Poverty and infectious diseases interact in subtle and complex ways. Casting the problem of destitution as intractable, or epidemics that afflict the poor as accidental, erroneously exonerates us from responsibility for protecting and caring for those most in need. Our experience working in Haiti and Rwanda has shown that appropriately and adequately addressing the scourges of communicable diseases requires a biosocial appreciation of the structural forces that shape disease patterns. Although there is ample evidence that heath investments pay dividends in labor productivity, educational attainment, population control, and, potentially, capital investments, the idea that health is an instrument for development should complement, not supplant, a rights-based approach to health equity. It is plausible that most health interventions in resource-poor settings could garner support based on cost/benefit ratios with appropriately lengthy time horizons to capture the return on health investments and an adequate accounting of externalities; however, such a calculus masks the untold suffering of inaction and risks eroding the most powerful incentive to act: redressing inequality. Forecasting incidence of hemorrhagic fever with renal syndrome in China using ARIMA model BACKGROUND: China is a country that is most seriously affected by hemorrhagic fever with renal syndrome (HFRS) with 90% of HFRS cases reported globally. At present, HFRS is getting worse with increasing cases and natural foci in China. Therefore, there is an urgent need for monitoring and predicting HFRS incidence to make the control of HFRS more effective. In this study, we applied a stochastic autoregressive integrated moving average (ARIMA) model with the objective of monitoring and short-term forecasting HFRS incidence in China. METHODS: Chinese HFRS data from 1975 to 2008 were used to fit ARIMA model. Akaike Information Criterion (AIC) and Ljung-Box test were used to evaluate the constructed models. Subsequently, the fitted ARIMA model was applied to obtain the fitted HFRS incidence from 1978 to 2008 and contrast with corresponding observed values. To assess the validity of the proposed model, the mean absolute percentage error (MAPE) between the observed and fitted HFRS incidence (1978-2008) was calculated. Finally, the fitted ARIMA model was used to forecast the incidence of HFRS of the years 2009 to 2011. All analyses were performed using SAS9.1 with a significant level of p < 0.05. RESULTS: The goodness-of-fit test of the optimum ARIMA (0,3,1) model showed non-significant autocorrelations in the residuals of the model (Ljung-Box Q statistic = 5.95,P = 0.3113). The fitted values made by ARIMA (0,3,1) model for years 1978-2008 closely followed the observed values for the same years, with a mean absolute percentage error (MAPE) of 12.20%. The forecast values from 2009 to 2011 were 0.69, 0.86, and 1.21per 100,000 population, respectively. CONCLUSION: ARIMA models applied to historical HFRS incidence data are an important tool for HFRS surveillance in China. This study shows that accurate forecasting of the HFRS incidence is possible using an ARIMA model. If predicted values from this study are accurate, China can expect a rise in HFRS incidence. Hemorrhagic fever with renal syndrome (HFRS), or epidemic hemorrhagic fever (EHF) is an acute viral syndrome caused by infection with one of hantaviruses. HFRS is an important infectious disease in developing countries. In China, HFRS is caused mainly by 2 types of hantaviruses, Hantaan virus (HTNV) and Seoul virus (SEOV), each of which has coevolved with a distinct rodent host. HTNV is associated with Apodemus agrarius, whereas SEOV, which causes a less severe form of HFRS, is associated with Rattus norvegicus [1] . In hantavirus -endemic areas, HFRS is most common among farmers and others who may have close contact with excreta of infected rodents [2, 3] . In mainland China, HFRS remains a serious public health problem with approximately 20,000-50,000 human cases reported annually, approximately 90% of the total cases worldwide [4] [5] [6] . Currently, HFRS is endemic in 28 of 31 provinces in mainland China [4, 7] .