Research related to racism and health has evolved in recent decades, with a growing appreciation of the centrality of the social determinants of health, life-course approaches and structural racism, and other upstream factors as drivers of health inequities. Examining how race, class, and structural racism relate to each other and combine over the life course to affect health can facilitate a clearer understanding of the determinants of health. Yet there is ongoing discomfort in many public health and medical circles about research on racism, including opposition to the use of racial terminology. Similarly, most major national reports on racial and ethnic inequities in health have given limited attention to the role of racism. We conclude that there is a need to acknowledge the central role of racism in the national discourse on racial inequities in health, and paradigmatic shifts are needed to inform equity-driven policy and practice innovations that would tackle the roots of the problem of racism and dismantle health inequities.