2024 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. 

2024 Initiatives

In light of these obligations and commitments and our revised organizational mission, vision, and values, the following Milbank Memorial Fund initiatives will be implemented in 2024. (An assessment of progress on our 2023 initiatives is available.) 

Organizational 

• Build the capacity of staff to incorporate diversity, equity and inclusion into their work by applying our Equity Lens tool to strategic decisions; formalizing staff-led learning and discussion sessions guided by our Building Equity at Milbank (BEAM) staff workgroup; and incorporating DEI goals into professional assessments and individual development plans  
• Implement a socially responsible investment strategy that is reflective of our organizational values 
• Codify Board DEI oversight responsibilities into Committee charters. The Board will oversee the Fund’s work and role in fulfilling the Fund’s commitment to an ongoing partnership with Voices for Our Fathers Legacy Foundation with direction from the Ad Hoc Committee on DEI Oversight 
• Continue to review and revise our human resources policies and procedures and vendor selection to promote diversity, equity, and inclusion 
• Continue our partnership with Voices for Our Fathers Legacy Foundation by collaborating with them on opportunities to share our joint story of “Harms and Healing,” raising scholarship funds for descendants, and developing a memorial at Tuskegee University 
• Continue to include opportunities to share expressions of individual identity into our network management activities 
• Determine internal organization structure best suited to ongoing organization culture and accountability to advance the Fund’s health equity commitment  

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  
• Increase health policy leaders’ capacity to facilitate depolarizing conversations to advance racial health equity work in states 
• Identify and promote best practices for programmatic interventions to promote health equity, recruiting consultants and faculty who are people of color, and ensuring that the strategies are relevant and applicable in environments in which it is challenging to advance this work 
• Increase participation among representatives of the communities we aim to serve, including underrepresented racial and ethnic minority communities, in Milbank State Leadership Network (MSLN) briefings and as authors of MSLN publications 

 Population health programs 

• Develop Medicaid’s role in strengthening primary care by convening and supporting the Making Care Primary (MCP) Network of state Medicaid agencies 
• Continue to support the newly established Primary Care Investment Network of states that are involved in developing, proposing, passing, or implementing legislation to measure and/or increase primary care spending as a percentage of total spending 
• Promote states’ focus on the impact of health care costs on health equity, including by supporting state communications focused on populations facing greater affordability challenges 

Communications 

• Maintaining health equity as one of four key area of editorial interest for The Milbank Quarterly, with at least 25% of published articles and opinions focused on health equity 
• Increase the percentage of Milbank Quarterly reviewers and authors, as well as Milbank Memorial Fund contributors, who are members of racial or ethnic minority groups 
  • Implement methods for capturing self-identification of racial and ethnic identity by reviewers and authors in order to collect more accurate data regarding the percentage of individuals who are members of racial or ethnic minority groups  
  • Maintain the practice of having at least one reviewer of  equity-related manuscripts be a member of a racial or ethnic minority group  
• ​​Additional one or two contributing writers are scholars of color 
• Update a diversity, equity, and inclusion style manual for both The Milbank Quarterly and the Milbank Memorial Fund 
• Continue a process to make the Milbank Memorial Fund website, including all new Milbank Memorial Fund publication PDFs, as well as Milbank virtual events, compliant with the Americans with Disabilities Act by, for example, using high-contrast colors and offering closed captioning