India’s healthcare system is once again under scrutiny — for fake medicines, unnecessary procedures, unethical trials, and the steady normalisation of preventable suffering. At the same time, disease risk is rising due to structural policy failures: ultra-processed food consumption is fuelling non-communicable diseases, environmental pollution is deepening morbidity, and climate change is emerging as a health multiplier. Access to quality healthcare remains deeply unequal, shaped by class, caste, gender, religion, and geography. The crisis is no longer episodic; it is systemic.
When illness mirrors inequality
Health outcomes in India closely track social hierarchies. Who falls sick, how early, and with what consequences is determined less by biology and more by social location. Malnutrition, anaemia, tuberculosis, kidney failure, cancers, and occupational injuries are disproportionately borne by the poor and marginalised.
Even when care is available, it is often financially ruinous. Out-of-pocket expenditure continues to be a leading cause of household impoverishment, reinforcing the idea that good health in India is still a privilege rather than a right.
Healthcare workers under strain
The crisis is equally visible from the provider’s side. Frontline workers such as ASHA workers continue to fight for basic rights, fair wages, and social security. Working conditions in most public hospitals remain stretched, understaffed, and under-resourced, contributing to burnout and moral distress among doctors and nurses.
Privatisation has further altered the nature of care. With private equity shaping large parts of India’s healthcare industry, doctors in corporate hospitals are increasingly subjected to revenue targets, blurring ethical boundaries between care and commerce.
Public money, private care
Schemes such as Ayushman Bharat Pradhan Mantri Jan Arogya Yojana have expanded financial coverage, but they have also accelerated the flow of public funds into private healthcare through public-private partnerships. This has weakened incentives to strengthen the public health system itself.
Instead of acting as a backbone, public healthcare risks becoming a payer of last resort, while private hospitals dominate service delivery without commensurate regulation or accountability.
Medical education and the cost of becoming a doctor
Privatisation has also reshaped medical education. With many private medical colleges charging upwards of ₹40 lakh for undergraduate training, young doctors graduate under intense financial pressure. This reality often shifts professional priorities — away from addressing social determinants of health and towards income recovery.
Medical education itself has become increasingly exam-centric, reduced to MCQ-solving and credential accumulation. Clinical reasoning, community health, and ethical judgment receive less emphasis. As a result, “just an MBBS” is widely perceived as insufficient, pushing doctors into endless cycles of specialisation and fellowships.
Doctors beyond the clinic: a historical perspective
The idea that doctors must engage with society beyond the clinic has deep roots. Rudolf Virchow, often remembered for cell theory, famously argued that “medicine is a social science.” In the 19th century, he linked disease to poverty, housing, hunger, and political exclusion, and entered politics to reform sanitation, education, and public health infrastructure.
Globally, physicians have repeatedly acted as agents of social change. The International Physicians for the Prevention of Nuclear War, awarded the Nobel Peace Prize in 1985, reframed nuclear weapons as a public health catastrophe. In apartheid-era South Africa, doctors challenged racial discrimination and medical complicity in state violence.
India has its own legacy. Dr. Muthulakshmi Reddy used her medical and legislative authority to fight child marriage, the devadasi system, and women’s exclusion from education and public life, demonstrating how medical credibility can advance social reform.
From symptoms to systems: demanding accountability
Across specialties, the same questions recur. Why are cancers detected late? Why are road traffic injuries rising? Why does anaemia persist among pregnant women? Why does tuberculosis remain entrenched despite decades of programmes?
The answers converge on policy failure — ineffective regulation, weak implementation, and political complacency. India’s health system increasingly resembles a leaking bucket: enormous effort goes into mopping up disease through diagnostics and treatment, while the upstream causes — pollution, unsafe roads, predatory industries, underfunded public health — remain unaddressed.
Why doctors cannot afford silence
Doctors occupy a rare position of trust and visibility. They witness, daily, how abstract policies translate into suffering bodies. This proximity gives them moral authority across social classes, in courts, media, and policymaking spaces.
Silence, in such a context, is not neutrality. It is a choice to relinquish influence. In an unequal society where affected communities often lack voice, doctors can amplify lived realities into public accountability. Their responsibility extends beyond curing disease to challenging the structures that produce it.
What to note for Prelims?
- High out-of-pocket health expenditure in India
- Role of AB PMJAY in healthcare financing
- Impact of privatisation on health systems and education
- Social determinants of health
What to note for Mains?
- Critically examine the effects of privatisation on India’s public health system
- Discuss the role of doctors in addressing social determinants of health
- Analyse healthcare inequality through the lens of class, caste, and gender
- Evaluate why disease prevention remains weaker than curative care in India
