Annals of Health Law
INTERVENING AT THE RIGHT POINT
reduce pediatric mortality and morbidity linked to road traffic accidents.98
Another L&P intervention that could be deployed to alleviate global pain
might be improving educational attainment across a population. A 2001
review concluded that “[s]cientific evidence supports the hypothesis that
less well educated people are more likely to be affected by disabling back
pain.”99 Low educational attainment very likely qualifies as a fundamental
cause of disease insofar as it robustly correlated with multiple diseases,100
multiple risk factors,101 and persists.102 L&P interventions designed to
increase educational attainment103 could therefore have a salutary effect in
Pain Syndromes and their Relation to Childhood Abuse and Stressful Life Events, 54 J.
PSYCHOSOMATIC RES. 361 (2003); but see Karen G. Raphael et al., Is Childhood Abuse a
Risk Factor for Chronic Pain in Adulthood?, 8 CURR. PAIN & HEADACHE REP. 99
(concluding that any link between childhood abuse and adult chronic pain is modest in
magnitude if it exists at all).
98. See, e.g., Jones et al, supra note 93, at 93 (noting that children hospitalized after a
road traffic accident faced an adjusted risk increase of experiencing pain as an adult of 40%
as compared to the control group); WORLD HEALTH ORG., WORLD REPORT ON CHILD INJURY
PREVENTION (Margie Peden et al. eds., 2008) available at http://www.who.
int/violence_injury_prevention/child/injury/world_report/en/ index.html. The WHO Report
notes that road traffic injuries in 2004 accounted for 262,000 deaths among children aged 0-
19 (30% of all injury deaths among children and nearly 2% of all deaths among children).
Id. at 31. And although 93% of child road deaths occur in low and middle-income nations,
road traffic injuries still account for a fifth of all childhood injury deaths in the European
Union. Id. These are mortality statistics, yet the fact that adult pain is linked with childhood
road traffic injuries suggests the latter’s linkage with (pain) morbidity as well.
99. C.E. Dionne et al., Formal Education and Back Pain: A Review, 55 J.
EPIDEMIOLOGY & COMM. HEALTH 455, 466 (2001); see also Randy S. Roth & Michael E.
Geisser, Educational Achievement and Chronic Pain Disability: Mediating Role of Pain-Related Cognitions, 18 CLINICAL J. PAIN 286 (2002) (concluding that low educational
attainment mediates chronic pain disability by increasing maladaptive coping strategies); see
also Randy S. Roth et al., Educational Achievement and Pain Disability Among Women with
Chronic Pelvic Pain, 51 J. PSYCHOSOMATIC RES. 563 (2001) (finding links between
educational attainment and pain disability among women with chronic pelvic pain)
100. See Andy I. Choi et al., Association of Educational Attainment With Chronic
Disease and Mortality: The Kidney Early Evaluation Program (KEEP), 58(2) AM. J. KIDNEY
DISEASE 228 (2011) ; Low et al., supra note 63, at 1137-1143.
102. WHO CSDH, Final Report, supra note 17, at 56-59; Low et al., supra note 63.
103. It is essential to avoid conflating improving educational attainment across the life
course with improving health education. Despite sounding similar, these are two very
different kinds of health interventions, with the former focused on improving general
education and literacy across the life course, while the latter is focused on specific kinds of
knowledge about specific health risks. Conceptualized in terms of the causal pathway
utilized here, emphasis on improving general education is targeted at an upstream factor
much higher in the pathway, while efforts at health education are typically located much
lower, proximal/subsequent to the onset of disease. Unsurprisingly, the evidence suggesting
efficacy is also quite different, with that supporting broad educational attainment much more
favorable than the more narrowly-focused health education interventions. Compare Low et
al., supra note 63, 1143-1147 with Goldberg, Social Justice, supra note 4, at 107-109
(discussing the general ineffectiveness of health education interventions).