India faces a dual challenge, rising life expectancy and an earlier disease burden necessitating Preventive healthcare  with focus on early detection.

What are Preventive Measures?

Preventive measures refer to proactive actions taken to avert the onset of diseases, manage risk factors, and maintain overall health. These include:

• Primary Prevention: Avoiding the occurrence of diseases through vaccinations, hygiene, and lifestyle changes.
• Secondary Prevention: Early detection and prompt treatment to prevent disease progression.
• Tertiary Prevention: Managing chronic diseases to minimize complications and enhance quality of life.

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Need for Preventive Measures in India

• Rising Elderly Population: With increasing life expectancy, India’s elderly population is projected to reach 320 million by 2050. This group faces a high prevalence of NCDs, such as cardiovascular diseases (CVDs), diabetes, and cancers.
• Malnutrition in Children: Childhood stunting remains a concern, with 35.5% of children under five stunted (NFHS-5). Malnutrition impacts cognitive development and increases susceptibility to infections.
  • Immunization and nutritional programs are vital to protect children from preventable diseases.
• Deficiency among Women: Anemia affects 57% of women aged 15-49, with nutritional deficiencies being a significant contributor. Additionally, breast and cervical cancers are on the rise, often diagnosed late.
  • Targeted health check-ups, nutritional supplementation, and cancer screenings can address these challenges effectively.
• Prevalence of Cardiovascular Diseases (CVDs): In 2016 India reported 63% of total deaths due to NCDs, of which 27% were attributed to CVDs. CVDs also account for 45% of deaths in the 40-69 year age group. Risk factors include hypertension, obesity, and high cholesterol.
  • Preventive measures such as regular screenings, lifestyle changes, and public awareness campaigns are critical.
• High Communicable Diseases Burden: Despite progress, diseases like tuberculosis (TB) and malaria remain endemic.
  • India recorded 1.6 million TB cases in 2022, with multidrug-resistant TB posing additional challenges. Necessiting improved diagnostics, vaccinations, and hygiene promotion are essential.
• Rising Risk of Non-Communicable Diseases (NCDs): The prevalence of risk factors for NCDs is worryingly high. One in four adult men are hypertensive. One in eight are diabetic.
  • Early diagnosis and lifestyle interventions can mitigate the growing NCD burden.
• Economic Burden of Disease in India: Rising healthcare expenses and productivity losses threaten financial stability, especially for middle and lower-income families.
  • As per National Health Accounts Estimates 2021-22, the Out-of-Pocket Expenditure (OOPE) as a percentage of Total Health Expenditure (THE) is 39.4%.
  • The Union Budget 2024 allocated ₹87,657 crore to healthcare, a 13% increase but insufficient for India’s challenges.
  • WHO predicts NCD costs in India to exceed ₹280 lakh crore by 2030, equivalent to ₹2 lakh per household.

Preventive Measures

To address the health challenges, India must implement comprehensive preventive strategies:

• Regular Health Check-Ups: Early detection through periodic screenings for diabetes, hypertension, cancer, and other conditions is crucial.
  • Tailored screening protocols for high-risk groups, such as women (mammograms, pap smears) and elderly individuals, can enhance outcomes.
• Filling the Hunger Gap: Strengthening nutrition programs, such as the Mid-Day Meal Scheme and Integrated Child Development Services (ICDS), can combat malnutrition.
  • Including nutrient-dense foods like fortified cereals and edible oils in public distribution systems (PDS) can further improve dietary intake.
• Medical Interventions: Scaling up vaccination programs for diseases like hepatitis, cervical cancer, and influenza.
  • Promoting routine deworming, particularly for children in high-risk areas.
• Healthcare Facilities for All: Expanding the Ayushman Bharat initiative to ensure universal healthcare access. Establishing telemedicine platforms to improve accessibility in remote regions.
• Public Awareness Campaigns: Disseminating information on healthy lifestyles, hygiene, and the importance of preventive care.
  • Engaging community health workers to promote awareness at the grassroots level.

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Government Initiatives to Improve Healthcare in India

• Universal Health Coverage through National Health Mission (NHM): The Central Government supports states in providing accessible and affordable healthcare, focusing on underserved and marginalized groups in rural areas.
  • Efforts include strengthening health infrastructure, ensuring adequate human resources, and improving healthcare accessibility and quality.
• Mission-Mode Healthcare Projects: 
  • Pradhan Mantri Ayushman Bharat Health Infrastructure Mission (PM-ABHIM):
    • Develops capacities in primary, secondary, and tertiary healthcare systems.
    • Strengthens existing national institutions and establishes new ones to address emerging diseases.
    • It is a Centrally Sponsored Scheme with an outlay of ₹64,180 crore.
  • Ayushman Aarogya Mandirs (AAMs): Deliver comprehensive primary healthcare, including preventive, promotive, curative, palliative, and rehabilitative services for all health issues, free and closer to communities.
    • 1,75,418 AAMs operationalized by converting Sub-Health Centres (SHCs) and Primary Health Centres (PHCs).
  • Ayushman Bharat-Pradhan Mantri Jan Arogya Yojana (PM-JAY): Provides health cover of ₹5 lakh per family annually for secondary and tertiary care to 55 crore beneficiaries (12.37 crore families).
    • Recently extended to cover all senior citizens aged 70 and above, irrespective of income.
•  Reducing Out-of-Pocket Expenditure
  • National Free Drugs Service Initiative: Ensures availability of essential drugs at public health facilities.
  • Free Diagnostic Services: Provides essential diagnostic services to patients at public facilities.
  • Pradhan Mantri Bhartiya Janaushadhi Pariyojana (PMBJP): Offers quality generic medicines at affordable prices in collaboration with state governments.
  • AMRIT Pharmacies: Set up in select hospitals to provide affordable medicines and implants.

Challenges in Preventive Healthcare in India

• Gaps in Primary Healthcare Infrastructure: Despite government initiatives like Ayushman Bharat, primary healthcare centers (PHCs) face issues such as understaffing, lack of medical equipment, and inadequate facilities, particularly in rural areas.
  • As per the Rural Health Statistics 2022-23, 8% of PHCs are without doctors, and 39% lack lab technicians, impeding service delivery.
• Lack of Awareness About Preventive Health Measures: A significant portion of the population remains unaware of the importance of preventive healthcare, such as regular screenings, vaccinations, and hygiene practices.
  • According to a 2023 survey by the National Family Health Survey (NFHS-5), only 45% of women were aware of cervical cancer screenings, indicating a need for widespread education campaigns.
• Hesitancy Towards Diagnosis and Immunization: Cultural stigmas and fear of diagnosis deter individuals from undergoing screenings for conditions like diabetes, cancer, and cardiovascular diseases.
  • Despite immunization drives, vaccine hesitancy persists, with NFHS-5 reporting 6% of children under five still not fully immunized in 2022.
• Negligence or Lack of Proper Implementation at the Primary Level: Policies like the Mid-Day Meal Scheme and Integrated Child Development Services (ICDS) often suffer from irregular implementation, impacting their effectiveness in addressing malnutrition and promoting health education.
  • Reports from the NITI Aayog (2022) highlighted irregularities in fund utilization and gaps in food quality across several states.
• Lack of Monitoring and Evaluation: Insufficient monitoring of healthcare programs leads to inefficiencies and limited accountability at the ground level.
  • A 2021 report by the Comptroller and Auditor General (CAG) pointed out lapses in monitoring and data collection under the National Health Mission, affecting service delivery outcomes.
• High Out-of-Pocket Expenditure (OOPE): High OOPE discourages regular health check-ups and preventive interventions, particularly among economically weaker sections.
• Inadequate Focus on Mental Health in Preventive Care: Mental health issues remain largely ignored in preventive strategies, despite the increasing prevalence of anxiety, depression, and stress-related disorders.
  • The National Mental Health Survey (2015-16) found that 10.6% of adults suffer from mental health disorders, with minimal access to early intervention.
• Resistance to Change in Lifestyle Habits: Many individuals remain reluctant to adopt healthier lifestyles, such as increased physical activity and reduced consumption of unhealthy foods.
  • The Global Nutrition Report (2022) stated that 25% of India’s adult population is obese or overweight, a growing concern linked to lifestyle choices.
• Dietary Gaps in Marginalized Communities: Tribal and marginalized groups often rely on calorie-dense but nutrient-poor diets, leading to both undernutrition and hidden hunger.
  • The Food and Agriculture Organization (FAO) 2022 reported that 74% of India’s rural population cannot afford a healthy diet, exacerbating malnutrition issues.
• Urban-Rural Divide in Healthcare Access: Urban areas have better access to healthcare facilities, leaving rural populations underserved.
  • According to NITI Aayog (2021), 60% of rural households need to travel over 5 km to access basic healthcare services, resulting in delayed diagnosis and treatment.

Way Forward for Preventive Healthcare in India

• Strengthen Early Intervention through Technology: Expand capabilities at Ayushman Health and Wellness Centres by integrating AI-enabled imaging for cost-effective, large-scale screenings and leveraging data to implement targeted, risk-driven interventions.
• Subsidize Screenings via Public-Private Partnerships: Encourage private health providers and insurers to offer subsidized screening packages for individuals aged 40-60. Utilize funds from healthcare cess or the proposed higher GST slab on tobacco and sugar products to offset costs and support preventive initiatives.
• Increase Tax Incentives for Preventive Health Checks: Revise the tax deduction limit under Section 80D of the Income Tax Act from ₹5,000 to ₹15,000 to account for healthcare inflation, encouraging individuals to undergo regular comprehensive health screenings.
• Promote Public Awareness and Accessibility: Launch widespread campaigns to highlight the importance of regular screenings and preventive measures, making preventive healthcare more accessible and affordable for all income groups
• Subsidized Preventive Services: Introduce affordable health screenings and checks similar to Singapore’s CHAS (Community Health Assist Scheme), ensuring preventive care is accessible to economically weaker sections.
• Expand Insurance for Preventive Care: Include preventive services in health insurance coverage, as seen in Germany, where mandatory screenings are a part of universal healthcare.

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Conclusion

Prioritizing preventive healthcare in India is crucial to mitigate the rising burden of diseases and associated economic costs. Preventive care is not just a medical necessity but a societal investment in human capital and national progress.

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