The Breast Cancer Donor’s Dilemma: Time to Revolt?

Sixty years ago, the largest national health charities in the United States dominated the philanthropic playing field and were able to carve up the fundraising calendar year among themselves. In the days when solicitations were still face-to-face encounters or mail campaigns, each charity within this charmed circle agreed to carry out its major campaign drive within an assigned time frame. The March of Dimes kicked off the year in January, followed by the American Heart Association, which launched its own campaign on St. Valentine’s Day. Easter Seals occupied the next major holiday, followed by American Cancer Society campaigns in April, and so on, with Christmas Seals bringing up the rear in December.

Competing for their charitable dollars were what came to be called community chests. These were federations of often smaller charities that agreed to participate in one combined annual fundraising drive and divide up its revenues. They were based on a practice that emerged in the First World War, when the government asked relief agencies to coordinate a collaborative fundraising campaign. War chests aimed at direct relief soon become permanent chests addressing a variety of welfare needs. By the middle of the 20th century, more than half of Americans were exposed to some form of federated giving.

Precursors of the United Way, such coalitions were thought to be a more cost-efficient means of conducting campaigns, minimizing overheads and other expenses. A New York Times article in 1969 noted that the administrative costs of community chests ranged “from 4 per cent to 10 per cent, considerably less … than the 25 per cent to 35 per cent overhead costs of independent charity campaigns.” [1] Community chests usually operated with a skeleton staff, often composed entirely of temporary volunteers in temporary offices, much like the transient and traveling infrastructure used to conduct electoral campaigns. Chests not only trimmed the demand for volunteer workers; they also limited the potential for “donor fatigue”; contributors would buy themselves immunity from further appeals, at least for another year.

The big national charities like the March of Dimes and the American Cancer Society spurned all appeals to join federated campaigns. They were reluctant to cede control of any aspect of fundraising and knew that the money they could raise on their own would outweigh whatever share of the proceeds they would receive from a collective effort. [2] Adamant about maintaining their separate identity and independence, they rejected all invitations to collaborate. If this imposed additional expenses in the form of larger, permanent staffs and more overhead, so be it. They were out to increase donations, not to increase efficiency. Cooperation was not in the cards.

For all these charities, success depended on an ever-ready supply of volunteer women willing to go door-to-door, soliciting funds for one charity after another, one year after the next. But from the early 1960s on, there were rumblings of discontent. Women began to object to the duplication of effort involved in multiple campaigns. A league of volunteer women near Madison, Wisconsin, complained that they were becoming pariahs in their own communities. When their neighbors saw them coming, they wondered, What is it this time? Charitable collection had become an embarrassment. [3]

In 1963, the year The Feminine Mystique was published, the Wisconsin women mounted what was deemed a “housewives’ revolt.” They took it upon themselves to set aside single-charity campaigns and conduct a “Combined Health Fund Drive.” Their chosen beneficiaries included the American Cancer Society, the March of Dimes and Muscular Dystrophy Association. The big charities were not amused. In fact, all three returned the checks that had been collected on their behalf. The women were undaunted. They decided to repeat the experiment the next year, stipulating that any funds that were returned to them this time would be handed over to the University of Wisconsin for medical research. In response, the American Cancer Society decided to be more accommodating; it allowed its name to be used in the campaign on condition that fundraisers obtain their approval in advance and provide the names and contact information for all those making donations to them. The other charities imposed similar conditions that allowed them to accept designated donations without losing face. In other words, no funds were rejected. The women volunteers took this as a victory.

It would be another 20 years before cancer charities figured out how to repurpose volunteer enthusiasm. In the 1980s, they discovered athletic events – walks, runs, swims – that liberated women from their door-to-door drudgery and moved them to a public venue where they could pick up the pace, extend the distance, and find sponsorship and companionship along the way.

By then, the charity landscape had radically changed. Gone, for most national players, was the commitment to a single, fixed, annual campaign. Though some charities kept their association with specific times of the year (as did the Easter Seals and Christmas Seals), most began to drift toward the state of play that prevails today, when no day in 365 is off-limits to fundraising, and no day belongs, by custom or practice, to any one charity. The blurring of long-respected turf boundaries helped to undermine another important social belief – the idea that every disease required one – and only one – major philanthropic organization to promote its interests.

Today, such an approach strikes us as impossibly naive, now that both diseases and charities have proliferated beyond counting. The National Cancer Institute lists well over a hundred different types of cancer, and there are nonprofit advocacy groups serving every one of them. Not surprisingly, the most commonly occurring cancers receive the most attention and the most money. Charity Navigator, for example, lists over two dozen of the largest breast cancer charities. Collectively, they raise nearly $1.7 billion a year. This is not small change. It explains why competition for donors is now less intense between one disease and another than among charities serving the same disease.

It also explains why the Komen Foundation, once it had joined the ranks of the national charities, began to behave like them. Just as the big independents had once spurned community chests, Komen chose not to make common cause with other, smaller groups fighting the same battle. In 2007, it set itself apart by trademarking the slogan “for the cure,” forbidding others to use it. Komen insisted that contributors to an event advertised as “Kites for a Cure,” for example, might mistakenly believe they were giving to Komen. Never mind that the money might go to the same clients in the end; it would still represent an unacceptable loss of income to Komen. In seeking to protect the charity’s “market share,” Komen has essentially allowed the tactics of corporate self-interest to trump its philanthropic purpose. Financial success has altered its ambition. Now it may be as interested in safeguarding its own future as in promoting its original mission.

Komen’s response reflects another difficulty: it is very hard to distinguish one breast cancer charity from another. Too many of these organizations are offering exactly the same thing: platitudes – “The more of us who walk, the more of us survive.” “This is where the end of cancer begins.” “Say yes to life.” – followed by promises of an imminent breakthrough in research or a cure just around the corner.

Of course, they can’t deliver on any of this. What they can deliver are endless variations on that nebulous and overworked concept, “awareness” – which boils down to readily available information and advice and, possibly, access to subsidized mammography screening, genetic counseling, support groups or a medical consultation somewhere. They are, in other words, largely pass-through operations, guiding women to resources provided by others, and paying themselves, often handsomely, for their role as middlemen or -women, no matter how hackneyed or misleading their advice (most, for instance, still suggest that women start screening mammography at 40 – despite the recommendation of the US Preventive Services Task Force to start at 50, unless family or medical history dictates otherwise).

There are, of course, plenty of worthwhile breast cancer nonprofits out there. Many broad-based national organizations like the YWCA and Planned Parenthood offer breast cancer services to the underserved. Charities like CancerCare provide direct, tangible benefits to patients in the form of practical and/or financial support to help pay for treatment and/or related travel or childcare expenses. Other groups focus on the politics of the disease and take a more critical look at the diagnostic and treatment options that most other groups accept without demur. Finding these groups on one’s own, however, can be a daunting task, especially online, where the wash of soft-focus appeals makes it difficult for donors to identify those charities that provide direct services to patients or funding for genuinely promising research. Like the frustrated volunteers in Wisconsin, today’s idealists may find their zeal quickly fading in the face of so much redundancy and surfeit of pink product.

But as the Wisconsin women discovered for themselves in the 1960s, there are alternatives to consider. We could, in fact, follow their lead and resurrect the idea of federated giving campaigns. These campaigns would be stripped of their bells and whistles; they would not sponsor merchandise or events. Instead, they would focus on the end users, the organizations that carry out breast-cancer-related programs on the ground. Echoing the community chests’ earlier emphasis on relief, participants would primarily be service agencies, dedicated to providing tangible help to all those at-risk for the disease or affected by it in any way. Many of these groups, including those that serve minority populations, are currently too small to attract much fundraising attention. A more inclusive coordinated campaign might help put them on a sounder financial footing. It might also create the potential for collaboration among projects that have a great deal in common.

A united fund approach would in no way interfere with the operations of existing breast cancer charities. But the availability of a more streamlined model of fundraising, shorn of its cause marketing, its overpaid executives and its false promises might be a godsend to committed donors who have grown disenchanted with the wasteful and often misleading tactics of pink-ribbon crusaders.

Endnotes

1.
In 1969, there were 2,250 United Funds in the US, with 33 million contributors. Jerry M. Flint, “Charity Drives Criticized About Middle-Class Goals; Institutional Charity Is Meeting Rising Unrest in Nation Over Middle-Class Goals,” New York Times, November 3, 1969.

2.
In 1949, the three independent campaigns of the Red Cross, March of Dimes and Christmas Seals raised a combined total of $113 million, compared with a total of $188 million raised by over 1,000 community chests (F. Emerson Andrews, Philanthropic Giving (New York: Russell Sage Foundation), 1950,p153.

3.
Polly Brody Temkin, “The Housewives’ Revolt,” The Progressive, February 1966.