Intended for healthcare professionals

Reviews Press

Ribbon development

BMJ 2004; 328 doi: (Published 04 March 2004) Cite this as: BMJ 2004;328:589
  1. Rebecca Coombes, freelance journalist (RebeccaCoombes{at}
  1. London

    With so many now to choose from, do ribbons make people more disease aware—or just more confused?

    Walk down any high street and you will see them pinned to assorted lapels in pink, red, tartan, and blue.

    This proliferation of looped empathy ribbons may be heartening, but it is also confusing. Not only are there too many colours to remember what cause they are promoting but, insome cases, one colour has been hijacked by several charities.

    In America, for example, if you meet someone wearing a purple ribbon you may assume itis in sympathy for people with pancreatic cancer. But these ribbons are also worn by breastfeeding campaigners, those against domestic violence, or to raise awareness of the tollof urban violence. Green is worn to publicise organ and tissue donation, but also childhood depression, ovarian cancer, and leukaemia. They are also worn by environmental activists.

    In the United States ribbon wearing is so out of control—you can buy chocolate ribbonsin coloured foils—that one website seeks to create order out of chaos by providing a handy catalogue of all known ribbons ( This includes a list oforphaned ribbons, those that “no longer have a home.”

    Although more restrained, the United Kingdom has embraced the idea of the ribbon: red for AIDS, pink for breast cancer, dark blue for ME (myalgic encephalomyelitis) awareness,teal blue for ovarian cancer—and this month is ovarian cancer awareness month—and a jigsaw of primary colours for autism.

    This modern trend for sporting your political, social, and possibly sexual leanings onyour label began with the launch of the red AIDS ribbon in 1991, when actor Jeremy Ironswore one to host the Tony awards, New York's theatre gongs. The ribbon was chosen by Visual AIDS, a group of professionals in the arts, who were inspired by the yellow ribbon wornto honour soldiers. Red was chosen for its connection to blood and passion.

    It has become one of the world's most widely understood symbols and, in its early heyday, wielded a deal of political clout. Barbara Bush, wife of then US president George Bush, made headlines when she was spotted in the audience of a fundraiser wearing a ribbon, which was then missing when she stood by her husband's side as he made a speech at the same event. Today the National Aids Trust, which organises the awareness ribbon in the UK, distributes over one million a year.

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    In Scotland the red ribbon is tartan thanks to a campaign by the country's leading HIV/AIDS charity, Waverley Care. The loops are mainly given out during the Edinburgh Festival, but non-resident Scots tend to pick them up on trips back to their homeland and then wear them all-year round as a symbol of national pride, says director David Johnson.

    “In terms of HIV we already had a ribbon that was very well known. But we decided to launch a tartan one because the name of our charity didn't really mean anything at all. So we gave a tartan tweak to the red ribbon—in corporate terms it located us in the HIV sector but also gave us a Scottish identity. The concerns about raising awareness about HIV were secondary but we've had an amazing success here as well,” he says.

    The pink ribbon is a more glamorous cousin of the red, but has rapidly become a global symbol of breast cancer awareness.

    When Estée Lauder, of the US beauty giant, launched the pink ribbon in 1993 she made wearing it a fashion statement. Today there is no end of corporate sponsors willing to manufacture pink ribbon-linked merchandise. Last year's campaign saw chemist Boots stocking a £10 ($19; €15) limited edition Swarovski crystal pink ribbon brooch branded “this season's must-have to support breast cancer.”

    Breast Cancer Care was the organisation that imported the pink ribbon to the UK from America. Spokesperson Christina McGill says: “It's informally seen as one of the most successful health awareness campaigns ever run. It's a nice hook for the media that we have a strong symbol that people recognise.

    “I can imagine that the HIV cause is still considered to be an unpopular cause to market because there is still stigma attached to the disease. But with breast cancer the field continues to grow. People are more willing to believe breast cancer could affect their lives. The figures for 1999—the latest available—show a rate of 41 000 diagnoses a year.”

    It's not hard to account for the ribbon's success. Ribbons are cheap, most likely manufactured in the Far East and costing pennies to make, and—thanks to celebrity-endorsed campaigns—fashionable and attractive. But their ubiquity has led to an inevitable backlash—author Patrick West dubs the trend “label loutism” in his new report Conspicuous Compassion, for the think tank Civitas.

    He argues that there is scant evidence that the wearing of ribbons raises awareness and points to figures from the National Council of Voluntary Organisations that show the number of Britons giving to charity is actually falling.

    “It is the by-product of our emotionally correct, crying-in public, post-Diana consensus, in which a lonely populace is prone to immodest, attention-seeking displays of compassion,” he blasts.

    Whether wearing a ribbon is just a pretty way of giving lip service to a cause or not, our passion for the silky loops shows no sign of waning. Breast Cancer Care distributed an extra 16% of ribbons in 2003 compared with the previous year. At Alan Salter, a leading manufacturer of fundraising merchandise, a spokesperson confidently predicted that ribbons are here to stay. “They are simply the least expensive way of putting an emblem on somebody's chest,” he said.

    Breast Cancer Care's Christina McGill also doesn't think that the ribbon's mass success will be its downfall: ‘It has become a recognised marketing vehicle. Just because someone was first to put an advertisement on the side of a taxi doesn't mean that other companies can't follow suit. And look at poppies—you can even buy white ones today.”