Friday, August 31, 2007
What Color Is Your Ribbon?
BY NANCY BERLINGER

A front-page story in The New York Times on August 31, on the American Cancer Society’s decision to dedicate its $15 million annual advertising budget to “the consequences of inadequate health coverage” for the fight against cancer, sent me straight to my in-box. On August 30, The Commonwealth Fund released a summary of a grant-funded study: “Lost Opportunities: Physicians' Reasons and Disparities in Breast Cancer Treatment.” The study documented “systems failures” in treatment for early-stage breast cancer, finding that one-third of the women enrolled in the study did not receive the standard follow-up therapies, such as chemotherapy, following surgery, even though such treatment was recommended by the women’s surgeons.

The study notes that the system was particularly likely to fail “vulnerable women”: “System failures were more common among minority women than white women (73% vs. 54%), and also more common among uninsured women or those receiving Medicaid compared with those with Medicare or commercial insurance (54% vs. 19%).” (Women treated at municipal hospitals were the most vulnerable of all: 82% of these women did not receive adjuvant therapy, as compared to 36% of women treated at nonmunicipal hospitals. The factors in those cases included “breakdowns in communication and coordination” – bad hand-offs – in the hospital itself.)

It is not difficult for most American women to see themselves, and to act, in social solidarity with women with cancer, particularly breast cancer. The Race for the Cure is now, according to its sponsor, Susan G. Komen for the Cure, “the largest series of 5K runs/fitness walks in the world,” with over one million participants in more than 100 races each year. The Avon Walk for Breast Cancer sponsors weekend-long, marathon-length fundraising walks in nine major cities, involving thousands of participants who camp overnight in a “Wellness Village” set up for each event. Grassroots self-help organizations, where cancer survivors staff hotlines and run support groups for other community members, also get themselves on the map through fundraising walks and runs. (While on jury duty recently, I found myself coveting another prospective juror’s “Team in Training” jersey: the Leukemia & Lymphoma Society bills itself as “the world's largest endurance sports training program.” On visiting the Team in Training website, I learned that to earn that jersey, I would have to cycle 100 miles, or complete a triathlon, or run a marathon. Maybe next year.)

Fundraising professionals know that the pink ribbons learned from the red ribbons. “Cause-related marketing” on behalf of breast cancer research, treatment, and support services modeled itself on the AIDS walks established in the 1980s: if you want to break down stigma – and raise some money – what could be easier than a walk in the park?

So what color ribbon will we wear to show our social solidarity with “the uninsured”? And what is the marketing strategy that will get us to do something about that terrifying number – 47 million? The American Cancer Society’s advertising campaign may offer Americans a way of connecting their compassion for their friends, neighbors, and colleagues whose lives have been affected by particular chronic diseases, and their willingness to do something – finish that walk, write that check, earn that jersey – to fight these diseases, with the failure of a inequitable health care system that does not allow for a fair fight.

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