Implementing Racial and Social Justice Policies: A Qualitative Study of Three Local U.S. Jurisdictions

Abstract

Objective:

Processes for implementing racial equity and social justice (RESJ) policies are not well understood, despite their growing adoption across local governments. To address this gap, this qualitative study examines how practitioners navigate the day-to-day work of translating RESJ policy mandates into practice and the institutional, political, and organizational conditions shaping implementation across three jurisdictions in a large U.S. metropolitan area.

Methods:

We conducted in-depth, semi-structured interviews with 10 practitioners involved in RESJ policy implementation and identified through purposive sampling between June and November 2023. Interviews explored participants’ experiences with policy interpretation, community and stakeholder engagement, organizational capacity, accountability, and perceived policy impact. Data were analyzed using a reflexive thematic analysis.

Results:

Six themes and 14 subthemes were identified. The themes characterized participants’ experiences with interpreting and operationalizing policy mandates; organizational capacity and resource constraints; data infrastructure and practices; formal and relational accountability and oversight; emotional and ethical challenges; and political durability and risk. The findings illuminated key barriers and facilitators shaping policy adoption, acceptability, feasibility, fidelity, and sustainment, highlighting critical leverage points within RESJ policy implementation processes.

Discussion:

These insights underscore the need for greater institutional capacity, explicit and transparent accountability mechanisms, and sustained political and material support to strengthen RESJ policy implementation. Amid recent retrenchment of equity-focused policies, these findings provide guidance for policymakers and administrators seeking to design, implement, and sustain equity policies within local government systems.

Introduction

Racism is a determinant of population health, which manifests in various ways through unfair practices, processes, and policies that result in inequitable access to resources and opportunities.^1,2 These inequities also shape who participates in legislative decision-making, how policy problems are framed, and the types of solutions pursued, potentially contributing to the absence or inadequacy of policies that effectively address racism. ³ In response, racial equity and social justice (RESJ) policies, through legislation, executive orders, regulations, and administrative actions (i.e., statutes and rule-making), have been increasingly integrated into federal, state, and local governance. These efforts have largely comprised the creation of equity offices and government leadership positions, the development of racial equity action plans, and the use of tools such as racial equity impact assessments and mandatory equity training.^4,5

At the federal level, Executive Orders 13985 (2020) and 14091 (2023) on Advancing Racial Equity and Support for Underserved Communities Through the Federal Government established “whole-of-government approach to embedding equity principles within federal operations. These actions directed agencies to conduct equity assessments, develop equity action plans, and strengthen civil rights enforcement capacity across service delivery, procurement, and budgetary processes. ⁶ At the state level, Maryland, for example, has emphasized accountability and training mechanisms, including legislation requiring health care professionals to complete implicit bias training when renewing licenses. ⁷

Local governments, in the Washington, D.C., Maryland, and northern Virginia (DMV) metropolitan area, have been at the forefront of RESJ policy innovation. Montgomery County, Maryland’s Racial Equity and Social Justice Act (2019) ⁸ and Washington, D.C.’s Racial Equity Achieves Change Amendment Act (2021) ⁹ each established dedicated equity offices, mandated racial equity impact assessments (REIAs), required racial equity training for government employees, and incorporated equity action plans and performance tracking tools. Fairfax County, Virginia’s One Fairfax Policy (2016) similarly institutionalized equity action planning across county agencies, although it did not adopt a formal REIA requirement. ¹⁰ Collectively, these examples illustrate the range of mechanisms local governments are using to embed equity principles across governance and decision-making processes to tangibly address social and health inequities.

The development and implementation of RESJ policies represent a critical step toward advancing health equity because they target the structural and social determinants of health that shape opportunities for well-being. By formally integrating equity into decision-making, these policies aim to redress longstanding inequities produced and sustained by exclusionary policies and practices.^4,5 This attention to equity more broadly is critical given that racial/ethnic health inequities stem from interconnected systems in housing, education, employment, health care, and criminal justice that structure opportunity and risks. ¹¹ In this context, RESJ policies are a legislative and administrative lever for local governments to disrupt structural drivers of inequity by influencing how resources are allocated and services are delivered, reducing the adverse impacts of policy decisions, and improving the broader conditions that shape population health and promote health equity.

Research shows that policy effectiveness is in part a function of implementation, ¹² which is widely recognized as a distinct and critical stage in the policy process. ¹³ Evaluating implementation processes (e.g., policy adoption, acceptability, feasibility, unintended consequences, and sustainability) provides valuable insight into barriers and facilitators, illuminates gaps between planned and actual implementation, and informs strategies to strengthen uptake and sustainability of the policies needed for maximal impact.^14,15 Yet, there is a dearth of studies that have systematically examined the facilitators and barriers influencing the implementation of RESJ policies in practice.^16–18 In particular, there is limited understanding of the perspective of practitioners, the government staff and leaders responsible for the day-to-day operationalization of these policies, whose experiences shape how RESJ policies are enacted, monitored, and sustained within local government institutions.

Guided by these considerations, this study examines the experiences of practitioners implementing RESJ policies across three local jurisdictions in the DMV region. Specifically, we aim to ¹ identify barriers and facilitators that shape RESJ policy implementation and ² generate insights to enhance policy adoption, fidelity, and sustainability. By centering practitioner experiences, this study contributes to a limited but growing evidence base on RESJ policy implementation and offers practical guidance for advancing equity-oriented governance and health equity.

Methods

Study design

We employed Braun and Clarke’s approach to reflexive thematic analysis for this study. Reflexive thematic analysis is a qualitative method used to identify and interpret patterns of meaning across data to represent participants’ experiences, perceptions, and interpretations.^19,20 This approach aligns with our interpretive perspective and provides flexibility to combine inductive and deductive analysis in exploring practitioners’ experiences with RESJ policy implementation while acknowledging the active and reflexive role of the researchers throughout the analytic process.

Participant recruitment and selection

Participants were purposively selected from three jurisdictions to capture maximum variation in perspectives, based on their expertise and active involvement in implementing RESJ policies. Recruitment was conducted via email using organizational role lists and a snowball sampling approach to ensure representation across relevant government departments and agencies. Consistent with reflexive thematic approaches, data comprehensiveness was prioritized over saturation or sample size. ²¹ The study received ethical approval from the Institutional Review Board at the University of Maryland.

Data collection

The research team developed the semi-structured interview guide based on an iterative process of literature review and expert consultation. ⁹ Two consultants, based on their expertise and experience in evaluating policy implementation processes, were selected to provide input on the scope and content of the tool. The guide was revised based on their feedback and the final questions addressed: implementation climate; facilitators of and barriers to policy implementation according to the policy requirements; description of and availability of inputs, resources, and support to implement the policy; activities accomplished during policy implementation; consistency of implementation across agencies; unintended consequences of implementation; whether policy processes needed to change; and external factors influencing implementation (Supplementary Appendix SA1). Additionally, a participant information sheet collected data about a limited set of characteristics among study participants including age, self-reported gender, self-reported race/ethnicity (Asian, Black, Hispanic, White), and years working in their position.

The interviews were conducted and recorded using a password-protected virtual video conference platform (Zoom) by investigators (K.W.W. and M.W.) between June 2023 and November 2023. All participants provided informed consent to participate, have their interviews recorded, and have their data used for the study. Interviews were conducted in English and lasted approximately 60–75 min. Participants were offered a $25 electronic gift card as compensation. However, government employees declined compensation in accordance with their respective agency policies.

Data analysis

Interview recordings were transcribed verbatim, de-identified, and reviewed for accuracy before being imported into NVivo software. Data were analyzed using reflexive thematic analysis, consistent with Braun and Clarke’s approach.^20,22,23 We followed an iterative, interpretive process that involved data familiarization, generating initial codes, searching, reviewing, and refining themes through reflexive discussion among the research team. ²⁴ The analysis began with repeated readings of the interview transcripts to achieve familiarity with the data. Initial codes were generated through a line-by-line review of transcripts incorporating both inductive (to support analytic development and engagement with the data) and deductive (drawing on relevant literature and theory) approaches to capture semantic and latent meaning relevant to RESJ policy implementation. Two members of the research team (K.W.W. and A.J.G.) met throughout the data analysis stage and, through iterative discussion, developed and refined a shared coding guide to promote consistency, transparency, and to ensure coherence in the coding. The codes were reviewed collaboratively to identify broader patterns and relationships, which were organized into themes. The team met to refine, define, and name themes and subthemes, engaging in reflexive dialogue throughout the process to consider how disciplinary perspective and lived experiences shaped coding decisions and interpretive emphasis.

Researcher positionality and reflexivity statement

The research team comprises three Black women with expertise in social epidemiology, health services research, social policy, and community-engaged qualitative research. All team members have lived, studied, and worked in the DMV area, providing contextual familiarity with the policy and institutional landscape. Our racial, gender, and professional identities informed the study, shaping research questions, data collection, and interpretation. The team engaged in ongoing reflexive practices, including regular team discussions to examine assumptions, positionality, and interpretive choices during data analysis.

Results

Between June 2023 and November 2023, 10 participants from 3 jurisdictions were interviewed (Table 1). Participants held local government positions and were involved in planning, executing, or overseeing RESJ policy implementation. Reflexive thematic analysis identified 6 themes and 14 subthemes describing barriers and facilitators related to adoption, acceptability, feasibility, fidelity, and sustainment (Table 2). While not every theme appeared in each interview, several were shared across roles and jurisdictions, particularly around organizational structures, political context, accountability, and the emotional labor of equity work.

Table 1.

Demographic and Professional Characteristics of Participants (N = 10)

Characteristics	N
Age
25–34	4
35–44	2
45–54	3
55–64	1
65+
Gender
Female	8
Male	2
Race/Ethnicity
Asian	1
Black/African American	6
Hispanic/Latino	1
White	2
Years working in current position
1–5	7
6+	3
Jurisdiction
Fairfax County, Virginia	2
Montgomery County, Maryland	4
Washington, DC	4

Table 2.

Overview of Qualitative Themes, Subthemes, Implementation Process, and Illustrative Quotes

Themes	Subthemes	Implementation process	Illustrative quote
1.Interpreting and operationalizing policy mandates	Policy ambiguity	Adoption	“… its vague legislation is something we often grapple with, you know, with racial equity, like you know you have to be specific … otherwise the laws and the systems will do what they do with vagueness.” (003) “… my understanding is it was intended to be broad almost vague, allowing us to have the latitude to figure out what we were doing.” (011) “…is how amorphous it is, right, like it’s not well defined. We are creating as we go. I used to say we’re building the plane as we fly, right when I first started.” (012)
	Misaligned interpretation	Acceptability	“…there is pushback from legislators a lot of times. A lot of times they don’t like what we say with our statements. So, you know, it is what it is.” (004) “…we have a generally liberal board, I mean, we wouldn’t exist, right, if we didn’t, let’s be honest. But also, I don’t think they totally get it.” (012)
2.Organizational capacity and resource constraints	Underinvestment in staff and resources	Feasibility	“… it requires a commitment of a lot more money or a lot more resources.” (008) “… there’s not enough funding, there’s not enough time. Yeah, I feel like we’re constantly working from a deficit.” (003)
	Workload imbalance and strain	Feasibility	“…the volume of work far exceeded the capacity of staff.” (006) “…very, very inadequate. There’s not enough people, there’s way too much work” (010)
3.Data infrastructure and practices	Limited local data	Feasibility	“… I think we need data to be able to measure the impact “ (010) “…really hard for us to do our job, and it’s really hard to do this work in places where that information just doesn’t exist at a local level. And because we don’t really like to rely as much on, like, national data when we don’t have to.” (005)
	Data-driven legitimacy	Feasibility	“…really seeing this as objective, data driven work, instead of just an opinion.” (004) “… we’re aggregators of information. So, like, we analyze a lot of information that already exists. Like, we don’t do, like, original research, because when we don’t have the resources to do that, and we don’t, and we just don’t have the capacity.” (009)
	Devalued lived experience	Feasibility	“… when a resident testifies, or a community organization testifies, it’s still seen as opinion, although I personally value lived experiences, and I know that, like you know, qualitative data is data. It’s just not always viewed that way in a government process.” (008)
4.Formal and relational accountability and oversight	Bureaucratic mechanisms	Fidelity	“…the policy doesn’t explicitly have an accountability provision.” (003) “… I worry to what degree it becomes a check the box so that they look good, you know, for themselves or their constituents” (004) “…REIAs are not legally binding … members can still move legislation and vote yes on it, regardless of whether or not the assessment has a positive or a negative conclusion on racial equity. So I think in that sense, maybe it like falls short of the like spirit of what like the law intended to do” (007)
	Relational commitments	Fidelity	“…I know personally, like I feel accountable to community, to residents, to those who are most marginalized.” (006) “…we are accountable to the truth, to the data, to the science and to the people we claim to want to support or serve.” (012) “… we are accountable to those residents to make sure we’re putting out, you know high quality, accurate information and that we don’t compromise on our objective analysis, based off of any other outside pressure or opinions, uh, yeah, making sure that we don’t play politics.” (004)
5.Emotional and ethical challenges	Emotional labor	Sustainment	“… I’m constantly battling like, I need to do this work, like this is the work, and like I also need to take care of myself” (011) “…taking in all of these statistics and trauma that we can, you know, it’s, it’s you know, that we can very much see ourselves in, you know and relate to … [the emotional labor] it takes a toll” (009) “…I mean, it’s difficult doing this work and knowing that it may not actually be acted on in any way.” (005)
	Ethical tensions	Sustainment	“…biggest challenge is trying to work with an institution that is just inherently like, racially inequitable, like these institutions were built to sustain white supremacy, and we know that.” (011) “…But I think, personally, like the hardest part is definitely, like that weight to make sure that I am not also a part of the problem, and that the work that we do is not causing harm in any way.” (007)
	Fulfillment and empowerment	Sustainment	“…I just didn’t envision a space that I could do that with integrity, and that was in alignment with my own politics” (008) “…. I’m in a position to influence change” (005) “… this work is meant to be disruptive. Like, if it wasn’t disruptive, then we wouldn’t be doing the right thing.” (011)
6.Political durability and risk	Political will and public support	Sustainment	“…there has to be like, true buy in from the people in power. willing to trust the people who are doing this work and see it like as an opportunity to improve the jurisdiction as a whole...” (004) “…what’s facilitated [RESJ policy implementation] it has been political will and public support.” (009)
	Exposure to political change	Sustainment	“…a new legislator can be voted in and decide that they don’t want this office.” (006) “…I would want that to be a permanent fixture... if you’re going to do it, make sure it’s secure and long-standing and can’t just be like, be taken away at the whims of a single politician.” (003)

Theme 1: Interpreting and operationalizing policy mandates

Participants described RESJ policies as broad and sometimes vaguely defined, which functioned as both a facilitator and a barrier to policy adoption and acceptability. This was captured by two subthemes: policy ambiguity and misaligned interpretation. Broad statutory language allowed local interpretation and adaptation giving practitioners discretion to tailor priorities and approaches. One participant stated that the policy was “intended to be broad almost vague,” providing “latitude to figure out what we were doing.” While this flexibility allowed for creative problem-solving, the limited specificity placed the burden of interpretation on staff, requiring trial-and-error navigation. Misaligned interpretation reflected heterogeneity in how different actors, including elected officials, agency leadership, and frontline staff, understood and operationalized the policy in varying ways. Some participants noted resistance from legislators, agency leadership, or other staff responsible for implementation, saying “there is pushback …,” while others suggested that even supportive leaders “don’t totally get it.” Divergent interpretations shaped how RESJ policy mandates were justified, prioritized, and enacted across agencies. For example, equity impact plans were inconsistently completed across departments, illustrating how differences in interpretation and priorities contributed to uneven uptake and constrained staff authority. These dynamics functioned as barriers that weakened the acceptability and influenced the consistency of adoption.

Theme 2: Organizational capacity and resource constraints

Organizational resources were a central barrier to the feasibility of RESJ policy implementation, captured in two subthemes: underinvestment in staff and resources, and workload imbalance and strain. Limited funding and staffing impeded participants’ ability to thoroughly carry out mandated components of the policy. One participant noted that meaningful implementation “requires a commitment of a lot more money or a lot more resources.” Another described conditions as “very, very inadequate,” citing insufficient personnel and funding. These limitations contributed directly to workload strain, as required analyses, reporting, and stakeholder engagement exceeded available staff capacity. Challenges to implementation feasibility including chronically strained environments, persistent time pressures, long hours, and ongoing overextension, ultimately narrowed the scope of stakeholder engagement. This limited the depth of required analyses and reporting and reduced participants’ capacity to fully implement RESJ policy activities across jurisdictions.

Theme 3: Data infrastructure and practices

This theme highlights how data infrastructure functioned as both a barrier and a facilitator to the feasibility of RESJ policy implementation. Three interrelated subthemes captured this: limited local data, data-driven legitimacy, and devalued lived experiences. Participants discussed relying on administrative and secondary data sources that lacked the granularity needed to assess and track community-level inequities. As one participant explained, gaps in locally available data made it “really hard to do this work … in places where that information just doesn’t exist.” These gaps restricted participants’ ability to generate timely, context-specific evidence for needs assessments and monitoring, which limited their ability to prioritize equity concerns, complete equity assessments, and monitor implementation progress. Participants also described a strong commitment to data-driven practices to establish institutional legitimacy. Those preparing REIAs and equity reports discussed presenting findings as “objective, data-driven work, instead of just an opinion,” reflecting rigorous approaches to evidence to ensure that their work was taken seriously in decision-making contexts. However, participants also noted that community members’ lived experiences were frequently dismissed as opinion, even as they themselves acknowledged that “qualitative data are data.” Integrating experiential knowledge into formal analyses was often challenging, creating a hierarchy of evidence that restricted responsiveness to local needs and hindered implementation feasibility. As a result, community perspectives were less consistently incorporated into equity assessments and implementation planning.

Theme 4: Formal and relational accountability and oversight

This theme highlights accountability as a critical component to maintaining fidelity in RESJ policy implementation. Participants described accountability as operating along two interconnected dimensions: bureaucratic mechanisms and relational commitments. Gaps in bureaucratic accountability limited the enforceability of RESJ policy mandates and functioned as a barrier to fidelity. Participants noted tools such as REIA lacked formal authority and were not legally binding, allowing policymakers to advance legislation even when adverse equity concerns were identified. One participant explained, “… the policy doesn’t explicitly have an accountability provision.” In the absence of enforceable mechanisms, implementation was sometimes perceived as symbolic, allowing policymakers to advance legislation despite identified equity concerns, thereby reducing the practical influence of REIAs on policy decisions. In contrast, relational accountability, rooted in moral responsibility to the communities most affected by inequities, served as a facilitator of fidelity. Participants described relational accountability as helping maintain adherence to equity principles despite the absence of formal oversight. One participant described feeling accountable “to community, to residents, to those who are most marginalized,” and “to the truth, to the data, to the science and to the people.” Whereas limited bureaucratic accountability weakened implementation fidelity by reducing enforcement of RESJ policy mandates, this sense of responsibility to affected communities supported continued implementation of RESJ policies even when formal accountability mechanisms were lacking.

Theme 5: Emotional and ethical challenges

This theme captured the emotional and ethical demands of RESJ policy implementation and its implications for policy sustainment. Three subthemes emerged: emotional labor, ethical tensions, and fulfillment and empowerment. Emotional labor was a barrier that contributed to burnout and psychological stress. Participants described the cumulative toll of engaging with data on structural inequities, hearing community narratives of trauma, and continually negotiating with colleagues who were unsupportive of equity work. One participant described “constantly battling” when doing the work while trying “to take care of myself.” These pressures can limit practitioners’ capacity for continued engagement, posing a threat to long-term policy sustainment. Participants also described ethical tensions associated with working within institutions perceived as inherently inequitable. Concerns about becoming “part of the status quo” or inadvertently causing harm highlighted the challenge of advancing equity while operating within systems they sought to transform. Navigating these tensions required ongoing negotiation of professional and moral responsibilities, which could undermine policy sustainment. In contrast, fulfillment and empowerment acted as facilitators. Participants described finding alignment between their values and professional roles, with one stating, “I didn’t envision a space that I could do that with integrity.” This sense of purpose supported engagement despite structural and emotional constraints. These findings also suggest that policy implementation could be facilitated by sentiments of duty, responsibility and altruism; however, the sustainability of these facilitators may be threatened by the burnout and stress caused by the weight of these very things. Implementation sustainment thus relies in part on sustainment of the implementing workforce, which is subject to varying external pressures.

Theme 6: Political durability and risk

This theme reflects participants’ views of political context as a determinant of RESJ policy sustainment. Two subthemes captured this: political will and public support, and exposure to political change. Supportive political environments were described as facilitators because they helped to legitimize the work, reduced internal resistance, and enabled staff to further implementation activities with institutional backing. Participants emphasized the importance of “political will and public support” and “true buy-in from the people in power.” Yet, RESJ policies were also viewed as vulnerable to political turnover, which functioned as a major barrier to sustainment. Participants expressed concern that leadership changes could result in offices being eliminated or defunded, with one explaining that “a new legislator can be voted in and decide that they don’t want this office.” This perceived fragility underscores that sustained implementation of RESJ policies depends on consistent political backing and ongoing public support.

Across themes, participants consistently described implementation as an iterative process shaped by interacting organizational, interpersonal, and political factors. Barriers and facilitators were complex and interrelated, such that inadequate data made it infeasible to conduct certain tasks, which also resulted in an emotionally draining experience for implementers. Having to justify the work constantly, its own barrier, also reinforced the barrier of volatile political will. Ambiguity in defining equity, limited organizational capacity, challenges measuring impact, emotional labor, and a shifting political environment did not operate independently but reinforced one another, influencing the adoption, acceptability, feasibility, and sustainment of RESJ policy implementation.

Discussion

This study contributes to a growing literature on equity-related policy implementation by examining how practitioners navigate the day-to-day work of translating RESJ policy mandates into practice within local government contexts. The analysis of the themes highlighted facilitators and barriers across key implementation processes including adoption, acceptability, feasibility, fidelity, and sustainment. Collectively, these findings suggest that implementation outcomes were shaped not only by isolated barriers but also by the interaction of organizational capacity, accountability structures, political context, and practitioners’ experiences.

RESJ policy adoption and acceptability were influenced by the degree of policy clarity and how political actors and implementers (e.g., agency leadership and frontline staff) interpreted policy intent. Across jurisdictions, participants routinely operationalized broad policy mandates using discretion to tailor approaches to local need and political realities, which is consistent with the “street-level bureaucrats” concept. ²⁵ However, policy ambiguity also lends itself to uncertainty and misalignment across actors, undermining the acceptability of RESJ policy mandates. Bullock et al. (2021) suggest that high policy ambiguity combined with actor conflict can produce fragmented implementation, where mandates are broadly endorsed but weakly translated into practice. ¹⁸ In our study, these conditions shaped adoption and acceptability by affecting how consistently RESJ policies were implemented across agencies, highlighting key leverage points for improving early uptake and alignment.

Organizational resource and capacity constraints (e.g., underinvestment in staffing, funding, workload burden) coupled with data systems lacking local granularity and disaggregation limited the feasibility of RESJ policy implementation. These constraints impeded participants’ ability to carry out required analyses, reporting, and community engagement, forcing practitioners to balance competing priorities and narrow the scope of equity work. Consistent with prior research, minimal material and institutional support constrains policy implementation. ²⁶ Our findings extend this literature by showing how resource scarcity and data limitations can undermine feasibility, consistent with reports from the Brookings Institution highlighting that high-quality, disaggregated, and locally relevant data are critical for key RESJ policy functions such as monitoring performance and developing equity action plans. ²⁷

Transparent accountability structures are central to policy fidelity, particularly for RESJ initiatives, where they are considered a cornerstone of racial equity work. ²⁸ Participants described accountability as both bureaucratic (i.e., reporting, oversight, and transparency) and relational (i.e., moral responsibility to affected community members), ²⁹ highlighting that effective implementation depends on formal systems of accountability and trust-building with communities. ³⁰ Structural barriers, including limited enforcement mechanisms, were perceived to undermine fidelity, increasing the risk that policies remain symbolic rather than substantive. These findings echo recent recommendations from policy think tanks calling for transparency, systematic evaluation, and community involvement.^27,31,32 A white paper from the Hamline Public Health Law Center noted that many RESJ initiatives lag in accountability, weakening implementation fidelity.

The human costs of policy implementation are rarely foregrounded, ³³ yet were central to participants’ capacity to sustain this work. Our findings indicate that the emotional and ethical demands of equity work shaped long-term capacity to remain engaged. Participants described both personal fulfillment and significant emotional labor in navigating complex institutional environments. These experiences parallel prior research documenting the greater burnout among racial equity practitioners, particularly in settings characterized by racial stressors, limited staffing, high workloads, inadequate organizational support, and microaggressions.^34–36 In politically volatile contexts, individual resilience alone may be insufficient for long-term policy sustainment.

The fragility of RESJ policies to shifts in political leadership was identified as a central concern for sustainment. Participants noted that newly elected officials or appointees could threaten ongoing equity efforts, reflecting broader cycles of racial and social justice progress followed by periods of retrenchment and resistance. ³⁷ In recent years, this resistance has been amplified by the politicization of equity, ³⁸ undermining the legitimacy, acceptability, and infrastructure necessary to sustain RESJ initiatives. These dynamics align with the theory of racialized organizations, which argues that government systems are structured by racial hierarchies that shape agency and resource distribution, making equity efforts vulnerable to reversal under changing political priorities. ³⁹ Political commitment and community engagement were identified as enablers, helping maintain progress amid political turnovers. This is consistent with scholarship emphasizing the need for ongoing vigilance and framing equity as benefiting all members of society.^37,38,40 The findings on emotional labor, ethical tensions, and political context collectively illustrate that sustainment depends on both individual and structural conditions, highlighting the need for institutional and political infrastructures that protect equity work beyond individual dedication.

The findings should be considered in light of several limitations. Participants were drawn from a single metropolitan region, which may limit generalizability to other jurisdictions with different political, administrative, or policy contexts. However, this regional focus allowed for an in-depth exploration of local policy implementation. Purposive sampling may not capture the full diversity of policy actors, since elected officials, community members, advocates, and organizations directly affected by the RESJ policies were not represented. While reflexive thematic analysis does not require strict data saturation, ²¹ participants were purposively selected to capture maximum variation and iterative coding and team discussions helped to ensure that the themes reflected the breadth of perspectives relevant to RESJ policy implementation. While the sample size may limit representation of some experiences, the study captures both common and unique insights across participants. As members of the same racial group as many participants, our positionality may have influenced data collection and interpretation. While this positionality may have facilitated rapport, it may also have led participants to assume shared understanding or leave certain perspectives implicit. To mitigate this potential bias, interviewers used active probing, and the research team engaged in ongoing reflective discussion during analysis. Finally, findings reflect experiences during a sociopolitical period of heightened attention to racial equity, and it is possible that the implementation dynamics could differ under different policy climates. Future research should examine broader samples of jurisdictions to identify both common patterns and context-specific barriers.

Conclusions

Policy implementation processes, particularly for equity policies, remain under-examined compared to other stages and domains of policymaking. ¹⁸ This study addresses that gap by examining how RESJ policies are implemented in a local government context. The documentation of how practitioners navigate policy ambiguity, resource constraints, accountability structures, emotional labor, and political volatility illuminates key barriers and facilitators shaping adoption, acceptability, feasibility, fidelity, and sustainment. These interacting barriers and facilitators influenced whether RESJ policies were adopted consistently, implemented as intended, and sustained over time, highlighting that implementation outcomes depend on the interplay of organizational, relational, and political conditions. Conducted prior to recent federal rollbacks of equity initiatives, the results remain timely and relevant. Persistent challenges such as resource scarcity, political resistance, institutional inertia, and practitioner strain constrained effective and sustained implementation. The findings also point to actionable strategies for strengthening RESJ policy implementation. First, ensuring adequate and stable funding is essential for feasibility and fidelity, particularly by appropriating sufficient resources for implementation activities and leveraging multi-sector partnerships to support coordinated action. Second, formal professional and peer support, such as communities of practice, may promote practitioner resilience, facilitate the sharing of best practices, help manage the emotional labor of equity work, and support the long-term sustainment of RESJ policies. By contributing to a nascent evidence base, this study provides a baseline for future research on RESJ policy implementation and offers concrete guidance for policymakers and practitioners seeking to advance population health equity.

Authors’ Contributions

K.W.W. conceived the study. M.W. contributed to conceptualization and was responsible for participant recruitment, data collection, and conducted interviews. K.W.W. and A.J.G. both performed the data analysis and contributed to the interpretation of the analyses. All authors contributed to writing the article and approved the article for submission.

Human Participant Protection

Written informed consent was obtained from each participant. The institutional review board of the University of Maryland, College Park, reviewed and approved the study.

Abbreviations Used

DMV

District of Columbia, Maryland, and Virginia

REIA

Racial Equity Impact Assessments

RESJ

Racial Equity and Social Justice

Cite this article as: White Whilby K, Walelo M, Gunn AJ (2026) Implementing racial and social justice policies: A qualitative study of three local U.S. Jurisdictions, Health Equity, 2026, 10, 24731242261473059, DOI: 10.1177/24731242261473059.