Jane Foot and Trevor Hopkins outline some of the issues with the traditional deficit approach, arguing that it focuses “on the problems, needs and deficiencies in a community such as deprivation, illness and health-damaging behaviours. It designs services to fill the gaps and fix the problems. As a result, a community can feel disempowered and dependent; people can become passive recipients of services rather than active agents in their own and their families’ lives."

Needs-focused assessments can have negative effects even when a positive change is intended because they force community leaders to highlight their communities' worst side in order to attract resources. Needs-focused perspectives may also unintentionally create one-dimensional images that characterise communities and the individuals within them based on disease risk profiles or social problem categories, such as "low income," "welfare mom," "the handicapped," or "high crime neighbourhood".