Funding Health Justice: Why Black Women Need More Than Pink Ribbons
This piece is dedicated to Eugenia “Gina” Nickole Williams (October 27, 1974 – March 15, 2018), and to every Black woman navigating breast cancer in the face of an inequitable health care system.
Every October, Breast Cancer Awareness Month saturates the public sphere with pink ribbons, branded slogans, and pink merchandise. These highly visible efforts rightly draw attention to a devastating disease that affects one in eight women in the U.S. over the course of their lifetime, upending far too many women’s lives and families along the way. Though this month has undeniably played a critical role in helping to reduce stigma, encourage early detection, and drive neighborly support, for many women—particularly Black women—awareness is simply not enough.
Understanding the Survival Gap
Despite a slightly lower incidence of breast cancer, Black women experience far worse outcomes than their white counterparts. According to the American Cancer Society’s Breast Cancer Facts & Figures 2024–2025 report, Black women are diagnosed about 5% less often than white women, yet their mortality rate is 38-40% higher—largely attributed to later diagnoses and significantly less access to high-quality treatment. Structural racism and socioeconomic barriers drive these disparities, compounding risk at each stage of care, from screening to survivorship.
As a result, Black women face the lowest 5-year relative survival rate of any other racial or ethnic group across every stage of diagnosis and every breast cancer subtype (Mass General Brigham; American Cancer Society). Further, as a 2025 Susan G. Komen report underscores, the persistence of systemic inequities means comparable screening rates do not translate into equal survival rates: even when Black women access mammograms, they too often encounter delayed follow-up, limited treatment options, or poorly resourced facilities. These barriers are further exacerbated by provider neglect, culturally incompetent care, medical racism, and the routine dismissal of Black women’s pain and concerns—factors that deepen mistrust in the health system and worsen outcomes.
These disparities are not the result of insufficient recognition—there is no shortage of visibility around breast cancer. Rather, they stem from a profound lack of health equity and chronic underinvestment in structural solutions that could move us from pink ribbons to power, saving thousands of lives each year.
A Crisis of Investment and Equity
In today’s political climate, the need to channel awareness into action in breast cancer care and R&D has never been more urgent. Sweeping cuts to federal health research budgets, grantmaking, and DEI measures under the Trump Administration have left breast cancer research, cancer care, and health equity initiatives vulnerable, threatening to reverse decades of progress.
When Investment Stops, Innovation Stalls
Reductions in funding for agencies such as the National Institutes of Health (NIH) and the National Cancer Institute (NCI) are stalling innovation, jeopardizing clinical trials, and destabilizing research institutions. Hundreds of grants from these institutes have been terminated or delayed, forcing cancer research programs nationwide to scale down operations (The ASCO Post). At Harvard alone, nearly $3 billion in funding has been frozen, a stark yet far from isolated example of a national crisis that has “left labs across the country … grappling with layoffs, halted projects, and hiring freezes” (WBUR). The effects are not only immediate but generational. As The ASCO Post warns, reduced NIH and NCI funding is dismantling the U.S. research pipeline and fueling a mass “brain drain” that drives talent, innovation, and drug development overseas—a disruption that could set back cancer outcomes for years to come.
From the Lab to the Patient
These disruptions don’t just stall science—they ripple down from researchers to patients, eroding the pipeline of discoveries that deliver earlier diagnoses, more effective treatments, and survival itself for those facing breast cancer. Compounding this, the One Big Beautiful Bill’s historic attack on healthcare puts over 10 million people at risk of losing coverage, including many cancer patients who rely on Medicaid, which “plays a critical role in ensuring access to timely diagnoses, life-saving treatments, and comprehensive care” (Cancer Therapy Advisor). This policy shift not only accelerates patient harm but also deepens inequities in access to care, with particular impact on low-income patients. Because “health insurance is one of the most important factors in achieving better cancer outcomes” (Cancer Therapy Advisor), experts predict cascading consequences, such as delayed care, a surge in cost-of-care-driven bankruptcies, and ultimately, more preventable deaths nationwide (Think Global Health).
The Cost of Undermining Equity Efforts
At the same time, federal rollbacks of DEI policies are intensifying these harms. As AJMC notes, many health systems are defunding and dismantling equity-focused initiatives designed to reduce disparities, leaving institutions uncertain how to sustain efforts that address structural racism in health care. Without DEI infrastructure, inequities deepen—particularly for Black women, who already face the highest mortality and lowest survival rates.
This deadly convergence of decreased federal investment and weakened equity frameworks means the gaps we already see in access and outcomes will widen dramatically—leaving already marginalized communities to bear the heaviest burden. With federal support retreating, we cannot afford to wait for certainty—we must step up now.
The Path to Transformative Action
Across the country, Black-led health equity organizations and equity-focused philanthropic investments are already modeling what it takes to advance real health justice in the face of political retrenchment and escalating health disparities. Black Women Thriving East of the River—an organization English Hudson is proud to call a longstanding client partner—demonstrates what’s possible when systemic strategies are paired with direct care. Community-driven and anti-misogynoir-focused, their model centers self-advocacy, culturally grounded and accountable care, and cross-sector collaboration that bridges policy and practice. Through advocacy, they’ve achieved significant systemic wins while remaining agile on the ground to meet evolving community needs. Their work embodies the power of investing in full ecosystems of care. By integrating patient navigation, equitable access to screenings and follow-up care, culturally informed providers, and interventions that meet people where they are, they’ve fostered empowerment, improved access, and strengthened trust between patients and providers—ensuring Black women receive the comprehensive care they deserve.
Following their example, funders can take several practical steps to ensure their investments drive systemic, equity-focused change:
Invest in systemic solutions: Tangible improvements to equity require systemic change. This means funding and advocating for stronger clinic infrastructure, expanded imaging access, equitable clinical trial participation, equitable care standard enforcement, accountability for treatment delays, and research on social determinants of health.
Maintain institutional commitment. Even as federal mandates are eliminated, institutions can choose to sustain their commitments. The American Cancer Society (ACS) offers a powerful example, pressing forward with ambitious, equity-focused studies despite shifting federal priorities.
Invest in patient navigation and follow-up care. Guidance after screening is essential, as delays in diagnosing and treating abnormal results remain a major driver of mortality gaps. By funding navigation programs, transportation supports, and follow-up infrastructure, funders can help close those gaps and ensure timely, equitable care.
Prioritize community-based organizations. Local, trusted organizations are best positioned to deliver culturally responsive interventions. To sustain their work, philanthropy should provide more flexible dollars (e.g., general operating support, unrestricted funding, multi-year commitments) to empower those closest to the problem to drive tangible change with direct community impact.
Measure what matters. Tracking incidence alone isn’t enough. We must also track time to diagnosis and treatment, disparities in facility quality, mortality gaps, and patient experience—using data not only as a reporting tool but, equally importantly, as a mechanism to hold systems accountable.
From Ribbons to Reform
If the narrative around breast cancer ends with ribbons and slogans, we risk obscuring the enduring inequities that shape breast cancer outcomes for Black women. We must move through the door that awareness has opened—toward sustained, equity-centered investment, systemic accountability, and structural reform that tackles root causes and dismantles barriers at every stage of the breast cancer journey.
Philanthropy, health systems, and policymakers each hold responsibility for building on the tireless work of local, grassroots breast cancer support groups to advance this shift.
By resourcing community-led organizations, safeguarding research and equity infrastructure, and ensuring innovations reach those most at risk, we can transform recognition into remedy—ensuring survival for every person diagnosed with breast cancer, regardless of race, ethnicity, or ZIP code.