HEALTH – SOCIAL PERSPECTIVE

HEALTH – SOCIAL PERSPECTIVE

According to the WHO, health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity. Thus, health is not simply a medical issue; it is closely connected with poverty, nutrition, sanitation, education, gender, occupation, environment and social inequality.

India follows a mixed healthcare system, consisting of public and private providers across primary, secondary and tertiary levels. Therefore, achieving “Health for All” requires not only hospitals and doctors but also equitable access, preventive healthcare and strong social determinants of health.

Constitutional Provisions Related to Health

Health is primarily a State subject under the Seventh Schedule. However, several constitutional provisions create responsibilities relating to public health.

Right to Health and Judiciary

Although the Constitution does not explicitly mention a separate Fundamental Right to Health, the judiciary has expanded Article 21 to include health and medical care.

Parmanand Katara v. Union of India, 1989

The Supreme Court held that doctors have a professional obligation to provide immediate medical assistance for protecting life.

Rakesh Chandra Narayan Case

The Court emphasized the government’s obligation to ensure medical attention to citizens.

Thus:

Right to Life → Right to Live with Dignity → Right to Health and Medical Care

Health as a Social Issue

Health outcomes are shaped not only by diseases but also by an individual’s social and economic environment.

Important social determinants include:

• Income and poverty
• Nutrition
• Drinking water
• Sanitation
• Housing
• Education
• Gender
• Employment
• Environment
• Social discrimination
• Geographical location

Therefore, unequal social conditions often produce unequal health outcomes.

Major Social Challenges of India’s Health Sector

Rural–Urban Divide

India’s healthcare system suffers from a strong urban bias.

Urban areas generally have greater access to:

• Hospitals
• Specialists
• Diagnostic centres
• Private healthcare

while rural, hilly and remote areas remain underserved.

Inadequate Public Expenditure

Limited public investment restricts:

• Infrastructure
• Human resources
• Medicines
• Diagnostics
• Preventive healthcare

The chapter stresses the need to increase public-health expenditure towards the 2.5% of GDP objective envisaged under the National Health Policy, 2017.

Shortage of Healthcare Personnel

India faces shortages and uneven distribution of:

• Doctors
• Nurses
• Specialists
• Community health workers

Remote and rural areas face particularly severe shortages.

High Out-of-Pocket Expenditure

Heavy dependence on private healthcare forces households to spend directly on:

• Hospitalization
• Medicines
• Diagnostics
• Consultation

High Out-of-Pocket Expenditure (OOPE) can push vulnerable households into financial distress. The chapter identifies expensive healthcare as a major challenge.

Inadequate Preventive Healthcare

India’s health system has traditionally focused significantly on curative treatment, while preventive, promotive and rehabilitative healthcare require greater attention.

The approach should shift from:

Illness → Hospital → Treatment

towards:

Prevention → Early Detection → Primary Care → Treatment → Rehabilitation

Universal Health Coverage

Universal Health Coverage (UHC) means ensuring that everyone receives the health services they need without suffering financial hardship.

SDG 3 aims to:

“Ensure healthy lives and promote well-being for all at all ages.”

The chapter emphasizes that achieving SDG 3 requires Universal Health Coverage and access to quality healthcare without leaving anyone behind.

Strengthening Primary Healthcare

A strong Primary Health Care (PHC) system is essential because it provides the first point of contact between people and the health system.

It should focus on:

• Preventive care
• Maternal and child health
• Immunization
• Basic diagnosis
• Health awareness
• Early treatment

The chapter highlights transformation of primary healthcare facilities into Health and Wellness Centres to strengthen preventive care.

Behavioural Change and Preventive Health

Public health also depends on individual and community behaviour.

Important areas include:

• Healthy diet
• Physical activity
• Adequate sleep
• Hygiene
• Sanitation
• Preventive screening

Thus:

Healthcare is not merely treatment of disease; it also involves prevention of disease.

Decentralisation of Healthcare

Local institutions such as Panchayats and municipalities should play a greater role in:

• • Nutrition
  • Drinking water
  • Sanitation
  • Hygiene
  • Local health awareness

The chapter therefore emphasizes making WASH – Water, Sanitation and Hygiene part of the core responsibilities of local governments.

Mental Health

Meaning

Mental health refers to a state of mental well-being that enables individuals to:

• Cope with stress
• Realize their abilities
• Learn and work effectively
• Build relationships
• Contribute to society

The chapter describes mental health as an integral component of overall health and a basic human right.

Major Mental Health Challenges

Social Stigma

Mental illness is frequently associated with stigma and stereotypes.

Affected persons may experience:

Stigma → Shame → Isolation → Non-reporting → Delayed Treatment

The source identifies stigma and the resulting cycle of shame, suffering and isolation as major barriers.

Lack of Awareness

Mental-health problems are often:

• • Ignored
  • Misunderstood
  • Diagnosed late

Treatment Gap

A large proportion of people requiring mental healthcare do not receive adequate treatment.

Shortage of Professionals

There is a shortage of:

• Psychiatrists
• Psychologists
• Counsellors
• Trained community workers

Human Rights Concerns

Poor conditions in some mental-health institutions can undermine the dignity and rights of patients.

Way Forward for Mental Health

• Destigmatize mental illness
• Increase public awareness
• Promote early detection
• Strengthen community-based care
• Increase funding
• Train community health workers
• Expand digital and telemedicine services
• Move beyond an excessive dependence on “doctors, diagnoses and drugs”
• Adopt evidence-based policies

Violence Against Healthcare Workers

Healthcare workers may face:

• • Physical violence
  • Verbal aggression
  • Threats
  • Workplace insecurity

Doctors, nurses, paramedics and frontline personnel are particularly vulnerable.

Reasons

Public Hospitals

• Infrastructure gaps
• High patient load
• Long waiting periods
• Service-delivery deficiencies

Private Hospitals

• High treatment costs
• Perception of medical profiteering

Other factors include:

• • Poor doctor-patient communication
  • Emotional stress among relatives
  • Lack of effective reporting
  • Crisis situations such as pandemics

Government Intervention

The Epidemic Diseases (Amendment) Act, 2020 introduced punishments relating to violence against healthcare personnel in the context covered by the law.

Way Forward

• Recognize violence against healthcare workers as a serious social issue.
• Improve public-health infrastructure.
• Strengthen doctor-patient communication.
• Ensure informed consent.
• Develop clear SOPs.
• Incorporate communication and soft skills in medical education.
• Protect the dignity of both patients and healthcare workers.

Patients’ Rights

Patient rights are closely connected with the Right to Life and Human Dignity under Article 21.

Important rights include:

• Right to safety
• Right to quality care
• Right to emergency medical treatment
• Right to dignified treatment

The chapter notes that hospitals are duty-bound to provide basic emergency medical care to injured persons.

Tribal Health in India

Tribal communities face multiple health vulnerabilities.

The chapter describes a burden involving:

• Communicable diseases
• Non-communicable diseases
• Malnutrition
• Mental-health problems and addictions

Major Tribal Health Problems

Malnutrition

Tribal children and women experience significant problems of:

• • Undernutrition
  • Anaemia
  • Stunting
  • Low BMI

Communicable Diseases

Tribal communities bear a disproportionate burden of diseases such as malaria.

Non-Communicable Diseases

Changing lifestyles have increased conditions such as:

• Hypertension
• Diabetes
• Respiratory diseases

Genetic Disorders

The chapter highlights conditions such as:

• Sickle Cell Anaemia
• G-6-PD deficiency

among some tribal communities.

Reasons for Poor Tribal Health

• Geographical isolation
• Poverty
• Malnutrition
• Poor sanitation
• Lack of drinking water
• Poor health infrastructure
• Shortage of medical personnel
• Weak health financing
• Low trust in modern healthcare
• Low community participation
• Weak governance and data systems

Improving Tribal Health

• Mobile medical camps
• Accessible medicines and diagnostics
• Emergency transport for pregnant women
• Recruit healthcare workers from tribal communities
• Improve infrastructure
• Strengthen awareness
• Create dedicated tribal-health institutions and research mechanisms

Should Health Be Shifted to the Concurrent List?

At present, health is primarily a State List subject.

The chapter discusses the suggestion of the 15th Finance Commission Chairman N. K. Singh that health should be shifted to the Concurrent List.

Arguments in Favour

• Greater flexibility for the Centre
• Uniformity in regulation
• Better coordination
• Greater technical expertise
• Streamlining of health-related legislation

Arguments Against

• Could weaken federalism
• States understand local healthcare requirements better.
• Centre already has substantial responsibilities.
• Better Centre-State cooperation may be preferable to constitutional transfer.

Thus, the broader requirement is:

National Standards + State-Level Implementation + Local-Level Delivery

The chapter also recommends greater expenditure on primary healthcare, standardization of health codes and consideration of an All India Medical and Health Service.

Hunger and Malnutrition

Health is closely related to nutrition and food security.

Malnutrition affects:

• • Physical development
  • Cognitive ability
  • Immunity
  • Educational outcomes
  • Productivity

Thus:

Malnutrition → Poor Health → Poor Learning → Low Productivity → Poverty

This can create an intergenerational cycle of deprivation.

POSHAN Abhiyaan

POSHAN (Prime Minister’s Overarching Scheme for Holistic Nourishment) Abhiyaan is a flagship programme aimed at improving nutritional outcomes among:

• Children
• Pregnant women
• Lactating mothers

It uses:

• • Convergence
  • Technology
  • Targeted interventions
  • Behavioural change

The chapter particularly highlights its focus on the first 1,000 days, Jan Andolan and real-time monitoring of nutrition programmes.

Building a Resilient Public Health System

The chapter stresses strengthening India’s ability to handle future health emergencies.

Important requirements include:

• Strong primary healthcare
• Better disease surveillance
• Public-health infrastructure
• Trained personnel
• Affordable healthcare
• Pandemic preparedness
• Centre-State cooperation

It cites support for PM-Ayushman Bharat Health Infrastructure Mission (PM-ABHIM) as part of efforts to improve public-health infrastructure and pandemic resilience.

Technology and Healthcare

Technology can improve healthcare through:

• Digitization of health services
• Cloud-based health information
• Telemedicine
• Artificial Intelligence
• Wearable devices
• Mobile technologies
• Internet of Things
• Improved diagnostics

However, technology should supplement rather than replace accessible primary and community healthcare.

Major Areas for Health-Sector Reform

A comprehensive health strategy should focus on:

Preventive Care + Primary Healthcare + Affordable Treatment + Nutrition + WASH + Mental Health + Digital Health + Human Resources + Social Inclusion

Universal Health Coverage (UHC), Health for All, Out-of-Pocket Expenditure, Preventive Healthcare, Social Determinants of Health, Health Inequality, Rural–Urban Divide, Mental Health Treatment Gap, Community-Based Healthcare, WASH, Primary Healthcare, Health and Wellness Centres, Tribal Health, Patient Rights, Public Health Resilience, Cooperative Federalism.

Health is both a fundamental component of human well-being and a prerequisite for inclusive and sustainable development. India’s health challenges cannot be addressed merely by constructing hospitals or increasing the number of doctors because health outcomes are deeply shaped by poverty, nutrition, sanitation, education, gender, geography and social inequality.

India therefore needs to move from a predominantly curative and hospital-centric model towards preventive, primary and community-based healthcare, supported by adequate public financing, trained human resources, digital innovation and effective Centre-State-local coordination.

The ultimate objective must be Universal Health Coverage, where every citizen—irrespective of income, gender, caste, tribe or geographical location—can access affordable, accessible and quality healthcare without financial hardship, fulfilling the broader goal of “Health for All.”