Annals of Health Law
INTERVENING AT THE RIGHT POINT
Understanding the criteria of progress for global pain policy is crucial.
For reasons that will become clear below, the criteria deployed here differ
in some important ways from the goals articulated by leading governmental
and nongovernmental organizations (“NGOs”) as to ameliorating global
burdens of pain. Building on prior work,4 this article adopts Benach et al.’s
two criteria for ethical population health policy: policy interventions should
seek (1) to maximize improvements in overall population health and (2) to
compress health inequities.5 Pain presents a paradigm case for application
of Benach et al.’s criteria because it produces an enormous adverse impact
on overall population health and is also inequitably distributed within and
between nations in both the global North and the global South.6 The scope
of these inequalities is staggering, and, as is the case for health inequalities
across the globe, they are expanding.7
In a sense, these criteria are quite simple when applied to pain or to any
other disease paradigm stakeholders are interested in mitigating. As to
global burdens of pain, ethically optimal public health interventions are
those which will reduce absolute prevalence and incidence of pain while
simultaneously compressing the large and growing inequities8 in such
pain is not only an inevitable part of the human condition, but is a phenomenologically
desirable one as well ( i.e., that it helps make meaning in life). The capacity to experience
pain is unquestionably a good, even if pain experiences themselves are frequently not so,
given that the inability to experience pain (congenital analgesia) results in enormous
increases in mortality and morbidity. Joseph H. Dimon III, Congenital Indifference to Pain:
Long-term Follow-up of Two Cases, 88 SO. MED. J. 851, 855 (1995).
