Annals of Health Law
INTERVENING AT THE RIGHT POINT
diminishing burdens of and inequities in pain across the globe. Moreover,
note a crucial policy implication of ameliorating a fundamental cause of
disease: precisely because the cause determines multiple diseases,
alleviating said cause offers the potential to ease the health burdens posed
by multiple diseases. Not only would improving general educational
attainment therefore be a promising means of reducing overall pain burdens
and compressing pain inequities, but L&P interventions that improve
educational attainment across a population would also be likely to improve
health outcomes overall as well as outcomes specific to a variety of
different education-linked diseases. Finally, because the affluent are
typically better educated than the least well-off, the poor and socially
disadvantaged are likely to gain greater benefit from improved educational
attainment than the affluent. Were this to happen, education-linked health
inequities would contract.
The above examples demonstrate the superiority of a whole population
approach to public health policy intended to ameliorate pain across the
globe. Such advantage is not altogether surprising; Rose proposed such an
approach over two decades ago, and there is no shortage of scholarship
applying and evaluating it.104 Indeed, the recent movement towards the
consideration of “Health in All Policies”105 (“HiAP”) is arguably cousin to a
whole population approach to the extent it is built upon the
acknowledgement that upstream socioeconomic and political factors are
major determinants of health that require express and dedicated political
However, advocating that global public health law efforts to ameliorate
pain target such upstream factors runs into what is likely to be the most
common objection to my claim: the boundary problem.
V. THE BOUNDARY PROBLEM
The most likely objection to calls to broaden the public policy
framework as to population health references the boundary problem.
Namely, emphasis on upstream, macrosocial determinants and the laws and
policies that shape their influence on health and its distribution quickly runs
into the fact that virtually every conceivable L&P domain impacts health.
Indeed, this is the point of departure for the aforementioned HiAP
approach. Because most laws and policies exert influence on public and
104. E.g. Lantz et al., supra note 82; Benach et al., A New Typology, supra note 5;
Benach et al., Beyond Rose’s Strategies, supra note 5.
105. See Health in All Policies, NATIONAL ASSOCIATION OF COUNTY & CITY HEALTH
OFFICIALS, http://www.naccho.org/topics/environmental/HiAP/index.cfm (last visited
January 6, 2013); Pekka Puska, Health in all Policies, 17 EUR. J. PUB.HEALTH 328 (2007).