Foci on Health Needs Public health imperative: concern with total population needs and the development of strategies based on prevention and health promotion. Economic imperative: concern with marginal met needs and the most efficient ways of meeting needs. Political imperative: reconcile welfare system to the demands of free market ideology.

Need for Health Relief from the negative states of distress, discomfort, disability, handicap and the risk of mortality and morbidity. Expressed need (absolute, perceived, demand) Comparative need (relative) Normative need (professional defined)

Need for Health Care Need for health care exists so long as the marginal product of care is positive, at reasonable risk and acceptable cost. Is the need for health care a basic human rights or a privilege? Individual need vs. group need?? Need for health care depends on value judgments, which were influenced by psychological, socio-economic, cultural factors, and supply of care.

Need Assessment and Priority Community need assessment (social) Public health need assessment (epi) Clinical need assessment Health care needs are infinite, but health care resources are limited. How do we prioritize the services?

Method of Need Assessment Epidemiological assessment of disease prevalence Evaluation of effectiveness of treatment, care options and their relative costs and effectiveness. Analysis of existing activity and resource data and the application of this knowledge to the public (e.g., users of health services, health care professionals, health authority). Community meeting, survey, and interviews with community leaders.

Epidemiology The study of the distribution, determinants and frequency of disease in human populations. Mainstream epidemiology examines data on levels of disease and risk factors for disease, taking environmental factors into account. Materialist epidemiology focuses on the role of underlying societal and structural factors. Community, social, environmental, occupational and communicable disease epidemiology

Types and Variable of Research Descriptive studies generate hypotheses, whereas analytical studies test hypotheses. But any study can be used to refute a hypothesis (Rothman). Independent Variable Dependent Variable Intervening (intermediate) Variable Confounding Variable

Methods of Epidemiological Studies Case series and case studies Cross-sectional survey, screening, case finding, ecological studies Case control studies Longitudinal cohort studies Randomized controlled trial Quasi-experiment Experiment (natural, field, community intervention)

Measurements of Epidemiological Studies Mortality and morbidity Incidence and prevalence rate Person-year at risk Case fatality rate Odds ratio Relative risk Attributable risk Population attributable risk

Demographical Methods Population growth Crude birth rate vs. specific birth rate Crude death rate vs. age-specific death rate Life expectancy Direct and indirect standardization SIR vs. SMR Survival analysis, life table DFLE, DALY, PYLL