This is a reply to the paper entitled Structure, (governance) and health: an unsolicited response by Daniel D Reidpath and Pascale Allote

Anatole S Menon-Johansson

AS Menon-Johansson

DD Reidpath

BMC International Health and Human Rights

English

PubMed

Abstract This is a reply to the paper entitled Structure, (governance) and health: an unsolicited response by Daniel D Reidpath and Pascale Allotey</p

Menon-Johansson Anatole S

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BMC International Health and 
Human Rights
ssOpen AcceCorrespondence
Structure, (governance) and health: authors reply
Anatole S Menon-Johansson*
Address: St. Stephen's Centre, Chelsea & Westminster Hospital, 369 Fulham Road, London, SW10 9NH, UK
Email: Anatole S Menon-Johansson* - anatole_uk@yahoo.co.uk
* Corresponding author    
Abstract
This is a reply to the paper entitled Structure, (governance) and health: an unsolicited response by
Daniel D Reidpath and Pascale Allotey
Text
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 gov-
ernance.
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 epi-
demic in many populous countries is becoming general-
ised (> 1% prevalence).
Reidpath and Allotey demonstrate a strong correlation
between healthy life expectancy and gross domestic prod-
uct per capita corrected for purchaser power parity (GDP-
PPP) with governance [1]. They further show that govern-
ance and GDP-PPP variables are themselves interrelated.
Tables 5–7 in the initial paper, showing health and eco-
nomic data for 149 countries grouped by low, middle and
high governance ranking, highlighted some of the struc-
tural 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 pro-
duce a dramatic increase in life expectancy with diminish-
ing 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 sec-
tor. The maternal mortality ratio was included in these
tables to illustrate the devastating impact of these interre-
lated variables.
Despite the quality concerns of the aggregate data availa-
ble, sufficient HIV variance was explained by governance
to reject the null hypothesis using non-parametric statisti-
cal analysis. The unprecedented international response to
the HIV pandemic is highly dependent upon the co-oper-
ation of local and national government thus warranting
an analysis of the relationship between HIV and govern-
ance. Again it is important to stress that 'horizontal' capac-
ity building strategies are vital if HIV/AIDS is going to be
Published: 26 January 2007
BMC International Health and Human Rights 2007, 7:1 doi:10.1186/1472-698X-7-1
Received: 25 July 2006
Accepted: 26 January 2007
This article is available from: http://www.biomedcentral.com/1472-698X/7/1
© 2007 Menon-Johansson; 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.Page 1 of 2
(page number not for citation purposes)
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effectively managed in nations with limited healthcare
infrastructure and underlying poor health.
Only with time and additional governance and health
data will it be possible to determine if they are causally
related. If they are, then it is likely that some dimensions
of governance are going to be more influential than others
on healthcare delivery. Consequently it is important that
each dimension of governance continues to be analysed
separately. Ideally future analysis should be controlled for
by wealth (GDP-PPP) and its distribution (GINI index) in
order to understand the role of governance more clearly.
I would like to thank the authors again for their unsolic-
ited response and encourage future researchers to focus on
governance and its impact on health care policy and deliv-
ery not only in regards to chronic treatable disease, such
as HIV, but also for more finite challenges such as mater-
nal health.
References
1. Reidpath DD, Allotey P: Structure, (governance) and health: an
unsolicited response.  BMC Int Health Hum Rights 2006, 6:12.
2. Menon-Johansson AS: Good governance and good health: The
role of societal structures in the human immunodeficiency
virus pandemic.  BMC Int Health Hum Rights 2005, 5:4.
Pre-publication history
The pre-publication history for this paper can be accessed
here:
http://www.biomedcentral.com/1472-698X/7/1/prepub
A scatter graph of GDP-PPP and life expectancy for 149 countries in 2002Figure 1
A scatter graph of GDP-PPP and life expectancy for 149 countries in 2002.
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55.0
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75.0
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0 5000 10000 15000 20000 25000 30000 35000
GDP PPP per capita ($) in 2002
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 (
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 in
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2 Median life expectancy = 69.4 yearsPage 2 of 2
(page number not for citation purposes)


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