INTRODUCTION:
Racism is a global health issue and major determinant of child health operating globally and in context-specific manifestations.1 Individual-focused interventions to tackle racism have tended to be unsuccessful as racism exists across the whole of society. Rather, a systems approach is needed that link together interventions, taking into account the mechanisms by which they occur and the importance of context.

METHODS:
The Lancet Commission on Racism and Child Health2 brought together 26 multi-disciplinary experts from around the world, supported by four youth advisory boards and engagement work with children and adolescents in Australia, Brazil, Sri Lanka and Uganda. We created a causal loop diagram mapping racism globally and conducted a realist review to understand the mechanisms by which anti-racism interventions work.

RESULTS:
The causal loop diagram included 120 nodes and 240 edges across structural, systems and institutional, spatial, community and individual layers. The interactive model describes the many ways in which children can be harmed by racism and the combinations of sites of action needed to combat racism. We reviewed 19,099 articles and included 78 that included interventions on racism and child health. From this, we built a realist middle range theory that summarises the contexts, mechanisms and outcomes required to successfully improve health interventions for minoritised children.

CONCLUSIONS:
Global racisms not only affect minoritised children; they create unfair and divided societies that threaten health for all. To tackle racism, we need to take a systems approach that understands the specific interplay of the context and mechanisms to produce the desired outcome of improvements in child health.