title: Work disability following major organisational change: the Whitehall II study.
abstract: BACKGROUND
  Privatisation and private sector practices have been increasingly applied to the public sector in many industrialised countries. Over the same period, long-term work disability has risen substantially. We examined whether a major organisational change--the transfer of public sector work to executive agencies run on private sector lines--was associated with an increased risk of work disability.
  
  
  METHODS
  The study uses self-reported data from the prospective Whitehall II cohort study. Associations between transfer to an executive agency assessed at baseline (1991-1994) and work disability ascertained over a period of approximately 8 years at three follow-up surveys (1995-1996, 1997-1999 and 2001) were examined using Cox proportional hazard models.
  
  
  RESULTS
  In age- and sex-adjusted models, risk of work disability was higher among the 1263 employees who were transferred to an executive agency (HR 1.90, 95% CI 1.46 to 2.48) compared with the 3419 employees whose job was not transferred. These findings were robust to additional adjustment for physical and mental health and health behaviours at baseline.
  
  
  CONCLUSIONS
  Increased work disability was observed among employees exposed to the transfer of public sector work to executive agencies run on private sector lines. This may highlight an unintentional cost for employees, employers and society.
authors.affiliation: Finnish Institute of Occupational Health, Unit of Epertise for Work Organizations, Helsinki, FIN-00250, Finland. marianna.virtanen@ttl.fi
authors.forename: M
authors.initials: M
authors.lastname: Virtanen
authors.forename: M
authors.initials: M
authors.lastname: Kivimäki
authors.forename: A
authors.initials: A
authors.lastname: Singh-Manoux
authors.forename: D
authors.initials: D
authors.lastname: Gimeno
authors.forename: M J
authors.initials: MJ
authors.lastname: Shipley
authors.forename: J
authors.initials: J
authors.lastname: Vahtera
authors.forename: T N
authors.initials: TN
authors.lastname: Akbaraly
authors.forename: M G
authors.initials: MG
authors.lastname: Marmot
authors.forename: J E
authors.initials: JE
authors.lastname: Ferrie
mesh_terms: D000288:Administrative Personnel / Q000458:organization & administration; D000328:Adult; D015331:Cohort Studies; D004185:Disability Evaluation; D004651:Employment / Q000523:psychology*; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000453:epidemiology* / Q000523:psychology; D009936:Organizational Innovation; D011446:Prospective Studies; D017150:Public Sector; D013315:Stress, Psychological / Q000453:epidemiology / Q000523:psychology; D014940:Work Schedule Tolerance; D017132:Workplace / Q000523:psychology*
references.citation: J Epidemiol Community Health. 1996 Dec;50(6):653-60
references.pmid: 9039385
references.citation: Int J Epidemiol. 2005 Apr;34(2):251-6
references.pmid: 15576467
references.citation: Soc Psychiatry Psychiatr Epidemiol. 1999 Oct;34(10):533-40
references.pmid: 10591813
references.citation: Soc Sci Med. 1998 Jan;46(2):243-54
references.pmid: 9447646
references.citation: Int J Epidemiol. 1996 Feb;25(1):80-5
references.pmid: 8666508
references.citation: Epidemiol Rev. 2008;30:118-32
references.pmid: 18587142
references.citation: Occup Environ Med. 2003 Oct;60(10):765-9
references.pmid: 14504365
references.citation: WHO Reg Publ Eur Ser. 1999;81:127-49
references.pmid: 10533429
references.citation: Scand J Work Environ Health. 2006 Dec;32(6):431-42
references.pmid: 17173200
references.citation: J Public Health Med. 2000 Mar;22(1):59-67
references.pmid: 10774906
references.citation: Cardiol Rev. 2009 Mar-Apr;17(2):83-97
references.pmid: 19367150
references.citation: Occup Environ Med. 2003 Jan;60(1):3-9
references.pmid: 12499449