Portugal's health in all policies: A comprehensive review of legal frameworks [version 2; peer review: 2 approved, 1 approved with reservations]

Introduction Health inequalities persist across Europe, highlighting the need for cross-sectoral strategies like Health in All Policies (HiAP). However, approaches to health and social policy vary across countries, implementation is difficult, and further evaluations are needed to assess the impact of policy decisions on health outcomes. This study evaluates the implementation of HiAP in Portugal, focusing on the effectiveness of public health measures, legislative actions, and governance structures to understand how HiAP is operationalized and its impact on public health governance up until October 31, 2024. Methods A scoping review of legal documents and a legal analysis were conducted from January 1, 2019, to October 31, 2024, following the PRISMA-ScR framework. The aim was to assess the integration and impact of the Health in All Policies (HiAP) approach, with a focus on understanding how HiAP is operationalized and its influence on public health governance in Portugal. Results Results reveal many foundational elements for a HiAP approach are already embedded in Portugal’s legal framework. Key laws are Article 64 of the Portuguese Republic Constitution, Article 168 of the Treaty on the Functioning of the European Union (TFEU), and the Health Bases Law. Yet, HiAP implementation has been inconsistent. Its effectiveness is hindered by gaps in policy coherence, political resistance, cultural barriers, and fragmented data-sharing, requiring stronger cross-sector collaboration, transparency, and accountability to fully address health inequalities. Conclusion The implementation of HiAP in Portugal has the potential to improve public health and reduce inequities. Achieving its full impact requires stronger policy coherence, political commitment to health equity, better intersectoral collaboration, and enhanced data integration.