Structural racism, which manifests as inequitable care for Black children (e.g., Black children are less likely to receive pain medication in the emergency department and experience higher postoperative mortality rates), continues to be an important public health focus. This article presents Racism as a Root Cause (RRC), a framework to identify and address racism in public health. The four components (precise impact, systems change, long-term, and reparations) and opportunities to apply RRC are presented.