4 hours Ago By Nitin Kumar
As we observe World Health Day, an annual reminder of the global commitment to promoting well-being and addressing emerging health threats, it also serves as a platform for critical reflection on the evolving landscape of public health. This day provides an opportunity to evaluate a wide range of health issues, from the eradication of infectious diseases to the growing challenges posed by non-communicable diseases (NCDs), mental health concerns, and disparities in healthcare access.Today, health challenges differ across geographies, shaped by the uneven distribution of resources, climate vulnerabilities, and demographic transitions.
While developed nations are contending with ageing-related conditions and lifestyle diseases, developing countries like India are confronting a double burden—the persistence of infectious diseases alongside a rapid increase in NCDs. At the same time, climate change and environmental degradation are compounding vulnerabilities, especially for the urban poor and rural workers.Despite these challenges, India has made commendable progress in public health.
The Total Fertility Rate (TFR) has dipped below the replacement level of 2.1, indicating a stabilizing population. The Maternal Mortality Ratio (MMR) has declined significantly—from 254 in 2004–06 to 97 in 2018–20.
Mortality among infants and children under five has also plummeted. These improvements are the result of flagship programs such as the Integrated Child Development Services (ICDS) and Janani Shishu Suraksha Karyakram (JSSK), which enhanced maternal and child health services.Moreover, targeted interventions have helped control diseases like polio, kala-azar, and tuberculosis.
However, these gains are threatened by the escalating burden of NCDs. Cardiovascular diseases now dominate the health landscape, with 47.7% of related deaths due to pulmonary and other heart disorders, and 23.
3% from ischemic heart disease. A Lancet study reveals that 101 million Indians—11.4% of the population—live with diabetes, a number set to rise with the compounding effects of poor diets, sedentary lifestyles, and increasing temperatures due to climate change.
Mental health, though less visible, is another growing crisis. Stigma, lack of trained professionals, and minimal budgetary allocations mean that conditions like depression, anxiety, and substance use disorders often go untreated, especially in rural areas. The COVID-19 pandemic served as a wake-up call, exposing the vulnerabilities in India’s public health system and the critical need for resilience, especially in mental health care.
Simultaneously, India continues to battle child malnutrition, with 36% of children under five stunted, 32% underweight, and 19% wasted. Meanwhile, adult obesity is on the rise—24% of women and 23% of men are overweight or obese—highlighting a disturbing nutritional paradox. As injuries and road traffic accidents also become a significant cause of mortality, India’s healthcare system faces a mounting strain.
These challenges are aggravated by urban-rural health disparities. Rural populations suffer from poor infrastructure, limited access to specialists, and understaffed facilities. More than 70% of rural Community Health Centres (CHCs) lack essential specialists—83% without surgeons, 75% without obstetricians/gynaecologists, and 82% without physicians.
Even urban CHCs report a 45% shortfall, signalling a systemic shortage of trained human resources.This shortage reflects a deeper crisis in health workforce planning and retention. Medical professionals often avoid rural postings due to poor infrastructure, lack of incentives, and safety concerns.
The National Health Policy recognizes this gap, yet implementation remains inconsistent. Training, motivation, and retention strategies for doctors, nurses, ASHAs, and allied health workers must be prioritized.Compounding these service gaps is India’s low public health expenditure, which has hovered around 1.
84% of GDP, among the lowest globally. The 2021–22 National Health Accounts reported a slight improvement in financial protection, with out-of-pocket expenditure (OOPE) dropping to 39.4% from 48.
8% in 2017–18. But the burden remains high, especially for low-income households, due to limited insurance coverage and underfunded public services.Digital health innovations, such as telemedicine, eSanjeevani, and health-tech startups, offer promising solutions to bridge these gaps.
The Ayushman Bharat Digital Mission (ABDM) aims to create integrated health records, enhance accessibility, and improve patient outcomes. Yet, these efforts must be accompanied by investments in digital infrastructure, data privacy, and digital literacy.The demographic shift toward an ageing population—projected to reach 20% by 2050—requires a reorientation of healthcare services.
Geriatric care, palliative services, and social support systems must become central components of India’s health architecture. The elderly need not just medical care, but dignified, age-friendly environments that allow them to live independently and with respect.India’s health outcomes are inextricably linked to social determinants such as clean water, sanitation, education, nutrition, and housing.
Without improving these foundational aspects, health interventions will have limited impact. Equally important is community participation in health governance. Local ownership, empowered health committees, and gram sabhas can ensure accountability and culturally sensitive care delivery.
While initiatives like Ayushman Bharat and disease-specific vertical programs provide a base, India must move toward a holistic and inclusive model centred around Universal Health Coverage (UHC). Preventive and promotive care should be prioritized over curative care, with a strong emphasis on primary healthcare, where 80–90% of a person’s health needs can be met.Achieving ‘Viksit Bharat’ (Developed India) is impossible without a healthy population.
Bridging health inequities requires more than policy declarations—it demands increased health financing, cross-sectoral collaboration, and a moral commitment to equity. The well-being of the poor and marginalised must be a shared national responsibility. As the nation celebrates World Health Day, it must renew its pledge to health for all—not as an aspiration, but as a guaranteed right.
The benefits of building a resilient, inclusive, and equitable health system are immense: a healthier population, a more productive workforce, and sustainable economic growth. In the end, a nation's health is its true wealth, and only by investing in it wisely can India hope to fulfil its demographic and developmental promises. (The author is an independent researcher and intern at Indian Council of Social Science Research, Delhi.
The views are personal).
