The Historic Journey of Public Health in India

The journey of Public Health in India reveals how the nation evolved from rudimentary public health practices to striving for universal healthcare.

Ancient Wisdom and the Foundations of Public Health¹

The earliest roots of public health can be traced back to the Vedic period (1200–900 BCE), where scriptures like the Atharvaveda described diseases and their causes, advocating rituals to prevent epidemics. Authors of  Atharvaveda were even aware about disease causing organisms, describing them as too small to be visible by naked eyes. Early urban planning in the Indus Valley Civilization reflected an advanced understanding of sanitation, with sophisticated drainage systems and soak pits at Mohenjo-Daro.

Rooted in the Atharvaveda, Ayurveda is considered its ‘Upveda,’ or a supplementary branch. The Charak Samhita, one of its foundational texts, vividly describes epidemics, termed Janapadodhwansa (the devastation of towns), emphasizing the importance of safeguarding water sources and purifying air to combat the spread of diseases. These timeless principles highlight the need for preventive care, a concept still vital today.

In the Mahabharata, healthcare emerges as a king’s sacred duty. At an instance, Bhishma while teaching lessons of Kingship to Yudhishthira (the eldest of the Pandava), also advises to employ skilled medical practitioners (vaidyas), ensure the availability of medicinal plants, and uphold hygiene and sanitation². Kautilya’s Arthashastra reinforced this ethos, championing public health as a cornerstone of governance.

With compassion at its heart, Buddha’s era saw the establishment of Viharas (monasteries) that served as centers of healing and medical education. The translation of Ayurvedic texts into Pali made this knowledge accessible, fostering a culture of learning and care. Ashoka’s reign marked a milestone in healthcare with the creation of hospitals, demonstrating the transformative power of leadership driven by empathy and service.

In medieval India, the Maratha emperors recognized the value of healthcare for all. Land grants and annual subsidies enabled vaidyas to provide free treatment to the poor. A letter from the reign of Madhavrao Peshwa suggests his efforts to introduce mandatory education for medical practitioners, laying the groundwork for structured learning. However, medical education had yet to be formalized in a systematic manner like any other scientific field. Bajirao Raghunath Peshwa (Bajirao, the second) even embraced the preventive aspect of modern medicine by taking a smallpox vaccine from an English doctor, showcasing openness to innovation.

The Colonial Era: Introducing Modern Systems Amid Challenges

With the advent of British rule, public health transitioned from indigenous methods to a Western framework. Hospitals like the Madras General Hospital (1679) and medical colleges, such as Calcutta Medical College (1835), marked the introduction of modern healthcare in India.

The British focused heavily on controlling diseases that threatened their administration, including cholera, plague, and malaria. Pioneers like Ronald Ross and Waldemar Haffkine led groundbreaking research, advancing knowledge on communicable diseases and developing vaccines. By 1902, India had 2,500 hospitals, yet access remained limited to urban elites and British officials.

Policy initiatives, like the Epidemic Diseases Act (1897), were implemented to control outbreaks but often led to resentment due to harsh enforcement methods. Census-taking began systematically in 1881, providing a foundation for demographic studies and planning.

Despite these advancements, healthcare under colonial rule prioritized military needs and Europeans, leaving the larger Indian population underserved. The Bhore Committee (1946) proposed a comprehensive public health system, but its recommendations were largely unfulfilled before independence.

Post-Independence: Building a Nation’s Health^3,4.

The dawn of independence in 1947 brought immense challenges. Poverty, illiteracy, and fragmented healthcare infrastructure hampered progress. Inspired by the Bhore Committee, India aimed to create a three-tier healthcare system, emphasizing primary, secondary, and tertiary care.

The Planning Commission (1950) prioritized healthcare in Five-Year Plans, focusing on rural outreach through Primary Health Centres (PHCs). Efforts to combat communicable diseases like malaria and smallpox yielded significant successes. By 1977, India eradicated smallpox, a monumental achievement in global health.

The National Health Policy of 1983 aligned with the Alma Ata Declaration, aspiring to achieve ‘Health for All’ by 2000. Programs targeting family planning, leprosy, and tuberculosis underscored India’s commitment to public welfare. Meanwhile, technological advancements improved census data collection, enabling more precise planning.

India’s healthcare infrastructure has evolved significantly. From catering to urban elites pre-independence to focusing on rural outreach post-independence, gaps still remain. Policy approaches have shifted from prioritizing military needs to aiming for universal access, with increased emphasis on preventive care.

Achievements and Ongoing Challenges^3,4.

India’s public health metrics saw a dramatic transformation. Life expectancy rose from 32 years in 1947 to over 60 years by the late 20th century. Infant mortality dropped from 161 per 1,000 live births to 25.8 in recent years. India’s phenomenal progress in healthcare is illuminated by the astounding reduction in maternal mortality, which has plunged from a staggering 2000 per lakh live births to an impressive 102.7 in 2024 stands as a testament to its relentless commitment to strengthening health infrastructure and fostering development. This extraordinary achievement reflects not only the nation’s strides in medical advancement and accessibility but also its unwavering dedication to safeguarding the lives of mothers, symbolizing progress, resilience, and a brighter future for generations to come.

Despite progress, India’s healthcare faces challenges. Many sections of the. Communities are yet underserved and equitable access is still elusive. The shift from curative to preventive care has been slow. Non-communicable diseases pose significant threats. Yet, India’s public health journey showcases resilience and adaptation, striving towards universal healthcare with a legacy of progress and a promise of a healthier future.

References –

1. A concise history of Science in India – D. M. Bose et al.
2. The Critical edition of Mahabharata – Bhandarkar Oriental Research Institute, Pune.
3. IAPSM textbook of Community Medicine, 3rd edition, Jaypee Publications.
4. Park’s textbook of Community Medicine, 27th edition, Banarsidas Bhanot.