Privatisation and policy gaps threaten India’s public health system

The state of healthcare in India has repeatedly been in the news. From fake medicines and unnecessary surgeries to unethical clinical trials, countless people have suffered across the country. At the same time, risk factors for disease are steadily rising due to policy gaps and systemic policy failures. The consumption of ultra-processed foods is driving an epidemic of non-communicable diseases, while unchecked air, water, and soil pollution, along with climate change, are pushing millions more into sickness. Access to good health and quality healthcare remains a privilege that only a few can afford. Class, caste, religion, gender, and other social markers profoundly determine how long one lives in good health and how much suffering one is made to endure.

Existing problems

The situation from the perspective of those providing care is equally worrisome. ASHA workers continue to struggle for their rights, and working conditions for healthcare workers in most public hospitals remain abysmal.

Privatisation further compounds the problem. With private equity increasingly driving India’s private healthcare industry, doctors are now expected to meet monthly targets, much like in any profit-driven sector. Through schemes such as AB PMJAY and rampant public-private partnerships, public money is increasingly shunted to the private sector, further weakening the public health system.

Privatisation has also impacted medical education. With most private medical colleges charging upwards of ₹40 lakhs for undergraduate medical training, doctors are forced to shift their focus from understanding and acting on the social causes of disease to earning enough to recover the massive investment of money and time required to become doctors. Additionally, the medical education system has reduced medical training to MCQ-solving, producing doctors who are more focused on memorising facts and cracking exams than acquiring real clinical skills that can save lives. Today, “just an MBBS” is seen as having little value, and doctors are expected to pursue fellowships even after post-graduation to secure respectable practice or employment.

As health and healthcare increasingly become expensive commodities, and the public health system continues to erode, the future of India’s health looks deeply worrisome. While increased public health funding, greater investment in primary care, and regulation of privatisation are frequently discussed as solutions, these remain largely abstract ideas. Their implementation depends on those in power, who repeatedly display apathy at every opportunity. What, then, can save India’s crumbling public health system?

Doctors as agents of change

Doctors occupy a unique position of power and trust in society, giving them an exceptional capacity to drive social change. They are among the few professionals who witness, firsthand and daily, how policy decisions translate into human suffering: how poverty becomes malnutrition, how unsafe roads become trauma, how weak regulation becomes cancer, kidney failure, or tuberculosis. This proximity to suffering grants doctors moral authority that few other groups possess. Their voices carry credibility across social classes, in courts, in the media, and in policymaking spaces, precisely because they speak from lived clinical experience rather than abstract ideology. 

The idea that the physician’s responsibility extends beyond the clinic is not new. To undergraduate students in India, Rudolf Virchow, a German pathologist, is known primarily for his contribution to cell theory and the foundations of modern pathology. However, Virchow’s role as a revolutionary physician is rarely discussed.

In 1848, he helped start Medical Reform, a weekly newspaper that promoted the idea that “medicine is a social science” and that “the physician is the natural attorney of the poor.” He argued that disease was not merely a biological event but a political and social outcome shaped by poverty, poor housing, hunger, lack of education, and exclusion from power.

Virchow did not limit these ideas to academic writing. Convinced that lasting improvements in health required structural change, he entered active politics. In 1861, he co-founded the German Progressive Party and was elected to the Prussian Diet, where he emerged as a leading constitutional opponent of Otto von Bismarck’s authoritarian and militaristic policies. Virchow consistently argued that state resources should be directed away from military expansion and toward sanitation, housing, education, and public health infrastructure. For him, these were not welfare measures but essential medical interventions.

His political engagement continued in the German Reichstag from 1880 to 1893, where he advocated for urban sanitation systems, clean water supply, public education, and scientific freedom. Virchow used legislative spaces to translate epidemiological observations into policy, insisting that physicians had a duty to confront the social conditions that produced illness.

By stepping beyond hospitals and laboratories into newspapers, parliaments, and public debate, Virchow exemplified the physician not as a passive technician, but as an active agent of social change.

Virchow’s legacy is not an isolated historical exception. 

In 1985, the Nobel Peace Prize was awarded to International Physicians for the Prevention of Nuclear War, recognising how physicians mobilised their scientific authority and moral credibility to challenge nuclear proliferation and frame it as an existential public health threat. Their work demonstrated how medical knowledge could be deployed to confront global political violence and reframe security debates around human survival and health.

Similarly, doctors have played visible roles in struggles against oppressive political systems. During the apartheid era in South Africa, physicians organised to expose racial discrimination in healthcare, document abuses, and challenge the medical establishment’s complicity with state violence. Groups of doctors openly opposed apartheid policies, asserting that neutrality in the face of injustice was incompatible with medical ethics.

India, too, has its own history of physicians as social reformers. Dr. Muthulakshmi Reddy stands out as a powerful example, a doctor who used her medical training to challenge deeply entrenched social injustices. As one of India’s first women doctors and legislators, she fought against child marriage, devadasi practices, and the exclusion of women from education and public life. Her work illustrates how medical authority can be leveraged to advance gender justice, social reform, and public welfare far beyond the clinic.

Together, these examples underline a critical point: the physician’s role has never been confined to diagnosis and treatment alone.

Across history and geographies, doctors have stepped into public life to confront injustice, authoritarianism, and structural violence, affirming Virchow’s enduring claim that medicine is inseparable from social change, and that physicians, by virtue of their work, are uniquely positioned to act as its agents.

Political accountability

It is high time doctors in India began questioning why their outpatient departments are increasingly crowded with patients presenting at advanced stages of disease; why the medicines they prescribe are unaffordable for most; and why, when affordable, those treatments are often ineffective.

Oncologists must ask why tobacco and alcohol continue to be aggressively promoted through surrogate advertising, why smokeless tobacco has become more affordable rather than less, why patients in India lack access to newer and potentially life-saving cancer therapies, and why so much suffering remains normalised. Trauma surgeons must confront why road traffic injuries are rising in India. Nephrologists must ask why the number of people requiring dialysis is rising so rapidly, and why access to dialysis remains so limited. Obstetricians must question why anaemia continues to be a major and persistent problem among pregnant women. Pulmonologists must ask why we have failed to eliminate tuberculosis despite decades of sustained effort and resources.

Following these questions inevitably leads to the same conclusions: policy failure, either because effective policies do not exist or because existing policies remain confined to paper and are never meaningfully implemented. These answers also point to persistent complacency, and often complicity, among those in power. They lead us to multiple “industries” that prioritise profit over people’s health, often enabled, protected, or even actively supported by the state.

India’s health system can be compared to a bucket whose job is to contain suffering and keep the floor dry. Today, that bucket is overflowing, yet most of our attention is focused on finding better and more sophisticated mops to manage the spill. These mops, our diagnostic and treatment modalities, are themselves often flawed, while the flooding continues to worsen because of the holes in the bucket: public-private partnerships, unchecked privatisation, and chronic underfunding of public healthcare. Meanwhile, few are willing to look upstream at the tap and ask the more uncomfortable questions: Who benefits from the tap being left open? How can it be closed? Who is responsible for closing it, and why are they not doing so? Doctors must help shift the focus to the tap, even as they continue to question the tools used to keep the floor dry.

Doctors not only have the power to drive social change; they also carry a moral responsibility to stand up for the rights of those who suffer, the very people who entrusted them with their bodies and made it possible for them to become doctors in the first place. Silence, therefore, is not neutrality but a conscious choice to forgo influence. In a deeply unequal society like India, where many affected communities lack voice or power, doctors can amplify lived realities into public action. Their social standing, combined with ethical obligation, places them uniquely, not just as healers of disease, but as challengers of the structures that produce it.

Parth Sharma is a community physician and a public health researcher. Views expressed are personal