From Tokyo, where I've spent considerable time reporting on a society that treats preventive health with the seriousness of a civic duty, I have come to view Australia's fraught relationship with the colonoscopy as one of the great missed opportunities in public health. Japan's colorectal cancer screening rates are among the highest in the developed world, and the cultural attitude is straightforward: discomfort now is far preferable to catastrophe later. It is a philosophy Australians would do well to borrow.
So when a piece of personal essay journalism crossed my desk recently, tracing one writer's journey through a procedure most people spend decades dreading, it struck me as something worth sharing. The original piece, which appeared in The New York Times Magazine, is part comedy, part confession, and part genuine public health argument. It is also, unexpectedly, rather convincing.
The writer begins where most of us live: in denial. A colonoscopy, they write, feels like "a distant, inevitable horror, like the heat death of the universe." It is the kind of thing that will happen to some future, older, unrecognisable version of yourself, so why think about it now? This psychological postponement is familiar to anyone who has been handed a bowel cancer screening kit in the mail and quietly slid it behind the recycling bin.
What the piece does well is reframe the experience from the inside. The day before the procedure, known in clinical terms as the "prep day," involves drinking a large quantity of bowel-clearing liquid. The writer describes this with cheerful abandon as a kind of enforced stillness, a day stripped of all obligation except the most biological. There is something almost meditative about it, they argue, and while that framing requires a considerable sense of humour, the underlying point is solid: the anticipation is genuinely worse than the reality.
The procedure itself passes in roughly twenty-two minutes of sedation-induced unconsciousness. The writer wakes to a box of juice and a set of photographs of their own colon, which they study with a mixture of bewilderment and curiosity. The results, in their case, were clear. They were told to return in a decade.
The health context behind this personal account is not trivial. Cancer Council Australia identifies bowel cancer as the second most common cancer affecting Australians, with roughly 15,000 new diagnoses each year. When detected early, survival rates improve dramatically. The National Bowel Cancer Screening Programme, which invites Australians aged 45 to 74 to complete a simple home test every two years, exists precisely to catch the disease before symptoms appear.
Yet participation rates remain stubbornly below where health authorities would like them. According to the Australian Institute of Health and Welfare, participation in the programme sits well below 50 per cent of those invited. The barriers are partly practical and partly cultural: a mixture of embarrassment, anxiety, and the persistent belief that if nothing hurts, nothing is wrong.
What Australian observers often miss about Japan's approach to preventive medicine is that it is not merely a product of a more disciplined national character. It is the result of decades of public health messaging that normalised early detection as an act of self-respect rather than a submission to fear. Annual health checks, including cancer screening, are embedded in workplace culture. The conversation is matter-of-fact. There is no shame in it.
Australia is not Japan, and the comparison has its limits. Access to bulk-billed colonoscopies varies considerably across the country, with rural and regional communities facing longer wait times and fewer specialists. The Gastroenterological Society of Australia has long pointed to capacity constraints in the public system as a genuine barrier to improving screening rates, and that is a legitimate structural problem that no amount of personal essay writing will resolve on its own.
The competing pressures here are real. Public health investment in screening infrastructure costs money, and governments face genuine trade-offs in allocating health budgets. The case for expanding colonoscopy capacity rests on long-term economic arguments, that preventing late-stage cancer treatment is cheaper than funding it, but those arguments play out over years and electoral cycles rarely accommodate that kind of patience.
Still, the writer's underlying message is worth taking seriously. The colonoscopy is not the ordeal most people imagine. It is brief, well-managed, and, in the great majority of cases, reassuring. The prep day is unpleasant. The sedation is, by all accounts, genuinely pleasant. The alternative, discovering something serious years later than necessary, is considerably worse on every measure.
Reasonable people can weigh the discomfort differently. But the evidence for early screening is not really in dispute. If a piece of comic personal journalism is what it takes to get a few more Australians to book the appointment, then perhaps it has done more useful work than a dozen policy papers ever could.