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OSONDU: The Race for Life (Part 4)

Clement Okoh is a cancer survivor, author, entrepreneur….and proud grandfather. Cancer Matters is sharing book excerpts of his personal journey, “OSONDU,", an inspiring story of hope.

Photo: Me and Dr. Eugene Shenderov

Read part 1 here: PART 1, PART 2, PART 3


OSONDU – Generating Action for Cancer Prevention and Donations to Cancer Causes (part 4)

Cancer is highly prevalent in the United States, and treatment is very expensive. According to the United States National Institute of Health (NIH) National Cancer Institute:

In 2016, there were an estimated 15.5 million cancer survivors in the United States. The number of cancer survivors is expected to increase to 20.3 million by 2026. Also, approximately 38.4% of men and women will be diagnosed with cancer at some point during their lifetimes (based on 2013–2015 data).[1]110

The survivorship number includes everyone who was ever diagnosed, whether or not actively living with cancer. The NIH also reports that:

Estimated national expenditures for cancer care in the United States in 2017 were $147.3 billion. In future years, costs are likely to increase as the population ages and cancer prevalence increases. Costs are also likely to increase as new, and often more expensive, treatments are adopted as standards of care.

Given the prevalence of cancer and that over 38% will get diagnosed at some point in their lives, why is it so difficult to have people prevent cancer and donate to causes?

Well, one way to look at this is that cancer risk is only 38% while death is 100% probability. And it’s difficult to get folks to plan for retirement and death. So, maybe it’s something built into how humans process information and issues.

Part of the problem is that most people can't relate viscerally to cancer as a risk worth avoiding. (If they saw it as a risk worth avoiding, people might be more likely to contribute to cancer causes such as research and support, in the name of self-interest. They might benefit from it). People understand "cancer risk" intellectually but have a better visceral feel for more mundane and immediate issues like hunger and eminent existential threats.

The affliction is painful and debilitating, and often fatal. It's also catastrophically expensive. Over 38% of people will get diagnosed, and the cost of treatment currently exceeds $150bn/yr in the U.S. But all these facts and numbers creep up on you - it doesn't happen to you until it's happened to you. So, the average person runs around blithely unaware and unprepared. Sometimes, there's an element of denial in the community. It's just not something people are ready to think about actively, so it's hard to generate action. (I know I didn't think about mine until I was diagnosed and fractured my spine).

More formally, decades of studies have shown that people tend to discount issues that are distant from them in spacetime and this affects the ability to generate action on cancer.

Unfortunately, like climate change, cancer involves a combination of four factors that make it hard for “healthy” people to get motivated. (I say “healthy” because some cancers result from internal changes built up over time. It might not be as compelling as a mosquito bite but that thing that catches up with you at age 55 could be going on in your “healthy” 45-year old body. Maybe even earlier).

The four factors that impede motivation are (1) temporal discounting, (2) non-linearity of cancer development, (3) psychological distance, and (4) time dependence of risk. [2], [3]

Temporal Discounting

Temporal discounting means we overvalue benefits in the short term relative to benefits in the long term.

The short term benefit being that we can continue our life pattern without disruption. Spend money as we do, eat and drink what we do, maybe lobby congress and donate to cancer causes when we get older, to stave off the 38% chance of getting cancer. Maybe.

The long-term benefit is that we have a better likelihood of not having cancer (our likelihood goes from 62% to a possibly higher but uncertain number). The long term benefit might also include a better prognosis and possibly better treatment.

Non-Linearity of Cancer Development

Cancer development is typically non-linear. Nothing happens for a long time while you don’t have it. Then it could start slowly and accelerate, so it gets progressively worse progressively faster. You might not have it for 60 years, and be dead in 3 years after you get it. But people tend to project linearly. So, you didn’t have cancer for 25 years of smoking, and you are linearly projecting another 25 years of no illness. Then suddenly the illness seems to sneak up on you in year 30.

Our linear projection has us thinking nothing bad will happen, and certainly not soon. So, we are slow to action and hard to motivate.

Psychological Distance

Increasing psychological distance causes people to conceptualize things more abstractly. The distance could be space-time or social distance. So, the effects of the atomic bomb in 1945 are hard to conceptualize in any real way. Even the more contemporary drinking water problem in Flint Michigan is psychologically distant for practically all Americans.

People are just not as motivated into action by things they view abstractly. Not like they are with a clear, present, and specific existential threat (a snake in your bedroom).

Time Dependence of Risk

Not only is the future uncertain, but the risk in the future is also uncertain. (It could be a bull market, but you might be a dot-com company on the way down). So, the perception and valuation of costs are uncertain.

Our challenge in raising support for cancer causes and in trying to prevent cancer is that we are trying to motivate specific actions to mitigate uncertain risk. Especially when the risk has an uncertain profile and will arise in an uncertain environment.

It’s very difficult to convince people to mitigate an uncertain risk (of cancer), with an uncertain risk profile (depending on what you do and how you live) in an uncertain risk environment (the future).

Especially if the mitigation involves contributing their time and money.

Possible Solution for Fundraising

How do we change the fundraising profile for cancer causes?

In addition to current efforts, we have to minimize the need for contributors to make decisions or evaluate risk and uncertainty. This would also help disarm the temporal discounting.

Contributions should be as passive as possible while remaining committed.

For example, we could seek long-term commitments of a small amount per month or per year, from

  1. credit cards (airline mileage, discounts, fees)
  2. taxes (airline mileage, personal income tax, online purchases)
  3. small percentage contributions (0.1% ) on online purchases from e-commerce giants like Amazon or eBay or Google (voluntarily from purchaser, seller or host platform)
  4. small percentages of online advertising revenue (voluntary from advertiser and/or host)
  5. small percentage of online space storage fees (e.g. Apple or Google storage)

Essentially, the idea is to get passive cashflows and deductions without saddling the contributor with temporal discounting calculations, evaluation of risk or assessment of uncertainty.

[1] “Cancer Statistics,” NIH National Cancer Institute, about-cancer/understanding/statistics Accessed November 18, 2018

[2] It’s arguable that time is the underlying factor, and the last three factors are functions of time.

[3]  Art Markman, Why People Aren’t Motivated to Address Climate Change, Harvard Business Review, 10/11/2018 Accessed 12/18/2019.