived injustice because of itsimpact on employee behavior, medical and epidemiological researchers cameto appreciate perceived injustice after it was found to be an antecedent ofillness in the workplace.

Much of this research follows from Siegrist’s (1996, 2002) and Siegrist,Siegrist, and Weber’s (1986) effort–reward imbalance theory (ERI). Similarto equity theory (Adams, 1965), ERI specifies that people who exert highamounts of effort but receive only low amounts of reward in return willexperience negative emotions and stress. Although the theories are similarwith respect to underlying processes, they differ in terms of their stated pur-poses. Whereas equity theory was designed to explain social exchange rela-tionships, ERI was developed in conjunction with research aimed atunderstanding of psychosocial factors as health risks. With this in mind, it isnot surprising that ERI has featured prominently as a framework guiding

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medical and epidemiological research (for a review of 45 such studies, seevan Vegchel, de Jonge, Bosma, & Schaufeli, 2005).

The vast majority of the medically oriented efforts have focused on coronaryheart disease (CHD) (e.g., Hintsanen et al., 2007) and psychiatric morbidity(Kivimäki, Vahetera, Elovainio, Virtanen, & Siegrist, 2007). And because med-ical researchers are concerned about workplace stress, they measure its effectsin the form of bodily reactions, such as cortisol dysregulation (Bellingrath,Weigl, & Kudielka, 2008) and norepinephrine secretions (e.g., Wirtz, Siegrist,Rimmele, & Ehlert, 2008), near-term physical reactions such as low-back andneck injuries (e.g., Rugulies & Krause, 2007), and the long-term onset of diseasestemming from it, such as type 2 diabetes (Kumari, Head, & Marmot, 2004).

Because findings from this research bear on the general principle on whichI am reporting, I will discuss this research in the present paper. And becausethis work has focused on different types of health issues, I examine these aswell. It is important to note that this literature focuses on the three establishedforms of organizational justice—distributive justice, procedural justice, andinteractional justice (which includes both interpersonal justice and informa-tional justice). Although much of this work was inspired initially by distribu-tive justice, in recent years it also has turned attention to procedural justice(e.g., Ben-Ari, Tsur, & Har-Even, 2006) and interactional justice (e.g., Kivimäkiet al., 2007).

Distributive justice

refers to the perceived fairness of distributions ofoutcomes. Among social psychologists, equity theory (Adams, 1965) is theprimary conceptualization of distributive justice, although medical research-ers focus instead on ERI, which has been referred to as “a tolerable proxy fordistributive justice” (Ferrie et al., 2006, p. 449). Given the considerable overlapbetween equity theory (Adams, 1965) and ERI (Siegrist, 1996, 2002), I willreport medically oriented findings from the ERI literature as relevant to man-agement researchers who may have used equity theory to guide their investi-gations of the health-related consequences of inequity.

Because much of the more recent medical and epidemiological researchalso examines

procedural justice

(i.e., the perceived fairness of processes usedto determine outcomes) and

interactional justice

(i.e., the perceived fairnessof the interpersonal manner in which procedures and distributions areexplained), I will examine studies focusing on them as well. As will becomeapparent from the breadth of this research and the consistency of its findings,examining these health-focused studies opens up an entirely new vista forresearch on organizational justice. This reflects a shift in justice research fromdependent variables of primary importance to organizations (e.g., perfor-mance, turnover) to dependent variables whose immediate and primary valueis to individuals (this is not to imply, of course, that the health of employees isnot also of interest to organizations) (Blustein, 2008; Kuoppala, Lamminpää,Liira, & Vainio, 2008).

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Effects on Health

The premise of this paper is that perceptions of workplace injustice are linkedto ill health. The evidence bearing on this notion is supported by several stud-ies revealing significant negative correlations between perceptions of proce-dural justice and interactional justice (assessed using Moorman’s, 1991, scale)and the number of medically certified absences among Finnish employees. InFinland, absences from work due to sickness that exceed three days must becertified by a doctor for the employee to be credited with sick leave. Lowerlevels of both procedural justice and interactional justice have been found tobe associated with higher numbers of medically certified absences (Elovainio,Kivimäki, Steen, & Vahtera, 2004) and absence spells that were longer in dura-tion (Elovainio et al., 2005). In fact, one study found that employees reportinglow levels of organizational justice were almost twice as likely to be absent asthose perceiving high levels of organizational justice (Elovainio, Kivimäki, &Jussi, 2002). Despite the consistent nature of this evidence, it is limited by thefact that the dependent measure failed to reveal anything about the nature ofemployees’ illnesses. (Although diagnoses must be reported officially, thesewere not disclosed to the researchers.) Fortunately, additional studies havelinked organizational justice perceptions to reports of specific physical andmental maladies. I now report these.

Physical Health Problems

Several studies have reported negative associations between perceptions ofjustice and self-reported physical health quality. For example, in their survey ofover 4000 Finnish hospital workers, Elovainio et al. (2002) found that men whoscored low on Moorman’s (1991) procedural justice scale were 1.84 times aslikely as high scorers to report their general health as “poor” (on a single-itemscale with response options of “good,” “fairly good,” “average,” “fairly poor,”“poor” and “cannot judge”

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) even after statistical adjustments were made tocontrol for the effects of demographic variables (e.g., income), behavioral risks(e.g., smoking), and psychosocial factors (e.g., social support). The corre-sponding odds ratio for women was somewhat lower (1.55) but also significantat the 95% confidence interval. Interestingly, the corresponding corrected-odds ratios using Moorman’s (1991) measure of interactional justice was lowerfor both men (1.30) and women (1.24). Subsequent studies have replicated thisgeneral pattern of findings in other samples from the same population,although the differences between men and women were less pronounced(Elovainio, Kivimäki, Vahtera, Keltikangas-Jjärvinen, & Virtanan, 2003;Kivimäki, Elovainio, Vahetera, & Ferrie, 2003).

Additional evidence from longitudinal research has revealed the dynamicnature of these findings. We see this, for example, in the long-term survey studyby Kivimäki, Ferrie, Head et al. (2004) in which justice measures completed at

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one time predicted self-rated health at two subsequent times, approximatelythree and six years later. Drops in organizational-justice perceptions over thisperiod were linked to declines in health, whereas rises in organizational justicewere associated with improvements in health.

Taken together, these findings lend strong support to the possibility of aconnection between justice perceptions and physical health. As Siegrist (2004)cautions, however, care should be taken in interpreting these findings for sev-eral reasons. To begin with, the lack of an externally assessed health measureprecludes insight into the nature of the medical problems about which partic-ipants are reporting. Additionally, it should be noted that the studies sufferfrom same-source bias, which threatens to inflate correlations between vari-ables. In view of this, the relatively modest odds ratios reported (often rangingfrom 1.10 to 1.50) may be overestimates of the true relationships, suggestingthat organizational justice perceptions may be more limited predictors ofhealth than claimed. This would appear to be indicative of relationshipsbetween justice and health that are more complex than captured by the maineffects reported. In this regard, consider the consistent reports of gender dif-ferences in the relationship between justice perceptions and health outcomes(weaker findings among women than among men). Instead of conceiving ofthese as nuisances to interpretation (Siegrist, 2004), I believe they should becharacterized as moderators worthy of further study in an effort to understandthe underlying complexities between justice and health.

Fortunately, instead of using self-reports of general health, some studiesexploring the connection between justice and health have examined reports ofspecific health problems. Insomnia (i.e., experiencing difficulties for at leastfour weeks in falling asleep and staying asleep) is one such ailment. Againstudying several thousand Finnish hospital workers, Elovainio et al. (2003)found that insomnia was related negatively to perceptions of procedural andinteractional justice. Interestingly, however, it also was found that insomniamediated the relationship between justice perceptions and self-reports ofhealth quality. Reflecting this, the odds that low perceptions of organizationaljustice were related to accounts of poor health were higher than unity,although this relationship dropped significantly after taking insomnia intoaccount. Although preliminary, these findings are important in that theybegin to shine light on some potential underlying processes. Apparently,whatever it is about injustice that promotes illness appears to manifest itseffects through insomnia.

Another specific health problem that has been linked to perceptions ofinjustice—and a particularly serious one—is CHD. Evidence bearing on thisrelationship is found in studies by Kivimäki and his associates that conceptu-alize justice in two different ways. In the first study, Kivimäki et al. (2002)examined cardiovascular mortality as reported in a national registry inFinland between 1973 and 2001. Participants were 812 men and women who

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worked in the metal industry in Finland who were free of CHD when thestudy began in 1973 and with whom the researchers followed up regularlyduring the study period. Comparisons were made between the number ofdeaths attributed to CHD and the degree to which participants reported expe-riencing ERI. The results were clear: after adjusting for age and gender,employees with high ERIs (i.e., low salaries, lack of social approval, and fewcareer opportunities relative to the effort required at work) were 2.4 timesmore likely to die from CHD than those who suffered no such imbalances.Biochemically, the researchers were able to anticipate these results, as reflectedby raised levels of serum total cholesterol (noted at the five-year follow-up)and increased body mass index (noted at the 10-year follow-up) among thosein the high ERI group.

Subsequent research by Kivimäki and another research group (Kivimäkiet al., 2005) took a different approach to assessing organizational justice.Specifically, using their own five-item ad hoc paper-and-pencil measure, theresearchers assessed perceptions of organizational justice among over 6000male civil-service workers in London. These data were collected at two timepoints in the mid to late 1980s that were between two and four years apart.Following this, participants were tracked for approximately nine years, duringwhich records were kept regarding incidents of nonfatal myocardial infarc-tions (revealed using electrocardiograms) and self-reports of angina (con-firmed independently by medical records and abnormalities revealed oncoronary angiograms). In addition, fatalities due to CHD were flagged usingreports in an official British government registry. Established risk factors forCHD also were assessed so that they could be included as control variables indata analyses (e.g., age, body mass index, smoking, alcohol consumption, etc.).The findings were clear: after controlling for risk factors, justice perceptionswere significant predictors of all measures of CHD. In fact, among men per-ceiving high levels of organizational justice, incident CHD was on average30% lower than it was for those perceiving intermediate or low levels of orga-nizational justice.

Mental Health Problems

In addition to collecting reports of physical health problems, many of theearlier-reported studies also gathered information about participants’ mentalwell-being. The General Health Questionnaire (GHQ) (Goldberg & Williams,1988) was used for this purpose. This instrument consists of items (either 12,28, or 30, depending on the version) describing various self-reports of mentalstates to which respondents indicate frequency of occurrence on scalesanchored “not at all,” “no more than usual,” “rather

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more than usual,” and“much more than usual.” Examples include, “Have you recently been gettingscared or panicky for no good reason?” and “Have you recently felt that lifeis entirely worthless?” The GHQ is used to assess depression and social

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dysfunction (Werneke, Goldberg, Yalcin, & Ustun, 2000) and has been vali-dated against standardized psychiatric interviews (Goldberg & Williams,1988).

Two studies (Elovainio et al., 2003; Kivimäki, Elovainio, Vahetera et al.,2003) found that after adjusting for gender, age, income, and health at base-line, workers reporting low levels of procedural justice (using Moorman,1991) were approximately 1.45 times more likely to report minor psychiatricmorbidity (using the 12-item version of the GHQ) than those reporting highlevels of procedural justice. As in the case of physical illness, the odds ratioswere lower for interactional justice. These findings were extended in a longi-tudinal study (Kivimäki, Elovainio, Vahtera, Virtanen, & Stansfield, 2003) inwhich managerial procedures believed to be unfair significantly predicteddepression (as diagnosed by a doctor) among initially healthy female hospitalworkers two years later. However, the results for interactional justice were notstatistically significant.

Contrasting with these European studies, which examined only maineffects of various forms of organizational justice on depression, two studies byTepper (2001) conducted in the United States focused on interactive effects.Specifically, in his first study, Tepper (2001) examined the relationshipbetween responses to brief, ad hoc measures of distributive justice and proce-dural justice completed by some 3300 employees of a public organization atthe first time point and scores on a measure of clinical depression (the depres-sion subscale from the Brief Symptom Inventory) (Derogatis, 1993) com-pleted two months later. The findings revealed a significant interaction effectsuch that when both distributive justice and procedural justice were low,depression was highest—significantly higher, in fact, than under any othercombinations of justice levels.

In a follow-up study using a different measure of depression (the DiagnosticInterview Schedule) (Robins, 1986), Tepper (2001) corroborated these find-ings, even when neuroticism was included as a control factor. This is importantin view of evidence revealing that negative affectivity (an alternative label forneuroticism) moderates the relationship between stressors (e.g., distributiveinjustice) and strain reactions (e.g., self-reports of depression) (Burke, Brief, &George, 1993). Indeed, it has been argued that correlations between measuresof stress and health overestimate the true association between these variablesbecause both measures share a significant negative affectivity component(Watson & Pennebaker, 1989). Accordingly, the fact that Tepper (2001) repli-cated the significant relationship between injustice and depression reported inhis first study, even after controlling for neuroticism, suggests that variance inthe injustice–depression relationship cannot be accounted for by the effects ofthis dispositional variable.

Another study conducted in the United States that explored the relation-ship between organizational justice and depression took a different approach

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to justice. Instead of analyzing individual responses, Spell and Arnold (2007)focused on justice climate, which they operationally defined by averaging theindividual justice perceptions of members of various workgroups and assign-ing this collective justice score to each individual. This is the so-called “directconsensus approach” to climate described by Chan (1998) and used in organi-zational justice studies by Liao and Rupp (2005). The individual measures thatSpell and Arnold (2007) combined were the distributive justice and proce-dural justice scales developed by Colquitt (2001), which are considered the defacto standard justice measures (Greenberg, 2010). The measure of depressionused in this study was the depression subscale developed by Axtell, Wall,Stride, Pepper, Clegg, Gardner, and Bolden (2002). The researchers partiallyreplicated the interaction effect for individual-level responses reported byTepper (2001). Specifically, they found that the highest levels of depressionwere reported by individuals whose groups perceived low levels of both dis-tributive justice and procedural justice.

It is noteworthy that Spell and Arnold (2007) also found the oppositeeffect—that is, lowest levels of depression were reported when collective levelsof distributive justice and procedural justice were high. These findings extendTepper’s (2007) individual-level findings, which revealed that depression issensitive only to low levels of justice but not to high levels. Spell and Arnold’s(2007) symmetrical findings in this regard follow from research revealing bothnegative reactions to injustice and positive reactions to justice (for a review,see Greenberg, 2010). It is not apparent, however, why these findings wereobserved by Spell and Arnold (2007) but not by Tepper (2001). Whether theyare due to the use of a collective measure of justice as opposed to an individualmeasure or to different measures of depression cannot be determined. Clearly,more research is needed to explore this question. Doing so would shed lightinto whether depression is responsive to gains in injustice (negatively) or gainsin justice (positively), which promises to contribute to efforts to avoid the prob-lems associated with depression in the workplace (e.g., Suls & Bunde, 2005).

To this point, I have reviewed research revealing both physical and mentalillnesses linked to perceptions of injustice. Although the findings are inconsis-tent with respect to the effects of gender and the impact of specific forms ofjustice, it is clear that, overall, injustice is predictive of ill health to someextent.

Underlying Processes

Having established the existence of a relationship between perceived injusticeand ill health, the stage is now set to identify the underlying processes thataccount for it. What, then, are the various pathways that result in this connec-tion? In this section, I describe research suggesting the existence of relation-ships that appear to form the links in this chain. Specifically, I describe sixparticular relationships depicted in Figure 1: (1) perceived injustice

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emotions, (2) perceived injustice

→

unhealthy behavior, (3) negative emotions

→

unhealthy behavior, (4) negative emotions

→

negative bodily reactions, (5)unhealthy behavior

→

negative bodily reactions, and (6) negative bodily reac-tions

→

illness. (It is important to note that the arrows reflect assumptions ofcausality that may not have yet been established empirically.)

Figure 1 Links in the Relationship Between Organizational Justice and Health.

Perceived Injustice

→

Negative Emotions

It should not be surprising that the first link in the chain connecting injusticeand ill health involves negative emotions (path 1). Such reactions are central toequity theory’s (Adams, 1965) claim that inequities create aversive emotionalstates, and these have been alluded to in the literature (e.g., Cropanzano &Baron, 1991; Zohar, 1995). Despite this, evidence regarding emotional reac-tions to inequity was lacking for many years (Greenberg, 1984). Then, in 1999,Weiss, Suckow, and Cropanzano (1999) linked discrete emotions to injusticein a seminal laboratory experiment.

These researchers had undergraduate students perform a desert-survivaltask as members of teams in which they were led to believe that their teamperformed either better or worse than another team. This resulted from eitheran unfair procedure that benefited them (i.e., they were given some correctanswers), an unfair procedure that benefited the other team (i.e., the otherteam was given some correct answers), or a fair procedure (i.e., neither teamwas given any advantage). Following these manipulations, participants com-pleted a questionnaire assessing the extent to which they were experiencingeach of four distinct emotions: happiness, anger, guilt, and pride. With respectto these, the key findings were as follows:

• For

happiness

, the fairness of the procedure had no significant impact. Allthat mattered was whether participants believed their teams won (in whichcase, happiness was high) or lost (in which case, happiness was significantlylower).

Figure 1 Links in the Relationship Between Organizational Justice and Health.

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• For

anger

, outcome and procedure had interactive effects such that thehighest levels of anger were expressed in the condition in which partici-pants lost the competition after the other team was given an unfair advan-tage. Levels of anger were significantly lower (and roughly equivalent toone another) in all other conditions.

• For

guilt

, outcome and procedure also had an interactive effect. The high-est levels of guilt were expressed among participants who won the competi-tion after being given an unfair advantage. Levels of guilt were significantlylower in all other conditions.

• For

pride

, the highest levels were expressed among participants who wonthe competition fairly and who won the competition despite the other teambeing given an unfair advantage. Mean levels of pride were significantlylower in all other conditions.

These findings suggest that emotional states are triggered by the favorabil-ity of outcomes in conjunction with beliefs about the fairness of the proce-dures used to determine those outcomes. Whereas happiness is solely outcomedriven, to experience pride people must believe that they won a competitioneither fairly or despite unfair conditions that disadvantage them. Analogousresults were found for negative emotions. People felt anger when unfair pro-cedures led them to lose and guilt when unfair conditions led them to win.

In a questionnaire study, Barclay, Skarlicki, and Pugh (2005) reported anal-ogous results. Specifically, these researchers found that laid-off employeeswho believed that their layoffs were handled in a procedurally fair mannerexperienced higher degrees of guilt and shame than those who believed thatprocedural violations occurred during the layoff process. This suggests thatthe use of fair procedures precluded the opportunity to discount negative self-attributions that otherwise would be available if procedures were unfair,thereby making workers feel worse about this outcome. In keeping with thisnotion, Barclay et al. (2005) also reported that this tendency (i.e., for peopleexperiencing procedurally fair layoffs to experience guilt and shame) wasgreater when the negative impact of the layoff was considerable (e.g., whenthey failed to receive a severance package) than when the effect of the layoffwas less severe.

Taken together, these findings support the idea that certain justice condi-tions trigger “affective events” as conceived by affective events theory (Weiss& Cropanzano, 1996). Interestingly, as Barclay et al. (2005) suggest, it is notonly unfair states that result in negative emotions but fair states as well. In thiscase, the negative emotions are not particularly intense and result frominward-focused states of guilt and shame. However, states of unfairness aremore inclined to trigger “hot” emotional reactions, such as anger and rage(Tripp & Bies, 2009), the kind of injustices that lead to burnout (e.g., Moliner,Martinez-Tur, Ramos, Peiro, & Cropanzano, 2008).

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Perceived Injustice

→

Unhealthy Behavior

Although management scholars are familiar with the idea that emotional reac-tions occur in organizations (De Cremer, 2007) and, as noted above, that thesecan result from perceptions of injustice, they are generally unaware of anothertype of reaction to perceived injustice that is known to health researchers—unhealthy behaviors. Specifically, health researchers have reported thatresponses to perceived injustices may manifest themselves in the form ofunhealthy behaviors—most notably, sedentary life-style, smoking, and heavyalcohol consumption (path 2).

Sedentary life-style.

Kouvonen et al. (2006) suggested that when workersfeel inequity (operationalized as high ERI), they are likely to feel frustrated,apathetic, alienated, and disengaged from work. Behaviorally, this manifestsitself as passivity. Spilling over into leisure time, passivity may lead to seden-tary life-styles, with physical inactivity posing health risks.

The researchers examined the connection between high imbalancesbetween effort and reward and sedentary life-style among almost 36,000Finnish workers. ERI was assessed using established measures (for a reviewof these, see Siegrist et al., 2004). Sedentary life-style was measured by multi-plying the number of hours spent per week engaging in various physicalactivities of different intensity levels (e.g., walking, jogging, running) by thetypical energy expenditures associated with them and adding them togetherfor each activity. The resulting metabolic index was dichotomized into sed-entary and active groups using established medical criteria (Kujala, Kapiro, &Koskenuvo, 2002). A modest relationship was found between ERI and seden-tary lifestyle. Among both men and women, high individual ERI was associ-ated with highly sedentary life-styles, even after controlling for possiblecovariates (e.g., age, occupational status).

Smoking.

Another form of unhealthy behavior that has been linked tofeelings of injustice is smoking. For example, it has been found that peopleexperiencing high levels of ERI are more inclined to smoke than those experi-encing low levels (Peter, 1995). More recently, in a study of over 34,000Finnish employees, Kouvonen et al. (2007) explored the extent to which feel-ings of procedural injustice and interactional injustice were associated withsmoking intensity. The researchers found that smokers who experienced lowlevels of justice in their organizations, both procedural and interactional,reported being heavier smokers than those who experienced high levels ofjustice. This finding resulted even after controlling for age, educationlevel, socioeconomic status, marital status, and trait negative affectivity.Importantly, the researchers found that the link between justice perceptionsand smoking also remained strong after controlling for ERI (which tapsdistributive justice as opposed to procedural justice or interactional justice)

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and job strain. This is noteworthy because it suggests that organizationaljustice “is not just a marker for other work-related psychosocial factors thatmight influence smoking intensity” (Kouvonen et al., 2007, p. 430) but a keydeterminant on its own.

Heavy alcohol consumption.

Using the same cohort of Finnish workers,Kouvonen et al. (2005) examined some 15,000 employees who indicated thatthey drank alcohol. At two time points separated by an average of 3.6 years,workers completed the procedural justice and interactional justice scales fromMoorman (1991). Alcohol consumption also was assessed on both occasionsby asking participants to indicate the amounts of various alcoholic beverages(e.g., beer, wine, etc.) they drank during an average week. People were classi-fied as heavy drinkers if they consumed at least 210 g of alcohol per week.

It was reported that low levels of procedural justice significantly predictedheavy drinking among both men and women. This occurred even when takinginto account such control factors as age, gender, and marital status. However,no such effects were found for interactional justice. This suggests that alcoholconsumption was influenced more by the unfair policies and procedures usedby organizations than by the unfair treatment of individual supervisors (whogenerally are referenced in measures of interactional justice).

It warrants mentioning that the unhealthy behaviors linked to feelings ofinjustice were all from the same “10 Town Study” conducted in Finland. As aresult, we do not have the kind of independent findings using different popu-lations that would be ideal in a series of studies. Additionally, many of theeffects noted were not particularly strong. Despite these limitations, one can-not overlook the consistency across studies: regardless of the type of unhealthybehavior studied, a link between it and injustice (particularly proceduralinjustice) was always found.

Negative Emotions

→

Unhealthy Behavior

So far, I have described two types of reactions to workplace injustice—emotional responses (path 1) and unhealthy behavioral responses (path 2). Itshould be noted, however, that the emotional reactions to injustice themselvescan be a cause of unhealthy behavior (path 3). Indeed, it is not unusual forpeople who suffer adverse emotional reactions to attempt to cope with thesestates in ways that are potentially unhealthy. Specifically, people soetimes turnto excessive alcohol use, “drowning their sorrows” to help minimize negativeemotional states (Cooper, Frone, Russell, & Mudar, 1995). Also, many peoplesmoke cigarettes when they feel nervous or upset, as is likely to be the casewith adverse emotional reactions to injustice (Green & Johnson, 1990). Andfinally, it has been found that some people are inclined to follow sedentarylifestyles to compensate for jobs that are particularly stressful subject to nega-tive emotional reactions (Wu & Porell, 2000).

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Negative Emotions and Unhealthy Behavior

→

Bodily Reactions

→

Illness

Thus far, I have established that people respond to perceived injustices in waysthat prompt negative emotions (path 1) and unhealthy behaviors (path 2) andthat these negative emotions themselves may trigger unhealthy behaviors(path 3). Now, I consider how these emotional reactions (path 4) andunhealthy behaviors (path 5) manifest themselves as bodily reactions, whichin turn, are linked to illness (path 6). I combine bodily reactions and associ-ated illnesses in this discussion because they tend to be linked inextricably byresearchers, many of whom are interested in negative bodily reactions prima-rily because of the illnesses to which they are associated.

Reactions to negative emotions.

Research has established not only thatinjustices are linked to illness but that biological pathways mediate this rela-tionship. For example, the anger associated with underpayment inequity andhigh ERI has been linked to high levels of ambulatory blood and heart ratethroughout the working day (Vrijkotte, van Doornan, & de Geus, 2000). Thesame study also found that anger is associated with lower vagal tone—that is,low variability in heart rate during respiratory cycles.

6

Such evidence of height-ened cardiovascular activity is of concern because it has been linked to thedevelopment of cardiovascular disease (Schwartz et al., 2003; Treiber et al.,2003), suggesting that it is a mechanism involved in findings linking injusticeto CHD (e.g., Kivimäki et al., 2005)

Additional research has focused on another biochemical pathway to CHD.For example, Siegrist, Peter, Cremer, and Seidel (1997) reported that prolongedperiods of heightened emotional states are linked to high levels of atherogeniclipids, such as LDL cholesterol, and plasma fibrinogen. This is in keeping withthe suggestion by Richards, Hoff, and Alvaranga (2000) that the primary factorresponsible for the adverse health effects of injustice is elevated serum lipids,whose connection to injustice has been revealed in controlled laboratory exper-iments (Vermunt & Reil, 2005). Two particular inflammatory and procoagu-latnt responses have been implicated in this connection: C-reactive protein(CRP) and von Willebrand factor (vWF). Synthesized in the liver, CRP is anacute-phase reactant that is predictive of CHD (Armani & Becker, 2005). vWFalso predicts CHD but works differently (Whincup et al., 2002). Released fromvascular endothelial cells and platelets, wVF promotes thrombus formation bystimulating the aggregation of platelets to the walls of damaged blood vessels.

Using CRP and vWF as markers, Hamer et al. (2006) studied 92 healthymen in England who were employed full time. These researchers found thatboth CRP and vWF were elevated among workers who believed they failed toreceive rewards that were in keeping with the levels of effort they exerted onthe job (i.e., when ERI was high), suggesting that their risk of CHD was high.Together with findings suggesting that high levels of ERI are associated withincreases in CHD (e.g., Kivimäki et al., 2002), it would appear worthwhile to

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monitor levels of key serum lipids among workers experiencing workplaceinjustice in an effort to detect potentially fatal conditions.

Reactions to unhealthy behavior.

Medical researchers have found, notsurprisingly, that the forms of unhealthy behavior studied in conjunction withorganizational injustice—sedentary lifestyle, smoking, and excessive alcoholconsumption—themselves are linked to bodily reactions that subsequentlylead to ill health. Because these connections are more likely to be of interest tomedical researchers than management researchers, I will discuss them onlybriefly. My main objective here is to establish that there are indeed bodilyresponses involved.

In the case of sedentary behavior, evidence suggests that the body respondsby lowering levels of HDL (so-called “good cholesterol”) and by raising bloodtriglyceride levels (Katzmarzyk, Church, Craig, & Bouchard, 2009). Suchresponses have been linked to CHD, in part due to hypertension resultingfrom raises in body mass index (Rankinen, Church, Rice, Bouchard, & Blair,2007). And, with respect to mental reactions, the obesity that results from sus-tained levels of sedentary behavior has been linked to depression (Onyike,Crum, Lee, Lyketsos, & Eaton, 2003).

7

The physiological effects of cigarette smoking and from excessive alcoholdrinking have been well established and need not be reiterated here. Somepeople respond to perceive injustices by increasing smoking (Kouvonen et al.,2007) and drinking (Kouvonen et al., 2005), ostensibly in an effort to reducethe stresses and adverse emotional reactions (Feldner, Babson, & Zvolensky,2007; Pohorecky, 1991) that result from feelings of injustice. In such cases, ofcourse, the escapes come at exceptionally high costs when one takes intoaccount the highly carcinogenic effects of smoking (Bellenir, 2004)

8

and thetoxic effects of excessive alcohol consumption (Royal College of Physicians,2001).

Mitigating Illness by Promoting Organizational Justice

Considering the ill-health effects linked to perceptions of organizational injus-tice, it is encouraging that some studies have reported interventions successfulin reducing health problems among employees by enhancing their percep-tions of organizational justice. These may be considered

primary prevention

studies, since they are designed to assess the prophylactic effects of interven-tions aimed at lessening the degree to which injustice is experienced. Giventhe direct relevance of this work to the present paper, I describe it in somedetail.

Another approach to minimizing adverse reactions to injustice amongemployees focuses on

secondary prevention

, typically in the form of stress-reduction techniques designed to help employees manage adverse reactionsbefore their cumulative effects become any more serious. Because few studies

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have examined stress-management efforts linked specifically to workplaceinjustices, I describe secondary-prevention efforts only briefly and with thehope of encouraging such research.

Finally, because tertiary prevention involves treating the medical symp-toms of stress, it falls outside the purview of this paper (and my expertise), soI will not discuss it at all. Still, the fact that 75–90% of all visits to physicians’offices are for stress-related ailments and complaints (American PsychologicalAssociation, 2006) suggests that preventative measures, if they are used, arehaving only limited benefits. Regardless of their approach to treating stress-related ailments (Everly & Lating, 2002), physicians involved in such activitiesare unlikely to be lacking business.

Primary Prevention: Prophylactic Benefits of Interactional-Justice Training

In commenting on the challenges of developing techniques for avoiding injus-tice in the workplace, Ferrie et al. (2006) noted that “it is not clear exactly what‘treatment’ should be designed to increase perceptions of justice” but that itmay be “possible to train supervisory staff in interpersonal skills and goodpractice” (p. 449). Indeed, I have done precisely this (Greenberg, 2006, 2008).

Greenberg (2006, 2008).

Building upon research revealing that peopletreated with high levels of interactional justice are inclined to accept unfavorableoutcomes, such as pay cuts (Greenberg, 1990), unfavorable policy changes (Green-berg, 1994), and job losses (Lind, Greenberg, Scott, & Welchans, 2000), I developedand tested an intervention (Greenberg, 2006) designed to help employees accepta pay cut by training their supervisors in how to promote interactional justiceamong their subordinates. I examined self-reports of insomnia (using the scalevalidated by Jenkins, Jono, & Stanton, 1996) by nurses at four hospitals belongingto the same parent company located in different cities in Northeastern UnitedStates. As part of a reorganization plan, the compensation system for nurseswas changed in two of these hospitals such that their pay was reduced by approx-imately 10%. Nurses’ pay was unchanged in the other two hospitals at the timeof the study. In one hospital in each group, I trained the supervisors of the nursesin ways of promoting interactional justice in the eyes of subordinates. I did thisby giving lectures, analyzing case studies, and conducting interactive exercisesin sessions held over two four-hour days. Specifically, training focused on threeinterpersonal aspects of interactional justice—(1) treating others with politeness,dignity and respect, (2) demonstrating emotional support, (3) avoiding intim-idation, manipulation and degradation—and three informational aspects—(1)providing thorough, accurate and complete explanations, (2) communicatinginformation in a timely manner, and (3) being accessible to others.

Insomnia ratings were collected at four time points over a 39-week periodrelative to the introduction of training. The stressful nature of the pay cuts(as suggested by equity theory in response to underpayment) was reflected by

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the high levels of insomnia reported by nurses who experienced those reduc-tions. Specifically, the insomnia levels of nurses who suffered pay cuts wassignificantly higher than those of (a) nurses whose pay was unchanged and(b) themselves before their pay was reduced. Revealing that the trainingintervention was effective, the levels of insomnia displayed by these nursesdropped significantly after their supervisors were trained in ways of promot-ing interactional justice. In keeping with earlier research, these findings sug-gest that high levels of interactional justice attenuate people’s negativereactions to unfavorable outcomes. More importantly, they reveal that super-visors can be trained successfully to bring about these beneficial effectsamong their subordinates.

It is noteworthy that I have replicated these dramatic findings in anotherstudy (Greenberg, 2008). Instead of involving pay cuts as a source of distribu-tive injustice, this investigation focused on insomnia among factory workers,some of whom worked under conditions in which layoffs occurred. This effec-tively increased these workers’ workloads while also prompting insecurityabout their own futures with their company. As part of a complex quasi-experimental design, I used the same protocol used for the nursing supervi-sors to train the foremen of some of these factory workers in ways to promoteinteractional justice among their direct reports. Compared to the nursingsupervisors, however, foremen’s spans of control were broader, and they alsohad more limited contact with their charges. As a result, they had more lim-ited opportunities to communicate in ways that enhance interactional justiceamong subordinates. Despite this, foremen who were trained to promoteinteractional justice successfully mitigated insomnia among their directreports.

Another methodological difference between my two intervention studiesdeserves mention. In the nursing study (Greenberg, 2006), supervisors weretrained only

after

the pay cut was introduced, thereby creating a situation inwhich the need to implement their interactional justice skills was madesalient. In other words, supervisors provided a therapeutic benefit by helpingworkers respond to an undesirable outcome. Such a condition was created inthe factory study as well (i.e., training followed information about the layoff).In addition, the factory study also included a condition in which foremenwere trained in interactional justice

before

the layoffs were announced. Underthese conditions, supervisors had opportunities to respond to their subordi-nates’ concerns at the time they arose, thereby

inoculating

them from adverseemotional effects in the first place. Not surprisingly, the effects of trainingin interactional justice were even stronger under these conditions. Takentogether, these findings suggest that interactional-justice training shouldbe made a part of the training regime of all supervisors, arming them withskills they can use both when negative outcomes present themselves and ineveryday interactions.

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In these two studies, the beneficial effects of interactional-justice traininginvolved improving the emotional states of workers who suffered distributiveinjustices resulting from organizational changes that affected them adversely.Ideally, such negative reactions could be avoided altogether, eliminating per-ceptions of distributive justice (i.e., by not reducing pay or by not increasingworkloads due to layoffs). However, given the rapidly changing nature oforganizations coupled with people’s inherent sensitivities to their own relativeoutcomes in the workplace, it seems inevitable that people may perceive atleast some minor degree of distributive injustice on a regular basis. With thisin mind, it is especially important for supervisory personnel to help managetheir subordinates’ perceptions of—and reactions to—injustice by promotinginteractional justice. Fortunately, the training protocol contains no uniquecontent: the six skills used to enhance interactional justice are among the mostbasic foci of existing effort to develop fundamental managerial competencies.Clearly, however, the successes of my intervention studies suggest that suchtraining deserves to be stepped up and made more salient, perhaps throughthe use of “booster shots” to regularly scheduled training initiatives.

Bourbonnais et al. (2006a, 2006b).

Fortunately, I am not alone in exam-ining the health-promoting benefits of enhancing perceptions of organiza-tional justice in the workplace. A team of Canadian health researchers,Bourbonnais, Brisson, Vinet, Vézina, and Lower (2006b), developed andimplemented a broadly based participative intervention designed to improvethe well-being of hospital employees by enhancing various elements of theirpsychosocial work environments (including the promotion of organizationaljustice). Specifically, following a series of interviews with staff members, theresearchers worked with hospital personnel to develop 56 different initiativesdesigned to make various changes in their organization, some of whichincluded promoting organizational justice:

• To promote distributive justice, job rotation plans were introduced. Theseavoided uneven distributions of work, and permitted sharing evenly theburden for performing undesirable tasks.

• To promote procedural justice, supervisors agreed to involve nurses in themaking of decisions into which they have input.

• To promote interactional justice, team meetings were conducted to iden-tify ways of enhancing the levels of dignity and respect that nurses receivedfrom their coworkers.

The effectiveness of these and other interventions were evaluated a year laterby comparing the health status of employees before and after they wereinvolved in these interventions and with those of a control group of comparablehospital employees who were not involved in the interventions (Bourbonnaiset al., 2006a). Specifically, within the intervention group, the researchers

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reported a significant reduction in sleep-related problems, as well as a reduc-tion in reports of burnout. Unfortunately, the very broad nature of the entireset of interventions used in the study makes it impossible to determine theunique benefits of any single event, making it challenging to replicate thesebenefits elsewhere. Regardless, supplementing Greenberg (2006, 2008), thefindings of Bourbonnais and his associates tell a compelling story about thepotential to use justice-based interventions as a primary mechanism for pro-moting occupational health.

Utility and Ethics of Interventions.

The costs and benefits of organiza-tional-justice-training interventions beg to be considered relative to the alter-native—doing nothing. Might organizations expect to receive sufficient “bangfor the buck” to make such justice interventions worthwhile investments? Adefinitive answer to this question would require evidence from far morejustice-training intervention studies than have been conducted to date. Thefew such studies that have been reported have revealed consistently positiveresults with respect to various organizational and individual outcomes (for areview, see Greenberg, 2009a). In the case of health-related outcomes, what weknow is so preliminary as to suggest that future organizational interventionsbe presented to host organizations as experimental research as opposed topractices whose effectiveness has been established.

Based on available evidence, there would be little reason to suspect thatorganizations undertaking such interventions would experience anythingother than low costs and high benefits. Training protocols are simple toadminister and can be incorporated into more broadly based managerialtraining programs requiring offsite participation by trainees in two four-hoursessions. To date, results have revealed significant reductions in stress reac-tions taking the form of insomnia (Greenberg, 2006, 2008). Although specificfinancial benefits resulting from the training have not yet been established,the high costs of insomnia in the workplace to both employees (Martin, Aik-ens, & Chervin, 2004) and their organizations (Godet-Cayré et al., 2006) aresuch that its reduction promises to be beneficial to these victims, if only tem-porarily. Admittedly, this presents a Catch-22 situation. To establish thedefinitive health benefits of specific training initiatives requires additionalresearch and for organizations to consider hosting such research; they surelywill want to believe that the results will be beneficial. With this simple cost–benefit analysis to guide us, however, participating in research involvingjustice-training interventions would appear to be worthwhile investments forhost organizations.

The justice-training interventions described here should be consideredalong with several other psychosocial interventions whose highly cost-effectivenature has been established in a variety of medical settings (Sobel, 1995).Indeed, a host of inexpensive programs designed to educate patients about

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ways of coping with the conditions they face have been effective in improvinghealth (Friedman, Sobel, Myers, Caudill, & Benson, 1995). Two mechanismshave been proposed that account for these effects. First, it is possible that psy-chosocial risk factors increase disease susceptibility because they lower hosts’resistance to disease. A second possibility is that psychosocial factors influenceadaptation to illness.

Both mechanisms appear to be involved in the case of interventionsdesigned to raise levels of interactional justice. For example, it is possible thathigh levels of interpersonal justice will mitigate the physiological reactionsthat ultimately result in illness (Boaz, 2002). Also, because interactional justiceexposes victims of injustice to new information regarding their stressors, suchindividuals are likely to receive social support that helps them learn new waysof coping with the symptoms while also enjoying the comfort of knowing thatthey are not alone in their suffering (Tomaska, Thompson, & Palacios, 2006).Although these are reasonable possibilities based on extrapolations from otherpsychosocial interventions in medical settings (Friedman et al., 1995; Sobel,1995), it is clear that additional research is required to determine their directapplicability to interventions involving interactional-justice training.

In concluding this section, mention should be made of the potential forabuse that may arise if organizational leaders treat employees in a distribu-tively unfair manner (e.g., by cutting pay) based on the belief that they cansubsequently neutralize any resulting adverse reactions. Obviously, if an injus-tice were created intentionally with nefarious motives, it would be highlyunethical. Having the opportunity to offset employees’ harm (at least some-what) does not give managers the right to inflict harm for its own wake.

Sometimes, however, undesirable conditions must be created as a byprod-uct of efforts to promote the greater welfare. This occurs, for example, whenpay cuts are introduced in an effort to save jobs, as has been occurring widelyin recent years (Kiviat, 2009; O’Donnell, 2008; Zimmerman, 2009). Undersuch circumstances, it may be argued that management has an ethical obliga-tion to minimize the adverse psychological impact of this practice, such as bytraining managers to treat employees in an interactionally fair manner. Thisobligation is augmented by the fact that evidence (Greenberg, 1990, 2006)points to the effectiveness of palliative treatments in such instances.

This discussion resurrects classic arguments regarding the need for organi-zations to draw on knowledge from social scientists (Baritz, 1960) whilealso serving the interests of the individuals working in them (Brief, 2000).Interactional-justice training interventions clearly do both. The introductionof such techniques clearly is not value free, as some would advocate. Rather, itrepresents an effort to promote the welfare of human beings under conditionsthat otherwise would be more difficult to endure. And the admonition—indeed, the obligation—of social scientists to do precisely this has been voicedrepeatedly over the years by individual scholars (Connell & Nord, 1996;

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Howard, 1985; Lefkowitz, 2008) and is embraced by professional organiza-tions (e.g., American Psychological Association, 2002).

Secondary Prevention: Justice-Inspired Stress Management

Given the prevalence of adverse health reactions to workplace injustice, it isapparent that it is not always possible to minimize injustice perceptions attheir sources. Indeed, the broader problem of illness stemming from work-place stress has created a vast industry devoted to helping workers cope withwork-related stress, including no lack of self-help books on this topic (e.g.,Davis, Eshelman, McKay, & Fanning, 2008; Smith, 2008).

Although it is limited, evidence suggests that stress-related health problemsstemming from perceptions of injustice are responsive to secondary preven-tion initiatives—that is, efforts to reduce the adverse effects of stress (Kinman& Jones, 2008). Indeed, it has been found that perceptions of ERIs are respon-sive to stress-management programs based around organizational change(Lavoie-Tremblay et al., 2005; Tsutsumi & Kawakami, 2004).

From a justice-specific perspective, any conceptualization of organiza-tional justice has the potential to inform interventions designed to manageworkplace stress and improve employee health. In the case of ERI, for exam-ple, it would appear that stress could be reduced by doing such things as bal-ancing the rewards received with the effort expended on the job and makingrewards commensurate with employees’ qualifications. To my knowledge,Aust, Peter, and Siegrist (1997) report the only study that uses justice-basedinterventions to reduce employee stress. Participants in this study were 54highly stressed male inner-city bus drivers. Approximately half were assignedto the intervention group, requiring them to attend a 12-week programdesigned to raise awareness of the adverse effects of ERI, whilst members ofthe control group were involved in no such activity. The intervention con-sisted of training in methods of relaxing, coping with anger, and managingconflicts with superiors. All participants completed a measure of need for con-trol, regarded to be an unhealthy way of coping with job demands. Comparedto the pre-intervention period, drivers trained in these techniques revealedsignificantly lower amounts of need for control 12 weeks after the trainingended. At that time, members of the trained group also showed significantlylower scores on this measure than members of the control group. Assumingthat self-reports of need for control translate into behavioral efforts to avoidexcessive control (which can have unhealthy effects) (de Rijk, Le Blanc,Schaufeli, & de Jonge, 1998), the findings suggest that participants derivedhealth benefits from the training.

Based on these findings, the authors concluded that “a theory-based work-site stress management program in an occupational risk group is feasible andshows beneficial psychological effects” (Aust et al., 1997, p. 297). As appealingas this suggestion may be in the abstract, there is good reason to question the

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extent to which the researchers’ findings constitute evidence supportive of ERI.This is because the interventions suggested by ERI that were used in theirresearch are far from unique to the theory itself. Indeed, any number of sourcessuggest that efforts to promote relaxation, coping, and anger-managementskills are effective means of mitigating the harmful effects of stress (e.g., Daviset al., 2008; Groves, 2004). By itself, ERI suggests no unique techniques forhelping people deal with stress in ways that promote health. Thus it need notbe introduced in this regard. I am not saying that the theory is irrelevant butthat its contributions in this connection are far from unique and fall within aset of suggestions that could be derived from other approaches.

Intellectual honesty requires that I level the same criticism against my ownstudies on training managers in ways of promoting interactional justice(Greenberg, 2006, 2008). That is, we do not need to draw on research and the-ory on interactional justice to realize that certain sources of illness may beavoided by failing to treat people in a manner that is interpersonally affronting(Davis et al., 2008). Where the theory provides benefits, however, is in shed-ding light on how and why those effects occur. And this, in turn, promises tobe the basis for future interventions that may not only have more unique con-tent but that also may be more effective.

Limitations and Future Directions

The research reviewed here makes a compelling case for a link betweenperceptions of injustice and health. However, several limitations in this workneed to be addressed and new directions need to be pursued to understandthese relationships fully and to use them as the basis for reducing health risksin the workplace. I discuss these here.

Methodological Concerns

Throughout this paper, various methodological issues have arisen thatwarrant mention because of the limitations they pose to our understanding ofthe connection between injustice and illness—and, as such, their implicationsfor future research on this topic. I address two such issues here—commonmethod variance and causality.

Common method variance.

In commenting on the justice and healthliterature, Kawachi (2006) has cautioned—correctly, in my opinion—thatcommon method variance may artificially inflate correlations given thatreports of both health problems and experiences of justice come from thesame individuals. Ferrie et al. (2007) acknowledge that although this may betrue on some occasions, there have also been studies—many of which werecited here—in which objective health measures are used. These include medi-cally certified sickness absence (Elovainio et al., 2002), as well as recordsrevealing both incidents of CHD (Kivimäki et al., 2005) and deaths stemming

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from it (Kivimäki et al., 2006). Importantly, these investigations have revealedresults that are

not

significantly different than those in which self-reportmeasures of health were used. Such findings may bolster to some extent confi-dence in the validity of studies using self-reported, single-source data.

Despite this, it still is useful to improve upon research designs in which thepotential for common method variance exists. As a recommendation fordoing this in future studies linking justice and health, Kawachi (2006) hassuggested aggregating individual justice responses at the group level, therebyconceptualizing organizational justice as an organizational-level characteristicinstead of an individual perception. Indeed, there is precedent for doing thisin research on procedural justice climate (e.g., Ambrose & Schminke, 2007;Rupp, Bashshur, & Liao, 2007), in which justice is routinely conceived of atthe unit level of analysis. Ferrie et al. (2007) note that such an approach hasalso been used in research linking justice and health.

In one study, for example, aggregate indices of procedural justice andinteractional justice were formed by computing mean procedural and interac-tional justice scores of hospital workers employed in various departments(Kivimäki et al., 2007). The researchers found that individual-level and group-level justice measures predicted subsequent mental disorders equally well.Despite this, other research has revealed that group-level reports of interac-tional justice were

less

predictive of absences due to medically certified sick-ness than were individual-level reports. As Ferrie et al. (2007) note, however,this is not surprising in view of the fact that interactional justice perceptionsare primarily individual responses to other individuals. Thus group-levelaggregation as a solution to the problem of common method variance maynot always be applicable.

Causality.

Noting the correlational nature of prospective cohort studies,Ferrie et al. (2007) acknowledge that it is very difficult to implicate organiza-tional justice as a direct cause of health using the strict criteria established inmedical research (Hill, 1965). However, suggestive evidence of causality doesexist. For example, Ferrie et al. (2006) examined changes in interactionaljustice reported over time relative to the onset of psychiatric problems. Theresearchers reported that psychiatric morbidity dropped as perceptions ofinteractional justice rose, and rose as perceptions of organizational justicedropped. Commenting on these findings, Kawachi (2006) noted that they“bolster the case that reverse causation is not the major explanation for theobserved association” (p. 578). At the same time, however, Kawachi (2006)also cautioned that “if health declines and changes in perceptions of justice arecontemporaneous, it is difficult to completely rule out reverse causation, evenwith longitudinal change analysis” (p. 578).

Also addressing the matter of causality, Ferrie et al. (2006) argue thatcontrolled experiments on justice and health are called for but are difficult to

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230 • The Academy of Management Annals

conduct in the workplace. The closest we come to such studies are the quasi-experiments used by researchers conducting some intervention studies. Takemy interactional-justice training studies, for example (Greenberg, 2006, 2008).It is important to note that the naturalistic nature of these quasi-experimentsprecluded the possibility of assigning participants at random to all conditions,as typically would occur in true experiments. Although these studies may fallshort of creating the ideal conditions for establishing causality in medicalresearch (e.g., as advanced in the classic work of Sir Austin Bradford Hill,1965), it is safe to consider them a major step in this direction. Noting thismethodological improvement, I regard as prematurely pessimistic the opinionof Ferrie et al. (2007), expressed in their rejoinder to Kawachi’s (2006) cri-tique, that establishing a causal link between interactional-justice perceptionsand illness is unlikely to occur. Not withstanding limitations resulting fromthe challenges of randomly assigning participants to organizations, the natureof my quasi-experimental research design enhances confidence that the inter-actional-justice training intervention of supervisors did, in fact, reduce insom-nia among their subordinates.

Although not always expressed, causality appears to be assumed byresearchers conducting intervention studies (e.g., Aust et al., 1997). Indeed,the assumption of causality is fundamental to the research design: if injusticecauses ill health, then good health should be promoted by doing things to raisethe levels of organizational justice. If the relationship were not inherentlycausal, then efforts to promote justice could not be assured to being about thedesired health benefits, and the potential benefits of justice-promoting inter-ventions would not be realized.

Cultural Generalizability

The vast majority of investigations testing the association between injusticeand illness are prospective cohort studies. Over a period of time, the research-ers follow a group of individuals who are alike in most respects but who differin some key way—here, perceptions of justice (e.g., ERI, judgments of proce-dural justice and interactional justice). At various points throughout thestudy, period comparisons are made with respect to outcome variable of inter-est, which in the studies reviewed here are various assessments of health(usually self-reported). Most such investigations have focused on two largeand well-established cohorts—the “Whitehall II study,” involving over 10,000British civil-service workers based in London over about 10 years (e.g., Ferrieet al., 2006) and the “10 Town Study,” in which over 35,000 Finnish healthcare workers in hospitals located in 10 small towns were followed over sevenyears (e.g., Vahtera et al., 2004).

It is clear that these ambitious, long-term projects have revealed a greatdeal of valuable information about the connections between injustice and ill-ness. At the same time, however, an obvious question of generalizability arises

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Organizational Injustice • 231

whenever we study the same populations repeatedly. To what extent are thefindings of these two sets of studies generalizable to employees performingdifferent types of jobs in different cultures? Unfortunately, the dearth ofresearch falling outside these two cohorts makes it impossible to address thiscritical question.

I refer to this as “unfortunate” because nationality may play a key role indetermining people’s assessments of justice and their reactions to injustice(Greenberg, 2010). As a result, limiting our knowledge about the link betweeninjustice and illness to any two cultures is likely to restrict our ultimate under-standing of this relationship (Leung, 2005). It is likely, for example, that ques-tionnaire items tapping dignity and respect are likely to be interpreted verydifferently by Asians (into whose cultures such concepts are well engrained)than by the people from Western cultures on whom present findings arebased.

Because people from different cultures may have different feelings aboutthe importance of and sensitivity to the nature and form of their interpersonaltreatment from others (Kim & Leung, 2007), it is reasonable to suspect thatthey may respond in ways that have different impact on illness. Cultures alsodiffer with respect to people’s attitudes toward healthcare and their willing-ness to report various physical and mental symptoms (Hartog & Hartog,1983), and this also would be likely to influence the extent to which the studieslinking justice and health are culture-bound. With an eye toward overcomingsuch cultural constraints, I encourage future researchers to study the relation-ship between justice and health in a wider variety of cultural contexts. Whatsuch investigations may reveal promises to provide greater insight into thenature of justice and health.

Focus On Health and Well-Being Instead Of Disease

Throughout this article, my emphasis has been on adverse health stemmingfrom injustice. However, considering the movements toward positivepsychology (Seligman & Csikszentmihalyi, 2000) and positive organizationalscience (Dutton & Ragins, 2006), it is reasonable to consider the oppositepossibility—that justice promotes health. The disease-prevention orientationthat dominates the field of medicine (Breslow, 1999) and the prevailing focuson injustice as opposed to justice (Greenberg, 2006, 2009b), however, make itdifficult to find support for this possibility.

As Aspinwall and Tedeschi (2010) suggest, to claim that positive psychol-ogy concepts (e.g., optimism, sense of coherence) promote mental and physi-cal well-being requires identifying the pathways through which such effectsmay occur. Two such mechanisms have been identified. One of these is sug-gested by Antoni, Carver, and Lechner’s (2009) research on the psychosocialdeterminants of health among women with breast cancer. Specifically, theseresearchers propose that “positive factors” such as dispositional optimism and

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benefit finding may affect neuroendocrine and immune-system regulation,which in turn affect tumor growth through stress-induced dysregulation.Additional research suggests that the causal mechanism works in the oppositedirection as well. Specifically, people who find religious or spiritual meaningin their families’ histories of disease are inclined to take protective actionagainst becoming victims of such disease themselves (Leaf, Aspinwall, &Leachman, 2010) and to seek social support, and to find greater meaning inloss when they anticipate becoming victims (McIntosh, Silver, & Wortman,1993).

Despite the attention to factors such as optimism and spirituality in thesestudies, the research continues to focus on avoiding or reducing adverse reac-tions to disease. As such, questions could be raised about whether such effortstruly move us beyond the neutral point and toward a positive pole, as the pos-itive organizational science movement purports to do (e.g., Cameron, Dutton,& Quinn, 2003). Indeed, mechanisms have not yet been articulated that wouldexplain how the fair treatment of an individual would promote health and well-being (on this, see Greenberg, 2006). Arguing against the possibility of suchmechanisms is evidence suggesting that physiological reactions are triggeredby deviations from steady states and that these are more potent in cases of neg-ative stimuli than positive stimuli (Ito, Larsen, Smith, & Cacioppo, 1998).

In the case of organizational justice, I have argued elsewhere (Greenberg,2006) that the opportunities for positive deviations are limited to cases ofinteractional justice. One cannot exceed standards of distributive justicebecause it is a point where balance exists, and if exceeded, constitutes injus-tice. Neither can one exceed procedural justice in the form of voice, becausetoo much voice, as well as too little voice, is believed to be unfair (Peterson,1999). However, it is, in fact, possible for people to receive far higher levels ofinteractional justice than they might have expected. That this would promotejoy and positive feelings toward one’s organization follows from the literatureshowing positive attitudinal and behavioral reactions to high levels of inter-actional justice (Greenberg, 2010). What is not yet established, however, isthat this also promotes levels of mental and physical well-being beyond thenorm (i.e., to enjoy what economists might refer to as “abnormal returns” ontheir investment in interpersonal justice). In examining this possibility,researchers will have to contend with challenges stemming from people’srapid adaptation to positive conditions (Brickman & Campbell, 1971; Helson,1964) and with it, the absence of activating forces that would encourage indi-viduals to grow and flourish as suggested by the positive organizationalmovement (Frederickson, 2001).

Conclusion

My objective in preparing this paper was to shed light on health as anoutcome worthy of consideration by management researchers interested in

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organizational justice. To date, most management scholars have ignoredthis critical factor, focusing instead on reactions to justice outcomes whoseconnections to organizational functioning are more direct in nature, such asjob performance and attitudes (Greenberg, 2010; Greenberg & Colquitt,2005). However, considering that the importance of employee health as adependent variable is self-evident, and as outlined here, that a connectionbetween justice and health has been established, the value of further explor-ing this connection should be readily apparent. In fact, given that some ofthe relationships are matters of life and death (Kivimäki et al., 2002) andthat we already have knowledge about how to mitigate some of the causaldeterminants (Greenberg, 2006), the case for examining injustice as anoccupational health risk cannot be overstated. It is my hope that by analyz-ing the strengths and limitations of this topic, I will have stimulated someof my colleagues to address the many important issues that remain to bestudied.

A potentially exciting aspect of such efforts is that its grounding in themedical literature may require management scholars to collaborate withother professionals who have medical training. Such interdisciplinary effortspromise to be quite fruitful and beneficial in that they lead us to move indirections that we otherwise would not have pursued. In this connection, it isindeed encouraging that some management scholars have already publishedarticles in our field’s major journals that highlight the important roles of vari-ous biomedical and physiological connections (e.g., Dulebohn, Conlon,Sarinopoulos, Davison, & McNamara, 2009; Heaphy & Dutton, 2008). It ismy hope that the present work will build upon such efforts and blaze somefascinating new trails in the future.

Acknowledgment

The author acknowledges the helpful comments of Art Brief, MarkoElovainio, Deshani Ganegoda, Jim Quick, and Jim Walsh on an earlier draft ofthis article.

Endnotes1. Following customary usage in the organizational behavior and social psychology

literatures, the terms “justice” and “fairness” are used interchangeably in this arti-cle, as are “injustice” and “unfairness” (Greenberg & Colquitt, 2005). Also inkeeping with these literatures, all references to various forms of justice or injusticeare regarded as perceptual in nature. This stands in contrast to sociologicallyoriented conceptualizations of justice couched in terms of structural qualities(e.g., Tornblom, 1977) and philosophical approaches that reference moral ideals(e.g., Rawls, 1971).

2. On the distinction between hypothetical constructs and intervening variables,readers are referred to the classic article by MacCorquodale and Meehl (1948).

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3. Although Adams depicts overpayment as a negative state, experimental evidencesuggests that people actually may be pleased about it privately (Rivera & Tedeschi,1976).

4. Despite its lack of specificity, this scale has been validated in several studies inwhich more negative responses were found to be linked to occurrences of specificmedical problems requiring a doctor’s treatment and, at the extreme, to mortality(e.g., Idler & Angel, 1990; Miilunpalo, Vuori, Oja, Pasanen, & Urponen, 1997). AsElovainio et al. (2003) indicated, “More than 20 published studies have consis-tently shown that global self-rated health is an independent predictor of mortal-ity, despite the inclusion of numerous specific health status indicators and otherrelevant covariates known to predict mortality” (p. 289).

5. As used here, the term “rather” is used in the British colloquial manner to mean“somewhat.”

6. During stressful experiences, sympathetic nervous system activity heightens,allowing the heart rate to meet the challenge of boosting blood flow (Lane,Addcock, & Burnett, 1992).

7. Curiously, although there is considerable research on the physiological benefitsof exercising (e.g., United States Department of Health and Human Services,1996), studies of the effects of sedentary lifestyles are only now appearing.Importantly, from what is known thus far, these two lines of research are notparallel: the benefits of exercise are not necessarily the obverse of the costs ofsedentary behavior.

8. According to the American Cancer Society (2010), “Smoking damages nearlyevery organ in the human body, is linked to at least 15 different cancers, andaccounts for some 30% of all cancer deaths.”

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Organizational Injustice as an Occupational Health Risk

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