Structure, (governance) and health: an unsolicited response

BACKGROUND: In a recently published article, it was suggested that governance was the significant structural factor affecting the epidemiology of HIV. This suggestion was made notwithstanding the observed weak correlation between governance and HIV prevalence (r = .2). Unfortunately, the paper raised but left unexamined the potentially more important questions about the relationship between the broader health of populations and structural factors such as the national economy and physical infrastructure. METHODS: Utilizing substantially the same data sources as the original article, the relationship between population health (healthy life expectancy) and three structural factors (access to improved water, GDP per capita, and governance) were examined in each of 176 countries. RESULTS: Governance was found to be significantly correlated with population health, as were GDP per capita, and access to improved water. They were also found to be significantly correlated with each other. CONCLUSION: The findings are discussed with reference to the growing interest in structural factors as an explanation for population health outcomes, and the relatively weak relationship between governance and HIV prevalence.