The Critical Balance: Preventive, Curative, and Public Health Strategies in India

India treats more than 500 million outpatient cases every year, yet a large share of that burden could be reduced – or avoided entirely – with better preventive measures and stronger public health infrastructure. This isn’t just a health argument; it is an economic and governance one. When people fall sick from preventable conditions, they lose income, children miss school, and public health budgets get consumed by treatment rather than strengthening communities. Understanding the three pillars of health – preventive care, curative care, and public health – and how they interact is essential to understanding why India’s health outcomes still lag behind what its resources should deliver.

The three pillars: what each one does 🔗

These three categories of healthcare are often confused or treated as interchangeable. They are not.

Preventive healthcare 🔗

Preventive care aims to stop illness before it occurs. It includes vaccinations, regular health screenings, lifestyle counselling, and early detection programmes. According to IBEF, the basic goal of preventive healthcare – also called prophylaxis – is to protect, promote, and preserve health while preventing sickness, disability, and mortality at both the individual and community level. Examples include screening adults over 30 for diabetes and hypertension, cervical cancer screening for women, and tobacco cessation counselling.

Curative healthcare 🔗

Curative care focuses on treating an existing illness – resolving the disease and returning the patient to health. This is the domain of hospitals, emergency medicine, surgeries, chemotherapy, and prescription drugs. Curative healthcare accounted for roughly 64% of total healthcare spending in India in 2021-22, growing at around 15% annually. While essential for managing acute conditions, this dominant spending pattern reflects the structural imbalance in India’s health system.

Public health 🔗

Public health operates at the population level rather than the individual level. It addresses the conditions in which people live – safe drinking water, sanitation, nutrition, hygiene, housing, and health education. Research published in PMC highlights that unsafe water and poor sanitation remain such persistent realities for millions of Indians that their connection to disease is often overlooked until an epidemic strikes – at which point government responses tend to be swift and curative, only for the underlying public health failures to go unaddressed once the crisis passes.

Why curative-heavy systems fall short 🔗

India’s health system has historically leaned heavily toward curative infrastructure – tertiary hospitals, specialist training, and treatment-focused insurance schemes. This approach is necessary but insufficient. Studies on healthcare equity in India show that preventive services like immunisation and antenatal care actually reach populations more equitably than curative services do, yet they remain systematically underfunded relative to hospital-based treatment.

The consequence is a double burden. India still battles communicable diseases linked to poor sanitation and malnutrition, while simultaneously facing a rapid rise in non-communicable diseases (NCDs) like heart disease, diabetes, and cancer. According to research in PMC, NCDs contributed to 62% of all deaths in India as per the Global Burden of Disease 2016 estimates, and account for 55% of all disability-adjusted life years lost in the country. Treating these conditions after they develop is far more expensive – and far less effective – than preventing or detecting them early.

India’s shift toward preventive and integrated care 🔗

Recognising this structural problem, India has progressively moved toward integrating preventive, curative, and public health approaches rather than running them in parallel silos.

The NP-NCD programme 🔗

The National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) – now expanded into the National Programme for Prevention and Control of Non-Communicable Diseases (NP-NCD) – was first launched in 2010. It covers cancer, diabetes, cardiovascular diseases, stroke, and has since been expanded to include chronic obstructive pulmonary disease, chronic kidney disease, and non-alcoholic fatty liver disease. The programme operates across sub-centres, Primary Health Centres (PHCs), Community Health Centres (CHCs), and district hospitals, with each level providing a different package of services – from health promotion and screening to specialist management and palliative care.

A key component of NP-NCD is population-based screening. As of January 2023, over 26 crore individuals aged 30 and above had been enrolled through the NCD application, with over 14 crore screened and their records maintained digitally. ASHA workers and ANMs conduct screenings at the community level using mobile-based applications, while PHCs and district hospitals provide follow-up care. This model directly integrates preventive screening with curative follow-up – the two do not operate independently.

Under NP-NCD, 724 District NCD Clinics, 210 Cardiac Care Centres, 326 District Day Care Centres, and 6,110 Community Health Centre NCD Clinics have been established across India, providing a nationwide infrastructure for both prevention and management of chronic conditions.

Ayushman Bharat: bridging prevention and treatment 🔗

The Ayushman Bharat scheme, launched in 2018, has two interlocking components that reflect the preventive-curative integration. The Health and Wellness Centres – now renamed Ayushman Arogya Mandirs (AAMs) – provide comprehensive primary healthcare including NCD screening, maternal and child health, mental health, oral health, and AYUSH services. Over 1,63,000 Ayushman Arogya Mandirs had been operationalised by December 2023, forming the backbone of India’s preventive care delivery at the grassroots. The second component, PM-JAY, covers hospitalisation costs for over 12 crore poor and vulnerable families – addressing the curative side. Together, the two arms create a system where communities are screened and counselled at the local centre and referred for treatment when needed.

Public health: the upstream intervention 🔗

Both preventive and curative care operate on individuals who already exist within a physical and social environment. Public health intervenes at that environment itself – making it less likely that disease will take hold in the first place.

Sanitation and the Swachh Bharat Mission 🔗

In 2014, roughly 60% of rural households had no access to a toilet, and India’s open defecation rate of around 40% was among the highest in the world. The Swachh Bharat Mission (SBM), launched in October 2014, became the largest sanitation programme ever undertaken globally. The health results were significant. Districts where more than 30% of toilets were constructed under SBM recorded 5.3 fewer infant deaths and 6.7 fewer under-five deaths per 1,000. WHO estimates that over 3 lakh fewer diarrhoeal deaths were reported in 2019 compared to 2014 as a direct result of improved sanitation under the Mission. This is public health in action – not treating diarrhoea, but eliminating the conditions that cause it.

Nutrition as a public health priority 🔗

Malnutrition – both undernutrition and diet-related disease – sits at the intersection of public health and NCD prevention. Undernutrition weakens immune responses and increases susceptibility to infection, while poor dietary habits drive the rise of obesity, diabetes, and cardiovascular disease. India has responded through schemes like POSHAN Abhiyaan (the National Nutrition Mission) and FSSAI’s Eat Right India movement, which promotes safe, healthy, and sustainable food. The Eat Right toolkit is provided in all PHCs to promote healthy diets as part of the preventive services package at Ayushman Arogya Mandirs.

Health education and community engagement 🔗

Knowledge is a public health tool. When communities understand the risk factors for diabetes, the importance of handwashing, or the dangers of tobacco, behaviour changes at scale. The NP-NCD programme incorporates IEC/BCC (Information, Education, and Communication / Behaviour Change Communication) as a core component, using print media, electronic media, social media, and designated national and international health days to reach populations. The National Tobacco Control Programme (NTCP) and legislation under COTPA 2003 – which prohibits smoking in public places and bans tobacco sales near educational institutions – are legislative examples of public health action targeting behaviour at the population level.

Integration as governance: why silos fail 🔗

India’s federal structure means that health is a state subject, while the Union government sets national policy and provides financial support through the National Health Mission. This creates coordination challenges. India’s National Multisectoral Action Plan for NCD prevention (2017-2022) recognised this by bringing together ministries of Health, Finance, Education, Agriculture, Women and Child Development, Panchayati Raj, and others under a “Health in All Government Policies” approach. The logic is sound: you cannot improve nutrition without engaging agriculture policy; you cannot reduce tobacco use without regulating commerce; and you cannot improve sanitation without strong local self-government.

The WHO recognises India’s primary health care system as the cornerstone of its health strategy – one that must address social determinants of health and ensure equitable access, not just provide clinical services. Primary Health Centres were envisaged from their inception to provide integrated curative and preventive care to rural populations, with emphasis on promotive and preventive aspects – yet in practice, curative demand tends to overwhelm this balance, requiring active policy effort to maintain it.

The community-level infrastructure – ASHA workers who bridge households and health facilities, Village Health Sanitation and Nutrition Committees (VHSNCs) that handle local public health concerns, and Self-Help Groups that often incorporate health promotion alongside economic work – represents the governance architecture that ties all three pillars together at the ground level. Without these institutions, programmes designed at the national level do not reach the last mile.

The unfinished agenda 🔗

Despite significant progress, gaps remain. India’s public health expenditure remains disproportionately concentrated in urban areas, with rural areas receiving a much smaller share. Digital health tools under NP-NCD face challenges of poor internet connectivity in remote areas, inadequate device availability, and workforce capacity constraints. Out-of-pocket expenditure on health in India has historically been among the highest globally, pushing millions into poverty annually – a problem that Ayushman Bharat addresses on the curative side but which requires stronger preventive coverage to fully solve.

The National Health Policy 2017 set a target of reducing premature mortality from cardiovascular diseases, cancer, diabetes, and chronic respiratory diseases by 25% by 2025. Reaching that target requires not just more hospitals or better drugs, but a genuine shift in how resources, training, and public attention are distributed across prevention, treatment, and the social determinants that drive disease in the first place.

What do you think? India has invested significantly in expanding curative infrastructure through schemes like PM-JAY, yet preventive and public health spending remains comparatively low – does treating disease after it occurs represent an efficient use of public health funds, or should local self-governance bodies like Gram Panchayats be given greater authority and resources to lead preventive and public health action in their communities?

References

1. https://www.ibef.org/blogs/preventive-healthcare-in-india
2. https://pmc.ncbi.nlm.nih.gov/articles/PMC2465762/
3. https://pmc.ncbi.nlm.nih.gov/articles/PMC3093249/
4. https://pmc.ncbi.nlm.nih.gov/articles/PMC7399556/
5. https://nhm.gov.in/index1.php?lang=1&level=2&sublinkid=1048&lid=604
6. https://ncd.nhp.gov.in/ncdlandingassets/aboutus.html
7. https://www.pib.gov.in/PressReleaseIframePage.aspx?PRID=1945739
8. https://www.ibef.org/government-schemes/ayushman-bharat
9. https://pmc.ncbi.nlm.nih.gov/articles/PMC11142006/
10. https://www.newsecuritybeat.org/2024/12/swachh-bharat-mission-intended-and-unintended-consequences/
11. https://ddnews.gov.in/en/swachh-bharat-mission-a-game-changer-for-public-health/
12. https://www.who.int/india/health-topics/primary-health-care
13. https://pmc.ncbi.nlm.nih.gov/articles/PMC5144115/
14. https://www.mohfw.gov.in/sites/default/files/NP-NCD%20Operational%20Guidelines_0.pdf