An NCI-designated Comprehensive Cancer Center
By Saundra Young | April 10, 2018
CV Bio Profile picture Ashing Giwa Kimlin Kimlin Tam Ashing, Ph.D.
Kimlin Tam Ashing, Ph.D., is troubled.

It’s not new that research has linked stress to racial discrimination.  But that research is now going a step further — tying infant mortality directly to racism.

“Finding epidemiological evidence for a link between racism and poor heath outcomes, whether it be infant mortality or maternal mortality or early death due to greater risk for cancer and other chronic diseases, is profound,” Ashing said.

Ashing, a psychologist and founding director of the Center of Community Alliance for Research & Education (CCARE) at City of Hope has spent much of her career working to document and end disparities in health.

CCARE is already working with community health leaders to address the links between racism and poor health outcomes.

“CCARE is housed within the Division of Health Equities,” Ashing said,  “and is working to increase knowledge and action to break barriers to good health at the community level, improving health behaviors focused on family kitchens and homes — what families buy and eat, and how they play and exercise.”

A Troubling Statistic

Nancy Krieger, Ph.D., a professor at Harvard University, is an internationally renowned epidemiologist who has researched health inequities for more than two decades. She has more recently focused on the growing body evidence that there is a relationship between racism and infant mortality rates in black newborns.  

She says the direct and indirect effects of racism on black infant mortality has been part of the public health agenda for a long time. Now, the effects on maternal morbidity and mortality are also being scrutinized.

Persons who report higher experiences of racism, are at greater risk for having poor maternal and infant outcomes, including death,” Ashing said. 
“The national health priorities must include racism as a health risk and we haven’t quite done that. So now we need to put race-based discrimination or racism on the population health agenda.”

Researchers say chronic stress can raise the levels of a hormone called cortisol that, in elevated levels can trigger labor.  And that stress can also trigger an immune response that restricts blood flow to that placenta which can stunt a baby’s growth. But even more concerning, they believe stress throughout a woman’s lifetime can result in biological changes that can affect the health of future children.

According to the U.S. Department of Health and Human Services Office of Minority Health, African-Americans have more than double the infant mortality rate than whites. And black babies are more than three times as likely to die of low birth weight and twice as likely to die from sudden infant death syndrome (SIDS) as white infants.

Black mothers, they found, were more than twice as likely to get late prenatal care, or no prenatal care, than white mothers.
But Ashing says that doesn’t tell the whole story.

“Racism seems to reach across all socioeconomic strata … so even black women who are wealthier may experience deleterious health effects, and more studies are showing that African-American women, even when they’re well resourced and have insurance and health care, still have an unacceptably high risk of low birth weight babies, early-term babies, infant mortality and maternal mortality.”

Community Collaboration

Wenonah Valentine, founder of iDREAM for Racial Health Equity, has been collaborating with Ashing and CCARE for more than a decade.

Dr. Ashing was the one who helped me understand that improving maternal health and birth outcomes was part of the bigger picture of eliminating health disparities,” Valentine said.  

“At CCARE we listen and respond to the needs of the community,” Ashing said. “Considering societal, policy, neighborhood, family and individual factors for actionable and sustainable community health.”  

Kathye Jenkins, founder of the Cynthia Perry Ray Foundation, is another community partner working alongside Ashing to address health disparities.

“We have inadequate health care, inadequate facilities,” she said. “With pervasive inequities we accept that state of affairs and do not speak up. And we’re the ones suffering in the meantime. We’re the ones that are dying early deaths.”

Something has to change. Jenkins feels education is the key.

“How do you educate people? You have to go where they are. That’s why we take our message to the street. You have to take it to the people. You have to find every way you can to educate the people on taking action for better health. “

Disparities Hit Home

As a mother of three, health inequity — especially maternal and infant health disparities — hit home for Ashing. She believes we are in uncharted territory, but she is hopeful.

“I believe the unfortunate, but emerging, data on the deleterious health effects of race-based discrimination should really stimulate the kinds of  urgent responses that we’re seeing around other important health issues like the opioid epidemic,” Ashing said. “The growing reports and studies are providing significant and causal evidence to energize all sectors to join together to advocate on a critical population health priority.”


On April 19,  Rick Kittles, M.D., director of the Division of Health Equities hosts City of Hope’s 8th Annual Minority Cancer Awareness Week Forum, during which health care professionals, educators and community advocates join together to discuss issues and develop strategies for community health improvement. To register, click here.

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