“Would you like to donate a dollar to breast cancer research?”
“Not today, thanks… Oh, and receipt in the bag please.”
I did it. I flagrantly betrayed my own gender, turning a blind eye to women everywhere suffering under the scourge of breast cancer. It wasn’t about the money. It wasn’t even about breast cancer research. It was simply that in that moment, beneath the glaring fluorescent lights of the check-out aisle, and inches away from a looming tower of hot pink standing mixers, the Susan G Komen Foundation struck me as more of a brilliant marketing guise than a champion of social justice. Focusing on an incredibly salient and emotionally-charged issue, its success as an institution is at least in part attributable to its unrivaled ability to resonate with women at both a personal and societal level.
In 2012, the mortality rate for breast cancer was 19.4 in 100,000, easily dwarfed by the number of deaths attributable to diabetes, coronary artery disease, and stroke. Where are they – the red and grey awareness ribbons – vibrant champions of these noble causes? Why is it that certain diseases take center stage in our public awareness while others are so quickly dismissed or forgotten?
Bump, Reich, and Johnson provide a historical account of the the emergence and regression of CDD as a major player in public health policy. Despite the fact that it has retained its position as the number one contributor to childhood mortality worldwide, it has lost a certain prominence in the areas of funding and implementation of initiatives.
Shiffman offers social constructionism as a framework for understanding the prominence of issues in global health. Clearly the ascendance of a specific global health agenda has as much to do with its portrayal than it does with simple raw data. It is incumbent upon us, then, as public health professionals to take into account this issue of salience as we approach public health policy.
Although the following list is in no way exhaustive, I would propose that several factors contribute to the degree to which certain issues resonate with individuals specifically and perhaps policy makers collectively.
- Individual contribution to illness: Childhood leukemia garners more sympathy than lung cancer due to tobacco use
- Etiologic specificity: Rotavirus is a more targetable objective than diarrhea
- Vividness of imagery: AIDS wasting syndrome invokes stronger emotion than hypertension
- Semantics: Dysentery may be perceived as a more virulent entity than diarrhea
- Perceived threat: Communicable diseases invoke greater fear of pandemic than non-communicable
- Plausibility of eradication: Hope of cure is more compelling than chronic management
- Personal or anecdotal experience of the disease
The appeal to which we call others to action, therefore, is not only towards an injustice, but a personally relevant injustice. And appeal itself is more compelling if cure or eradication seems plausible. Every year, the Komen Foundation hosts a national Race for the Cure. Its marketing concept is far more based in ideology than in scientific fact. A Race for a Potentially Life-Prolonging although Non-Curative Therapy simply does not garner the same enthusiasm.
In the end, we race because it could happen to us.
We race because it could happen to our daughters.
We race because we think we can win.
1. Bump, JB, Reich RR, Johnson AM. “Diarrhoael Diseases and the Global Health Agenda: Measuring and Changing Priority.” Health Policy and Planning 2012; 1-10.
2. Shiffman, Jeremy. “A Social Explanation for the Rise and Fall of Global Health Issues.” Bull World Health Organ 2009; 87:608-613.
3. Website: http://www.cdc.gov