Goldberg and McGee BMC Public Health 2011, 11:770 http://www.biomedcentral.com/1471-2458/11/770 Similarly, Rios and Zautra documented a significant cor- relation between the severity of daily pain and levels of daily financial worry [35]. Moreover, the fact that social disadvantages tend to cluster implies that communities suffering from any one such disadvantage are more likely to experience others [37,38]. This clustering results in compound effects of deleterious social and economic conditions on health, which, given the stress- health connection, supports a belief in the pathways between such conditions and pain across the globe. An enormous body of literature demonstrates quite strongly that policy action on these social determinants of health cannot be left to the health care sector itself [23,39,40]. As important as medical services are to ameli- orating disease and human suffering, medical care is neither intended to nor generally equipped to address the macrosocial factors that determine patterns of pain and its distribution in populations. Understanding the power- ful connections between deleterious social and economic conditions and global chronic pain therefore provides additional reason for regarding pain as a public health priority rather than simply a medical priority. Moreover, the primary response to the undertreatment of pain both in the developed world and beyond has clo- sely tracked a medical model, one which analyzes the problem almost exclusively in context of the availability and distribution of opioid analgesics [9,41-43]. Yet as Ichiro Kawachi observed in the award-winning docu- mentary Unnatural Causes, however useful aspirin may be in the treatment of fever, the cause of fever is not lack of aspirin [44]. Moreover, while there is no ques- tion that access to essential medicines is a global health priority, the Final Report of the WHO’s Commission on the Social Determinants of Health makes plain the abundant evidence that remedies for the most pressing and inequitable global health problems are typically to be found outside the provision of health care services [23]. Thus, this essay strikes outside the confines of the medical model, and argues that global chronic pain ought to be perceived as a public health priority. Finally, regarding chronic pain as a global public health priority could have a salutary effect on chronic pain research. Where the medical model dominates research and funding on pain, research allocation is similarly skewed towards basic science (pain at the molecular level) and to clinical medicine, the latter consisting largely of a focus on medical treatments and health care services. Given the likelihood that many of the key determinants of pain across the globe are the social and economic condi- tions in which people work and live, regarding chronic pain as a global public health priority could shift the emphasis to funding research directed at the root struc- tural, social and cultural factors that shape pain and its inequitable global distribution. Page 3 of 5 Summary The high prevalence and incidence of global chronic pain, its substantial and growing comorbidities, and its linkage with myriad social and economic determinants collectively provide ample justification for regarding pain as a public health priority. Moreover, there are significant public policy consequences for doing so. Thinking about global chronic pain as a public health priority implies immediately that the global focus on access to essential medicines like opioids is insufficient as a primary policy strategy. A public health focus requires stakeholders to heed Rose’s insistence that ministering to the health of populations necessitates attention to the causes of the causes [45,46]. Chronic pain, akin to most diseases on the planet, is strongly determined by the social and eco- nomic conditions in which people work and live [47]. However important essential medicines are to treating chronic pain, a public health model recommends that significant global attention and resources be shifted to the macrosocial determinants that most powerfully shape the patterns of chronic pain, its comorbid diseases, and the distribution of both. This shift in policy from the micro-level focus on the provision of health care services to a macro-level approach addressing the structural determinants of health dovetails with a number of prac- tices and reports urging the same kind of health policy shift, including but not limited to the World Health Organization, the Marmot Review, and the Commission to Build a Healthier America. Acknowledgements and Funding The authors would like to thank Myra Christopher for reading a late draft of the manuscript and offering her comments and criticisms. Funding for the article processing charges was provided by DSG and SJM’s Departments, and by Pain Action Initiative: A National Strategy (PAINS) housed at the Center for Practical Bioethics, Kansas City, MO, USA. Neither the Departments nor the PAINS Project played no role in the planning and conceptualization of the manuscript, did not participate in the writing of the manuscript, and played no role in the decision to submit the manuscript. Myra Christopher, Principal Investigator of the PAINS Initiative, read a late draft of the manuscript and offered comments and criticisms. No other funding was provided for the planning, writing, or submission of the manuscript. Author details 1Department of Bioethics & Interdisciplinary Studies, Brody School of Medicine, East Carolina University, 600 Moye Blvd, Mailstop 641, Greenville, N.C. 27834, USA. 2Department of Health Policy & Management, University of Kansas School of Medicine/KU Medical Center, Center for Practical Bioethics, The Harzfeld Building, 1111 Main St. Ste. 500 Kansas City, MO 64105, USA. Authors’ contributions DSG and SJM conceived of the manuscript together and participated in planning the writing, workflow, and timeline. DSG wrote the first draft. SJM reviewed the first draft and offered substantial revisions, which DSG and SJM iteratively incorporated into second and third drafts. All authors read and approved the final manuscript. Authors’ Information DSG has been working on the issue of pain and its undertreatment since 2005. The issue was the subject of DSG’s 2009 doctoral dissertation, which