Health: Social Perspective and the Indian Perspective and Policy Perspectives in India

India's Healthcare System: Overview and Statistics

Introduction

• WHO Definition: Health is a state of complete physical, mental, and social well-being, not merely the absence of disease.

• Dual Structure: Comprises government-run public facilities (primary, secondary, tertiary) and a private sector ranging from individual clinics to super-specialty hospitals.

• SDG-3: Aims to ensure healthy lives and well-being for all through Universal Health Coverage (UHC).

Key Health Statistics

• Public Expenditure: Projected at $2.1\%$ of GDP for 2023-24.

• Life Expectancy: Males at $69.5$ years, females at $72.2$ years, and an overall average of $70.8$ years.

• Infant Mortality Rate (IMR): Reduced to $28$ per $1,000$ live births as of 2022.

• Maternal Mortality Ratio (MMR): $97$ per $100,000$ live births (2018-20).

• Neonatal Mortality Rate (NMR): Approximately $23$ per $1,000$ live births as of 2021.

Constitutional and Legal Provisions

Framework

• Relevant Articles: Article 38, Article 39(e), Article 41, Article 42, Article 47, Article 48A, and the Seventh Schedule.

• Article 21: Interpreted by the judiciary to include the right to health as an implied fundamental right.

Landmark Rulings

• Parmanand Katara v Union of India & ORS (1989): Established a doctor's professional obligation to provide medical expertise regardless of hospital type to save a life.

• Union of India AIR 1995: Recognized the right to medical care as fundamental for workers during and after service.

• Rakesh Chandra Narayan: Emphasized government responsibility in ensuring medical care accessibility.

Social Challenges and Strategic Recommendations

Key Challenges

• Disparity and Rural Neglect: Healthcare access is concentrated in urban areas, leaving rural populations underserved.

• Underinvestment: Public spending is lower than in the USA, UK, and China.

• Financial Burden: High out-of-pocket expenses.

• Human Resource Shortage: Severe lack of medical personnel and limited research into tropical diseases.

• Transition of Models: Excessive reliance on Western treatment models over preventive measures.

Way Forward

• National Health Policy 2017: Recommends boosting funding to $2.5\%$ of GDP.

• Health and Wellness Centres (HWCs): Prioritizing preventive care at the primary level.

• Decentralization: Integrating Nutrition, Water, Sanitation, and Hygiene (WASH) into Panchayati Raj institutions.

Mental Health and Fast Food Industry

Mental Health Status

• Burden: $2443$ disability-adjusted life years (DALYs) per $100,000$ population; age-adjusted suicide rate of $21.1$ per $100,000$.

• Professional Shortage: Currently $0.75$ psychiatrists/psychologists per $100,000$ people, against the required minimum of $3$.

• Treatment Gap: Staggering $92\%$ of those needing care lack access; only $1$ in $10$ receive evidence-based treatment (NIMHANS 2016).

Growing Fast Food Industry (UPSC 2025)

• Drivers: Urbanization, time pressure, digital delivery (Swiggy, Zomato), and the "Indianisation" of menus (e.g., McAloo Tikki).

• Health Concerns: High salt, sugar, and fat lead to obesity, diabetes, and hypertension.

• Double Burden: Concurrent occurrence of undernutrition in poor sections and lifestyle diseases in the middle class.

Policy Debate: Shifting Health to the Concurrent List

The Proposal Fifteenth Finance Commission Chairman N.K. Singh suggested moving "Health" from the State List to the Concurrent List in the Seventh Schedule.

Arguments for Change

• Enables a unified national health policy and equitable resource distribution.

• Enforces standardized care and quality across states.

• Facilitates coordinated responses to crises like pandemics.

Arguments Against Change

• Erosion of state autonomy and local priorities.

• Potential for increased bureaucracy and administrative delays.

• One-size-fits-all approach may ignore diverse regional capacities.

Questions & Discussion

Previous Year Questions

• 2025: How do you account for the growing fast food industries given that there are increased health concerns in modern society? Illustrate with the Indian experience.

• 2021: Primary health structure is a necessary pre-condition for sustainable development. Analyze.

• 2020: Discuss the need for sound healthcare policies in geriatric and maternal health care.