Annals of Health Law
INTERVENING AT THE RIGHT POINT
both of Benach et al.’s criteria ( i.e., both diminished overall burdens of pain
and compressed global pain inequities).
In short, L&P approaches to ameliorating global pain are, like most
clinical medical interventions themselves, by their nature only applicable
proximal or subsequent to the onset of disease itself. They are therefore
unlikely to substantially diminish – and indeed, by most reliable measures
they have not diminished – global prevalence and incidence of pain.
Worse, since L&P interventions designed to reduce access barriers to
medical care will, if successful, generally facilitate agentic interventions,
medicalized L&P schemes run a very real risk of expanding the very global
pain inequities stakeholders are ethically charged with compressing.88 This
If the L&P interventions devoted to ameliorating global burdens of pain
have tended to be those inserted significantly downstream on the causal
pathway, the preferable policy correction is plain: categories of L&P
interventions that address upstream distal factors that constitute
fundamental causes of pain.89 Of what would such interventions consist?
Recall that fundamental causes involve access to resources that can be
used to avoid disease or to effectively manage its sequelae once it develops.
Such causes tend to (1) cause multiple diseases (many of which may result
in pain), (2) contextualize multiple risk factors for pain, and (3) persist over
time.90 It is not difficult to postulate social and economic conditions that
are robustly correlated with pain outcomes and which satisfy these three
In recommending health policy approaches that avoid medicalization,
one obvious starting point is Rose’s whole population approach.91 The idea
here is that implementing policy interventions at structural levels that
resonate through an entire population as opposed to simply focusing on
high-risk groups will result in more substantial improvements to overall
population health at the same time they compress health inequities.92
88. See notes 77-80 supra & accompanying text.
89. Fundamental cause theory is young, having first been proposed in 1995. Although
the evidence base supporting the theory is growing, there are as yet no empirical studies
specifically designed to assess how certain kinds of pain fit the framework. However, given
that pain is comorbid with a host of diseases, some of which have been subjected to
evaluation under a fundamental cause rubric, there is every reason to suspect a fit reasonable
enough to generate the policy prescriptions adduced above. As noted in Part III, there is
little doubt that patterns of pain in human populations are strongly determined by social and
economic conditions. In any event, the notion that social and economic conditions are
fundamental causes of global pain is offered as a potentially useful frame rather than asserted
as a or the definitive explanation.
90. See note 52 supra.
91. See Benach et al., supra note 5; Theo Lorenc et. al., supra note 81.