The Fund supports networks of state health policy decision makers to help identify, inspire, and inform policy leaders.
A bipartisan group of state health policymakers from both the executive and legislative branches who are focused on improving population health.
Networks of state officials, advocates, and others aiming to invest in and transform primary care.
A program dedicated to advancing state-based efforts to make health care more affordable for residents, employers, and states.
The Milbank Memorial Fund supports two state leadership programs for legislative and executive branch state government officials committed to improving population health.
A leadership development program for early and mid-career state government officials who are committed to improving the health of all people in their communities.
A leadership program for senior state government officials who are committed to improving population health.
The Fund focuses on creating an affordable health care system built on strong primary care and partnerships that improve health outcomes for all.
Improving state leaders’ ability to enact and implement evidence-based health policies.
Advancing policies that create a more prevention- and primary care-oriented health system.
Improving population health through policies that contain health care cost growth.
Our state health policy resources offer relevant data analysis and best practices.
The Fund publishes reports, issues briefs, and case studies on state health policy issues.
Short takes on health policy issues from Milbank staff and guest authors.
Insights from Milbank President Debra Lubar on state health policymaking.
Reported articles and Q&As on timely health policy issues, as well as foundation updates.
Milbank Memorial Fund and Milbank Quarterly webinars featuring state health policymakers and researchers.
Updates and expert contact information for reporters.
The Milbank Memorial Fund is a private foundation that works to improve population health and health equity.
June 12, 2026
Quarterly Article
Yusra Murad
Kristina Medero
Chloe Gansen
Jasmine Sandate
Marissa Hallo
Sarah E. Gollust
September 2025
June 2024
June 2020
Back to The Milbank Quarterly
Policy Points:
Context: Building narrative power, a foundational strategy used in community organizing, involves dismantling dominant narratives that uphold inequity and constructing counternarratives that advance health equity and racial justice by reshaping how people make sense of the world. Yet, the mechanisms through which narrative power can influence public opinion and subsequent policy are seldom evaluated with research.
Methods: In partnership with a power-building organization, we developed and tested two counternarratives that challenge dominant framings of the US health care system. In this three-phase study, we (1) conducted interviews with community organizers to explore their motivations and health care experiences, (2) iteratively developed two counternarratives reflecting the system’s complexity and unaffordability, and (3) tested the counternarratives in a randomized experiment (N = 1,587), against a constructed dominant narrative and a no-message control. Following exposure to an assigned narrative, participants completed a posttest questionnaire measuring the primary (policy perceptions and intentions to participate in civic actions to improve health care) and secondary (perceptions of causal attributions and blame) outcomes.
Findings: Our results indicate the dominant narrative effectively individualizes blame for poor health and dampens motivation for civic engagement. Meanwhile, counternarratives rooted in the lived experiences and language of those most harmed by the system have potential to shift public beliefs, increase attribution for poor health to external factors vs. internal factors, and motivate some types of collective action.
Conclusions: Our findings show the dominant narrative about health care does what health justice organizers argue it is designed to do: perpetuate harmful myths of individual blame for structural problems, shifting blame for health challenges away from powerful institutions. However, there is potential for counternarratives to reframe public perception and motivate collective action. Our study underscores the value of research partnerships between grassroots organizers and academic researchers in developing narrative power strategies.