“Racism is a public health emergency of global concern.” Since we wrote these words in June, 2020, a monumental worldwide reckoning with racism, xenophobia, and discrimination in society—its roots, its consequences, and its redress—has gathered pace. Marches have taken place and statues have been toppled, activists galvanised and institutions investigated, reforms proposed and elections contested. Progress has been uneven, but interrogation of the power structures that prejudice and mistreat specific groups of people while privileging others has heightened an acknowledgment of racism and its harms—hatred, intolerance, and discrimination kill. These issues are as pervasive in medicine, medical science, and global health as in society. Today, The Lancet publishes a special issue bringing together the strongest evidence and analysis on advancing racial and ethnic equity in science, medicine, and health. Our issue does not offer easy solutions, but does set out important principles to guide thinking and actions in the future.