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Health is only necessary if youre taking damage or have Health is Power. But its really hard not to take damage so getting health is often important, how much depends on how confident you are in how you can avoid getting hit. Ive won runs on True Nightmare where I have 300 max health, ive won runs where I have 32000 max health. In the first run, I was insanely fast and got an early RIng of Gravity, so avoiding damage was really easy. I didnt grab health because I didnt need it, and the damage I was able to deal made up for it.
TLDR Experiment with it. The more often you can NOT go through health portals, usually the more powerful your build will
If there is no other great item i will pick up 2 health-items: gain max-health after each round, gain health-multiplier after each round.
But that's about it.
It is way more important to be able to deal enough damage. IF you can stay ahead of the curve and you can kill elites fast then there is very little that would acutally hurt you.
I'm finding now as I'm going for higher tier clears (emerald+) and enabling nightmare mode that things like DR, "chance to ignore damage" and armor are becoming incredibly valuable. Along with things that give constant steady healing. So probably meta is like a decent chunk of HP like 1000 but also lots of armor, damage reduction, dodge chance etc..
Conversely 1000 health, some minor healing, 40% damage reduction, and an occasional armor plate can feel just fine.
THEN, you need to take it another step further. If your damage is terrible and it takes you 2 minutes to kill an elite, then even a glut of health might not keep you going. Conversely a rapid firing, huge global damage, arc-split-homing shot sniper rifle can win with 1 health.
It all adds up together. In general terms, the better you are at dodging, the less health you need. The shorter the fight, the less health you need. So by doing better at avoiding projectiles and melee, either through practice and talent, or in-game choices like zoom-slow, hammer dodges, higher speed or extra dashes, then you will hit "enough" health faster. The more damage you can do, the faster you kill enemies, and the less time you need to be dodging around, and thus a lower amount of health will be "enough." This means that if your damage doesn't scale (say, a reliance on an early thorn explosion to do a thorn-grenade build that fails to ever really scale on its own), what used to be "enough" health, suddenly won't be anymore.