Putting Public Back in Public Health

There is a quiet but consequential shift taking place in India's public health policy. It is not occurring in hospitals crowded with patients or in villages where overburdened health workers continue their daily rounds. It is happening in policy documents, institutional restructuring and the language of governance. The vocabulary of "public health" is increasingly being replaced by that of "wellness", "personalised care" and "digital health". While these ideas carry undeniable promise, they also raise a fundamental question: Can a nation still struggling to provide basic healthcare afford to prioritise wellness over treatment?

Healthcare is not merely about preventing illness; it is equally about ensuring that when illness strikes, treatment is accessible, affordable and timely. For millions of Indians, that remains an unrealised promise.

India's public health architecture has historically been built around a simple yet powerful principle: health is a collective responsibility. Primary Health Centres (PHCs), Community Health Centres (CHCs) and sub-centres were designed not merely to treat individuals but to safeguard entire communities through immunisation, maternal healthcare, disease surveillance, sanitation and nutrition programmes. These institutions recognised that disease rarely emerges from individual choices alone. Poverty, unsafe drinking water, malnutrition, pollution and inadequate sanitation shape health outcomes far more profoundly than lifestyle advice.

The recent emphasis on Health and Wellness Centres marks a philosophical departure from this tradition. Wellness, by its very nature, focuses on the individual encouraging healthier behaviour, preventive care and personalised health management. These are worthwhile objectives. Yet, wellness cannot become a substitute for public health.

A patient suffering from tuberculosis does not merely need digital health records; she needs uninterrupted access to medicines. A pregnant woman in a remote tribal district does not primarily require a wellness consultation; she requires a functioning primary health centre staffed with trained doctors and nurses. A child battling acute malnutrition cannot be rescued through an electronic health account alone.

Technology undoubtedly has an important role in modernising healthcare. The Ayushman Bharat Digital Health Mission and Ayushman Bharat Health Account (ABHA) promise continuity of care by creating portable digital medical records. Such innovations can reduce duplication, improve referrals and make healthcare more efficient. But digital infrastructure cannot compensate for the absence of physical infrastructure.

A digital prescription has little value if the nearest doctor is fifty kilometres away.

Equally concerning is the administrative blurring created by the uniform branding of diverse healthcare institutions as Health and Wellness Centres. Primary Health Centres, Community Health Centres and sub-centres were established with clearly differentiated responsibilities, staffing patterns and service capacities. Rebranding them under a single umbrella may simplify public communication, but it risks obscuring institutional accountability. Healthcare systems function effectively not because every institution looks similar, but because every institution performs a distinct role within a coordinated network.

The shift also raises important questions about measurement. Traditional public health programmes could be evaluated through objective indicators infant mortality, maternal mortality, immunisation coverage, tuberculosis detection or disease prevalence. Wellness, however, is inherently subjective. How does one accurately measure mental well-being, lifestyle improvement or holistic health across a population of over 1.4 billion people? Without robust metrics, policy risks becoming driven more by aspiration than evidence.

More importantly, an excessive emphasis on individual behaviour can inadvertently shift responsibility away from the state. If poor health is increasingly framed as a consequence of unhealthy lifestyles, structural determinants such as unsafe housing, contaminated water, inadequate sanitation, poor nutrition and environmental pollution receive less policy attention. Public health has always recognised that health inequalities are produced not simply by personal choices but by unequal living conditions.

This distinction matters profoundly in India.

The country's epidemiological profile presents a complex double burden. Infectious diseases continue to persist alongside a growing epidemic of diabetes, hypertension, cancer and mental health disorders. Maternal mortality has declined but remains uneven across states. Rural healthcare facilities continue to grapple with vacancies, inadequate equipment and chronic underfunding. These challenges cannot be addressed solely through wellness campaigns or digital platforms. They demand sustained investment in doctors, nurses, laboratories, medicines, ambulances and district hospitals.

The three-tier public healthcare system remains the backbone of India's health security. Sub-centres provide the first point of contact for rural populations. Primary Health Centres deliver essential outpatient care, maternal services and disease prevention. Community Health Centres serve as referral facilities capable of handling more complex cases. Strengthening these institutions should remain the central priority of health policy rather than assuming that technological innovation alone can bridge longstanding structural deficits.

The way forward lies not in rejecting wellness but in restoring balance.

Preventive healthcare and healthy lifestyles undoubtedly reduce disease burden. Digital health records can improve efficiency and continuity of care. Traditional knowledge systems and community participation can strengthen public trust.

Yet none of these should come at the expense of affordable curative care. A resilient healthcare system must ensure that prevention and treatment complement rather than compete with one another.

India also requires more meaningful measures of health system performance. Instead of focusing primarily on the number of ABHA accounts created or facilities rebranded, evaluation should emphasise treatment outcomes, reductions in out-of-pocket expenditure, timely access to medicines, improvements in maternal and child health, and reductions in unmet healthcare needs. Public policy succeeds not by counting registrations but by improving lives.

Ultimately, healthcare is measured in human experiences rather than administrative achievements. It is reflected in whether a child survives pneumonia because oxygen was available in time. It is reflected in whether an elderly patient receives affordable treatment for hypertension without selling family assets. It is reflected in whether a woman in labour reaches a functioning health facility before complications become fatal.

A nation does not become healthier because its clinics have new signboards or because millions possess digital health IDs. It becomes healthier when no citizen is denied treatment for lack of infrastructure, affordability or access.

India's public health journey must therefore resist the temptation to confuse modernisation with transformation. Wellness, technology and digital innovation are valuable additions to healthcare but they cannot replace its foundation.

For in the end, the true test of a public health system is not how well it records illness, but how effectively it heals it.