Annals of Health Law
INTERVENING AT THE RIGHT POINT
It is crucial to note that the criticisms of such emphasis that follow herein
are not intended to deny the importance and significance of access to
evidence-based therapies that are needed for the treatment of clinical pain.
No matter how social and economic life is structured, people across the
globe will still become sick and/or experience pain, and ensuring adequate
treatment for that pain is ethically imperative. Nevertheless, two important
qualifications are needed. First, the fact that access to treatment for pain is
ethically imperative does not imply it is ethically paramount; for many
reasons other imperatives may simply be more important. Second, insofar
as other imperatives are of greater moral significance, it follows that L&P
interventions should in some rough sense correspond to the general
hierarchy of such imperatives. Thus, while a bundle of laws and policies
might be appropriate and necessary to alleviating the burden of pain across
the globe, if those laws and policies track approaches that are less
significant than others, said laws and policies are ethically suboptimal. To
put it in terms of Benach et al.’s criteria, L&P interventions that at the same
time promise to maximize improvements in overall health (by reductions in
absolute burdens of pain) and to compress health inequities are preferable to
those that do not.32 The remainder of this article is devoted to arguing that
L&P interventions that focus on ameliorating the structural determinants of
pain across the globe are preferable to those that emphasize access to
medical treatments for pain. And the magnitude of the quantum of
preference, as it were, is stark.
III. SOCIAL EPIDEMIOLOGY, FUNDAMENTAL CAUSES OF DISEASE AND THE
MEDICALIZATION OF PAIN
Goldberg and McGee argue that the medicalization of global pain is a
somewhat curious affair given the obviousness of its qualification as a
public and population health problem.33 Of course, in a crucial sense a
dichotomy between clinical and population health paradigms is artificial.
Population health problems tend by definition to become clinical problems
in populations to whom clinical care is provided just as clinical problems
are constitutive of key population health problems.34 Regarding pain as
32. See Benach et al, A New Typology, supra note 5.
33. See Goldberg & McGee, supra note 9.
34. See generally Thomas Frieden, A Framework for Public Health Action: The Health
Impact Pyramid, 100 AM. J. PUB. HEALTH 590 (2010); see also INSTITUTE OF MEDICINE, FOR
THE PUBLIC’S HEALTH: INVESTING IN A HEALTHIER FUTURE (2012), available at
Future.aspx (last visited January 4, 2013); Steven H. Woolf, Social Policy as Health Policy,
301 JAMA 1166 (2009); Steven H. Woolf, The Power of Prevention and What it Requires,
2999 JAMA 2437 (2008).