Public Health Policy in India

Introduction

• Public health policy plays a crucial role in improving population health, reducing health inequalities, and enabling India to fully harness its demographic dividend.

• In recent years, India has accelerated its journey towards Universal Health Coverage (UHC) through flagship initiatives such as Ayushman Bharat Health and Wellness Centres (HWCs) and the Ayushman Bharat Digital Health Mission (ABDHM). While these reforms have expanded preventive healthcare and digital health infrastructure, concerns remain regarding their ability to address the core challenges of healthcare accessibility, affordability, and quality.

• The increasing emphasis on wellness and digitalisation should therefore complement, rather than substitute, the strengthening of India's healthcare delivery system.

Evolution of the Wellness Approach

• The concept of wellness emerged as an extension of the traditional understanding of health. Earlier, health was largely viewed as the absence of disease, but over time it evolved to include physical, mental, social, emotional, spiritual, and environmental well-being. This holistic approach encouraged greater attention to healthy lifestyles, preventive care, and behavioural changes.

• However, public health has traditionally focused on health promotion, which emphasises the social determinants of health such as income, education, nutrition, housing, sanitation, employment, clean drinking water, and environmental conditions. Unlike wellness, these determinants are objective and measurable, making them more suitable for evaluating public health outcomes and designing effective government policies.

Key Concerns in Contemporary Public Health Policy

Shift from Population Health to Individual Well-being

• The conversion of existing Primary Health Centres (PHCs) into Health and Wellness Centres (HWCs) represents a broader policy transition from focusing on population health indicators to promoting individual well-being.

• Earlier, healthcare systems were evaluated based on measurable indicators such as maternal mortality, infant mortality, immunisation coverage, nutrition levels, communicable disease control, safe drinking water, and chronic disease management. These indicators directly reflected the health status of communities.

• The growing emphasis on wellness, however, introduces a concept that is subjective and varies across individuals, making systematic assessment and policy evaluation increasingly difficult. Excessive focus on wellness may therefore divert attention from ensuring universal access to essential healthcare services.

Individualisation of Health Responsibility

• A significant concern associated with the wellness narrative is the individualisation of health responsibility.

• Health is increasingly portrayed as the outcome of personal choices, healthy lifestyles, exercise, yoga, diet management, and behavioural modifications.

• This has led to the proliferation of health coaches, wellness influencers, fitness applications, and social media-driven health campaigns.

• While behavioural change is important, this approach often overlooks the structural barriers that shape health outcomes. Millions of Indians continue to face challenges arising from poverty, poor sanitation, inadequate nutrition, weak public health infrastructure, shortage of healthcare professionals, and unequal access to medical services. These systemic issues cannot be resolved merely through individual lifestyle modifications.

Challenges in Measuring Wellness

• One of the fundamental principles of good governance is that public policies must be evaluated using objective and measurable indicators.

• Healthcare systems already use indicators such as disease burden, healthcare utilisation, mortality rates, nutritional status, life expectancy, and immunisation coverage to assess performance. However, there are no universally accepted indicators for measuring wellness at the population level.

• As a result, excessive reliance on an inherently subjective concept may reduce policymakers' ability to accurately identify unmet healthcare needs, allocate resources efficiently, and assess the effectiveness of health interventions.

Critical Analysis of the Ayushman Bharat Digital Health Mission (ABDHM)

• The Ayushman Bharat Digital Health Mission (ABDHM) seeks to establish a comprehensive digital health ecosystem through ABHA (Ayushman Bharat Health Account) Cards, Electronic Health Records (EHRs), and national registries of healthcare professionals and health facilities.

• These initiatives have the potential to improve data management, continuity of care, interoperability, health planning, and administrative efficiency.

• However, digitalisation alone cannot solve India's healthcare challenges.

• Digital records cannot compensate for the absence of qualified doctors, functional hospitals, diagnostic facilities, medicines, ambulances, or emergency healthcare services. Technology is merely an enabling tool whose effectiveness ultimately depends upon the strength of the underlying healthcare infrastructure.

• Thus, digital health should be viewed as a support mechanism rather than a substitute for healthcare delivery.

Structural Causes of Inadequate Healthcare Access

• India's healthcare challenges arise primarily from the high cost of private healthcare and the limited capacity of many public health institutions.

• Despite expanding health insurance coverage under Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (AB-PMJAY), Out-of-Pocket Expenditure (OOPE) continues to remain significant, particularly for outpatient care, diagnostics, and medicines.

• Large sections of the population continue to experience difficulty in obtaining timely, affordable, and quality healthcare services.

• Strengthening the country's three-tier healthcare system remains essential.

• The network of Sub-Centres (SCs), Primary Health Centres (PHCs), and Community Health Centres (CHCs) constitutes the backbone of India's healthcare system and plays a vital role in delivering preventive, promotive, curative, rehabilitative, and palliative healthcare services.

Government Initiatives Supporting Universal Health Coverage

• India has undertaken several important reforms aimed at strengthening healthcare delivery and advancing Universal Health Coverage (UHC).

• The Ayushman Bharat Programme integrates Health and Wellness Centres with the Pradhan Mantri Jan Arogya Yojana (PM-JAY) to expand primary healthcare and financial protection.

• The Ayushman Bharat Digital Health Mission (ABDHM) promotes digital health records, interoperability, and efficient healthcare management through ABHA IDs.

• The National Health Mission (NHM) continues to strengthen rural and urban healthcare infrastructure by improving maternal and child health services, disease control, and primary healthcare delivery.

• The PM-Ayushman Bharat Health Infrastructure Mission (PM-ABHIM) seeks to develop resilient public health infrastructure, disease surveillance systems, laboratories, and critical care facilities.

The Way Forward

• A balanced and sustainable public health strategy should place accessible, affordable, equitable, and quality healthcare at the centre of policy making.

• Greater public investment should be directed towards strengthening Sub-Centres, Primary Health Centres, Community Health Centres, district hospitals, healthcare workforce, diagnostics, and essential medicine availability.

• Digital health initiatives should be fully integrated with service delivery reforms, ensuring that technological advancements improve the efficiency of healthcare institutions rather than replacing them.

• Public health policies should address the social determinants of health through coordinated action involving sectors such as education, nutrition, sanitation, housing, employment, drinking water, and environmental protection.

• At the same time, governments should continue evaluating health programmes using objective and measurable health indicators, while treating wellness as a complementary rather than primary policy objective.

• Greater accountability, evidence-based policymaking, and regular monitoring will ensure more effective implementation of healthcare reforms.

Conclusion

• Achieving Universal Health Coverage (UHC) requires much more than promoting wellness or building digital health databases. Sustainable improvements in health outcomes depend upon strong public healthcare institutions, adequate financial investment, quality service delivery, equitable access, and robust healthcare infrastructure.

• While wellness initiatives and digital health technologies can significantly complement healthcare reforms, they cannot replace investments in hospitals, healthcare professionals, medicines, diagnostics, and primary healthcare systems. A public health model that prioritises accessibility, affordability, quality, and equity remains the most effective pathway towards ensuring better health outcomes and inclusive development in India.