Health, Nutrition & Disease — Public Health, Epidemics & Government Schemes

Overview

Health, Nutrition and Disease is a high-yield topic for both UPSC Prelims and Mains. In Prelims, questions frequently appear on government health schemes, disease transmission mechanisms, and nutritional deficiency indicators. In Mains (GS3 — Science & Technology and GS2 — Social Justice), questions test the candidate's understanding of India's public health challenges, policy responses, and the intersection of science with governance. Essay papers also draw on public health themes such as pandemic preparedness and malnutrition.

India faces a double burden of disease — persisting communicable diseases like tuberculosis and malaria on one hand, and a rapidly growing epidemic of non-communicable diseases (NCDs) like diabetes and cardiovascular conditions on the other. NCDs now cause approximately 60% of deaths in India, yet communicable diseases remain a major burden, especially in rural and low-income populations. This dual challenge strains the health system and is a recurring Mains theme.

Communicable Diseases

Tuberculosis (TB)

India carries the world's highest TB burden. According to the WHO Global Tuberculosis Report 2025, India's TB incidence declined by 21% — from 237 per lakh population in 2015 to 187 per lakh in 2024 — nearly double the global decline rate of 12%. Treatment coverage surged from 53% (2015) to over 92% (2024), with 26.18 lakh patients diagnosed out of an estimated incidence of 27 lakh cases.

India bears the single largest share of global TB burden — approximately 26% of global TB cases.

Malaria

India launched the National Framework for Malaria Elimination (NFME) 2016-2030, targeting zero indigenous cases by 2027 and complete elimination by 2030. In 2024, India exited the WHO's High Burden to High Impact (HBHI) group — a major milestone. The Intensified Malaria Elimination Project-3 (IMEP-3) targets 159 high-burden districts across 12 states.

HIV/AIDS

India's National AIDS Control Programme (NACP) — now in Phase V — operates through the National AIDS Control Organisation (NACO). India has the third-largest HIV-positive population globally but has achieved significant reductions in new infections through targeted interventions, free ART (antiretroviral therapy), and awareness campaigns.

Dengue

A mosquito-borne viral disease (Aedes aegypti), dengue remains endemic in tropical India. Managed under the National Vector Borne Disease Control Programme (NVBDCP). There is no specific antiviral treatment; management is supportive. India approved its first dengue vaccine for restricted use in 2024.

Nipah Virus

A zoonotic virus (fruit bats are natural hosts) with a high case fatality rate (40-75%). Kerala has reported nine Nipah outbreaks since 2018, the first outbreak being in Kozhikode district (May 2018) with 18 confirmed cases and 17 deaths. Between May and July 2025, four confirmed cases (two deaths) were reported from two Kerala districts. There is no approved vaccine or specific treatment.

Zika Virus

Transmitted by Aedes mosquitoes; linked to microcephaly in newborns. India has reported outbreaks in Rajasthan (Jaipur), Kerala (Thiruvananthapuram, 2021), and Maharashtra. The virus is under surveillance by NCDC and ICMR.

Kala-azar (Visceral Leishmaniasis)

Lymphatic Filariasis (Elephantiasis)

Caused by Wuchereria bancrofti (nematode worm); transmitted by Culex mosquitoes. Causes elephantiasis (severe lymphedema of limbs). India runs the National Programme for Elimination of Lymphatic Filariasis (NPELF) with mass drug administration (MDA) — a single annual dose of albendazole + DEC — in endemic districts to break the transmission cycle.

COVID-19 — Lessons Learned

Key takeaways include the need for decentralised health infrastructure, robust surveillance systems, digital health tools, and domestic vaccine production capacity. The zoonotic origin of SARS-CoV-2 underscores the importance of the One Health approach.

Exam Tip: For Prelims, remember the vector/host for each disease — Aedes (Dengue, Zika, Chikungunya), Anopheles (Malaria), fruit bats (Nipah). UPSC often tests vector-disease pairing in match-the-following format.

Non-Communicable Diseases (NCDs)

NCDs account for an estimated 63% of all deaths in India. The four major NCDs are cardiovascular diseases, cancers, chronic respiratory diseases, and diabetes.

NPCDCS Programme

The National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) was launched in 2010. Infrastructure created under NPCDCS includes 682 District NCD Clinics, 191 District Cardiac Care Units, and 5,408 CHC-level NCD Clinics. Population-based screening for diabetes, hypertension, and three cancers (oral, breast, cervical) is conducted at Health and Wellness Centres under NHM for persons above 30 years.

Key distinction: Communicable diseases spread through pathogens (bacteria, viruses, parasites) via vectors, air, water, or contact. NCDs are non-infectious, caused by genetic, behavioural, and environmental factors. UPSC may ask which diseases fall in which category — note that TB is communicable while diabetes is non-communicable.

Malnutrition in India

Types of Malnutrition

NFHS-5 Data (2019-21)

The National Family Health Survey (NFHS-5) showed improvement over NFHS-4 (2015-16):

NFHS-5 covered 636,699 households, 724,115 women, and 101,839 men across all states and UTs.

Key concern: Rising anaemia levels despite improvements in other indicators — especially anaemia in women (57%) and children (67.1%). This is a critical policy failure area and a recurring Mains theme.

Global Hunger Index (GHI) Debate

India has consistently contested its GHI ranking, arguing that the index relies on a flawed methodology — particularly the FAO's Food Insecurity Experience Scale (FIES) opinion poll with a small sample size of 3,000, which is not representative of India's 1.4 billion population. India's official position is that NFHS and government nutrition surveys provide more reliable data.

Key Nutrition Programmes

POSHAN Abhiyaan (National Nutrition Mission) — Launched 8 March 2018 in Jhunjhunu, Rajasthan. Targets reduction in stunting, undernutrition, anaemia, and low birth weight. Uses the Poshan Tracker application for real-time monitoring of Anganwadi services.

Saksham Anganwadi and POSHAN 2.0 — Approved for the 15th Finance Commission period (2021-22 to 2025-26). Merges supplementary nutrition and POSHAN Abhiyaan into an integrated nutrition support programme. Focuses on maternal nutrition, infant and young child feeding (IYCF), and treatment of SAM (Severe Acute Malnutrition) and MAM (Moderate Acute Malnutrition).

PM POSHAN (Pradhan Mantri Poshan Shakti Nirman) — Renamed from Mid-Day Meal Scheme. Covers approximately 11.80 crore children in Classes I-VIII across 11.20 lakh government and government-aided schools. Total outlay of Rs 1,30,794.90 crore for 2021-22 to 2025-26.

ICDS (Integrated Child Development Services) — India's flagship programme for children under 6, pregnant women, and lactating mothers, delivered through a network of Anganwadi Centres across the country.

Government Health Schemes — Key Table

India's Public Health Infrastructure

The Three-Tier Pyramid

As of March 2023 — India has 1,69,615 Sub-Centres, 31,882 PHCs, 6,359 CHCs, 1,340 Sub-District Hospitals, and 714 District Hospitals.

Doctor-Population Ratio

Considering 80% availability of registered allopathic and AYUSH practitioners, India's doctor-to-population ratio stands at approximately 1:811, better than the WHO recommendation of 1:1,000. However, the distribution is skewed — urban areas have far higher density than rural and tribal regions.

National Health Policy 2017

The Policy targets raising public health expenditure to 2.5% of GDP progressively. As of FY 2023-24, health expenditure stands at 1.9% of GDP (up from 1.4% in FY 2017-18) — progress made, but target not yet met.

National Digital Health Mission — ABHA

The Ayushman Bharat Digital Mission (ABDM) provides a unique Ayushman Bharat Health Account (ABHA) to every citizen. As of August 2025, approximately 79.91 crore ABHA accounts have been created, with 67.19 crore health records linked. Key registries include the Health Facility Registry (HFR) with 4.18 lakh facilities and Healthcare Professional Registry (HPR) with 6.79 lakh professionals registered.

One Health Approach

The One Health approach recognises the interconnection between human health, animal health, and the environment. It is especially relevant for zoonotic diseases (diseases transmitted from animals to humans) such as Nipah, Avian Influenza, and COVID-19.

India's One Health Framework

• Centre for One Health (CoH) at the National Centre for Disease Control (NCDC) coordinates inter-sectoral activities
• National One Health Programme for Prevention and Control of Zoonoses (NOHP-PCZ) operationalises One Health at national, state, and district levels
• ICMR-DBT-ICAR One Health Consortium (2021) — India's research collaboration among ICMR, Department of Biotechnology, and ICAR to address zoonotic disease threats at the human-animal-environment interface
• Key ministries involved: MoHFW (human health), Ministry of Agriculture/Animal Husbandry (animal health), MoEFCC (wildlife/ecosystem health), plus ICMR, ICAR, DBT, DST (research)
• India launched an inter-ministerial study to address zoonotic spillover risks, covering bird sanctuaries and wetlands across Sikkim, Maharashtra, and Tamil Nadu

Mnemonic — "HAE" for One Health: Human health + Animal health + Environmental health = One Health. Remember this triad for any question on zoonotic diseases or pandemic preparedness.

Antimicrobial Resistance (AMR)

AMR occurs when bacteria, viruses, fungi, or parasites evolve mechanisms to survive drug treatments. It is one of the greatest threats to global health, food security, and development.

India's National Action Plan on AMR (NAP-AMR) — first launched 2017, updated as NAP-AMR 2.0 in 2024:

• Awareness campaigns on antibiotic stewardship
• ICMR's AMR Surveillance Network (AMRSN) for tracking resistance patterns
• Infection prevention and control in hospitals
• R&D for new diagnostics and therapeutics
• Regulation of antibiotic use in agriculture and veterinary sectors (One Health link)

Root causes in India: Over-the-counter availability of antibiotics; irrational prescriptions; self-medication; antibiotic use in poultry/livestock farming; poor sanitation enabling spread of resistant organisms.

Exam Tip: AMR is a strong GS2/GS3 topic linking governance (regulatory gaps), science (resistance mechanisms), and global health (WHO Global Action Plan on AMR). Connect to One Health — resistance genes cycle across humans, animals, and the environment. ESKAPE pathogens are a Prelims fact to remember.

Mental Health

Mains Tip: The Mental Healthcare Act 2017 decriminalising suicide attempt is a frequently cited example of progressive legislation. Use it in governance/rights answers. Connect Tele-MANAS to digital governance and e-health infrastructure.

Epidemics and Pandemic Preparedness

International Health Regulations (IHR) 2005

The IHR is a legally binding framework for 196 countries (all WHO Member States) to detect, report, and respond to public health emergencies. Amended IHR provisions (adopted at WHA77, 2024) entered into force on 19 September 2025, introducing a new alert level — "pandemic emergency" — for situations escalating beyond a Public Health Emergency of International Concern (PHEIC).

WHO Pandemic Agreement (2025)

Adopted by consensus at the 78th World Health Assembly on 20 May 2025, this is the world's first Pandemic Agreement. It establishes an Intergovernmental Working Group to negotiate a Pathogen Access and Benefit Sharing (PABS) system, ensuring equitable access to vaccines, diagnostics, and therapeutics during future pandemics.

India's Vaccine Manufacturing Strength

India is known as the "pharmacy of the world", accounting for approximately 60% of global vaccine production. During COVID-19, the Vaccine Maitri initiative supplied nearly 300 million doses to 94 countries. Key manufacturers include the Serum Institute of India (Covishield, capacity ~250-275 million doses/month) and Bharat Biotech (Covaxin, capacity ~50-60 million doses/month).

Important for UPSC

Prelims Focus Areas

• Disease-vector/pathogen pairing (Dengue-Aedes, Malaria-Anopheles, TB-Mycobacterium, Kala-azar-sandfly)
• Scheme launch years and key features (PMJAY-2018, JSY-2005, Mission Indradhanush-2014)
• NFHS-5 indicators: TFR = 2.0, stunting 35.5%, anaemia in women 57%, anaemia in children 67.1%
• Vaccine types (live attenuated, inactivated, mRNA, viral vector)
• IHR 2005 and WHO Pandemic Agreement 2025
• ESKAPE pathogens and AMR — 1.27 million deaths/year globally
• Mental Healthcare Act 2017 — decriminalised suicide attempt; Tele-MANAS = Dial 14416
• ICMR-INDIAB 2023: 101 million diabetics; 188 million hypertensives in India
• Ayushman Arogya Mandirs (renamed from HWCs); 1.78 lakh+ active
• Nikshay Poshan Yojana: ₹1,000/month for TB patients; CBNAAT for rapid TB diagnosis

Mains Dimensions

• GS2 (Social Justice): Right to health, universal health coverage, equity in access, Mental Healthcare Act 2017
• GS3 (Science & Technology): Disease mechanisms, vaccine development, One Health, AMR, CBNAAT
• GS2 (Governance): Public health infrastructure gaps, NHP 2017 targets, digital health (CoWIN, ABDM), double burden of disease
• Essay: Pandemic preparedness, malnutrition as a governance failure, health as development, AMR as a silent pandemic

Interview Angles

• India's dual disease burden (communicable + NCD)
• Federalism in health — health is a State subject but central schemes drive implementation
• Ethical dimensions of pandemic response (lockdowns vs livelihoods)

Vocabulary

Pathogen

• Pronunciation: /ˈpæθədʒən/
• Definition: Any microorganism — such as a bacterium, virus, fungus, or parasite — capable of causing disease in a host organism.
• Origin: From Greek pathos (suffering, disease) + -genēs (born of, producing); first used in English in the 1880s.

Pandemic

• Pronunciation: /pænˈdɛmɪk/
• Definition: An outbreak of an infectious disease that spreads across a wide geographical area — typically multiple countries or continents — and affects a significant proportion of the population.
• Origin: From Greek pandēmos (of all the people), from pan- (all) + dēmos (the people); first recorded in English in the 1660s.

Malnutrition

• Pronunciation: /ˌmælnjuːˈtrɪʃən/
• Definition: A condition resulting from an unbalanced or insufficient diet, encompassing both undernutrition (stunting, wasting, micronutrient deficiencies) and overnutrition (overweight, obesity).
• Origin: From mal- (bad, from Latin malus) + nutrition (from Latin nūtrītiōnem, a nourishing); first recorded in English in the 1850s.

Key Terms

One Health Approach

• Pronunciation: /wʌn hɛlθ əˈprəʊtʃ/
• Definition: A collaborative, multisectoral, and transdisciplinary framework that recognises the interconnection between human health, animal health, and the environment to achieve optimal health outcomes for all three domains. It acknowledges that approximately 75% of emerging infectious diseases in humans are zoonotic in origin (transmitted from animals), and that environmental degradation, deforestation, climate change, and intensive animal farming increase the risk of disease spillover from animals to humans.
• Context: The concept builds on 19th-century ideas of Rudolf Virchow (coined "zoonosis") and William Osler linking human and animal medicine. The modern term emerged during the SARS outbreak (2003-2004) and was formalised through the 2004 Manhattan Principles by the Wildlife Conservation Society. Three international organisations -- WHO (human health), FAO (food/agriculture), and WOAH/OIE (animal health) -- jointly promote the One Health approach, later joined by UNEP (environment) in a Quadripartite Alliance. In India, the NAP-AMR (National Action Plan on Antimicrobial Resistance, launched 19 April 2017, updated as NAP-AMR 2.0 in 2024) explicitly adopted the One Health framework, requiring inter-ministerial coordination between MoHFW, Ministry of Animal Husbandry & Dairying, and MoEFCC. NCDC (National Centre for Disease Control) hosts a Centre for One Health. Key zoonoses in India: Nipah virus (Kerala outbreaks 2018, 2023, reservoir: fruit bats), avian influenza (H5N1), Kyasanur Forest Disease, and rabies.
• UPSC Relevance: GS3 (Science & Technology) and GS2 (Health/Governance). Prelims may test the One Health definition, the three-plus-one promoting agencies (WHO, FAO, WOAH/OIE, UNEP), and the fact that ~75% of emerging infectious diseases are zoonotic. Mains frequently asks about One Health in the context of COVID-19 (zoonotic spillover, bat coronaviruses), Nipah virus outbreaks in Kerala, antimicrobial resistance (AMR), avian influenza, and pandemic preparedness. The institutional challenge in India is inter-ministerial coordination between health, agriculture/animal husbandry, and environment ministries -- a governance angle that adds value to answers. India's NAP-AMR (2017, updated 2024) and the WHO Pandemic Agreement (adopted May 2025) are key current affairs connections.

Universal Immunisation Programme

• Pronunciation: /ˌjuːnɪˈvɜːsəl ˌɪmjuːnaɪˈzeɪʃən ˈprəʊɡræm/
• Definition: India's nationwide vaccination programme, launched in 1985, that provides free immunisation against 12 vaccine-preventable diseases (tuberculosis/BCG, polio/OPV+IPV, diphtheria, pertussis, tetanus, hepatitis B, Haemophilus influenzae type b, measles, rubella, Japanese encephalitis in endemic areas, rotavirus, and pneumococcal disease) to all children and pregnant women through a network of public health facilities. It is one of the world's largest immunisation programmes, targeting ~26.7 million newborns and ~30 million pregnant women annually.
• Context: Evolved from India's Expanded Programme on Immunization (EPI, launched 1978, initially covering 6 diseases in urban areas); universalised in 1985 to extend coverage nationwide. Mission Indradhanush (launched December 2014) and its intensified phases (IMI 1.0 through 5.0) specifically targeted low-coverage districts with full immunisation rates below 70%. New vaccines added over time: Hepatitis B (2002), Pentavalent (DPT+HepB+Hib, 2011), IPV (2015), Rotavirus (2016, phased), Measles-Rubella (2017), and Pneumococcal Conjugate Vaccine (PCV, 2017, expanded nationwide 2021). India was declared polio-free by WHO in March 2014 (last case: January 2011). Full immunisation coverage has improved from ~62% (NFHS-4, 2015-16) to ~76.4% (NFHS-5, 2019-21). India's COVID-19 vaccination drive (launched 16 January 2021, 220+ crore doses administered) was built on UIP infrastructure.
• UPSC Relevance: GS2 (Health/Governance) and GS3 (Science & Technology). Prelims tests UIP launch year (1985), diseases covered (12), Mission Indradhanush (December 2014), polio-free certification (March 2014), and vaccine types (live attenuated -- BCG, OPV, measles; inactivated/killed -- IPV, hepatitis B; conjugate -- PCV, Hib; toxoid -- DPT). Mains asks about India's immunisation coverage gaps (urban slums, tribal areas, migrant populations), full immunisation targets vs ground reality, cold chain infrastructure challenges, and how UIP infrastructure enabled the world's largest COVID-19 vaccination drive. Links to Vaccine Maitri (India supplied vaccines to 100+ countries), India as "Pharmacy of the World" (Serum Institute produces 1.5 billion+ vaccine doses annually), and Ayushman Bharat HWCs as immunisation delivery points.

Quick Reference — Key Data Points

Current Affairs Connect

For the latest developments on health schemes, disease outbreaks, WHO updates, and Union Budget health allocations, visit Ujiyari.com — our companion current affairs portal.

Sources

• WHO Global Tuberculosis Report 2025
• PIB — TB Incidence in India (2025)
• NFHS-5 Phase II Report (MoHFW)
• NPCDCS — National Health Mission
• PM-ABHIM (PIB)
• Ayushman Bharat PMJAY (PIB)
• National Health Policy 2017 (MoHFW)
• ABDM — Ayushman Bharat Digital Mission
• Centre for One Health — NCDC
• WHO Pandemic Agreement (May 2025)
• Vaccine Maitri — MEA
• National Framework for Malaria Elimination
• WHO — Nipah Virus Outbreak in Kerala