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This is an open access title available under the terms of a CC BY-NC-ND 4.0 International license. It is free to read at Oxford Scholarship Online and offered as a free PDF download from OUP and selected open access locations. Necessary Conversations: Understanding Racism as a Barrier to Achieving Health Equity reflects the conviction that a true prioritization of health in our communities is impossible without a commitment to racial equity. Drawing on the pivotal social events of 2020 in America, it extends a powerful call to action based on a growing body of evidence that racism is the underlying cause of so many poor health outcomes. Contributors across health, education, law, and media further the longstanding work of the Robert Wood Johnson Foundation to create a "Culture of Health" by engaging in authentic discussions about the systems and structures that harm people of color and offering provocative ideas and strategies to inspire action. Necessary Conversations ultimately highlights the importance of building leadership and partnerships through those who are most affected in the community. It considers what it would take to overhaul institutions that treat people differently on the basis of race and recognizes that we all must share resources and join together to support the advancement of health and racial equity.