This review addresses the question of whether Thoroughbred horse racing is sustainable in the context of current social values. A recently acknowledged framework, known as ‘Social License to Operate’ (SLO), provides us with a lens through which to view and assess racehorse welfare. In multiple surveys of the general public, the horse owning public, and university students, the primary topics of concern regarding Thoroughbred racing show considerable concordance: concern about catastrophic injuries—particularly as related to track surfaces, concern over the racing of two-year-olds, whip use by jockeys, drug/medication policies, and aftercare opportunities for retired Thoroughbred racehorses. Legitimacy of an industry, consent from industry stakeholders, and trust between the community players, are all essential to have and maintain SLO. In the current era of 24/7 global media access, and the proliferation of social media providing an interactive platform for all interested parties, a dramatic change has occurred in commentary related to racehorse welfare concerns. The situation at Santa Anita (California, USA) from late December 2018 through mid-November 2019 demonstrated just how tenuous the SLO for horse racing is. This article will provide a brief review of what ‘Social License to Operate’ is, along with a brief literature review of five of the areas of primary concern voiced by stakeholders.