Key points

• Health needs should be distinguished from the need for health-care, which is nowadays defined in terms of ability to benefit.

• Health-care needs assessment is central to the planning process.

• There are three commonly contrasted approaches to needs assessment: corporate, comparative and epidemiological.

• Many toolkits and other resources have been developed to assist those undertaking health-care needs assessments.

Theoretical perspectives

Health professionals spend much time learning to assess the needs of individuals; many know less about defining the needs of a population. The need for health underlies but does not wholly determine the need for health-care. Health-care needs are often measured in terms of demand, but demand is to a great extent ‘supply-induced’ (see Chapter 7). For example, variations in general practice referral or consultation rates have less to do with the health status of the populations served than with differences between doctors, such as their skills or referral thresholds [1].

There is no generally accepted definition of ‘need’. Last’s notion of the ‘clinical iceberg’ of disease [2] (see Chapter 3) has been supported by various community studies indicating much illness is unknown to health professionals. Needs can be classified in terms of diseases, priority groups, geographical areas, services or using a lifecycle approach (children/teenagers/adults/elderly). Bradshaw‘s often-quoted taxonomy highlighted four types of need [3]:

• expressed needs (needs expressed by action, for instance visiting a doctor);

• normative needs (defined by experts);

• comparative needs (comparing one group of people with another);

• felt needs (those needs people say they have).