The Number One Reason Employees Get Sick….Perceived Unfairness at Work

March 6, 2016 by Ken Nowack

Sticks and stones can break my bones, but words can never hurt me.


Recent studies confirm that emotional hurt and rejection, whether part of social interactions or the perception of inequitable and unjust workplace conditions can actually trigger the same neurophysiologic pathways associated with physical pain and suffering (Eisenberger, Lieberman, & Williams, 2003).

In a nifty study by Naomi Eisenberger and colleagues at UCLA, she was able to use the latest technology to peer into the inner workings of our brain called functional magnetic resonance (fMRI) while a team was involved in a social exercise designed to provoke feelings of social isolation and rejection.

She studied what part of the brain was activated while a group of subjects played a computer game with other individuals they did not know. She created two possibilities of being rejected–either actively or passively (she told them they couldn’t not continue because of some technical problems). Comparison of fMRI brain activity in the active exclusion group versus inclusion conditions revealed greater activity in the part of the brain that is associated with physical pain (anterior cingulate cortex). Additionally, the subjects who were rejected also reported feeling psychological distress based on self-report measures ((Eisenberger, N., Lieberman, M. and Williams, K. (2003). Does rejection hurt? An fMRI study of social exclusion. Science, 302, 290-292)).

Current findings suggest that people report higher levels of self-reported pain and have diminished performance on a cognitively demanding task after reliving a past socially meaningful event than a past physically painful event ((Chen, Z., Williams, K., Fitness, J. & Newton, N. (2008).  When hurt will not heal. Exploring the capacity to relive social and physical pain.  Psychological Perspectives, 19, 789-795)).

Additionally, interpersonal judgment and social evaluation tends to elicit strong stress reactions with cortisol levels in our system being elevated fifty percent longer when the stressor is interpersonal versus impersonal ((Dickerson, S. & Kemeny. M. (2004).  Acute stressors and cortisol responses: A theoretical integration and synthesis of laboratory research. Psychological Bulletin, 130, 355-391)).  It might take approximately an hour for our cortisol levels to respond to “normal” after dealing with an upsetting interpersonal situation.

Perceived Unfairness and Employee Health

Quite a bit of research supports the idea that when employees experience injustice (distributive or procedural), psychological contract breach (e.g., feeling exploited in our work relationship with the company) or unfairness can negatively impact an employee’s health.

In a very comprehensive meta-analysis, 279 studies were reviewed to explore the association between employee perceived fairness at work and diverse health outcomes (e.g., absenteeism, job burnout, unhealthy behaviors, negative emotional states, and physical health problems ((Robbins, J. (2012).  Perceived unfairness and employee health: A meta-analytic integration.  Journal of Applied Psychology, 97, 235-272)).  Perceived unfairness was significantly associated with indicators of physical and mental health.

Several findings were interesting to note:

  1. Although unfairness was significantly associated with poorer health, the results suggested that unfairness was more strongly associated with indicators of strain and psychological conditions, rather than, physical health outcomes.
  2. Mental health problems were most pronounced for those experiencing distributive injustice (i.e., the kind of injustice related to distribution of rewards and recognition).
  3. Neither age or gender had any impact on the association between unfairness and health.
  4. Interactional unfairness (interpersonal interactions) was consistently one of the weaker predictors of employee health.  However, a closer look at the analyses suggested that interactional justice uniquely predict some health indicators such as job burnout and stress above and beyond distributive and procedural injustice.

These findings suggest that perceived unfairness is a pretty significant predictor of employee health and that the experience of interpersonal mistreatment (e.g., disrespect, bullying behavior, evaluative feedback) are highly associated with well-being.

We already know that working for a competent jerk can be a health risk ((Nyberg. et al., 2008.  Managerial leadership and ischemic heart disease among employees: The Swedish WOLF study. Occupational and Environmental Medicine, 66, 51-55)).

It would seem safe to conclude that both perceived social inequity, unfairness and negative interpersonal interactions might be more important than just impacting disengagement–it might actually directly lead to such health outcomes as job burnout, absenteeism and psychological distress…Be well…..

Kenneth Nowack, Ph.D. is a licensed psychologist (PSY13758) and President & Chief Research Officer/Co-Founder of Envisia Learning, is a member of the Consortium for Research on Emotional Intelligence in Organizations. Ken also serves as the Associate Editor of Consulting Psychology Journal: Practice and Research. His recent book Clueless: Coaching People Who Just Don’t Get It is available for free for a limited time by signing up for free blog updates (Learn more at our website)

Posted in Engagement, Wellness

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  1. terrific article Ken…so useful! Will be sharing this with many other people so thank you very much.

  2. Mickster says:

    You must be kidding me! People are getting promoted or congratulated and others are mad? Someone is and someone isn’t (fill in the blank)–that’s life. Not everyone will score a 100% on a test or be the MVP, not everyone is equal, and many are smarter, stronger, bigger, and faster than me and you! Those are facts. In reality we have many more failures than successes; it’s not how we fall, rather it’s how we get up. Some people just need to shut up, suck it up, get up, and drive o

  3. […] credit for your ideas or work? Does your boss deflect blame for project failures onto others? The number one reason employees get sick is due to perceived unfairness at […]

  4. Ann Scott says:

    Mickster, I don’t think it’s about somone being promoted or congratulated when others are not. Instead it’s about situations when those things are perceived to have happened unjustly. So for example, if you understand that the person who got the promotion had more related experience than you and it makes sense, then you wouldn’t have the related physical or mental symptoms that the article is talking about. It’s a case for transparency and internal perception of justice, not an expectation that everyone gets everything. I worked as a recruiter for many years and I most often found that people wanted to hear the outcome of the selection process (whether or not they got the position) and if the ultimate person who was hired had strong qualifications, most people were very accepting of the outcome. It was when they perceived that the person hired had fewer or less related qualifications than they had (whether or not the perception was accurate), that they would be upset because of the perceived injustice of the situation.

  5. Amelia Jayne says:

    How did you come to the conclusion that unfairness is the “Number One” reasons that Employees get sick. Seems like conjecture and bad analysis.

  6. Ken Nowack says:

    Perceived injustice or unfairness at work is one of the leading contributors to perceived stress which is significantly associated with absenteeism. Some current findings show a strong link between justice and absenteeism including:

    Ybema, J. et al. (2010). Effects of organizational justice on depressive symptoms and sickness absence: A longitudinal perspective. Social Science & Medicine, 70, 1609-1617.

    Ndjaboue, R. et al. (2012). Organisational justice and mental health: a systematic review of prospective studies. Occupational and Environmental Medicine, 69, 694-700.

    Stiller, M. et al. (2011). The employee as a punching bag: The effect of multiple sources of incivility on employee withdrawal behavior and sales performance. Journal of Organizational Behavior, 33, 121-139.

    Working with bullying bosses/colleagues and in organizations that don’t create a psychological climate for engagement, control, security and adequate salary/benefits has been linked empirically to both presenteeism and voluntary absenteeism at work due to poor physical health and psychological well-being.

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