Context: World Health Organisation (WHO) has launched the “3 by 35” Initiative calling on countries to raise ‘Health tax' or ‘Sin tax’ on tobacco, alcohol, sugary drinks by at least 50% by the year 2035.
Relevance of the Topic: Prelims: About the 3 by 35 Initiative.
WHO’s 3 by 35 Initiative
It is a global effort to increase the real prices of any or all of three unhealthy products – tobacco, alcohol, and sugary drinks by at least 50% by 2035 through tax increases, while taking into account each country’s unique context.
Key action areas of the Initiative:
Cutting harmful consumption by reducing affordability: Increase or introduce excise taxes on tobacco, alcohol, and sugary drinks to raise prices and reduce consumption, cutting future health costs and preventable deaths.
Raising revenue to fund health and development: Mobilise domestic public resources to fund essential health and development programmes, including universal health coverage. The initiative aims to raise $1 trillion over the next 10 years.
Building broad political support across ministries, civil society, and academia: Strengthen multi sectoral alliances by engaging ministries of finance and health, parliamentarians, civil society, and researchers to design and implement effective policies.
Significance of Health Tax/ Sin Tax:
Prevent global NCD burden: Consumption of tobacco, alcohol and sugary drinks is fuelling the Non-Communicable Diseases (NCD) epidemic which accounts for over 75% of all deaths worldwide. A recent report shows that a one-time 50% price increase on these products could prevent 50 million premature deaths over the next 50 years.
Augment shrinking development aid and growing public debt: These taxes cut the consumption of harmful products and create revenue governments can reinvest in healthcare, education and social protection.
India's Efforts
India has implemented tobacco taxation under the GST framework, with 28% GST and an additional compensation cess on cigarettes and select products.
However, bidis (smoked by low-income groups) and smokeless tobacco (SLT) (used by over two-thirds of tobacco users) remain under-taxed.
India’s current approach to taxing tobacco, alcohol and sugar-sweetened beverages represent a fragmented, revenue-centric model that lacks a coherent public health framework.
Context:Mental Healthcare is now covered at par with physical illnesses across health insurance plans in India, following the Mental Healthcare Act, 2017 and IRDAI directive. This milestone will help people to see mental illness with the same lens they use for physical diseases.
Relevance of the Topic: Mains: Mental Healthcare in India: Challenges, Govt. Initiatives & Way Forward.
Globally, mental health conditions affect about one in five adults. The World Health Organisation estimates an annual productivity loss of over $1 trillion due to untreated mental health issues. In India, the conversation related to mental health is gaining momentum.
Challenges pertaining to Mental Healthcare
Visibility and Tangibility: Physical disabilities are usually visible and tangible, making them easier to recognise and diagnose. Mental health issues, on the other hand, are often invisible and intangible, leading to difficulties in diagnosis and understanding by others.
Social Stigma: The stigma around mental health can cause individuals to feel ashamed, leading to avoidance of seeking help and increasing isolation. Cultural factors play a crucial role in shaping attitudes (negative attitude) towards mental health in India.
Inadequate Healthcare Infrastructure: India's healthcare infrastructure is severely under-resourced, particularly in the realm of mental health. There is a profound shortage of mental health facilities and psychiatric wards, especially in rural areas. Additionally, existing facilities often lack the resources and capacity to provide comprehensive and continuous care, leading to inadequate treatment and support.
Lack of access, affordability, and awareness: National Mental Health Survey (NMHS), 2015-16 found that nearly 80% of those suffering from mental disorders did not receive treatment for over a year.
Difficulty in Measuring Outcomes: The outcomes of mental health interventions are often harder to measure compared to physical health interventions.
Government Initiatives
National Mental Health Program: To address the burden of mental disorders, the Government of India is implementing the National Mental Health Program (NMHP) since 1982. NMHP and Health and Wellness Centres are efforts to provide quality care at the primary healthcare level. Deaddiction centres and rehabilitation services are also available. Information, Education and Communication (IEC) activities are an integral part of the NMHP.
Mental Health Policy of 2014 upholds a participatory and rights-based approach to quality service provisions. The main objectives are:
Universal Access to Mental Health Care
Decriminalisation of Suicide
Enhance availability and distribution of skilled human resources for mental health.
Increase access to mental health services for vulnerable groups.
Mental Healthcare Act of 2017 provides the legal framework for providing services to protect, promote and fulfil the rights of people with mental illnesses. These are in line with the United Nations Convention on the Rights of People with Disabilities (UNCRPD).
Kiran Helpline: In 2020, the Ministry of Social Justice and Empowerment launched a 24/7 toll-free helpline ‘Kiran’ to provide support to people facing anxiety, stress, depression, suicidal thoughts and other mental health concerns.
Tele Manas Seva: To provide free tele-mental health services all over the country round the clock, particularly catering to people in remote or under-served areas & to open at least one Tele-MANAS Cell in each State/UT.
Way Forward
The mental health situation in India demands:
Active policy interventions and resource allocation by the government. Developed countries allocate 5-18% of their annual healthcare budget to mental health, while India allocates roughly 0.05% (OECD, 2014).
Measures to trainand sensitise the community/society to reduce the stigma around mental health. The need of the hour is to provoke masses to learn about mental health through campaigns like Swach Mansikta Abhiyan. Persistent nationwide efforts by utilising Accredited Social Health Activist (ASHA) workers.
Access to safe and effective care to people experiencing mental health problems in lines with those with physical health problems. By integrating mental health services with primary healthcare, mental health care becomes more accessible and less stigmatised.
Leverage Technology: Telemedicine and digital health platforms can extend the reach of mental health services, particularly in areas with a shortage of mental health professionals.
Context: A study by the US researchers finds first molecular level evidence of how exposure to PM2.5 pollutants by pregnant women could lead to higher risk of premature deliveries.
Relevance of the Topic: Prelims: Health implications of Pollution.
Link between Air Pollution and Premature Birth:
Exposure to pollutants like fine particulate matter, nitrogen dioxide, and sulfur dioxide during pregnancy can lead to an increased risk of complications such as preterm birth, low birth weight, and developmental issues.
A recent study has identified that two biological molecules- 'cortexolone' and 'lysoPE(20:3)', show altered levels in women exposed to air pollution.
Cortexolone is a glucocorticoid crucial to regulating metabolism, inflammation, and the immune response.
lysoPE(20:3) is a lipid present in cells and important for cell function.
Deregulation of these molecules cause disruptions in protein digestion and absorption which are crucial to foetal development.
Previous studies have shown that these pollutants can penetrate the placental barrier, potentially affecting fetal growth and development.
Context: The Ministry of Health and Family Welfare has launched the National Zero Measles-Rubella Elimination campaign 2025-26, marking a significant step towards India's goal of eliminating Measles and Rubella by 2026.
Relevance of the Topic: Prelims: Key facts about Measles, Rubella; Measles-Rubella Elimination campaign.
About Measles:
Measles is a highly contagious airborne disease caused by the measles virus virus. Measles virus is a single-stranded, negative-sense, enveloped RNA virus.
Transmission:
spreads easily from one person to the next through the coughs and sneezes of infected people.
spread through direct contact with mouth or nasal secretions.
Symptoms: High fever, cough, runny nose, red watery eyes and rash. Rashes usually appear near the hairline & cheeks, slowly moving to the chest and trunk area, and later on the limbs. Koplik spots (small white spots) may form inside the mouth. Measles can also lead to serious health issues, including- ear infections, diarrhea, pneumonia and death. Fatality rate: 5-10%
Measles Vaccine: The first effective measles vaccine was developed in 1963. In the last 50 years, it is estimated that measles vaccinations have prevented over 9 crore deaths worldwide. The vaccines reduce chances of developing measles 20-fold.
Key Facts: Most people do not get the disease more than once. Measles is not known to occur in other animals.
About Rubella
Rubella is caused by the rubella virus that invades the lymph nodes, eyes and skin. Rubella or German measles is milder than measles.
Transmission: Transmitted through droplets from the cough or sneeze of an infected individual. Transmitted through direct contact with fluids from the nose or mouth of an infected person.
Symptoms: Low-grade fever, rashes, sore throat. Rubella may not cause serious complications in healthy adults, it poses a great risk to pregnant women as it can result in Congenital Rubella Syndrome which affects the development of the baby.
Measles-Rubella Elimination Campaign 2025-26:
With the ‘ACT NOW’ policy, govt. aims to target the elimination of Measles-Rubella in the same way as Polio and Maternal and Neonatal Tetanus.
Aim: Achieve 100% immunisation coverage to children by administering them with the two doses of Measles and Rubella vaccine.
Key Facts:
Under the Universal Immunisation Programme, two doses of the Measles-Rubella vaccine are provided free of cost to all eligible children, at 9-12 months and 16-24 months of age, respectively.
Currently, India's MR vaccination coverage stands at 93.7% for the first dose (2024-25 HMIS data) and 92.2% for the second dose.
In 2024, India recorded a remarkable decline of 73% in Measles cases and a 17% reduction in Rubella cases in comparison with 2023.
Context: The Central Board of Secondary Education (CBSE) has made it mandatory for schools to set up sugar boards in schools to educate students on the risks of high sugar intake.
The National Commission For Protection of Child Rights has pushed for the introduction of a ‘sugar board’ in all schools- not only CBSE affiliated but affiliated to various State boards.
Relevance of the topic:
Prelims: Key facts about the Initiative- Sugar Boards.
Mains: Efforts by the government in promoting healthy dietary habits and nutritional intake.
What are Sugar Boards?
Sugar board is a visual representation of the quantity of sugar contained in commonly consumed foods and drinks.
Objective: To educate students about the risks of excessive sugar intake.
It provides essential information including- recommended sugar intake, sugar content in commonly consumed foods (such as junk food and cold drinks), health risks associated with high sugar consumption and healthier dietary alternatives.
Significance: It is a significant initiative towards nutritional literacy and preventive healthcare to create awareness in nearly 2 crore students and their families.
Sugar Intake and Prevalence of Type 2 Diabetes
Over the past decade, there has been a significant increase in Type 2 Diabetes among children, a condition primarily seen in adults. The incidence of Type 2 Diabetes among children and adolescents is 397 per lakh population, next only to China which has 734 estimated cases per lakh.
Studies indicate that sugar constitutes 13% of daily calorie intake for children aged 4-10 years and 15% of those aged 11-18 years, substantially exceeding the recommended limit of 5%.
This alarming trend is attributable to high sugar intake and easy availability of sugary snacks, beverages and processed foods within school environments.
India’s Regulatory Stand
Food Standards and Safety Authority of India (FSSAI) had convened a scientific panel of experts in 2025 to decide on a High Fat, Salt and Sugar (HFSS) definition pertaining only to school meals. However, the FSSAI has still not set HFSS standards or finalized the ‘health-star rating system’, for front-of-pack labelling regulations.
While there are regulations in place for making claims on packaged food, FSSAI has not fixed a cut-off for High Fat, Salt, Sugar consumption for the Indian population.
India currently relies on World Health Organisation (WHO) cut-offs for ideal HFSS intake. For instance, WHO guidelines restrict daily sugar intake in adults and children to 25 grams (six teaspoons).
Experts emphasise the need for India-specific sugar intake cut-offs based on indigenous epidemiological data, as Indians are genetically more prone to heart diseases, necessitating studies on BMI, insulin resistance, and other health indicators.
The initiative must be complemented by stringent food regulations in school canteens, formulation of India-specific HFSS standards, and widespread parental and community engagement.
Context:57% of women in their reproductive age in India have undiagnosed and untreated Anaemia. This increases the risk of pre-term birth, low birth weight, and life-threatening maternal complications which contribute to maternal and perinatal morbidity and mortality.
Relevance of the Topic:Prelims: Key facts about Anaemia.
About Anaemia
Anaemia is a condition in which the number of red blood cells (RBCs), and consequently their oxygen-carrying capacity, is insufficient to meet the body’s physiological needs.
Anaemia impairs the body’s ability for gas exchange by decreasing the number of RBCs transporting oxygen and carbon dioxide.
The function of the RBCs is to deliver oxygen from the lungs to the tissues and carbon dioxide from the tissues to the lungs.
This is accomplished by using haemoglobin (Hb), a protein composed of haem and globin.
Symptoms: Fatigue, weakness, dizziness and shortness of breath etc.
Treatment: Anaemia is preventable and treatable. Treatments include folic acid supplements, iron chelation, and blood transfusions and bone marrow transplants (in advanced cases).
Factors causing Anaemia
Anaemia results from one or more of the following process:
Iron deficiency is the most common cause of anaemia globally (around 50% cases).
Iron is necessary for synthesis of haemoglobin (Hb).
Other nutritional deficiencies (including folate, vitamin B12 and vitamin A)
Defective red cell production, increased red cell destruction or blood loss.
Inherited or acquired disorders that affect Hb synthesis, red blood cell production or red blood cell survival can all cause anaemia.
Iron deficiency anaemia results in impaired cognitive and motor development in children and decreased work capacity in adults.
In pregnancy iron deficiency anaemia can lead to perinatal loss (miscarriage, still birth), prematurity and low birth weight babies.
Iron deficiency anaemia adversely affects the body’s immune response.
Burden of Anaemia in India
India’s anaemia burden has grown alarmingly with NFHS-5 (2019-21) finding that:
57% of women in the age group (15-49)
67% of children between 6-59 months
59% in adolescent girls (15-19 yrs)
31% in adolescent boys (15-19 yrs)
This is a rise from the data in NFHS-4 (2015-16).
Government Initiatives to tackle Anaemia burden
1. Anaemia Mukt Bharat strategy (2018):
6X6X6 strategy to reduce prevalence of anaemia in children, adolescents, and women.
Reduce Anaemia among six beneficiary age groups:
children 6-59 months
children 5-9 years
adolescents 10-19 years
women of reproductive age (15-49 years)
pregnant women
lactating women
Implementation of six interventions:
Prophylactic Iron Folic Acid Supplementation
Periodic deworming (Albendazole tablet)
Intensified year-round Behaviour Change Communication Campaign
Testing of anemia using digital invasive haemoglobinometer
Point of care treatment
Mandatory provision of Iron Folic Acid fortified foods in public health programmes
Addressing non-nutritional causes of anemia in endemic pockets, via six institutional mechanisms.
2. Mission Poshan 2.0:
Supplementary nutrition is provided to children (6 months to 6 years), pregnant women, lactating mothers and Adolescent Girls (14 to 18 years in Aspirational districts and North-East States).
Poshan Maahs and Poshan Pakhwadas: Celebrated in September and March-April, dedicated activities for awareness on anaemia are conducted.
3. Rice Fortification Initiative:
Government is supplying fortified rice enriched with iron, folic acid and vitamin B12 under the Targeted Public Distribution System (TPDS), Pradhan Mantri Poshan Shakti Nirman (PM-POSHAN) Scheme, Integrated Child Development Services (ICDS) Scheme in all States and Union Territories.
4. Diet and Biomarkers Survey in India (DABS-I)survey (2022):
New survey launched to map diet, nutrition and health status pan India. It will collect individual dietary intake data of different age groups for correct estimates of anaemia among urban and rural populations.
5. AnemiaPhone:
It is a latest technology to accurately, quickly, and cheaply assess iron deficiency, recently transferred to the Indian Council of Medical Research.
It requires a small finger prick, a drop of blood is placed on a test strip, and the device can determine iron deficiency in a few minutes. It would enable access to rapid screening, and diagnosis of iron deficiency at the point of need.
Context: Hypertension, often termed the "silent killer", is a growing public health concern in India. Once considered a disease of old age, recent data indicate that children and adolescents are increasingly affected, highlighting an urgent need for preventive strategies at the population level.
Relevance of the Topic : Prelims: Key facts related to Hypertension.
About Hypertension
High blood pressure, also called hypertension, is blood pressure that is higher than normal. It is a condition in which the force of the blood against the artery walls is too high.
High blood pressure is consistently at 140/90 mm Hg or higher. It is common but can be serious if not treated.
Hypertension typically progresses without symptoms, gradually damaging the heart, brain, and kidneys.
Risk factors for Hypertension:
Unhealthy Diet: High intake of salt, processed, and packaged foods; alcohol and tobacco use.
High Salt Consumption: Average Indian adolescents consume over 8 grams of salt/day whereas WHO recommends less than 5 grams/day even for adults
Rising Childhood Obesity: Excess weight increases cardiac and vascular strain.
Physical Inactivity: Sedentary lifestyle becoming the norm.
The risk factors also include non-modifiable factors like age, genetics, and co-existing conditions such as diabetes.
Key Trends in India
Comprehensive National Nutrition Survey (2016-18): 7.3% of Indian adolescents already had hypertensive blood pressure levels, rising to 9.1% in urban areas.
NFHS-5 (2019-21):
12% of teenagers aged 15-19 already exhibit elevated blood pressure.
21% women and 24% men aged 15 and above have elevated blood pressure. The rates are slightly higher in urban areas than in rural areas.
A study conducted between 2019 and 2021 revealed that over one in four Indian adults has hypertension. Of these, only one-third are diagnosed, fewer than one in five are treated, and a mere one in 12 have their blood pressure under control.
Government Initiatives to Tackle Hypertension:
Population-Based Screening (2016): Launched under the National Health Mission for early detection of NCDs, including hypertension.
India Hypertension Control Initiative (IHCI, 2017): Joint initiative by MoHFW, ICMR, WHO India, and Resolve to Save Lives. It focuses on standard treatment protocols, uninterrupted medicine supply, task-sharing, and decentralized care at the primary level.
Integration with NP-NCD: IHCI best practices merged into the National Programme for Prevention and Control of Non Communicable Diseases (NP-NCD) to enable real-time tracking of screening, treatment, and control outcomes down to village level.
‘75 by 25’ Target: Goal to bring 75 million people with hypertension or diabetes under standard care by 2025; 71 million already enrolled (as of 2025).
Solutions & Way Forward
Strengthen Primary Healthcare Delivery: Ensure continuous availability of antihypertensive drugs at Ayushman Arogya Mandirs. Promote the use of validated, automated BP monitors for accurate diagnosis and monitoring.
Enhance Digital Health Integration: Leverage ABHA (Ayushman Bharat Health Account) to track patient history and treatment across facilities for better continuity of care.
Incentivize Screening and Follow-up: Expand and align incentives for frontline workers (CHOs, ASHAs) with outcomes such as diagnosis, treatment initiation, and BP control.
Transform Mid Day Meal Scheme: Upgrade PM POSHAN into a nutrition + food literacy platform reaching 120 million children. Incorporate regionally-inspired, fresh menus and student participation in meal planning and preparation.
Adopt Global Best Practices: Adapt Japan’s ShoKuiku model of food education and Vietnam’s school lunch reforms to instill healthy eating habits from a young age.
Policy Actions: Increasing excise taxes on tobacco and alcohol, banning their advertisement, reducing salt in processed foods, eliminating trans fats, and promoting healthy eating and physical activity.
Context: The Registrar General of India (RGI) has recently released the Sample Registration System (SRS) Report for 2021. Among other data, the report provides insights about the key trends of Total Fertility Rate in India.
Relevance of the Topic: Prelims: Key trends about Total Fertility Rate in India.
What is Total Fertility Rate?
Total Fertility Rate (TFR) of a population is the average number of children that are born to a woman over her lifetime if:
They were to experience the exact current age-specific fertility rates (ASFRs) through their lifetime.
They were to live from birth until the end of their reproductive life.
Replacement level fertility is the level of fertility at which a population exactly replaces itself from one generation to the next. It is considered to be 2.1 children per woman.
If the TFR of a population goes down below 2.1- it indicates that a generation is not producing enough children to replace itself. Thus, indicative of reduction in population in general and depletion of working age population in particular.
Major Highlights of the SRS Report:
Total Fertility Rate (TFR) in India has remained constant at 2.0 in 2021, same as the year 2020.
India has witnessed a steadily declining TFR from 6.18 in 1950 to 4.60 in 1980 to 2.0 in 2021.
Bihar has reported the highest TFR at 3.0, while Delhi and West Bengal reported the lowest TFR of 1.4.
Gradual decline in the share of population in the age group of 0-14 from 41.2% in 1971 to 24.8% in 2021.
The proportion of the economically active population between 15-59 years has increased from 53.4% to 66.2% during the same period (1971-2021).
Elderly population has gone up to 5.9% for the 65+ age group and to 9% for the 60+ age group during the same period (1971-2021). Kerala recorded the highest percentage of population in the age group of 60.
Mean age at effective marriage for females has increased from 19.3 years in 1990 to 22.5 years in 2021.
Key Facts:
As the Census is usually counted every 10 years, the Sample Registration System (SRS) Report is the largest demographic survey in the country mandated to provide annual estimates of fertility and mortality indicators at the State and national level.
Context: Vaccines are one of the most effective tools in modern medicine and one of humanity’s greatest achievements. India has earned the title of 'pharmacy of the world', and is the backbone of a stable, resilient and equitable global healthcare system.
Relevance of the topic:
Prelims: Key facts related to various immunisation efforts.
Mains: India's role as a global vaccine hub, challenges and solutions.
India’s Immunisation Journey
1. Early beginning of Immunisation:
India’s first smallpox vaccine was administered in Bombay in 1802, laying the foundation for public preventive healthcare.
Tuberculosis campaign (1948): Preventive mass immunisation began with the adoption of the International Tuberculosis Campaign, targeting TB which claimed an estimated 500,000 lives per year in India in the 1940s.
2. Institutionalising Immunisation:
Expanded Programme on Immunisation (EPI): In 1978, EPI was launched which aimed at providing free vaccines, initially against six diseases.
Universal Immunisation Programme (1985): EPI was renamed as UIP. It provided free vaccines against 12 vaccine-preventable diseases including: TB, polio, measles, and hepatitis B. UIP is among the largest public health programs globally, reaching over 2.67 crore newborns and 2.9 crore pregnant women each year. Significant achievements: successful eradication of polio in 2014.
Mission Indradhanush (2014): Aim: To improve full immunisation coverage for children in India from 65% in 2014 to at least 90% earlier than 2020. MI focuses on vaccinating women and children against a host of diseases, including diphtheria, pertussis, tetanus, polio, TB, meningitis and pneumonia. The initiative has completed twelve phases so far, covering 554 districts across the country.
In 2023-24, India reached full, national immunisation coverage — a milestone made possible through the consistent and extensive efforts of programmes like UIP and MI.
3. Technological Innovations:
eVIN: India has introduced technology-driven innovations such as the Electronic Vaccine Intelligence Network (eVIN) to strengthen vaccine logistics and transparency. It is an AI-integrated application that modernises healthcare delivery through real-time vaccine stock monitoring.
India’s role in Global Immunisation Efforts
Covering 60% of the global vaccine supply, India is remarkably one of the biggest suppliers of low-cost vaccines in the world.
Initiatives like Vaccine Maitri during the COVID-19 pandemic further underscored India's commitment to global health equity.
International collaborations with GAVI, COVAX, and WHO underlines India’s commitment to global health.
India’s immunisation journey illustrates an inspiring story of transformation- from early experiments with smallpox vaccines to achieving full national immunisation coverage and becoming the "pharmacy of the world."
Context: Non-Communicable Diseases (NCDs) are rapidly rising in India, particularly in the urban areas. Studies have shown increased risks of NCDs for women post-menopause, with a significant rise in diabetes, obesity, fatty liver, and hypertension.
Relevance of the topic: Mains- Role of Urbanisation in increasing the Burden of NCDs; Government Initiatives.
What are Non-Communicable Diseases?
NCDs: Group of chronic diseases that are not caused by infectious agents and typically have a long development period.
Diseases: They include a range of conditions such as cardiovascular diseases, cancer, diabetes, chronic respiratory diseases , and mental health disorders.
Risk factors for NCDs: Unhealthy diets, physical inactivity, tobacco use, harmful use of alcohol, pollution and environmental factors.
According to the World Health Organisation, NCDs account for 71% of all deaths globally, with cardiovascular diseases being the leading cause.
As per the WHO’s latest report (2022), 66% of total deaths in India in 2019 were due to NCDs.
Older adults (60 and above) have reported the highest infectious, NCDs, disability and injuries.
Role of Urbanisation in Increasing the Burden of NCDs:
Economic Structure: Urban economies are primarily service-oriented, which reduces the need for manual labor compared to agrarian rural economies. This contributes to the sedentary lifestyle and associated risk of NCDs.
Changing Dietary Patterns: Urban areas often see increased consumption of processed foods, unhealthy fats, and sugars, leading to poor nutrition which are directly related to rising incidence of NCDs.
Environmental Factors: Pollution and the Urban Heat Island effect exacerbate health risks associated with NCDs.
Lifestyle Choices: Higher prevalence of alcohol consumption and smoking in urban settings increases the risk of developing NCDs.
Family Structure Changes: The shift towards nuclear families in urban areas can lead to mental health issues due to a lack of emotional support from extended family members.
Initiatives taken by the Government:
National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NP-CDCS): Implemented since 2010 intends to prevent and control major NCDs (Hypertension, Diabetes, Cardiovascular disease, Cancer, Stroke, Chronic kidney disease, COPD/ Asthma, Non-Alcoholic Fatty Liver Disease, etc).
National Action Plan: India has adopted the National Action Plan with specific national targets and indicators aimed at reducing the number of global premature deaths from NCDs by 25% by 2025.
The plan was based on the WHO's Global Action Plan for the Prevention and Control of NCDs (2013-2020). UN SDG (Target 3.4) aims to reduce premature mortality from NCDs by one-third by 2030 in the world.
Ayushman Bharat Pradhan Mantri Jan Arogya Yojana includes coverage for treatment of NCDs, to over 10 crore families, including cancer.
Fit India Movementand promotion of Yoga to encourage people to remain healthy and fit by including physical activities and sports in their lifestyle.
National Mental Health Programme and National Tele Mental Health Programme to improve access to quality mental health counselling and care services in the country.
Context: Theneglect of Primary Health care (PHC) systems under AB-PMJAY and focus on targeted interventions instead of a comprehensive agenda to tackle malnutrition call for an urgent overhaul of the healthcare sector in India.
Relevance of the Topic: Mains: Healthcare in India- Nutrition, Insurance- challenges, way forward
Health for All
India is committed to the principle of 'Health for All' under WHO’s Universal Health Coverage (UHC) framework. This framework prioritises Primary Health Care (PHC) and aims to reduce out-of-pocket expenditure (OOPE).
Initiatives likeAyushman Bharat Pradhan Mantri Jan Arogya Yojana (AB-PMJAY) aim to provide financial protection and reduce OOPE. However,there are growing concerns regarding neglect of primary healthcare (PHCs) and increasing reliance on market-driven private healthcare.
Present Healthcare Landscape in India
Malnutrition: India has one of the highest rates of malnourished children and anaemic women. According to National Family Health Survey-5:
36% of children under five are stunted.
Only 11% of children aged 6-23 months are breastfed and receive an adequate diet.
57% of women in the 15-49 age group are anaemic.
Non-communicable diseases (NCDs) such as diabetes, hypertension, and lifestyle-induced diseases are on the rise, highlighting another dimension of under-nutrition.
24% of women and 23% of men are overweight or obese.
14% of the population uses medication for diabetes.
Skewed Health Budget: Budget 2025 places much emphasis on medical digital infrastructure and expanding medical education over strengthening primary healthcare.
Privatisation in Insurance: The government has increased Foreign Direct Investment (FDI) cap in the insurance sector aims to boost insurance penetration. While it attracts more private players, it further intensifies privatisation of healthcare services.
Challenges in Healthcare
1. Problems with current nutrition schemes (Narrow Focus):
Poshan 2.0 fails to recognise the broader national nutrition challenge confining efforts to certain geographic regions and population segments.
Current policies predominantly focus on malnutrition among women and children, leaving out other vulnerable groups such as men, senior citizens, and individuals suffering from non-communicable diseases (NCDs) related to diet.
The policies do not address the broader aspects of under-nutrition, such as insufficient access to nutritionally rich food or lifestyle-induced diseases like obesity and diabetes.
2. Inadequate Infrastructure:
Rural areas may have a higher concentration of Health and Wellness Centres (HWCs),but urban areas face a lack of sufficient coverage.
Current services at HWCs (includingnutrition advice for pregnant women, lactating women, children, adolescents and the elderly) are not systematically implemented and not consistently available.
3. Cultural and Socio-economic barriers: Dietary habits are influenced by culture and caste dynamics which complicate the design and implementation of nutrition interventions leading to fragmented approaches. E.g., Resistance to eggs in mid day meal schemes.
4. Overpriced drugs: Private firms have invested heavily in R&D for new drugs, especially for secondary and tertiary care; hence, the price of patented drugs is passed on to consumers.
5. Healthcare policies-related challenges:
Concerns with Ayushman Bharat: PMJAY excludes outpatient care. As people requiring only outpatient care outnumber those requiring hospitalisation, the majority have to rely on costly private facilities for outpatient care.
Low Health Budget: Despite the significant increase in government expenditure on Health, it is still below the target of National Health Policy (2017)- 2.5% of GDP. The National Health Mission, essential forgrassroots healthcare, receives a declining sharein the Health budget.
Insurance illiteracy: Migrant workers and the non-literate sections of the population face challenges in accessing insurance services.
Health security for Informal workers: Informal workforce remains without adequate health security due to the lack of universal coverage.
Outdated data from the 2011 Census and the 2020-21 Periodic Labour Force Survey hinders effective resource allocation and limits the efficiency of social protection schemes.
As a result, a significant portion of healthcare expenditure in India is from out-of-pocket expenditure (47.1% in 2019-20).
Way Forward
Comprehensive National Nutrition Strategy beyond maternal and child malnutrition. Identifying the nutritional needs of men, senior citizens, and people suffering from lifestyle diseases and a wider range of deficiencies.
Locally available nutrient-dense, and low-cost food options can ensure access to nutritious food.
Strengthen Health and Wellness Centres. HWCs must be morewidely distributed, particularly inurban areas, equipped with a comprehensive set of nutrition services for all age groups with dedicated nutrition staff.
Public health education campaigns focusing on dietary habits and lifestyle changes to combat the rising incidence of NCDs.
Strengthen Primary Health Care to expand access to affordable and preventive healthcare at the grassroots level. Allocate more funds to National Health Mission (NHM).
Address Informal workers’ health security to achieveuniversal health coverage. E.g., PMJAY is expanded to gig workers.
Regular surveys and Census updates to track the health needs of the populationand for better allocation of resources.
To move India towards UHC, the government, civil society, health-care providers, and communities need to work together.
Context: There have been calls to designate Cancer as a notifiable disease in India, in order to enhance Cancer surveillance and treatment. However, the Union Ministry of Health has resisted the move, citing that the practice is to notify only infectious diseases.
Relevance of the Topic:Prelims: Key facts about Notifiable diseases; India’s National Cancer Registry Programme (NCRP).
Major Highlights:
Cancer in India is not a notifiable disease. The Indian Ministry of Health and Family Welfare refuses to declare it as a notified disease despite recommendations from the Indian Council of Medical Research.
Reasons given by the Ministry:
Cancer is not a communicable disease and does not have community spread.
Cancer requires long-term management rather than emergency interventions.
Which are Notifiable Diseases?
Notifiable disease is a disease that is legally required to be reported to the government by both private and public hospitals.
The primary purposeof disease notification is to ensure that contagious diseases are kept under check. Notifiability triggers rapid containment measures. Usually, diseases are declared notifiable if they:
Have the potential to cause an outbreak
Leads to significant mortality
Require rapid investigation and public health action.
State governments are responsible to declare a disease as a notifiable disease, and the list of notifiable diseases differsfrom state to state.
Registered medical practitioners must notify such diseases, typically in a standard form within three days, or notify verbally via phone within 24 hours if urgent.
Every government hospital, private hospital, laboratory, and clinic will have to report cases of the disease to the local government authorities.
Any failure to report a notifiable disease is a criminal offence and the state government can take necessary actions against defaulters.
India’s National Cancer Registry Programme (NCRP):
NCRP functions as a data collection mechanism. It compiles crucial information on:
demographics of cancer patients
cancer identification including type, stage, and morphology
timing of diagnosis and staging at the time of detection
treatment details such as chemotherapy, radiation, and surgery, and follow-up and survival outcomes.
The NCRP includes hospital-based registries, which collect data from cancer-treating hospitals, and population-based registries, which capture cancer incidence in a defined geographic area.
Rather than legally mandating notification, strengthening existing cancer registries is a more thorough and effective alternative for comprehensive nationwide cancer surveillance.
