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Work disability following major organisational change: the Whitehall II study
  1. M Virtanen1,
  2. M Kivimäki2,3,
  3. A Singh-Manoux2,4,5,
  4. D Gimeno2,6,7,
  5. M J Shipley2,
  6. J Vahtera1,8,
  7. T N Akbaraly2,9,10,
  8. M G Marmot2,
  9. J E Ferrie2
  1. 1Finnish Institute of Occupational Health, Helsinki, Finland
  2. 2Department of Epidemiology and Public Health, University College London, London, UK
  3. 3Faculty of Behavioral Sciences, University of Helsinki, Helsinki, Finland
  4. 4INSERM U687-IFR69, Saint-Maurice, France
  5. 5Centre de Gérontologie, Hôpital Ste Périne, AP-HP, Paris, France
  6. 6Health Science Center at Houston, Division of Environmental and Occupational Health Sciences, The University of Texas School of Public Health, San Antonio Regional Campus, San Antonio, Texas, USA
  7. 7The Institute for Work and Health, Toronto, Canada
  8. 8Department of Public Health, Turku University Hospital, University of Turku, Turku, Finland
  9. 9INSERM U 888, Montpellier, France
  10. 10University Montpellier I, Montpellier, France
  1. Correspondence to Dr Marianna Virtanen, Finnish Institute of Occupational Health, Unit of Epertise for Work Organizations, Helsinki, FIN-00250, Finland; marianna.virtanen{at}


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.

  • Disability SI
  • employed C
  • epidemiology FQ
  • workplace

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  • Funding The Whitehall II study has been supported by grants from the Medical Research Council; British Heart Foundation; Health and Safety Executive; Department of Health; National Heart Lung and Blood Institute (HL36310), US, NIH: National Institute on Aging (AG13196), US, NIH; Agency for Health Care Policy Research (HS06516); and the John D and Catherine T MacArthur Foundation Research Networks on Successful Midlife Development and Socio-economic Status and Health. JEF is supported by the Medical Research Council (grant G8802774), MK, JV, TNA and MV by the Academy of Finland (grants 117604, 124271, 124322, 129262 and 133535), MK is also supported by the BUPA Foundation, UK, and the NIH/National Heart, Lung, and Blood Institute (R01HL036310-20A2) and the National Institute on Aging (R01AG034454), USA; ASM is supported by a “EURYI” award from the European Science Foundation and the National Institute on Aging (R01AG013196 and R01AG034454), MGM by an MRC Research Professorship and MJS by a grant from the British Heart Foundation.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the University College London Medical School committee on the ethics of human research.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.