Intervening at the Right Point in the Causal Pathways: Law, Policy, and the Devastating Impact of Pain Across the Globe

Abstract

This essay uses a case study – pain across the globe – to show how public health laws and policies targeted proximal or subsequent to the onset of disease are highly likely to be ineffective in meeting the two paramount goals of ethically optimal public health policy: absolute improvements in overall health and the compression of health inequities. Drawing on a variety of social epidemiologic concepts and frameworks, the article argues that the root causes of the pervasive and inequitable distribution of pain across the globe are the social, political, and economic conditions in which people in both the global North and the global South live and work. In turn, these conditions are strongly determined by domestic and international political economies, past and present. The paper deploys the ample evidence suggesting that laws and policies embodying a whole-population approach and therein targeted at ameliorating the structural causes of ill health are much more likely to decrease pain prevalence and incidence and to compress global pain inequities. Unfortunately, global law and policy efforts to ameliorate the devastating impact of pain have hitherto focused overwhelmingly on the dispensation of medical treatment for pain. Although such efforts are both laudable and necessary, insofar as they intervene in the causal pathway at a point proximal to or subsequent to the onset of pain, they do nothing to address the macrosocial causes and structural variables that represent fundamental causes of pain in resource-rich and resource-poor settings alike. The paper criticizes the fact that the bundle of laws and policies levered to alleviate the impact of pain across the globe has focused so narrowly on medical interventions like drugs, and concludes by proposing several law and policy approaches that, by virtue of being targeted at structural and fundamental causes, are more likely to ameliorate global burdens of pain and compress inequities in its prevalence and in its outcomes.

Keywords: pain, global health, public health policy, public health law, fundamental causes, social determinants, health inequalities