Financing Neurosis

“You should get a mammogram,” the doctor told my neurotic friend. At 30, my friend was unnerved, to say the least. She was even more undone by the reason her doctor proposed such an invasive procedure – my friend did not know her father’s family history of cancer. Because she was asymptomatic, a mammogram in her 30s was the last thing she expected to hear from her GP and the news precipitated unsolicited advice to her 30something girlfriends that they, too, should consider getting mammograms. But, with all of the conflicting accounts by doctors worldwide regarding the implications and potential dangers of mammography, resolving whether to allow technicians to invade her personal space that way was far from simple. After researching the procedure, my friend was even more hesitant to subject herself to it.

The machine itself was the source of many sleepless nights – it looks like a medieval torture device!

Further research showed that, not only is a mammogram invasive, it may be unnecessary. Specifically, according to a spokesperson for the Young Survival Coalition, “Mammograms are not a perfect screening tool – far from it – but for young women especially, they are often not helpful at all.”[1] And, the Cancer Prevention Coalition describes mammography as a “profit-driven technology posing risks compounded by unreliability.”[2]  In this country, however, doctors routinely prescribe precautionary tests to otherwise healthy people. To some, this seems about right: we have the technology, so why not use it? To others, preventive diagnostic testing is excessive, wasteful, and unnecessary if the person being tested is not predisposed to the disease. Beyond discomfort and questionable utility, for many women, cost is only a factor in determining whether to get a mammogram if they are uninsured.

As a global health policy student, this conversation with my friend was unsettling. I thought most about the fact that the gap between rich and poor countries is even more pronounced in relation to health care spending. This week’s reading added to my discomfort as I learned that, although developing countries account for 90 percent of the global disease burden, high income countries spend nearly one hundred times more on health per capita than developing countries.[3]

This begs the question: are preventive mammograms for healthy people necessary or is the expense wasteful, given the disparity in health care expenditures worldwide?

I concluded that, undoubtedly, allocations to health care in developing countries do not include preventive screenings like mammograms, especially for younger women. I felt something akin to survivor’s guilt as I contemplated what kind of treatments and medications that $80-120 (the average cost of a mammogram for uninsured Americans) could buy a young mother in a poor country. I imagined explaining a preventive mammogram to a woman whose child died of malnutrition or to a father who lost his wife in child birth. And, I decided that my friend’s dilemma was not a dilemma at all.

Given the high rates of maternal and child mortality and the MDGs , my friend’s dilemma seems trivial. Yet, outside of the global public health arena, people in developed countries do not necessarily envision access to health care in poor countries as their concern. As with most issues that are not made more appealing by celebrities or other high profile people, global health care outcomes are ruled by the luck of the draw, with access to adequate health care dictated by citizenship i.e. a person’s national identity rather than their health needs.


[1] Elizabeth Cohen. “When a mammogram isn’t enough.” www.cnn.com. October 14, 2010.

[2] Epstein, Bertell, and Seaman. “Dangers and Unreliability of Mammography: Breast Examination is a Safe, Effective, and Practical Alternative.” http://www.preventcancer.com/patients/mammography/ijhs_mammography.htm

[3] Gottret and Schieber. Health Financing Revisited: A Practitioner’s Guide. The World Bank. p vi.

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