Annals of Health Law
INTERVENING AT THE RIGHT POINT
Allyn L. Taylor concludes that “for millions of people across the globe,
excruciating pain is an inescapable reality of life.”22 Although the evidence
for global pain is necessarily regionalized and localized to specific contexts,
this reveals an important point: pain is an enormous population health
problem in both the global North and the global South. The ubiquity of
pain is unsurprising given the considerable evidence suggesting that while
health concerns and priorities differ across the globe, such differences mask
the underlying commonality in the determinants of disease and health,
namely social and economic conditions typically referred to as the “social
determinants of health” (“SDOH”).23
Moreover, the epidemiologic evidence also strongly suggests that the
highly inequitable distribution of pain both between regions and countries
and within such regions and nation-states is largely the result of said SDOH.
Goldberg and McGee cite evidence linking global chronic pain to a variety
of such social determinants, including but not limited to, “mental and
physical stress at work, socioeconomic status, rurality, occupational status,
neighborhood, race, and education.”24 Dorner et al. showed that even at the
same intensity of pain, the least well-off reported feeling two to three times
more disabled than the most well-off.25 Lacey, Belcher, and Croft recently
found that “older adults . . . with a life course trajectory of consistently low
[socioeconomic position] had almost three times the odds of reporting
chronic disabling pain . . . compared [to] those with a consistently high
[socioeconomic position] trajectory throughout life.”26
In terms of both its overall burden and its inequitable distribution along
Diseases and Injuries in 21 Regions, 1990–2010: A Systematic Analysis for the Global
Burden of Disease Study 2010, 380 LANCET 2197, 2203 (2012). And of course, there are
many kinds of pain other than that which results from musculoskeletal disorders, suggesting
that the “large” total of DALYs comprised of pain experiences may be significantly larger.
22. Allyn L. Taylor, Addressing the Global Tragedy of Needless Pain: Rethinking the
United Nations Single Convention on Narcotic Drugs Addressing the Global Tragedy of
Needless Pain: Rethinking the United Nations Single Convention on Narcotic Drugs, 35 J. L.
MED. & ETHICS 556, 556 (2007).
23. See, e.g., WORLD HEALTH ORGANIZATION COMMISSION ON SOCIAL DETERMINANTS
OF HEALTH, CLOSING THE GAP IN A GENERATION: HEALTH EQUITY THROUGH ACTION ON THE
SOCIAL DETERMINANTS OF HEALTH 3 (2008), available at http://whqlibdoc.who.int/
publications/2008/9789241563703_eng_contents.pdf [hereinafter WHO CSDH, Final
Report]; accord Sridhar Venkatapuram et al., The Right to Sutures: Social Epidemiology,
Human Rights, and Social Justice, 12(2) HEALTH AND HUMAN RTS 3 (2010).
24. GOLDBERG & MCGEE, supra note 9, at 2.
25. Thomas E. Dorner et al., The Impact of Socio-Economic Status on Pain and the
Perception of Disability Due to Pain, 15(1) EUR. J. PAIN 103 (2011).
26. Rosie J. Lacey et al., Does Life Course Socio-economic Position Influence Chronic
Disabling Pain in Older Adults? A General Population Study, EUR. J. PUB. HEALTH
(Advance Access 2012) (adjusting for confounders like age, BMI, income, depression, and
diabetes reduced the strength of but did not eliminate the association.)