Health Scenario of India – Past, Present, and Future
India’s health scenario has undergone major transitions since independence. From battling epidemics and malnutrition in the early decades, the country has progressed to tackling non-communicable diseases, aging populations, and the challenges of universal health coverage in the present era. Understanding the past, present, and future trends of India’s health system is crucial for policymakers, healthcare professionals, and students of optometry and public health, as it highlights achievements as well as persistent gaps.
Health Scenario in the Past
At the time of independence in 1947, India’s health indicators reflected the challenges of a newly liberated, low-income country with limited resources and infrastructure.
- Low life expectancy: Around 32 years in 1947 due to high mortality rates.
- High infant and maternal mortality: Infant mortality rate (IMR) was over 150 per 1,000 live births, and maternal mortality ratio (MMR) exceeded 2,000 per 100,000 live births.
- Prevalence of epidemics: Malaria, smallpox, cholera, tuberculosis, and leprosy were widespread, causing millions of deaths annually.
- Poor healthcare infrastructure: Limited hospitals, doctors, and medical colleges; most care delivered by untrained practitioners in rural areas.
- Malnutrition and poverty: Widespread undernutrition, vitamin deficiencies (especially vitamin A, leading to blindness), and anemia.
- Limited public health expenditure: Health spending was less than 1% of GDP.
Key interventions in the past
- Launch of the National Malaria Eradication Programme (1953) and National TB Control Programme.
- Implementation of family planning programs to control population growth.
- Vaccination drives and eventual eradication of smallpox in 1977.
- Strengthening primary healthcare infrastructure through the creation of PHCs and sub-centres.
Health Scenario in the Present
Over the last seven decades, India has made remarkable progress in improving health indicators, though inequities remain.
Achievements
- Increased life expectancy: Now above 70 years on average.
- Reduced maternal and infant mortality: IMR reduced to around 27 per 1,000 live births (2023), MMR reduced to 103 per 100,000 live births.
- Control of infectious diseases: Polio eradicated (2014); smallpox eradicated; leprosy nearly eliminated as a public health problem.
- Expanded immunization: Introduction of new vaccines (pentavalent, rotavirus, pneumococcal) under Universal Immunization Programme.
- Improved healthcare infrastructure: Growth of AIIMS-like institutes, district hospitals, and Ayushman Bharat Health and Wellness Centres.
- Medical tourism: India has become a global hub for affordable, high-quality healthcare, especially in cardiology, oncology, and ophthalmology.
Current challenges
- Double disease burden: Infectious diseases like TB and dengue persist, while non-communicable diseases (diabetes, hypertension, cancer) are rapidly rising.
- Out-of-pocket expenditure: Still accounts for about 55–60% of health spending, pushing millions into poverty annually.
- Rural-urban disparity: Rural areas remain underserved compared to urban centers with advanced tertiary care.
- Human resource shortages: Inadequate doctors, nurses, optometrists, and specialists in public facilities.
- Quality of care: Variability in standards, poor patient safety mechanisms, and overcrowding in tertiary hospitals.
- Eye health burden: Over 275 million Indians live with visual impairment; cataract and uncorrected refractive errors are leading causes.
Future Health Scenario of India
Looking ahead, India’s healthcare system will need to adapt to demographic, epidemiological, and technological changes.
Expected trends
- Aging population: By 2050, nearly 20% of Indians will be above 60 years, increasing demand for geriatric and chronic care.
- Rise in NCDs: Diabetes, cardiovascular diseases, cancer, and eye complications like diabetic retinopathy will dominate health priorities.
- Digital and AI-driven healthcare: Telemedicine, electronic health records, and AI-based diagnostics will expand accessibility and efficiency.
- Personalized and preventive medicine: Genomics, lifestyle medicine, and integrative care (AYUSH with allopathy) will grow in relevance.
- Universal Health Coverage (UHC): Expansion of Ayushman Bharat and insurance schemes will reduce catastrophic expenditure.
- Focus on sustainability: Eco-friendly healthcare practices and green hospitals will be prioritized to address climate change’s health impacts.
Strategies for the future
- Strengthen primary healthcare through Health and Wellness Centres with integrated services.
- Expand human resources by training more doctors, nurses, optometrists, and AYUSH practitioners.
- Increase public health spending to at least 2.5% of GDP by 2025.
- Integrate digital health solutions and telemedicine for rural-urban connectivity.
- Implement preventive eye care programs for diabetic retinopathy, glaucoma, and refractive errors.
- Foster public-private partnerships to expand infrastructure and reduce inequities.
- Encourage community participation for sustainable health promotion and monitoring.
Conclusion
India’s health scenario has moved from tackling epidemics and malnutrition in the past to addressing the double burden of communicable and non-communicable diseases in the present. The future will require stronger investments in preventive care, digital health, and universal coverage, with special attention to equity, quality, and sustainability. For optometry and eye care, the transition implies a focus on preventive screening, integration with primary healthcare, and management of age- and lifestyle-related eye diseases. With coordinated efforts, India can achieve the vision of equitable and comprehensive healthcare for all by 2030 and beyond.
