Purtle and Roman Respond

Thank you for bringing this literary reference into the discussion about health awareness days. It’s reassuring to know that we are not the first health professionals, fictional or otherwise, to cast skepticism about the motivations and effectiveness of health awareness initiatives. As you note, we share Dr. Arrowsmith’s concern that health awareness days, weeks, and months might do little more than generate funds for the organizations that champion them. If alive today, the doctor might enjoy searching CharityNavigator.org—a Web site that rates charities on indices of finance, accountability, and transparency.¹

If Arrowsmith were to conduct a keyword search for “awareness,” he would find that the proportion of charities with “awareness” in their name or mission is more than twice as high for health charities than charities in other categories (e.g., environment). Arrowsmith would also find that these awareness-oriented health charities vary in the extent to which they allocate funds to support direct services and research, the mechanisms through which they would likely promote health. Arrowsmith would see charities with four-star ratings such as the National Sleep Foundation, which works toward the mission of “Improving sleep health and safety through education, public awareness, and advocacy” and allocates 93.0% of its budget to services and research. He would also find one-star charities such as the Defeat Diabetes Foundation, which operates under the slogan “Awareness + Action = Prevention” and spends only 45% of its budget on services and research.

Given that awareness campaigns are unlikely to fade from the repertoire of health charities, what can be done to help ensure that these initiatives improve population health? We suggest that a template be developed to guide effective distribution and transparent reporting of funds generated from health awareness initiatives. The template would walk charities through a process to consider and document how proceeds will be allocated to produce positive health outcomes. The template could be included in all monthly toolkits available on the US Department of Health and Human Services’ National Health Observances resource center.² Use of the template could also be required by public and private funding agencies. Once organizations have completed these fundraising templates, they could be made publicly available on Web sites such as CharityNavigator.org. Such a template would increase accountability, transparency, and the likelihood that awareness initiatives improve the health of populations—not just the financial health of the organizations that implement them.