Pink Ribbon Awareness Campaigns Will Never Deliver Public Health

In 2010, only 1 percent of Americans chose disease as “the most important problem facing the world in the future,” while 14 percent focused on the climate emergency and threats to the environment. (In more recent surveys, diseases weren’t even mentioned). Yet in 2014, for instance, three times as many participated in the Race for the Cure than joined the largest march against climate change. Many of us may not feel comfortable asking our neighbors for donations to fight climate change or poverty, but we can all come together to fight diseases.

It’s been this way since the beginning of mass philanthropy. The first large-scale fundraising effort to target a single problem was the early 20th-century campaign against tuberculosis, according to Olivier Zunz’s Philanthropy in America: A History. By the mid-20th century, three-quarters of urban Americans had donated to fight the disease, according to David L. Sills’s The Volunteers: Means and Ends in a National Organization.

Americans next turned their attention to polio. In Polio: An American Story, David Oshinsky reports that by 1954, two-thirds of Americans had donated to the March of Dimes and 7 million had volunteered for the campaign. From the 1940s through the 1970s, fewer than 1 percent of Americans identified health as the most important problem facing the country. And yet, by the 1970s, four of the six charities with the most volunteers targeted single diseases. From the telethons for muscular dystrophy to the Ice Bucket Challenge for ALS, disease campaigns have continued to inspire mass participation.

Unfortunately, fighting one disease at a time isn’t the most efficient way to improve our health. For one thing, we end up devoting enormous sums to a few particular diseases while neglecting others. For instance, in 2017, cancers of the breast, colon and pancreas each killed about 40,000 Americans. But while only a few nonprofits target colon or pancreatic cancer, there are hundreds of breast cancer nonprofits. This month, pink ribbons are decorating an array of consumer goods, and the Susan G. Komen Foundation’s Race for the Cure will add to its $2 billion fundraising tally.

Disparities also emerge in public funding: In 2017, the National Institutes of Health budgeted $689 million for breast cancer research, but only $270 million for colon cancer and $199 million for pancreatic cancer.

In addition to creating lopsided distributions of funds, single-disease campaigns can limit the strategies we use to improve our health. When single-disease voluntary associations describe their goals, a majority mention awareness campaigns and research dollars. Far fewer discuss ensuring access to health care or preventing disease in the first place.

Why do disease campaigns focus so much on awareness and research, and less on health care and prevention? According to one health advocate I interviewed, “Everyone wants to have something to report back to their constituencies who care about ‘what have you done for diabetes.’” This pressure makes it “hard to get the advocacy groups to see the common ground” around issues that cross disease categories, from health care access to clean air.

Moreover, single-issue disease campaigns’ goals can never fully reflect broad public health goals because they are also shaped by corporate funding and nonprofit leaders’ desire to avoid controversy. By encouraging more people to be screened and treated, awareness campaigns can increase profits for drug makers and the rest of the health care industry. Meanwhile, disease prevention efforts, including efforts to regulate environmental hazards, can threaten corporate profits. For this reason, more corporate dollars flow to “awareness” campaigns than to environmental health initiatives.

Take AstraZeneca, for instance. The company, which manufactures a blockbuster breast cancer drug called Tamoxifen, created Breast Cancer Awareness Month and controls the content of related promotional materials. However, AstraZeneca has been sued for dumping carcinogenic chemicals into the environment. Cancer prevention efforts hurt both AstraZeneca’s pharmaceutical and chemical businesses, but the company profits when awareness campaigns lead more women to be diagnosed early and spend more years taking Tamoxifen.

Other awareness efforts “pinkwash” environmentally harmful behavior, as when the Susan G. Komen Foundation announced in 2014 that it would be painting fracking drill bits pink. These trends aren’t universal — environmental breast cancer organizations are pushing for disease prevention and challenging corporate interests — but their efforts receive less funding and attention than the mainstream campaigns.

Politicians in the U.S. rarely agree on efforts to expand access to health care, but they are often able to reach bipartisan consensus on approving funding for medical research. So disease campaigners seeking political influence may see research funding as a more achievable goal. The result is that the U.S. spends more than any other country in the world on biomedical research — five times as much as the entire European Union, according to K.M. Murphy and R.H. Topel’s Measuring the Gains from Medical Research. And yet, millions of Americans still lack health insurance.

When everything turns pink this month, we should step back and question how well this extravaganza of awareness-raising and medical research funding is serving public health goals. It’s time for more of us to go beyond raising awareness about particular diseases and focus our energy on confronting environmental health hazards and agitating for equal access to health care.

This article draws on arguments made in the author’s book, Common Enemies: Disease Campaigns in America.