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India completed 75 years of its independence on August 14, 2022. It will be observed throughout the year with full enthusiasm. The achievements and failures after independence in various areas like political, economic, social and health are being evaluated by the government and various stakeholders with an aim to bridge those gaps.  

The success story

The foremost success has been the increase in life expectancy at birth or simply the average longevity from about 32 years in 1947 to 70.19 years in 2022. Global average of this is 72.98 years as per the ‘UN World Population Perspective’ data. The infant mortality rate has fallen substantially to 27.695 deaths per 1000 live births. In the 1940s, the maternal mortality ratio was 2000 per 1 lakh live births. The target is to bring down to 70 deaths per 1 lakh by 2030.

Communicable diseases

India has achieved success to a great extent in controlling many communicable diseases like malaria, polio, smallpox, leprosy, cholera and Kala Azhar. According to a report, in 1947, there were 75 million cases of malaria.  It declined to just one lakh in 1964. Later in 1976 it climbed to around 6.4 million. But later it fell substantially. The World Malaria Report 2021, published by WHO, mentions that among the world’s 11 highest malaria burdened countries, only India’s progress is commendable. Polio in India has mostly been eradicated. Even in the 1990s, 500 to 1000 people per day got afflicted by polio. In 2014, India was declared as a polio free country. In case of leprosy, India is one of the most successful countries to eradicate the disease. In 1979, India was declared as a smallpox free country. In case of cholera, Kala Azhar and HIV, India has also progressed significantly.

The non-communicable diseases

There is significant weakness in the case of non-communicable diseases (NCDs) like cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases. NCDs contribute to about 5.87 million deaths per year - about 60% of all deaths in India. A WHO report in 2014 mentioned that out of all NCDs related deaths, the diseases mentioned contribute 82% of all deaths. Low and middle income countries are mostly affected by these NCDs. It is highly related to personal behaviour and lifestyle, environmental exposure, or hereditary characteristics. In this matter, the government and non-state actors have a role to play.  

Areas to be emphasised

A UNICEF report on India’s child health points out, “Nearly 3.5 million babies in India are born early, 1.7 million babies are born with birth defects, and one million new-borns are discharged each year from Special New-born Care Units. These new borns remain at high risk of death, stunting and developmental delay.” 

It is true that India has made progress in reducing newborn mortality. But weak babies may face several health problems. The same report mentions that India is the only large country in the world where more girl babies die than boy babies. The gender differential in under five mortality is 3%.  

There have been many positive improvements in the basic health sector but at the same time, there is an increase in anemia among women and children. This in turn has a long-term impact in mal-nutrition among women and children. In the Budget 2022-23, a 43% increase in Pradhan Mantri Swasthya Suraksha Yojna (PMSSY) and allocation of `5,846 to PM Ayushman Bharat Health Infrastructure Mission may be of help.

The way forward

Nobel Laureate and economist Amartya Sen considers that the insurance-based health system has severe shortcomings. The key is to boost immunity and health of infants and children through better dietary supplements at the primary health care level. Spending on Ayushman Bharat helps people to get specialised care but only if they survive the early dangers of life. The public health system needs to be developed.