By Janine Ewen. Published: 11 April 2025.
Janine Ewen, a specialist in trauma, public health, policing and harm reduction, outlines a careful approach to conducting a Health Needs Assessment (HNA), and advice on how to collaborate on project work that properly represents the needs and safety required for underserved populations at community level.
A health needs assessment (HNA) is one of several approaches that can be used to improve health, maximise local strengths, and reduce health inequalities in your community (making it an example of both place-based action and Asset-Based Community Development (ABCD). An HNA is a systematic method for identifying the unmet health needs of a population. It helps inform commissioning, service planning, and policy development to improve health.
The hardest part of developing an HNA can be working together, as the more people/partners you involve, the more complicated and challenging it is. It’s true that collaborating can take a longer time, but this will give the HNA a stronger impact. So, it’s crucial to make sure no communities are left behind. We can achieve this only if there are proper democratic structures and knowledge equity for deciding on the priorities; this will leave time to properly and meaningfully develop public health projects, rather than hastily catching up when we encounter crisis situations.
We often think we know what is best for marginalised communities. From my experience, an HNA is one of the most efficient ways of identifying what the actual needs are, and to determine priorities for the most effective use of resources/public health actions that are intended to make an actual difference. If community needs are ignored or misunderstood, there is a danger of imposing a top-down approach, which relies too heavily on what a few people perceive to be the needs of underserved populations, rather than what they really are.
When addressing public health, policing, underserved populations, and designing an HNA, you may feel/find there is an immediate need to safeguard those who are vulnerable, because vulnerability is both caused and mitigated through policing. Perhaps the project is being proposed because of proactive policing agendas that have been reliant on raids, targeting or disrupting communities (sometimes presented as promoting welfare), attempting to eradicate situations, or because people have experienced trauma from police and services. Perhaps the very people who are the focus of the project haven’t had their actual needs and care prioritised, or they haven’t been included in any consultation or designs for the project; therefore, their needs have been inadequately understood.
Being able to distinguish actual rather than perceived needs is crucial. Projects can remain in planning (sometimes over several months) because the police, sometimes with health providers, propose gathering data to fulfil ‘business as usual’ aims (continuing to harm). Don’t be afraid to challenge this situation. If it involves redesigning by going back to the drawing board, that’s a good sign that much more has been taken into consideration. Services might assume that they are in contact with or are supporting X, but this might be a partial reality; or the police might be co-opting welfare support by seeking avenues to continue with punitive actions.
Therefore, if you are joining as a partner, always read the details of a proposed HNA, and ask questions, to ensure that police, health providers and NGOs have thought about the proposal comprehensively. There are dangers of conflicting aims at the beginning, and a plan of action will need to be crafted with great care and diligence. The police should not be leading on the HNA, but they can be involved in the following ways:
- Sharing their own data
- Being present during the presentation of needs
- Involved in the discussion of actions from the HNA
Understanding the unique health needs of underserved populations is crucial for effective intervention. An HNA is a practical place-based and asset-focused approach to de-escalating tensions arising from enforcement, empowering communities and health providers to address disparities, and to create tailored solutions.
Janine’s framework can be found here with additional advice. She is also available for consultancy support in developing police and public health HNAs: janine.ewen@gmail.com.