Academic Journal
Racial Equity Impact Assessments as Tools for Advancing Population Health and Equity in Local Policy.
| Title: | Racial Equity Impact Assessments as Tools for Advancing Population Health and Equity in Local Policy. |
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| Authors: | Whilby KW; School of Public Health, University of Maryland, College Park., Walelo M; School of Public Health, University of Maryland, College Park., Bondoc H; University of Maryland, College Park. |
| Source: | The Milbank quarterly [Milbank Q] 2026 Sep; Vol. 104 (3), pp. 593-606. Date of Electronic Publication: 2026 May 24. |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: Blackwell Publishers Country of Publication: United States NLM ID: 8607003 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1468-0009 (Electronic) Linking ISSN: 0887378X NLM ISO Abbreviation: Milbank Q Subsets: MEDLINE |
| Imprint Name(s): | Publication: Malden, MA : New York, NY : Blackwell Publishers ; Milbank Memorial Fund Original Publication: New York, NY : Published for the Milbank Memorial Fund by Cambridge University Press, c1986- |
| MeSH Terms: | Health Equity*/legislation & jurisprudence , Health Policy*/legislation & jurisprudence , Racism*/legislation & jurisprudence , Population Health*, Humans ; Policy Making ; Diversity, Equity, Inclusion ; Local Government |
| Abstract: | Policy Points Racial equity impact assessments (REIAs) provide policymakers with systematic evidence on how proposed legislation may affect racial equity and subsequently shape structural determinants of health. Across 409 bill-level equity impact ratings derived from 296 final REIAs from 2021 to 2024, nearly half of REIAs (46%) indicated that proposed legislation would likely advance racial equity, 9% signaled potential adverse effects, 10% were neutral, and one-third were inconclusive or negligible. REIAs provide an opportunity to assess potential equity impacts prior to enactment, informing policy design by helping policymakers anticipate harms and consider revisions that may support more equitable policy processes. The effectiveness of REIAs depends on a supportive political context and accountability structures, as adverse findings alone do not guarantee legislative action to mitigate inequities. 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. (© 2026 The Author(s). The Milbank Quarterly published by Wiley Periodicals LLC on behalf of The Milbank Memorial Fund.) |
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| Entry Date(s): | Date Created: 20260525 Date Completed: 20261006 Latest Revision: 20261006 |
| Update Code: | 20261006 |
| PubMed Central ID: | PMC13560478 |
| DOI: | 10.1111/1468-0009.70094 |
| PMID: | 42178806 |
| Database: | MEDLINE |
| ISSN: | 1468-0009 |
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| DOI: | 10.1111/1468-0009.70094 |