Editors’ Note: Rachel Best discusses the long history of single disease charitable campaigns in the United States, the subject of her new book, Common Enemies: Disease Campaigns in America (Oxford, 2019).
In October, pink ribbons decorate everything from sneakers to buckets of fried chicken, and hundreds of thousands of people participate in walks or runs to fight breast cancer. Breast Cancer Awareness Month dates back to the 1980s, but it’s part of a much longer tradition in American public life. Across the decades, campaigns against single diseases have been at the center of American philanthropy.
The first mass fundraising campaign to target a single problem was the early twentieth-century campaign against tuberculosis, which Olivier Zunz credits with “institutionalizing mass philanthropy.”[I] By the mid-1950s, huge numbers of urban Americans had donated money to fight tuberculosis (77%), polio (70%), heart disease (45%), and cancer (43%). When combined with the Red Cross and Community Chest campaigns, four organizations targeting these diseases accounted for fully a third of non-religious and educational philanthropy in America.[ii] In the 1970s, when the National Association of Fundraising Counsel tracked the number of people volunteering their time to national agencies, three of these disease organizations ranked near the top. The American Cancer Society, the American Heart Association, and the National Foundation (also known as the March of Dimes, which had expanded its focus beyond polio) each reported over 2 million volunteers per year, second only to the United Way and UNICEF.[iii] Today, hundreds of national voluntary associations and thousands of nonprofits target diseases. Yet though disease campaigns are a dominant feature of American public life, they are rarely remarked upon in scholarship on philanthropy, advocacy, and public policy.
Why are diseases the problems Americans come together to address? Why do some diseases attract more attention than others? And how has fighting one disease at a time changed how we distribute charitable dollars and what types of health policies we pursue? My new book, Common Enemies: Disease Campaigns in America, answers these questions with decades of data on voluntary associations, nonprofits, congressional testimony, corporate philanthropy, and government policy.
Common Enemies shows that disease campaigns became the battles Americans can agree to fight for three reasons. First, Americans perceive health as a particularly worthy goal, viewing infectious diseases and widespread chronic conditions as universally shared risks, and viewing patients with non-stigmatized diseases as especially deserving of public help. This means that with the exception of AIDS, diseases marked by the stigma of contagion, preventability, or mental illness see much less advocacy. Second, Americans donors respond to targeted campaigns. Reformers have repeatedly tried to launch more general campaigns to promote public health. But they’ve never been able to work up the same excitement as the single-disease campaigns. These narrower disease campaigns funnel vast sums of money and attention to a few particular diseases like AIDS, breast cancer, diabetes, and Alzheimer’s, with much less attention to others, like cancers of the colon, lung, and liver. And finally, mainstream disease campaigns have successfully pursued a politics of consensus, often emphasizing a limited set of goals and avoiding challenges to corporate interests and inequality. Many focus predominantly on awareness campaigns and research funding, paying much less attention to preventing disease and ensuring access to health care.
Fighting one disease at a time, then, means devoting vast sums to raising awareness and funding research for a few particular conditions. It’s easy to imagine more efficient ways to promote our collective well-being. But arguing that the distribution of funding is inefficient is different from arguing that these campaigns are harmful. The key question is whether the money and attention devoted to disease campaigns is being taken away from other, more important goals. Do disease campaigns crowd out responses to other problems? If we weren’t fighting diseases, would we be devoting more attention to broader health campaigns, fighting poverty, and pursuing social justice? Do diseases siphon resources form each other? If we weren’t fighting breast cancer, would we be devoting more attention to chronic obstructive pulmonary disease? And, do goals displace each other? If we weren’t busy raising awareness, would we be removing carcinogens from the environment?
By collecting data on the entire field of disease advocacy over decades, I show that rather than taking money away from other problems, disease campaigns benefited other causes. The experiences of buying Tuberculosis Seals, donating dimes for polio, wearing ribbons, and racing for the cure trained millions of Americans to be donors and volunteers. If these campaigns had never existed, we wouldn’t see the same amount of money targeting other problems—the philanthropic sector would simply be smaller. Likewise, federal investments in public health grew up around disease campaigns. If there were no campaigns securing public funding for breast cancer research, the money wouldn’t otherwise be going to study hepatitis—the National Institutes of Health budget would just be smaller. And finally, while many disease campaigns fail to promote the policies that would most improve our health, they do not crowd out campaigns for those policies. We’re less likely to prioritize prevention and treatment access when we fight one disease at a time than when we launch general public health campaigns. But fighting one disease at a time attracts more money and attention to health promotion, some of which flows to prevention and treatment access. Campaigns encouraging mammograms do not cancel out the fight against environmental carcinogens—in fact, the larger breast cancer movement helps more radical organizations gain visibility and influence, as when the environmental health group Breast Cancer Action used Breast Cancer Awareness Month to criticize corporations that use pink ribbons while marketing carcinogenic chemicals.
Dread diseases are our common enemies, the fears everyone shares, the battles we can fight without generating opposition. Big-hearted, benevolent, and sometimes misguided, disease campaigns are a lopsided bonanza, an imperfect but indomitable blessing.
-Rachel Kahn Best
Rachel Kahn Best is an Assistant Professor of Sociology at the University of Michigan. She is the author of Common Enemies: Disease Campaigns in America (Oxford University Press, 2019).
[i]Olivier Zunz, Philanthropy in America: A History(Princeton University Press, 2011), 51.Earlier large fundraising campaigns had been humanitarian responses to disasters and the Civil War, not responses to ongoing problems.
[ii]David L Sills, The Volunteers: Means and Ends in a National Organization(Glencoe, IL: Free Press, 1957), 176–82.
[iii]American Association of Fund-Raising Counsel, “Giving USA: A Compilation of Facts and Trends on American Philanthropy for the Year 1973.” (New York: American Association of Fund-Raising Counsel, 1974), 9.