Coronary Mortality in China
Fence, Ambulance, or Hospital Treatments?
“… an ounce of Prevention is worth a Pound of Cure.”
–Benjamin Franklin, Pennsylvania Gazette, February 4, 1735.
In a poem titled “Fence or Ambulance” written more than one hundred years ago, Joseph Malins described the policy dilemma a city faced in tackling the rising morbidity and mortality from accidental falls from a dangerous cliff.1 The 2 policy options considered included building a strong fence around the edge of the cliff or raising funds to support an ambulance down in the valley. The city initially chose to fund the ambulance to efficiently transport victims to the hospital for treatment. However, the city eventually realized that even the best and most efficient ambulance system was not enough and that it also had to build the fence.
Article see p 78
The rising mortality from coronary heart disease (CHD) in China presents a similar policy dilemma. In 2010, CHD caused nearly 1 million deaths in China.2 Rapid demographic and epidemiological changes, plus adverse trends in dietary risk factors, high blood pressure, and tobacco exposure, have contributed significantly to premature CHD mortality and disability in China.2 For example, between 1984 and 1999, CHD mortality rates in Beijing increased by 50% in men and 27% in women aged 35 to 74 years.3 More recently, Cheng et al4 showed that CHD death rates have further increased in Beijing in 1999 to 2010. In fact, China is projected to experience a dramatic 69% and 64% increase in CHD events and deaths by the year 2030, respectively.5 To what extent can interventions addressing CHD risk factor prevention and in-hospital treatments attenuate and reverse these trends, and at what costs? How should these interventions be prioritized, especially given limited healthcare resources and competing national priorities? Cost-effectiveness analysis presents a strategy for …