1. 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.

2. 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)

3. 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.

4. 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?

5. 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.

6. 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

7. 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

8. 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)

9. 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

10. 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