Structure, (governance) and health: authors reply

I would like to thank Drs Reidpath and Allotey for their analysis [1] of some of the variables described in the tables of the initial paper [2] and their use of other health and economic data to demonstrate correlations with governance.HIV infection was chosen as the focus in the original work because in some sub-Saharan African countries this single disease has become ubiquitous. This is also the case within high risk groups across the world from men who have sex with men in London to sex workers in Mumbai. Unlike geographically determined disease such as Chagas disease and Guinea worm infections cited by Reidpath and Allotey, HIV is found in every nation and the epidemic in many populous countries is becoming generalised (> 1% prevalence).Reidpath and Allotey demonstrate a strong correlation between healthy life expectancy and gross domestic product per capita corrected for purchaser power parity (GDP-PPP) with governance [1]. They further show that governance and GDP-PPP variables are themselves interrelated. Tables 5–7 in the initial paper, showing health and economic data for 149 countries grouped by low, middle and high governance ranking, highlighted some of the structural challenges these countries face. The small GDP-PPP in low governance countries is compounded by poorer distribution of wealth. The impact of GDP-PPP on life expectancy in 2002 is demonstrated in Figure 1, using data from the additional file included with the original paper [2]. In poor countries, small increases in wealth produce a dramatic increase in life expectancy with diminishing returns above the median life expectancy of 69.4 years in 2002.In addition to wealth, these low governance countries have fewer physicians per population and less investment in health and education in relation to military spending. The residents of poorer countries are more reliant on their governments to support public investment in healthcare since they are less able to purchase care in the private sector. T