The Fund supports networks of state health policy decision makers to help identify, inspire, and inform policy leaders.
The Milbank Memorial Fund supports two state leadership programs for legislative and executive branch state government officials committed to improving population health.
The Fund identifies and shares policy ideas and analysis to advance state health leadership, strong primary care, and sustainable health care costs.
Keep up with news and updates from the Milbank Memorial Fund. And read the latest posts from our staff and guest authors.
The Fund publishes The Milbank Quarterly, as well as reports, issues briefs, and case studies on topics important to health policy leaders.
The Milbank Memorial Fund is is a foundation that works to improve population health and health equity.
June 1, 2026
Quarterly Article
Kellee White Whilby
Makeda Walelo
Heron Bondoc
Mar 3, 2026
March 2026
December 2025
Back to The Milbank Quarterly
Policy Points:
Context: Racial equity impact assessments (REIAs) are used by local governments to integrate equity considerations into policymaking and decision-making processes by evaluating potential impacts of proposed legislation before enactment. Despite their growing adoption, limited empirical evidence exists on how REIA findings are characterized or how equity-focused evidence is taken up within legislative processes.
Methods: A descriptive analysis of all racial equity impact assessments (REIAs) conducted in the District of Columbia between 2021 and 2024 (n = 296 REIAs; 409 bill-level equity impact ratings). REIA ratings were categorized as positive, adverse, neutral, or inconclusive/negligible and analyzed across eight policy domains (e.g., health and human services, criminal justice and public safety, budget and fiscal policy). Legislative outcomes for bills with adverse ratings were classified as enacted with modification, enacted without modification, or not enacted.
Findings: Nearly half (46.4%) of REIA ratings indicated positive equity impacts, while 9.0% identified potential adverse effects; 34% were inconclusive/negligible. Equity impacts varied substantially by policy domain, with positive findings concentrated in health and human services and economic policy and adverse findings more common in criminal justice, environmental, and infrastructure domains. Among bills with adverse ratings, 62.2% were enacted with modifications, 24.3% without modification, and 13.5% were not enacted.
Conclusions: REIAs provide a mechanism for identifying potential policy equity impacts prior to enactment, but adverse findings alone do not guarantee legislative action. Strengthening institutional accountability structures and the integration of equity evidence into decision-making processes is critical to ensuring that identified harms lead to meaningful policy change and to maximizing the effectiveness of REIAs as a tool to advance population health equity.