Background: There has been a renewed interest in broadening the research agenda in health promotion to include action on the structural determinants of health, including a focus on the implementation of Health in All Policies (HiAP). Governments that use HiAP face the challenge of instituting governance structures and processes to facilitate policy coordination in an evidence-informed manner. Due to the complexity of government institutions and the policy process, systems theory has been proposed as a tool for evaluating the implementation of HiAP. Methods: Our multiple case study research programme (HiAP Analysis using Realist Methods On International Case Studies -HARMONICS) has relied on systems theory and realist methods to make sense of how and why the practices of policy-makers (including politicians and civil servants) from specific institutional environments (policy sectors) has either facilitated or hindered the implementation of HiAP. Herein, we present a systems framework for the implementation of HiAP based on our experience and empirical findings in studying this process. Results: We describe a system of 14 components within three subsystems of government. Subsystems include the executive (heads of state and their appointed political elites), intersectoral (the milieu of policy-makers and experts working with governance structures related to HiAP) and intrasectoral (policy-makers within policy sectors). Here, HiAP implementation is a process involving interactions between subsystems and their components that leads to the emergence of implementation outcomes, as well as effects on the system components themselves. We also describe the influence of extra-governmental systems, including (but not limited to) the academic sector, third sector, private sector and intergovernmental sector. Finally, we present a case study that applies this framework to understand the implementation of HiAP -the Health 2015 Strategy -in Finland, from 2001 onward. Conclusions: This framework is useful for helping to explain how, why and under what circumstances HiAP has been successfully and unsuccessfully implemented in a sustainable manner. It serves as a tool for researchers to study this process, and for policy-makers and other public health actors to manage this process.

PurposeThe purpose of this study was to describe factors that support and prevent managers' work wellbeing by reviewing international studies and interviewing Finnish social- and healthcare managers.Design/methodology/approachTwenty-two studies were identified in the systematic literature search. Seven social care and healthcare managers were recruited to participate in thematic interviews. Data were analyzed by using content analysis.FindingsSupportive and preventive factors for managers' work wellbeing were identified in the literature review, including managerial position, decision latitude, job control, social support and ethical culture at the workplace. The interviews further suggested that the supportive and preventive factors affecting social and healthcare managers' work wellbeing could be divided into five broad categories: (1) Individual factors, (2) Social factors, (3) Professional support from one's own manager, (4) Work-related factors and (5) Organizational factors.Originality/valueWe conducted a systematic literature search together with expert interviews to find the factors most crucial to managers' work wellbeing. These findings can assist social and healthcare organizations and policymakers to pay attention to these factors as well as in policies guiding them.

Male human service professionals had a higher risk of antidepressant use than men working in non-human service occupations. Gendered sociocultural norms and values related to specific occupations as well as occupational selection may be the cause of the elevated risk.

To investigate sickness absence due to mental disorders in human service occupations. Methods Participants (n=1,466,100) were randomly selected from two consecutive national nine-year cohorts from the Statistics Finland population database; each cohort represented a 33% sample of the Finnish population aged 25-54 years. These data were linked to diagnosis-specific records on receipt of sickness allowance, drawn from a national register maintained by the Social Insurance Institution of Finland, using personal identification numbers. Results Sociodemographic-adjusted hazard ratios (HRs) for sickness absence due to mental disorders in all human service occupations combined was 1.76 for men (95% confidence interval [CI], 1.70-1.84), and 1.36 for women (95% CI, 1.34-1.38) compared to men and women in all other occupations, respectively. Of the 15 specific human service occupations, compared to occupations from the same skill/education level without a significant human service component, medical doctors, psychologists, and service clerks were the only occupations with no increased hazard for either sex and the HRs were highest for male social care workers (HR 3.02; 95% CI, 2.67-3.41). Conclusions Most human service occupations had an increased risk of sickness absence due to mental disorders, and the increases in risks were especially high for men.