Health in All Policies in Sectoral Legislation: A Content Analysis of Selected Laws in the Republic of Srpska

Background: The Health in All Policies (HiAP) approach promotes the systematic integration of health considerations into policymaking across non-health sectors to address social determinants of health and improve population health outcomes. Although increasingly recognized internationally, the extent of its legislative implementation in the Republic of Srpska remains unclear. Objective: To assess the extent to which HiAP principles are embedded in sectoral legislation in the Republic of Srpska and to identify strengths and gaps in current legal frameworks. Methods: A structured content analysis of the text of laws was conducted across ten priority sectors. Twenty-two laws were reviewed using an analytical framework based on five core HiAP components: health outcomes, intersectoral governance, health equity, evidence-informed policymaking, and monitoring and accountability. The presence and distribution of these components were systematically examined across sectors. Results: Health considerations were frequently reflected in the text of the analysed legislation. Explicit references to health outcomes and intersectoral governance were identified in more than 60% of laws. However, integration was uneven across sectors. Health equity principles were inconsistently incorporated, while monitoring, evaluation, and accountability mechanisms were insufficiently developed, with explicit provisions found in fewer than half of the laws. No analysed law formally mandated Health Impact Assessment as a policy instrument. Conclusions: The Republic of Srpska has an existing legislative basis for advancing HiAP, but implementation remains fragmented rather than systematic. Addressing identified gaps—particularly in health equity, Health Impact Assessment, and health-oriented monitoring mechanisms—through targeted legislative reforms could improve policy coherence, accountability, and long-term sustainability. To our knowledge, this is the first systematic content analysis of HiAP integration in the sectoral legislation of the Republic of Srpska; it applies a replicable analytical framework derived from the WHO HiAP Framework for Country Action that is transferable to other decentralised and transitional governance settings.