I have this health plan. My doctor was very nice when I told her that I did not want a Pap or pelvic exam, and she hasn’t hassled me about it. The health care plan, on the other hand, seems perturbed that I haven’t toed the line and agreed to have a Pap. A few weeks ago I received this “invitation” in the mail. It offers a bribe of a $50 Target gift card if I go for a Pap before the end of 2014.
I think it is VERY important to note, at this point, that TARGET HAS NOTHING TO DO WITH THIS. They are NOT sponsoring this, donating the gift cards or participating in this ruse in any direct way. The bribe just happens to be a gift card from their store. There’s a disclaimer on the purple page about that. Apparently the health plan is buying these cards themselves.This promotion is very, very clever, and very, very insidious. To point out the most glaring issues with it:
1. The card is covered with photos of smiling women. What’s the message there? “Getting your Pap is fun, ladies!”
2. “You still need a cervical cancer screening.” Not “you should talk to your doctor and make an informed decision” here, no siree. You NEED that Pap. The language here is clearly designed to make women think that the Pap is mandatory or essential to their continued good health. It takes away women’s agency and choice in the matter.
3. “You could have cervical cancer and not know it.” Fear-mongering, much? You could also have heart disease, ovarian cancer, a brain tumor, or melanoma – and the odds of having any of those things is way higher than your risk of cervical cancer — but your insurance company isn’t going to aggressively insist on screening you for those, are they? And no, they’re not going to mention that your risk of cervical cancer is highly dependent on a number of factors, or that the average incidence of cervical cancer in Los Angeles County is something like 10 women out of 100,000 (“Health Indicators for Women in LA County,” LA County Department of Public Health. Page 14, “Health Conditions – Incidence and Prevalence.”) Nor will they mention that cervical cancer isn’t even one of the top ten most-diagnosed cancers in California (http://ccrcal.org/pdf/Factsheets/Ten_Most%20Common_Types_Cancer_California,_2009.pdf).
4. “…the whole process takes only a few seconds” …and we won’t mention it’s an internal exam in which a doctor or nurse practitioner shoves a large instrument in your vagina, pokes around your cervix, possibly does physical damage, causes you pain, humiliation or PTSD, and performs a test that has a high rate of false positives! Shhhh!
5. “Do it for yourself and for your family.” C’mon, ladies. Take one for the team. The language here makes it seem as though women are neglecting their families if they refuse a Pap.
6. “Find out how to stay healthy…” More misleading language here, eh? There isn’t any information on how to stay healthy in this flyer. I don’t see anything that talks about women’s risks for heart disease or diabetes. I don’t see a list of warning signs for ovarian cancer or a guide to self-examining one’s skin for melanoma. I don’t see good exercise guidelines or nutrition information. Hell, I don’t even see anything about safe sex or preventing STDs here. Nope, apparently the magic key to staying healthy is just getting a Pap, ladies!
7. I suppose it’s Captain Obvious to mention that this entire flyer is written in a very paternalistic, condescending tone of voice, at about a third-grade reading level. They’re clearly assuming that any woman who refuses Pap testing is uneducated, illiterate or too stupid or ignorant to make informed choices about her medical care.
And if that isn’t insidious enough:
This insurance company is one of the two major managed care systems that handles Medi-Cal, California’s version of Medicaid. Thus, it’s safe to assume that a majority of the women who received this notice were low-income Medi-Cal recipients. This “promotion” dangles a $50 gift card in front of women who are living around or below the poverty line. $50 is a lot of money, especially to those who are financially struggling. A gift card to Target is a perfect bribe, too, since one can buy just about anything from groceries to personal care products to clothing there.
In addition, this “promotion” was sent out in the middle of the summer. If you look closely on the flyer, you see a 7/14 date right there in the corner. Why is that significant? The school year in California starts sometime between early August and early September, depending on one’s district. It’s the time of year when many parents stress out over the cost of school expenses…particularly those who are poor.
How many women who received this card were desperate to pay for their kids’ school clothes or supplies? How many were short on grocery money? How many looked at this promotion and decided that they really, really needed that $50 and went for a Pap even though they didn’t want to do it, they were not giving fully informed consent and the test had absolutely zero benefit to them? How many thought that declining the Pap would be “throwing money away” because of that gift card?
This isn’t informed consent. It’s coercion. It’s a pack of lies targeted to a vulnerable population.