The events of 2020 were an inflection point in an American journey toward health and racial equity. Necessary Conversations: Understanding Racism as a Barrier to Achieving Health Equity extends a powerful call to action. RWJF’s Sharing Knowledge conference was held in Jackson, Miss., a setting where it could build on its conviction that a Culture of Health is impossible without a commitment to racial equity. Hundreds of participants from around the country engaged in authentic dialogue about the systems and structures that are doing grave harm to people of color. With so many types of knowledge-builders in the room, a palette filled with blunt, provocative, and insistent ideas and strategies could be shared to inspire action. This sixth book in the Culture of Health series reflects a distinct shift in RWJF’s emphasis, based on a growing body of evidence that racism is the underlying cause of so many poor health outcomes. RWJF is considering what it would take to overhaul institutions that treat people differently on the basis of their race and to make very intentional shifts in their investments to elevate that focus. They are recognizing they have to commit resources and join with others to support working to advance health and racial equity. They are deepening their understanding of what it means to build partnerships and community power and the centrality of leadership by those who are most affected by the decisions that influence their lives.