The North Carolina Division of Public Health, Chronic Disease and Injury Section recommends local health departments (LHDs) adopt an "inside-out" approach to advance health and racial equity. Internally, LHDs must increase their capacity to address equity by establishing LHD policies and practices that prioritize equity and nurture a culture of trust. Externally, LHDs must seek guidance from historically marginalized populations to inform LHD policy changes and community-based public health approaches affecting these populations for greater engagement in LHD programs. (Am J Public Health. 2024;114(S7):S554-S557. https://doi.org/10.2105/AJPH.2024.307719).