2026 Racial Equity Statement of Purpose

Race, Population Health, and Equity

The Board of Directors and staff of the Milbank Memorial Fund acknowledge and affirm that laws, practices, and societal norms that have categorized people by race — a concept with no biological basis — have harmed people of color in general and Black populations in particular for centuries in the United States. They have resulted in inadequate access to and use of high-quality health care, differences in patient experience, disparate health outcomes, and a medical and health care system that for many is not worthy of trust.

We believe that addressing inequities in health status, access to care, and outcomes of care that continue to harm historically under resourced and under represented groups in society is fundamental to improving population health. Moreover, it is not possible to achieve health equity for all populations without addressing broader social inequities that disadvantage members of racial and ethnic minority groups and Black populations in particular. These inequities in education, employment, housing, and other social and environmental factors directly influence population health.

Our Legacy

The Milbank Memorial Fund has a 100-plus-year history of making advances toward its stated mission of improving population health. Yet, like many organizations, we must acknowledge all of our history. 

Some of our organization’s own actions have reinforced and perpetuated the systemic racism that contributes to fundamental health inequities in this country. Historically, our efforts to improve population health in our programming and publications have not prioritized improving health equity. The racial and ethnic composition of our state health policymaker networks has not resembled the populations they serve. In our organization, disproportionate numbers of staff members, board members, partners, and network members, as well as the authors and reviewers of our publications and The Milbank Quarterly, have been white and socioeconomically advantaged. 

Most egregiously, the Fund played a role in the United States Public Health Service (USPHS) syphilis study at Tuskegee and Macon County, Alabama. Specifically, from 1935 to 1972, the Fund paid for services associated with the burials of men who died over the course of the study when their families agreed to autopsies. We acknowledge our role in creating this legacy. We deeply regret and apologize for the harm caused to study participants, their descendants, and all those affected by the study, and for taking five decades to acknowledge our involvement publicly. 

A comprehensive external audit of all Fund programming and publications since 1921 has identified that the Fund also supported, with funds or staff, six other studies that may have violated current standards of clinical research ethics. In these studies, requisite informed consent was not obtained and available remedies were not provided at the end of the study. These studies involved troubling lapses of ethical standards that we deeply regret. The most troubling was involvement in a survey conducted from 1942 to 1944 on the dietary habits and nutritional status of 400 indigenous persons conducted by the Canadian government in Northern Manitoba. 

Obligations

This legacy of racist and unethical studies is not in keeping with our mission, vision, and values, and it compels certain obligations. In all our work we must:

• With humility, attempt to create opportunities for justice and reconciliation where our racist actions have caused harm.
• Ensure that we never again are involved in unethical practices that may exploit or harm individuals or communities.
• Embed specific, affirmative strategies that promote diversity, equity, and inclusion within the governance and operation of our organization in each strand of our program work (currently state health policy leadership, primary care, and health care cost growth) and our editorial process and publications.

Commitments

In light of our obligations, we are committed to pursuing strategies in our own organization, our programming, and our publications that address ongoing health inequities among members of racial and ethnic minority groups and Black populations in particular. 

Specifically, we have undertaken or committed to the following actions: 

• Examining our history, and identifying, acknowledging, and developing means of remedying ways that the Fund contributed to the perpetuation of systemic racism and health disparities. This included (1) documenting the nature and extent of the Fund’s involvement in the USPHS syphilis study, past opportunities for the Fund to address this involvement, and the reasons for its action and inaction; (2) apologizing for our role in the USPHS syphilis study and acknowledging how the study reflected racist practices, harmed the men in the study and their descendants, and undermined the trustworthiness of the health care system for Black populations; (3) making material financial contributions to honor the legacies of the men who participated in the study; (4) building partnerships with the families of men in the study to help build a bridge from mistrust to trust; (5) commissioning an external audit of the Fund’s history to identify other instances of racist and unethical activities; and (6) commissioning and publishing an external review of the Fund’s governance practices. 
• As part of our annual planning process, examining our programs, investments, governance, editorial processes, and publications through an equity lens, and developing and executing strategies to: 
  • raise awareness and create urgency internally and externally around achieving health equity; 
  • steward all our organizational assets — material, financial, reputational, and human — in ways that promote equity; 
  • develop organizational competency and fluency around structural racism and the means of addressing it, including: 
    • listening to and learning from others with expertise and lived experience in equity-related work 
    • ensuring participation of representative perspectives and voices 
  • increase demonstrably the racial and ethnic diversity of our staff, board, partners, editorial contributors, and networks; 
  • build an internal organizational culture and means of convening networks of state health policy leaders in which everyone feels valued and respected; 
  • establish measurable goals for these commitments and track and publish data points that will enable assessment of progress toward them; and 
  • review and revise the selected strategies consistent with experience and lessons learned. 

2026 Initiatives

Given these obligations and commitments and our revised organizational mission, vision, and values, the following Milbank Memorial Fund initiatives will be implemented in 2026. (An assessment of progress on our 2025 initiatives is available.)

Organizational

• Become an organization that is and is viewed by staff as racially equitable and inclusive and values the full participation of individuals of diverse backgrounds.
  • Build the capacity of staff to incorporate diversity, equity, and inclusion into their work by applying our Equity Lens tool to strategic decisions; continuing staff-led learning and discussion sessions guided by our Building Equity at Milbank (BEAM) staff workgroup on a bimonthly basis; incorporating DEI goals into professional assessments and individual development plans; and conducting regular team discussions on holding to our values in challenging political environments.
• Document systems, policies, and practices to ensure transparency and identify areas for improvement.
  • Continue to conduct surveys to assess staff satisfaction and belonging and track organizational DEI metrics.
  • Continue to review and revise our human resources policies and procedures on a yearly basis using an equity lens.
  • Incorporate contractor and vendor selection practices that promote diversity, equity, and inclusion.
• Implement a mission-and-values-aligned investment strategy that is reflective of our organizational values.
  • Continue quarterly Board investment committee meetings with Cambridge.
  • Continue to implement the Socially Responsible Investment strategy.
• Plan for Board and staff DEI strategies and oversight implementation.
  • The Milbank executive team will meet regularly with the leadership of the Voices for Our Fathers Legacy Foundation to fulfill the partnership, with direction from the Ad Hoc Committee on DEI Oversight.
  • The Board will implement its framework for DEI action and measurement into ongoing committee work.

State Health Policy Leadership Programs

• Maintain participation by members of racial and ethnic minority groups in our two state leadership program cohorts that is representative of the US population.
  • Outreach and Engagement: Track and regularly assess applicant demographics to ensure we are seeing applications from every demographic. Review these metrics at set intervals throughout the recruitment process.
• Increase health policy leaders’ capacity to facilitate depolarizing conversations to advance racial health equity work in states.
  • Leadership Curriculum and Briefings: Integrate depolarization strategies and racial equity principles throughout the leadership program curriculum and Milbank State Leadership Network (MSLN) briefings to equip state health leaders with the tools needed to foster inclusive, equity-driven dialogues within their communities.
• Identify and promote best practices for programmatic interventions to promote health equity, recruiting consultants and faculty among people of color and ensuring that the strategies are relevant and applicable in environments in which it is challenging to advance this work.
  • Faculty & Curriculum Evaluation: Set evaluation intervals to assess whether sessions and speakers advance racial equity and are representative of the communities we aim to serve.
• Assure participation among representatives of the communities we aim to serve, including underrepresented racial and ethnic minority communities, in Milbank State MSLN briefings and as authors of MSLN publications
  • Demographic Data: Track demographics for MSLN authors and speakers and evaluate twice annually.

 Population Health Programs

• Support states in strengthening primary care, which reduces health disparities, as well as tracking the impact of rising health care costs and affordability policies on racial and ethnic minority populations.
  • Continue to develop Medicaid’s role in strengthening primary care, which is proven to reduce health disparities, by convening Milbank’s network of state Medicaid agency leaders and supporting the Primary Care Investment Network. Intentionally integrate and elevate discussions about health equity in meetings.
  • Commission primary care workforce publications with strategies, such as supporting nurse practitioners in primary care, that will improve access to primary care in underserved areas.
  • Leverage the Health of US Primary Care Scorecard to highlight the need for data on the racial and ethnic diversity of the primary care workforce.
  • Promote states’ focus on the impact of rising health care costs on health equity and encourage them to track the impact of affordability policies on marginalized populations.
  • Analyze the impact of federal policy changes on marginalized groups’ access to affordable health care.

The Milbank Quarterly

• Maintain or enhance The Milbank Quarterly’s identity as premier journal for population health scholarship
  • Maintain population health as the principal area of editorial interest for The Milbank Quarterly
  • Maintain health equity as one of 5 key areas of editorial interest forThe Milbank Quarterly, with at least 20% of published articles and opinions focused on health equity
  • Ensure that the 2026 special issue of the Quarterly includes articles that focus on health equity
  • Continue to participate in panel sessions at professional meetings (e.g., IAPHS, AcademyHealth) that promote the journal and its editorial interest in health equity to emerging scholars.
• Maintain or improve the representation of people of color among Milbank Quarterly contributors and reviewers
  • Maintain or increase the percentage of Milbank Quarterly reviewers and authors who are members of racial or ethnic minority groups
  • Consult Editorial Advisory Board members regarding best practices to increase the racial/ethnic, political, and geographic diversity of Quarterly authors and reviewers, and if necessary, convene an expert subset of members to assist in implementation.

Communications

•  Improve the racial and ethnic diversity of Milbank Memorial Fund writers
  • Maintain the percentage of Milbank Memorial Fund contributors who are members of racial or ethnic minority groups as 30% or higher.
    • Implement methods for capturing self-identification of racial and ethnic identity by reviewers and authors to improve accuracy and better ensure we are meeting this goal.
• Ensure that the Milbank Memorial Fund is using respectful and inclusive language that also resonates broadly.
  • Continue to update the Milbank Memorial Fund diversity, equity, and inclusion style manual to incorporate the latest evidence-based guidance.
• Ensure Milbank Memorial Fund publications advance our values of diversity, equity, and inclusion.
  • Apply Milbank’s Equity Lens to all blogs, briefs, and reports during commissioning and review; explore AI tools for equity assessment of publication drafts.