Goldberg and McGee BMC Public Health 2011, 11:770 http://www.biomedcentral.com/1471-2458/11/770 D E B A T E Abstract Pain as a global public health priority Daniel S Goldberg1* and Summer J McGee2 Open Access Background: Pain is an enormous problem globally. Estimates suggest that 20% of adults suffer from pain globally and 10% are newly diagnosed with chronic pain each year. Nevertheless, the problem of pain has primarily been regarded as a medical problem, and has been little addressed by the field of public health. Discussion: Despite the ubiquity of pain, whether acute, chronic or intermittent, public health scholars and practitioners have not addressed this issue as a public health problem. The importance of viewing pain through a public health lens allows one to understand pain as a multifaceted, interdisciplinary problem for which many of the causes are the social determinants of health. Addressing pain as a global public health issue will also aid in priority setting and formulating public health policy to address this problem, which, like most other chronic non- communicable diseases, is growing both in absolute numbers and in its inequitable distribution across the globe. Summary: The prevalence, incidence, and vast social and health consequences of global pain requires that the public health community give due attention to this issue. Doing so will mean that health care providers and public health professionals will have a more comprehensive understanding of pain and the appropriate public health and social policy responses to this problem. Background By any measure, pain is an enormous global health pro- blem. Globally, it has been estimated that 1 in 5 adults suffer from pain and that another 1 in 10 adults are diag- nosed with chronic pain each year [1]. While pain affects all populations, regardless of age, sex, income, race/ethni- city, or geography, it is not distributed equally across the globe. Those who experience pain can experience acute, chronic, or intermittent pain, or a combination of the three. The four largest causes of pain are cancer, osteo- and rheumatoid arthritis, operations and injuries, and spinal problems, making the etiology of pain a complex, transdisciplinary affair. Pain has multiple, serious seque- lae including but not limited to depression, inability to work, disrupted social relationships and suicidal thoughts. Of those living with chronic pain, the median time of exposure is 7 years [1]. In this article, we argue that the paradigmatic view of pain as a symptom of disease, rather than as a disease state itself,[2] has contributed to the neglect of this * Correspondence: goldbergd@ecu.edu 1Department of Bioethics & Interdisciplinary Studies, Brody School of Medicine, East Carolina University, 600 Moye Blvd, Mailstop 641, Greenville, N.C. 27834, USA Full list of author information is available at the end of the article condition in the world of public health. Raising awareness about pain for the public health community requires clearly defining pain as a disease state and demonstrating why it must be a public health priority. The undertreat- ment of pain, a persistent problem for those who experi- ence it, only can be reduced with better diagnosis and treatement applied from a public health framework. Understanding pain as a disease may reduce the global burden of this health problem and its co-morbid condi- tions as well as potentially decrease the undertreatment and misdiagnosis of pain. These issues ought to be among the major priorities for public health in the next century. Public health officials must gain a better understanding of the magnitude and characteristics of the problem, contribute to the development and evaluation of pain management programs, and develop the best possible interventions to diagnose and treat chronic pain. Discussion Priority Setting for Pain and Public Health The setting of public health priorities is a complex, con- troversial and political process. These priorities are deter- mined, it has been argued, by those who have wealth, political power or both [3]. In the United States, for example, public health priorities are often set by scientific © 2011 Goldberg and McGee; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.