The general framework for evaluation of health programs presented includes a nine-step procedure for systematically enumerating the impacts that can be expected, quantifying the most important ones, introducing other considerations, and finally judging the net impacts associated with nine categories of diseases. Five principal approaches to systematic evaluation are assessed: (1) values implicit in past decisions of the political sphere; (2) explicit statements of political representatives or their designees; (3) human capital, or livelihood-saving approach; (4) implicit values of individuals; and (5) explicit statements of value by individuals. It is concluded that important conceptual and empirical differences exist between these approaches and that selection of a particular method involves tradeoffs between ease of application and conceptual soundness. Methodologies based on livelihood-saving (human capital) and individual preferences are considered the most attractive alternatives by these criteria, but severe conceptual shortcomings in the livelihood-saving approach suggest an active search for an alternative is needed. 135 pp. Ref.