Reconnect public health with people’s needs

The transition from population health promotion to individualised wellness reflects a fundamental shift in public policy governance. Health promotion, a cornerstone of traditional public health, acknowledges that structural and social determinants (like poverty, sanitation, and environment) shape health outcomes, thus requiring state intervention. The new paradigm of "wellness" individualises health, placing the onus on citizens to make healthy choices while potentially obscuring the state's failure to provide adequate structural support. The renaming of grassroots institutions (SCs, PHCs, CHCs) to Ayushman Bharat Health and Wellness Centres creates ambiguity regarding their mandate. By focusing on subjective "well-being" rather than objective, measurable unmet health needs (preventive, promotive, curative, rehabilitative), the policy undermines outcome-based evaluation, a core principle of effective governance. This shift challenges the efficacy of public health governance in addressing concrete deficiencies in healthcare access.

The core social issue highlighted is the deteriorating access to healthcare, exacerbated by unaffordability in the private sector and poor quality in the public sector. The pursuit of Universal Health Coverage (UHC) aims to ensure access without financial hardship, a goal undermined by the current policy direction. The focus on individualised wellness underestimates the social determinants of health—the conditions in which people are born, grow, live, work, and age. For a vast majority of the population, access to basic services (drinking water, nutrition, emergency care) and curative care are immediate, felt needs. Only when these basic requirements are met can individuals engage with preventive interventions. When policies fail to address these fundamental, structurally driven disparities, they risk widening the health equity gap, as wellness becomes a privilege for those with the capacity and resources to pursue it.

The editorial raises questions about the allocation and efficacy of public health expenditure. The Ayushman Bharat Digital Health Mission (ABDHM), with an annual budget of approximately ₹300 crore, aims to create digital health records (via the ABHA card), facility registries, and healthcare professional databases. The author argues that mere data generation is an inefficient use of resources if it does not translate into improved provisioning of care. The creation of digital infrastructure without commensurate strengthening of physical health infrastructure (the three-tier system) represents a misallocation of resources. The economic burden of unaffordable private healthcare remains unaddressed by a digital registry. Effective public finance management demands that investments yield measurable outcomes in improved healthcare access and affordability, which current policies are failing to demonstrate.