Context

• Public health policy plays a vital role in improving population health, reducing inequalities, and enabling a country to harness its demographic dividend.
• In recent years, India has sought to advance Universal Health Coverage (UHC) through initiatives such as the Ayushman Bharat Health and Wellness Centres (HWCs) and the Ayushman Bharat Digital Health Mission (ABDHM).
• While these reforms aim to strengthen healthcare delivery, concerns remain regarding their ability to address the fundamental challenges of healthcare access, affordability, and quality.
• The growing emphasis on wellness and digital health infrastructure has often overshadowed the need to strengthen the country’s healthcare delivery system.

Background: Evolution of the Wellness Approach

• The concept of wellness emerged as an expansion of traditional definitions of health.
• Initially associated with the absence of disease, it later evolved to include mental, social, spiritual, and environmental dimensions of well-being.
• This holistic perspective influenced modern healthcare thinking and encouraged attention to lifestyle and behavioural factors.
• However, public health traditionally focuses on health promotion, which recognises the role of social determinants of health such as income, education, housing, nutrition, sanitation, and environmental conditions.
• Unlike wellness, health promotion is more measurable and better suited to evaluating outcomes at the population level.

Key Concerns in Contemporary Public Health Policy

• Shift from Population Health to Individual Well-being
  • The transformation of existing healthcare institutions into HWCs reflects a broader policy shift from measurable population health outcomes to individual well-being.
  • Earlier assessments of health focused on access to preventive, promotive, curative, and rehabilitative services, including maternal and child healthcare, nutrition, safe drinking water, and chronic disease management.
  • The increasing focus on wellness may divert attention from these essential healthcare needs.
  • Since well-being is subjective and varies across individuals, it becomes difficult to measure and evaluate systematically.
• Individualisation of Health Responsibility
  • A significant consequence of the wellness narrative is the individualisation of health.
  • Health is increasingly portrayed as a result of personal choices and lifestyle decisions, leading to the rise of health coaches, wellness campaigns, and social media-driven health advice.
  • Such an approach risks overlooking structural barriers that influence health outcomes.
  • Factors such as poverty, inadequate healthcare infrastructure, poor living conditions, and unequal access to services cannot be addressed solely through individual behavioural changes.

Challenges in Measuring Wellness

• An important principle of governance is that effective policy requires measurable outcomes.
• While indicators exist for disease burden, healthcare utilisation, nutrition, and mortality, there are no universally accepted measures of wellness at the population level.
• Excessive reliance on an inherently subjective concept may weaken the ability of policymakers to identify unmet healthcare needs and evaluate the effectiveness of health interventions.

Critical Analysis of the Digital Health Mission

• The ABDHM seeks to establish a comprehensive digital health ecosystem through ABHA cards, electronic health records, and registries of healthcare facilities and professionals.
• These initiatives can improve data management, coordination, and health system planning.
• However, digitalisation alone cannot resolve the problem of inadequate healthcare access.
• The existence of health records does not guarantee the availability of hospitals, doctors, medicines, or emergency services.
• Information systems are valuable tools, but they cannot substitute for a robust healthcare delivery mechanism.
• The effectiveness of digital health initiatives ultimately depends on the strength of healthcare institutions and service provisioning.

Structural Causes of Inadequate Healthcare Access

• India’s healthcare challenges are rooted primarily in the unaffordability of private healthcare and the inadequate quality of many public health facilities.
• Large sections of the population continue to face difficulties in obtaining timely and affordable treatment.
• Strengthening Sub-Centres (SCs), Primary Health Centres (PHCs), and Community Health Centres (CHCs) remains essential for improving healthcare access.
• These institutions constitute the backbone of the country's three-tier healthcare system and are critical for delivering preventive, promotive, curative, and rehabilitative care.

The Way Forward

• A more balanced public health strategy should:
• Prioritise accessible, affordable, and quality healthcare.
• Strengthen public healthcare infrastructure and human resources.
• Improve the functioning of SCs, PHCs, and CHCs.
• Integrate digital health initiatives with service delivery reforms.
• Address social determinants of health through inter-sectoral policies.
• Focus on measurable health outcomes alongside broader well-being objectives.
• Enhance accountability through evidence-based policy evaluation.

Conclusion

• The pursuit of Universal Health Coverage requires more than wellness-oriented narratives and digital databases.
• Sustainable improvements in health outcomes depend on strong public institutions, effective service delivery, and equitable access to care.
• While wellness and digitalisation can complement healthcare reforms, they cannot replace investments in healthcare infrastructure and population health measures.
• A public health system that prioritises accessibility, affordability, and quality remains the most effective pathway toward achieving better health outcomes for all citizens.