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Racial Equity Impact Assessments as Tools for Advancing Population Health and Equity in Local Policy
Kellee White Whilby1, Makeda Walelo1, Heron Bondoc2
1School of Public Health, University of Maryland, College Park.
The Milbank Quarterly
|May 25, 2026
Summary
Racial equity impact assessments (REIAs) show nearly half of legislation advances equity, but adverse findings don't guarantee change. Strengthening accountability is key for REIAs to effectively reduce inequities.
Area of Science:
- Public Health Policy
- Health Equity Research
- Governmental Policy Analysis
Background:
- Local governments use racial equity impact assessments (REIAs) to integrate equity into policy.
- Limited empirical data exists on REIA findings and their legislative uptake.
- REIAs evaluate potential impacts of legislation before enactment.
Purpose of the Study:
- To analyze the characteristics of REIA findings.
- To examine how equity-focused evidence influences legislative processes.
- To assess the effectiveness of REIAs in promoting racial equity.
Main Methods:
- Descriptive analysis of 296 REIAs and 409 bill-level ratings in Washington D.C. (2021-2024).
- Categorization of REIA ratings: positive, adverse, neutral, inconclusive/negligible.
- Analysis of legislative outcomes for bills with adverse REIA ratings.
Main Results:
- 46.4% of REIA ratings indicated positive equity impacts; 9.0% identified adverse effects.
- Positive findings were common in health and economic policy; adverse findings in criminal justice, environmental, and infrastructure.
- 62.2% of bills with adverse ratings were enacted with modifications; 24.3% without.
Conclusions:
- REIAs identify potential policy equity impacts but do not ensure legislative action on adverse findings.
- Strengthening accountability structures is crucial for translating REIA findings into policy change.
- Integrating equity evidence into decision-making maximizes REIAs' effectiveness in advancing health equity.
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