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Every NCERT book that matters for UPSC — open a book, then a chapter. Learn each chapter's concepts, then how UPSC tests them — with diagrams, flowcharts and the past questions to attempt.
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← Social and Political Life – II — all chaptersRole of the Government in Health
Start here: why this chapter matters
In simple wordsWhen a child in your class falls ill, three questions decide what happens next: Is there a doctor nearby? Can the family pay? Does anyone take the child seriously? This chapter is about who should make sure the answer to all three is ‘yes’ for every child — and why, in India, it often is not.
This is Chapter 2 of NCERT's Class 7 Social and Political Life – II (2024–25 reprint) and the first of two chapters in Unit Two, ‘State Government’; the next, gess303, is ‘How the State Government Works’. The PDF has 14 pages: the unit opener (book p. 10), a Teacher's Note (p. 11) and the chapter, book pp. 12–23 (PDF page n = book page n + 9). Its parts: a photo collage and What is health?; Healthcare in India (a two-column table — the ‘paradox’); the storyboard ‘The Cost of a Cure’; Public and private health care services (with a box on taxes); Healthcare and equality; What can be done? (Kerala and Costa Rica); four exercises and a seven-term glossary. We use seven concept sections. The book's numbers are recomputed with asserts; nearly all are undated and several are out of date — each is flagged. Health data we add carry a source and year (†). No map is drawn — the book's map of India with Kerala shaded is answered in words. Public versus private care is set out side by side, with no verdict.
- How this chapter relates to UPSC, honestly: health is a GS2 staple — public versus private provision, primary healthcare, community health workers, malnutrition, ‘Health for All’. The book gives the questions a first-time reader needs (Who provides? Who pays? Who is left out?); the senior chapters and government reports give the data.
- Senior chapters: hess307 (Public Facilities — why the government must bear responsibility; water and sanitation); keec104 (Human Capital Formation — health spending); keec103 (Liberalisation, Privatisation and Globalisation); keps104 (Social Justice); keps202 (Rights — Article 21's widening); keps208 (Local Governments — Kerala and the Eleventh Schedule); Class 10 jess201 (Development — Kerala's health indicators and public facilities).
- Before and next: gess301 (On Equality — the midday meal and dignity); gess303 (How the State Government Works — health is a State subject, and an MLA is questioned about a diarrhoea outbreak); Class 8 hess308 (Law and Social Justice — the closing essay recalls Hakim Sheikh's case, 1996, the right to health).
- UPSC from this chapter: eight questions — Prelims 2012 (the ASHA's tasks) and 2023 (is public healthcare mainly curative; States organise health services); Mains GS2 2015 (public health's limits; can the private sector help?), 2016 (Amartya Sen on primary health), 2018 (community-level care for ‘Health for All’), 2021 (primary health as a welfare-state imperative), 2024 (the State against marketisation of healthcare) and 2026 (malnutrition as equity and governance). List and keys at the end.
| Word | What it means here |
|---|---|
| Health | Being free of illness and injury — and also active, in good spirits and without mental strain (book p. 13) |
| Healthcare | Services that prevent and treat illness: health centres, hospitals, laboratories, ambulances, blood banks, trained people, medicines and equipment |
| Public | A service meant for all people, mainly organised by the government, which people can demand and question (glossary) |
| Private | A service organised by an individual or company for their own gain (glossary) |
| OPD | Out Patient Department — where people are first seen and treated without being admitted (glossary) |
| PHC | Primary Health Centre — a centre with doctors that covers many villages and supervises village health workers |
| Communicable disease | A disease spread from person to person through water, food, air and so on (glossary) |
| Medical tourist | A foreigner who comes to India for treatment at world-class hospitals that cost less than at home (glossary) |
| Generic name | The chemical name of a drug, recognised worldwide — acetyl salicylic acid for Aspirin (glossary) |
| Ethics | Moral principles that guide a person's behaviour (glossary) — here, a doctor's |
| Paradox | Something contrary to what we would expect — plenty of doctors and money, yet poor health for many |
| Out-of-pocket expenditure † | What families pay from their own money at the time of treatment, not covered by the State or insurance |
Reading the Unit Two opener and the Teacher's Note (pages 10–11)
- Opener drawing (black-and-white on pink, vertical stripes): two schoolchildren ride bicycles side by side, one with a school bag, smiling at each other. The point we take: ordinary, healthy everyday life — the thing government services exist to protect (the book does not caption it).
- Teacher's Note: the two chapters on State Government use health as a concrete example (other choices were possible); healthcare has public and private sides and is not available to all; the Constitution supports the view that the right to health is part of our Fundamental Rights, yet provision is unequal. Chapter 3 will cover representation, accountability and welfare. Teachers should welcome questions such as ‘Why can't the MLA solve the problem?’ and use wall charts and familiar issues to avoid boredom and cynicism.
At a glance — the six ideas to carry away
- Health ≠ only no illness: water, clean surroundings, food, housing and freedom from mental strain are part of it.
- The paradox: most medical colleges, 30,000+ new doctors a year, hospitals 2,717 (1950) → 23,583 (2017), medical tourists — yet rural shortages, TB, malaria, unsafe water, underfed children.
- The Cost of a Cure: Ranjan (private) pays Rs 500 before seeing a doctor and gets three medicines; Aman (government) queues, waits three days for results, gets one.
- Public health service: village health centre → PHC → District Hospital → city and specialised hospitals; tax-funded, free or low cost, prevents disease; Right to Life covers emergency treatment.
- Private facilities grow while public ones do not: costly, urban; barely 20% can afford all medicines; 40% of those admitted borrow or sell; women and tribal areas lose most.
- What can be done: healthcare and basic amenities — Kerala 1996 (funds to panchayats) and Costa Rica (no army; health, water, nutrition for all). Article 47 in the exercises.
1. What is health? More than not being ill
In simple wordsA plant does not stay healthy only because someone sprays it when it gets a disease. It needs clean water, good soil, sunlight and room to grow. People are the same: medicines help when we fall ill, but food, clean water, a decent home and peace of mind keep us from falling ill in the first place.
The chapter opens: in a democracy people expect the government to work for their welfare — through education, health, employment, housing, roads, electricity and so on — and this chapter takes health. Health means our ability to remain free of illness and injuries, but it is not only about disease. If people get clean drinking water or a pollution-free environment, they are likely to be healthy; if they do not get adequate food or must live in cramped conditions, they will be prone to illness. It is not healthy to be dull, inactive, anxious or scared for long stretches: we need to be without mental strain. All these aspects of life are part of health. The photo collages on pp. 12–13 make the reader notice that situations which do not look ‘medical’ — a woman carrying water pots, a slum lane, children running, a vegetable market — are as much about health as an operating theatre.
Reading the chapter-opener collage (page 12)
- Collage of photographs around the title: a crowded slum lane where women and children walk past pots at a tap; a woman's face in blue shadow; a hospital ward of iron beds with sleeping patients; a vegetable market heaped with greens; a toddler sitting in a dry field; children cooking at a roadside hearth; a plate of rice and curries; a pharmacy shopfront; a car in traffic; a doctor examining a child; an old black-and-white photograph of a busy clinic; and two small children running hand in hand.
- Opening text: what people expect from government in a democracy, and a prompt to read the sub-headings and ask how health is the government's work.
- The point: food, water, traffic fumes, worry and play sit beside wards and pharmacies — health is everywhere in daily life.
Reading the second collage and its two margin questions (page 13)
- Collage: women carrying earthen water pots on their heads in a desert village; a white ambulance-jeep with a red cross among huts; tin-roofed slum houses; a surgical team in an operating theatre; a man treating a child's eye; nurses walking; children running at sunset; pots lined up at a dry water point.
- Margin questions: would you link all or some of these pictures with health, and how? And pick two situations not related to illness and say in two sentences how they relate to health (outlines in the in-text section).
Beyond NCERT — defining health (bare facts)
- The World Health Organization's Constitution (in force 7 April 1948, now World Health Day) defines health as ‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’ — the book's idea in a sentence.
- The Alma-Ata Declaration (1978) made primary health care the route to ‘Health for All’ — the phrase UPSC used in 2018.
- Health is SDG 3 (‘Good health and well-being’), one of the posters in this chapter.
2. Healthcare in India: the paradox
In simple wordsImagine a school with the biggest library in the city, where half the children still cannot read. The books are there, the teachers are there, the money is there — but they are not reaching the children who need them. That is what the book calls a paradox, and it says Indian healthcare is like that.
To prevent and treat illness we need facilities — health centres, hospitals, testing laboratories, ambulances, blood banks — run by health workers, nurses, qualified doctors and other professionals, with the right medicines and equipment. A two-column table compares India's position. Column 1: India has the largest number of medical colleges in the world and is among the largest producers of doctors, with more than 30,000 new doctors qualifying every year; government hospitals grew from 2,717 (1950) to 11,174 (1991) and 23,583 (2017); medical tourists come from many countries to hospitals that compare with the world's best; India is the third largest producer of medicines and a large exporter. Column 2: most doctors settle in urban areas, so rural people travel long distances and have far fewer doctors per head; about five lakh people die of tuberculosis every year, a number the book calls almost unchanged since Independence; almost two million malaria cases are reported every year; clean drinking water is not available to all, and 21 per cent of communicable diseases are water-borne (diarrhoea, worms, hepatitis); half of all children do not get adequate food and are undernourished. The book adds that India also has long experience of running a public healthcare system that can reach people across hundreds of thousands of villages, and that medical science has advanced greatly. Yet with the money, knowledge and experienced people, the country cannot make the necessary healthcare available to all — ‘the paradox’.
Reading the two-column table and the margin questions (page 14)
- Table with two blank header cells and four rows, each pairing a strength with a gap, as summarised above. Margin question: can you give titles to these columns?
- Second margin question: it is often said India cannot provide health services for all because the government lacks money and facilities — after reading the left column, is this true? (outlines in the in-text section).
- The point: the left column says the capacity exists; the right says it does not reach those who need it.
Reading the OPD-queue photograph (page 15)
- Photograph (colour): outside a pink-walled building marked in Hindi as a laboratory (‘prayogshala’), a crowd of men and women — one in a bright yellow veil — press round a table where staff write slips; Hindi notices on the wall about test reports. Caption: patients usually have to wait in long queues in government hospitals, like this one.
- The point: the public system is used by very many people — and the waiting is part of its cost.
Beyond NCERT — the same questions with dated sources (check the latest)
- Child nutrition, NFHS-5 (2019–21), children under five: 35.5% stunted, 32.1% underweight, 19.3% wasted. None of these is ‘half’; the book's line is a rounded, undated claim.
- Who pays, National Health Accounts estimates for 2021-22: government health expenditure about 1.84% of GDP; out-of-pocket spending about 39.4% of total health expenditure. The National Health Policy, 2017 set a target of public health spending of 2.5% of GDP by 2025.
- Doctors: medical education is regulated by the National Medical Commission (NMC Act 2019; constituted 25 September 2020), which replaced the Medical Council of India. MBBS seats today are far above the book's 30,000 — check the NMC's current count.
- TB and malaria: India runs a national TB elimination programme and a vector-borne disease programme; official malaria cases have fallen sharply since the 2010s — use the latest WHO or programme reports, not the book's figures.
NCERT details to read carefully — the table
- Undated or out of date: ‘more than 30,000 new doctors’, ‘about five lakh TB deaths … almost unchanged since Independence’, ‘almost two million malaria cases … not decreasing’, ‘21 per cent’, ‘half of all children’. None has a year or source. In an answer, cite a dated source (NFHS-5, NHA, WHO) instead.
- Hospitals: 2,717 → 11,174 → 23,583 (1950, 1991, 2017) — about 8.7 times in 67 years (our arithmetic); the book gives no source and calls them ‘government hospitals’.
- ‘Third largest producer of medicines’ is usually said of volume, not value †.
- The paradox is that capacity exists but does not reach people — not that India lacks doctors or money altogether.
3. The Cost of a Cure: Aman and Ranjan
In simple wordsTwo friends catch the same cold. One goes to a shiny shop where everything is quick and pleasant but expensive; the other waits in a long line at a free counter. Both get better. The story asks: what did each pay — in money, in time, in comfort — and should getting well depend on which family you were born into?
A two-page storyboard. Ranjan comes from a well-to-do family; Aman's parents struggle to make ends meet. Both had viral fever. Ranjan's father took him to a new private hospital that looked like a five-star hotel; he paid Rs 500 at the reception before they even met the doctor; there was music and everything shone; the doctor asked for many tests, the staff were friendly, results came back, and the doctor said everything was fine — only viral fever — and prescribed a pill, a tablet and a syrup and rest. Aman's father (‘Abba’) at first did not want to take him because it would take so much time. At a big government hospital they waited in a long queue at the OPD counter while Aman, feeling very sick, leaned on his father; the doctor examined him and asked for a blood test — another long, crowded queue; the results came after three days, and a different doctor, in a hurry, said it was viral fever, nothing to worry about, and gave one fever-reducing medicine. Ranjan: ‘My hospital was nice, but they gave me many medicines and the whole thing cost quite a lot!’ Aman, to himself: ‘My treatment did not cost much!’ Four margin questions follow.
⤵ Aman's day at the government hospital (p. 17)
Hesitationhis father first does not want to go — it will take too much time (lost wages)
OPD queuea long wait at the Out Patient Department counter; Aman leans on his father
Doctor and testexamined; sent for a blood test — another long, crowded queue
Three days laterback with the results; a different doctor, in a hurry, asks for the OPD card
Treatmentviral fever, nothing to worry about — one fever-reducing medicine
Costlittle money, but time, crowding and two trips
Reading the storyboard ‘The Cost of a Cure’ (pages 16–17)
- Page 16 (purple-tinted drawings, twelve panels): the boys meet at the school bus; Ranjan's account — a hotel-like building with ‘AMBU…’ on an ambulance outside; the reception desk where his father pays; a cheerful technician joking while she draws blood; a doctor writing a prescription.
- Page 17: Aman's account — a crowded OPD waiting hall with a counter numbered ‘4’; a crush of patients round the testing table; a doctor asking for the OPD card; a woman doctor saying it is only viral fever; the two boys comparing.
- The point: the same diagnosis can cost very different amounts of money, time and dignity — and over-treatment (many tests, many medicines) is a cost too.
NCERT details to read carefully — the storyboard
- The story is an illustration, not data: Rs 500 and ‘three days’ carry no year or place (Kingsway is just named as the hospital's area).
- It does not say private care is bad and public care good: Ranjan was treated kindly and quickly; Aman cheaply. The margin questions ask about problems in both.
- Notice the hidden costs for the poor: time off work (‘Abba didn't want to take me’), repeated trips, crowding.
4. Public health services: a chain run by the government
In simple wordsThink of a school system: a small village school, a bigger school in the block, a college in the district town and a university in the city. Each passes on what it cannot handle to the next. Public healthcare is built the same way — a chain from a village nurse to a city specialist — and, like government schools, it is paid for from everyone's taxes so that anyone can walk in.
From the story we can roughly divide health care into public health services and private health facilities. The public health service is a chain of health centres and hospitals run by the government, linked so that they cover rural and urban areas and treat everything from common illnesses to special problems. At the village level are health centres, usually with a nurse and a village health worker, trained for common illnesses and working under the supervision of doctors at the Primary Health Centre (PHC), which covers many villages. At the district level is the District Hospital, which also supervises all the health centres. Large cities have many government hospitals, like Aman's, and specialised government hospitals. Why ‘public’? Because the government set them up to fulfil its commitment of providing health care to all citizens; because they are run from the taxes we pay; so they are meant for everyone, and must give quality care free or at low cost so that even the poor can be treated. Another key function is to prevent the spread of diseases — TB, malaria, jaundice, cholera, diarrhoea, chikungunya — which must be organised by the government with people's participation: a campaign to stop mosquitoes breeding in coolers and on rooftops works only if it covers every house. The book then states that, according to our Constitution, it is the primary duty of the government to ensure people's welfare and provide health care to all, and that the government must safeguard every person's Right to Life: if a hospital cannot give timely treatment, the protection of life is not being given. It ends: ‘The Court also said’ the government must provide the necessary health services, including emergency treatment, and asked the State Government to repay ‘him’ for his treatment — the remains of a box on Hakim Sheikh that the 2022 edition cut (see trap and Beyond).
⤵ The Hakim Sheikh case (Beyond NCERT — the story behind the book's dangling ‘The Court also said’)
1992 †Hakim Sheikh, a farm worker in West Bengal, is badly hurt after falling from a train
Turned away †several government hospitals in Kolkata refuse him — no bed, or no facility for his treatment
To court †a farm workers' organisation (Paschim Banga Khet Mazdoor Samity) takes the case to the Supreme Court
Principle (1996) †the Right to Life (Article 21) obliges the State to provide timely medical treatment, including in emergencies
Remedy (book)the State Government must pay him what he spent on his treatment
Reading the box ‘Why pay taxes to the government?’ and the margin questions (page 18)
- Shaded box: tax money pays for services that benefit all — defence, police, the judicial system, highways — which citizens cannot organise for themselves; for developmental programmes such as education, health care, employment, social welfare, vocational training; for relief and rehabilitation after floods, earthquakes and tsunamis; and for space, nuclear and missile programmes. Some services, like health care, are provided especially for the poor who cannot buy them in the market — ‘Can you give other examples?’
- Four margin questions on the storyboard: where you go when ill; Aman's problems and how the hospital could work better; why Ranjan spent so much; problems in private hospitals (outlines in the in-text section).
Reading the two photographs and margin questions (page 19)
- Photograph 1 (colour): in a rural health centre, a doctor hands medicine to a woman in a pink sari while another woman watches. Caption: a doctor in a rural health care centre giving medicines to a patient.
- Photograph 2 (colour): a mother sits on an iron hospital bed beside her baby lying on a thin mattress, a drip bottle hanging above. Caption: a woman and her sick child at a government hospital; according to UNICEF, more than a million children die every year in India from preventable infections (no year given).
- Margin questions: in what ways is the public health system meant for everyone? List PHCs or hospitals near you and find out their facilities and staff.
Beyond NCERT — the public system in law and policy (bare facts; check the latest)
- Constitution: ‘Public health and sanitation; hospitals and dispensaries’ is a State List subject (entry 6) — that is why this chapter sits in a unit on State Government; ‘population control and family planning’ (entry 20A) and the medical profession (entry 26) are Concurrent. Article 47 (a Directive Principle) makes raising nutrition and the standard of living and improving public health a primary duty of the State; Article 21, as read by the courts, covers timely medical treatment.
- Cases: Parmanand Katara v Union of India (1989) — every doctor must give emergency aid to an injured person without waiting for legal formalities; Paschim Banga Khet Mazdoor Samity v State of West Bengal (1996) — Hakim Sheikh's case (hess308).
- Structure: the PHC idea goes back to the Bhore Committee (1946). Today's tiers: sub-centre (now Ayushman Arogya Mandir), PHC, Community Health Centre, sub-district and district hospitals, medical colleges.
- Missions: the National Rural Health Mission began on 12 April 2005 and created the ASHA (Accredited Social Health Activist), a village woman who links families to the system; with the urban mission it became the National Health Mission in 2013. Ayushman Bharat: Health and Wellness Centres from 14 April 2018; PM-JAY insurance from 23 September 2018 — up to Rs 5 lakh a family a year for hospital care.
NCERT details to read carefully — public health services
- The dangling Court paragraph (p. 19): ‘The Court also said … give him the money’ — ‘him’ is Hakim Sheikh, whose story was cut in 2022. Safe line: ‘in Paschim Banga Khet Mazdoor Samity (1996) the Supreme Court held that failure to provide timely treatment violates Article 21 and ordered compensation’.
- ‘According to our Constitution, it is the primary duty of the government …’ — the words are close to Article 47, a Directive Principle (not enforceable in court); the enforceable side comes through Article 21.
- The book's chain has three named tiers (village centre, PHC, District Hospital) plus city hospitals; the CHC is missing. Don't say the book teaches CHCs.
- Public health is not only treatment: prevention (anti-mosquito drives, TB, cholera) is ‘another important function’, and it needs every household to take part.
5. Private health facilities
In simple wordsA private tuition centre may teach very well — but you pay for every class, it opens where it can find paying students, and a few may push extra classes you do not need. Private healthcare is similar: it can be excellent, but every service has a price, it gathers where people can pay, and some providers sell more than the patient needs.
There is a wide range of private health facilities: doctors' own clinics; in rural areas, Registered Medical Practitioners (RMPs); in cities, many doctors, many of them specialists; privately owned hospitals and nursing homes; laboratories for tests, X-rays and ultrasound; and medicine shops. As the name suggests, they are not owned or controlled by the government, and patients pay a lot for every service they use. Today there are also large companies that run hospitals and some that manufacture and sell medicines, and medical shops are found in every corner of the country. A box quotes the Medical Council of India's Code of Medical Ethics: every physician should, as far as possible, prescribe drugs by generic names and ensure rational prescription and use of drugs. A poster advertises Jan Aushadhi Medical Stores — a chain started by the Central Government to sell quality generic medicines at much lower prices (‘Daam kam, Dawai Uttam’ — lower price, best medicine).
| Public or private healthcare? — positions side by side (no position endorsed) | Who | Position |
|---|---|---|
| The government's responsibility | NCERT (pp. 18–19, 21) | health care for all is a primary duty of the government, especially for the poor and disadvantaged; public services are tax-funded, free or low-cost and also prevent disease |
| Concerns about private care | NCERT (pp. 19–20) | patients pay for every service; services concentrate in cities; some providers prescribe superfluous medicines, injections or saline to earn more |
| What private care offers | NCERT (pp. 14, 16) | world-class hospitals that attract medical tourists; quick, courteous service (Ranjan's story); a large medicine industry |
| Use both, with the State purchasing care † | National Health Policy, 2017; PM-JAY (2018) | strengthen public facilities and also buy services from private hospitals for poorer families through insurance-style schemes |
| Caution about marketisation † | the framing of UPSC Mains 2024 (GS2) | in a crucial domain like public healthcare, the State should contain the adverse effects of marketisation |
Reading the private-hospital photograph, the ethics box and the Jan Aushadhi poster (page 20)
- Photograph (colour): a long, bright post-operative ward of motorised beds and monitors, a doctor in blue scrubs and cap walking past patients. Caption: a post-operative room in a leading private hospital in Delhi.
- Box: the Medical Council of India's Code of Medical Ethics on generic, rational prescribing (summarised above).
- Poster (green): ‘Jan Aushadhi Medical Stores — Daam kam, Dawai Uttam’, with medicine bottles and the question ‘As a consumer, do you want branded medicines at higher prices or the same generic medicines at lesser prices?’
- Margin questions: what private health facilities mean in your area; how health care can be made more affordable. The point: the same medicine under its generic name can cost much less.
NCERT details to read carefully — private facilities
- The Medical Council of India no longer exists: it was replaced by the National Medical Commission (NMC Act 2019; NMC constituted 25 September 2020) †. Quote the generic-prescribing principle, not the MCI as a current body.
- Jan Aushadhi stores belong to a Central Government scheme (begun 2008, now the Pradhan Mantri Bhartiya Janaushadhi Pariyojana †) — not a private chain.
- RMPs in the book are rural private practitioners; their qualifications vary — the book does not equate them with MBBS doctors.
- Generic name = the chemical name (acetyl salicylic acid), not ‘a cheap copy’; Aspirin is the brand in the glossary's example.
6. Healthcare and equality: is adequate healthcare available to all?
In simple wordsIf the only good shop in town is expensive and far away, the family with a car and money barely notices; the family without either goes without, or borrows to buy. When illness strikes, the same thing happens — and it happens again and again to the same families.
In India, private services are increasing but public services are not, so what is available is mainly private: concentrated in urban areas, costly, with expensive medicines; many people cannot afford them or must borrow when someone falls ill. Some private services encourage incorrect practices to earn more: cheaper alternatives are not used, and some practitioners prescribe superfluous medicines, injections or saline when simple medication would do. Barely 20 per cent of the population can afford all the medicines they need during an illness, so even people one would not think of as poor face hardship; a study reported that 40 per cent of people admitted to hospital have to borrow money or sell possessions to pay. For the poor, every illness brings anxiety and distress, again and again: they are undernourished to begin with, lack drinking water, adequate housing and clean surroundings, so fall ill more often, and the cost of illness makes things worse. It is not only money: women are not taken to a doctor promptly — their health is treated as less important than men's — and many tribal areas have few health centres, which do not run properly, and not even private services.
⤵ Why the poor fall ill more and recover less (book p. 21)
Undernourishedpoor families are not eating as much as they should
No basic amenitiesdrinking water, adequate housing, clean surroundings are missing
Illnessmore likely to fall ill — and it happens again and again
Costmedicines and hospital bills: borrowing or selling possessions
Poorerless money for food and housing — back to the start
Not only moneywomen not taken to a doctor promptly; tribal areas with few working centres
Reading the three pictures on page 21
- Photograph 1 (colour): a white jeep painted in Hindi as a mobile malaria-eradication clinic, parked in a field with villagers beside it. Caption: in rural areas a jeep is often used as a mobile clinic.
- Photograph 2 (colour): a woman in a green sari walks across a bare field beside a man pushing a bicycle. Caption: this pregnant lady has to travel many kilometres to see a qualified doctor.
- Poster: ‘Goal 03 — Good Health and Well-Being’ from the UN's Sustainable Development Goals (credited to www.in.undp.org): a girl holding a baby. The point: distance, gender and a global goal — care has to reach people, not wait for them.
NCERT details to read carefully — healthcare and equality
- ‘Barely 20 per cent’ and ‘40 per cent’ come from an unnamed study with no year. For a dated figure use the National Health Accounts (out-of-pocket share about 39.4% of total health spending in 2021-22 †) — a different measure, so do not mix them.
- The book's claim is that private services are increasing but public ones are not — a statement about supply, not a verdict that private care is worse.
- The two non-money barriers the book names are gender (women's health given less importance) and tribal areas (few, poorly run centres). Caste is not named here.
- ‘Medicines are expensive’ connects to the generic-medicine box: rational prescribing is the book's own suggested remedy.
7. What can be done? Kerala and Costa Rica
In simple wordsA school can hire more nurses for its sick room, or it can also make sure every child has clean water, a proper lunch and a clean toilet — so fewer children reach the sick room at all. The book says both are needed, and gives two places that tried to do both.
There is little doubt that the health of most people in India is not good. It is the government's responsibility to provide quality healthcare to all citizens, especially the poor and the disadvantaged. But health depends as much on basic amenities and social conditions as on healthcare services, so both must be worked on — ‘and this can be done’. The Kerala experience: in 1996 the Kerala government gave 40 per cent of the entire state budget (the book's words) to panchayats, which could plan and provide for their own needs — water, food, women's development and education. Water-supply schemes were checked, schools and anganwadis were made to work, local problems were taken up and health centres improved. Yet shortages of medicines, hospital beds and doctors remained and needed attention. The Costa Rican approach: Costa Rica is considered one of the healthiest countries in Central America, and the book traces this to its Constitution: it decided not to have an army, and spent the money on health, education and other basic needs. Its government holds that a country must be healthy to develop; it provides safe drinking water, sanitation, nutrition and housing to all, and makes health education part of education at every level.
⤵ Kerala, 1996 (book p. 22): from money to better health centres — and what remained
Funds devolved40% of ‘the entire state budget’ to panchayats (book); plan funds, People's Plan Campaign, August 1996 †
Local planningvillages plan for water, food, women's development and education
Checking the workwater schemes checked; schools and anganwadis made to run; local problems taken up
Betterhealth centres improved; the overall situation improved
Still shortmedicines, hospital beds, doctors — to be addressed
Reading the map and its activity (page 22) — no map reproduced
- The book's figure: a political map of India with the States in colours and Kerala in pink; the caption asks the reader to outline Kerala on the map at the back of the book (p. 97).
- Our handling: no map is drawn here. In words: Kerala is a narrow State on India's south-western coast, along the Arabian Sea, bordering Karnataka and Tamil Nadu (see the activity outline below).
- The point the book draws from Kerala is about decentralised planning, not geography.
NCERT details to read carefully — Kerala and Costa Rica
- ‘Forty per cent of the entire state budget’: the share devolved under Kerala's People's Plan Campaign (1996) was about 35–40% of the State's plan outlay (development funds), not of its entire budget †. Safe line: ‘about 40 per cent of plan funds’.
- The book's Kerala story is about panchayats (local government; 73rd Amendment, keps208) — not a health-insurance scheme.
- Costa Rica is in Central America; it abolished its army in 1948 and wrote this into Article 12 of its 1949 Constitution †. The book's ‘several years ago’ is vague.
- The book says both healthcare and basic amenities matter — an answer that lists only hospitals misses its main point.
In-text questions and activities — answer outlines
Every margin question, in page order.
(p. 12) Look at the sub-headings of this chapter. In what ways do you think this topic is related to the work of government?
The sub-headings — what is health, healthcare in India, public and private services, healthcare and equality, what can be done — all ask who provides care, who pays, and who is left out. Government runs hospitals and health centres, collects taxes to pay for them, makes rules for private doctors and medicines, prevents epidemics and provides water, food schemes and sanitation. In a democracy people expect it to work for their welfare, health included.
(p. 13) Would you associate all or some of these pictures with 'health'? In what ways? Discuss in groups.
All of them: carrying water from far (safe water, physical strain), slums (crowding spreads disease), an ambulance and an operating theatre (care), children running (activity, good spirits), a market (food and nutrition), vessels at a dry tap (water shortage). Health includes food, water, housing, clean air and peace of mind, not only hospitals.
(p. 13) Pick two situations from the above collage that are not related to illness and write two sentences on how they are related to health.
E.g. (1) Women carrying water pots a long way: if water is scarce or unsafe, families fall ill from water-borne disease, and the carrying itself strains the body. (2) Children running and playing: exercise and good spirits keep body and mind healthy; children who can play freely are less anxious.
(p. 14) Can you provide a title to these columns?
Left: ‘What India has’ or ‘Strengths of healthcare in India’. Right: ‘What people actually face’ or ‘Gaps in health and healthcare’. Any pair that shows capacity on one side and poor outcomes on the other.
(p. 14) In India, it is often said that we are unable to provide health services for all because the government does not have enough money and facilities. After reading the above left hand column, do you think this true? Discuss.
Not entirely. The left column shows many medical colleges and doctors, a large and growing number of hospitals, world-class hospitals that attract foreigners and a big medicine industry — the resources exist. The problem is how they are distributed: doctors stay in cities, private care is costly, and public facilities are too few or too crowded. So it is more a question of priorities and reach than of absolute shortage — though more public spending would also help.
(p. 18) Where do you go when you are ill? Are there any problems that you face? Write a paragraph based on your experience.
Name the place (government hospital, PHC, private clinic, chemist, RMP); how far it is; how long you wait; cost of fees, tests and medicines; how the doctor treats you; whether medicines are available there. Note problems — distance, queues, costs, missing doctors or medicines — and one thing that would help.
(p. 18) What problems did Aman face in the government hospital? How do you think the hospital can work in a better manner? Discuss.
Problems: long OPD queue while very ill; a second queue and crowding for the blood test; results after three days; two trips; a different, hurried doctor; his father losing a day's work. Better: more doctors and counters; token or online appointments; faster labs with same-day results; seating and a separate line for the very sick; continuity of doctor; medicines available in the hospital.
(p. 18) Why did Ranjan have to spend so much money? Give reasons.
A private hospital charges for everything: a Rs 500 fee before seeing the doctor, many tests, three medicines; it also pays for a posh building, music and comfort, and earns a profit. Some of the tests and medicines may not have been necessary for a viral fever — Aman got well with one medicine.
(p. 18) What problems do we face in private hospitals? Discuss.
High fees and charges for every service; unnecessary tests, medicines, injections or saline; branded rather than generic drugs; concentrated in cities, so far from villages; families borrow or sell possessions to pay; the poor are effectively shut out.
(p. 18 box) Government provides some services especially for the poor who cannot afford to purchase them from the market. One example is health care. Can you give other examples?
Free or subsidised food grains through ration shops (PDS); the midday meal in schools (gess301); free education in government schools; public housing schemes; old-age and widow pensions; free or cheap public transport passes; drinking-water supply in poor areas.
(p. 19) In what ways is the public health system meant for everyone?
It was set up to give care to all citizens; it is paid for from the taxes everyone pays; it is free or low-cost so even the poor can use it; it reaches villages and cities through a linked chain; and its disease-prevention work (anti-mosquito drives, vaccination) protects everyone in an area at once.
(p. 19) List some Primary Health Centres (PHCs) or hospitals near your place. From your experience (or by visiting any one of them), find out the facilities provided and people who run the centre.
Record the name and distance; the staff (medical officer, nurses, ANM, pharmacist, lab technician, ASHA links); facilities (OPD hours, medicines, tests, delivery room, beds, vaccinations, ambulance); what is missing. Compare with what the book says a PHC should do.
(p. 20) Private health facilities can mean many things. Explain with the help of some examples from your area.
A neighbourhood doctor's clinic; an RMP in a village; a specialist's chamber; a nursing home; a large corporate hospital; a diagnostic laboratory for X-rays and blood tests; chemist shops; companies that make medicines. All are owned by individuals or companies and charge for each service.
(p. 20) How can health care be made more affordable? Discuss.
Prescribe and buy generic medicines (Jan Aushadhi stores); avoid unnecessary tests and injections (rational prescribing); strengthen PHCs and government hospitals so free care is available near home; supply free medicines and diagnostics in public facilities; health insurance or State-funded schemes for the poor; and prevention — clean water, sanitation, nutrition — so fewer people fall ill.
(p. 22) Page 97 of this book has a map of India. Using your pencil outline the state of Kerala on this map.
On your own book's map (we do not draw maps here): Kerala is the narrow strip along India's south-western coast, facing the Arabian Sea, with Karnataka to its north and Tamil Nadu to its east; its capital is Thiruvananthapuram.
Exercises (page 23) — answer outlines
Four exercises, the third with a table, and a margin quotation from the Constitution (Article 47 †). Try first, then open.
1. In this chapter you have read that health is a wider concept than illness. Look at this quote from the Constitution and explain the terms 'living standard' and 'public health' in your own words.
The quote — the duty of the State to raise the level of nutrition and the standard of living and to improve public health — is from Article 47, a Directive Principle †. Living standard: how well people live — enough food, safe water, a decent home, clothes, sanitation, income, education, electricity. Better living standards prevent illness. Public health: the health of the whole community, protected by collective action — clean water, sanitation, vaccination, controlling epidemics like malaria and cholera, health education — mostly organised by the government with people's participation.
2. What are the different ways through which the government can take steps to provide healthcare for all? Discuss.
(1) Build and staff the public chain — village centres, PHCs, district and city hospitals — and keep it free or low-cost. (2) Prevent disease: vaccination, anti-malaria and TB drives, health education. (3) Provide basic amenities: safe water, sanitation, nutrition (midday meals, rations), housing. (4) Make medicines affordable: generic drugs, Jan Aushadhi stores, free medicines in government facilities. (5) Regulate private providers for rational treatment and fair charges. (6) Send doctors and mobile clinics to rural and tribal areas; give priority to women's health. (7) Decentralise — give funds and powers to panchayats, as Kerala did. (8) Spend more on health, as Costa Rica chose to.
3. What differences do you find between private and public health services in your area? Use the following table to compare and contrast these (Facility: Private / Public; Affordability; Availability; Quality).
Fill from your area. A typical pattern — Private: affordability low (fees for everything); availability mainly in towns, quick, open long hours; quality varies — modern equipment and courtesy, but sometimes unnecessary tests and medicines. Public: affordability high (free or cheap); availability spread to villages but often crowded, with long waits and missing staff or medicines; quality varies — trained doctors and essential care, but overburdened. Say which you and your neighbours use, and why.
4. 'Improvement in water and sanitation can control many diseases.' Explain with the help of examples.
Many communicable diseases are water-borne (the book: 21 per cent) — diarrhoea, cholera, typhoid, jaundice (hepatitis), worms. Safe piped water and treatment remove the germs; toilets and drainage stop faeces reaching water and food; clean surroundings and no stagnant water stop mosquitoes breeding (malaria, dengue, chikungunya); hand-washing cuts infections. Examples: Costa Rica's safe water and sanitation for all; Kerala's panchayats checking water schemes; the SDG 6 poster (‘Clean water and sanitation’) on this page. Prevention through water and sanitation is cheaper than treating the sick.
Reading the exercise page: the Constitution quotation, the SDG 6 poster and the glossary (page 23)
- Margin quotation: an important part of the Constitution says it is the duty of the State to raise the level of nutrition and the standard of living and to improve public health (this is Article 47 †; the book does not number it).
- Poster: ‘Goal 06 — Clean Water and Sanitation’ (www.in.undp.org): women carrying steel water pots on their heads.
- Exercise 3's table: rows Private and Public; columns Affordability, Availability, Quality.
- Glossary: public, private, medical tourists, communicable diseases, OPD, ethics, generic names — all in the key-terms table above. Note that it lists telephone services as a public service, a dated example.
Keys and slips to handle with care
- Stored keys: Prelims 2012 ASHA (key a — 1, 2 and 3; ASHAs do not conduct deliveries) verified. Prelims 2023 (key d as stored: Statement-I incorrect, Statement-II correct) is disputed — several policy documents describe India's public system as largely curative, which would make Statement-I correct; we keep the question with this note. Mains carry no key.
- Book slips with safe lines: undated table figures; the dangling Hakim Sheikh paragraph; the Medical Council of India (now NMC); Kerala's ‘entire state budget’ (plan funds); the Constitution quote (Article 47, a Directive Principle); UNICEF's undated ‘more than a million’; the CHC tier missing from the chain.
⤵ Answer frame for a GS2 health question
Framehealth is wider than illness (WHO, 1948); Article 47 and Article 21 as read by courts; health a State subject
Evidencedated data with source — NFHS-5 nutrition, National Health Accounts spending and out-of-pocket share — not undated textbook figures
Structurethe public chain (sub-centre, PHC, CHC, district hospital), community workers (ASHA), private providers
Gapsrural–urban, cost, gender, tribal areas, over-prescription
Positionspublic provision, purchasing private care, regulation — attributed side by side
Way forwardhealthcare plus basic amenities; local planning (Kerala); priorities in spending (Costa Rica) — without characterising any present-day party or government
What to remember
Numbers
Chapterbook pp. 12–23 (with Unit Two opener p. 10 and Teacher's Note p. 11; 14 PDF pages); Unit Two, State Government
Government hospitals (book, no source)2,717 (1950) → 11,174 (1991) → 23,583 (2017); about 8.7× since 1950 (asserted)
New doctors (book, undated)more than 30,000 a year; India has the most medical colleges in the world
Disease (book, undated)about 5 lakh TB deaths a year; almost 2 million malaria cases; 21% of communicable diseases water-borne
Children (book)‘half’ undernourished; NFHS-5 (2019–21) †: 35.5% stunted, 32.1% underweight, 19.3% wasted
The Cost of a CureRanjan: Rs 500 at reception, many tests, 3 medicines; Aman: OPD queue, results after 3 days, 1 medicine
Public chain (book)village health centre (nurse, village health worker) → PHC → District Hospital → city and specialised hospitals
IPHS norms †sub-centre 5,000 (3,000 hilly/tribal); PHC 30,000 (20,000); CHC 1,20,000 (80,000)
Affordability (book, unnamed study)barely 20% can afford all medicines; 40% of those admitted borrow or sell
Spending †NHA 2021-22: government health spending about 1.84% of GDP; out-of-pocket about 39.4% of total; NHP 2017 target 2.5% of GDP by 2025
Courts †Parmanand Katara (1989): emergency aid; Paschim Banga Khet Mazdoor Samity (1996): Hakim Sheikh, Article 21
Missions †NRHM 12 April 2005 (ASHA); NHM 2013; Ayushman Bharat — HWCs 14 April 2018, PM-JAY 23 September 2018 (Rs 5 lakh per family a year)
Kerala1996: 40% of ‘the entire state budget’ to panchayats (book) — plan funds; People's Plan Campaign, 17 Aug 1996 †
Costa RicaCentral America; no army (1948 †; Art 12, 1949 Constitution †); water, sanitation, nutrition, housing for all
Medical regulation †Medical Council of India replaced by the National Medical Commission (Act 2019; constituted 25 Sept 2020); Jan Aushadhi from 2008
ConstitutionArticle 47 (DPSP) — nutrition, standard of living, public health; health is State List entry 6 †
One-liners
- Health is more than freedom from illness; water, food, housing and peace of mind are part of it.
- India has the doctors, hospitals and medicines, yet cannot provide healthcare for all — a paradox.
- The same illness can cost a family very different amounts in a private and a public hospital.
- The public health service is a linked chain from village centres to city hospitals.
- Public health services are tax-funded, free or cheap, and also prevent the spread of disease.
- The courts read timely medical treatment into the Right to Life.
- In private facilities patients pay for every service, and some prescribe more than needed.
- Generic medicines can make treatment cheaper.
- Illness hits the poor hardest, and women and tribal areas face extra barriers.
- Health needs both healthcare and basic amenities, as Kerala and Costa Rica show.
Traps to avoid
- The table's TB, malaria, doctor and nutrition figures are undated; quote dated sources instead.
- Child undernutrition in NFHS-5 is about a third, not the book's ‘half’.
- The ‘Court’ paragraph on p. 19 refers to Hakim Sheikh's 1996 case, whose story was cut.
- The Constitution quote in the exercises is Article 47, a Directive Principle, not a Fundamental Right.
- Health is a State List subject; population control and family planning are Concurrent.
- The Medical Council of India was replaced by the National Medical Commission in 2020.
- Jan Aushadhi is a Central Government scheme, not a private chain.
- Kerala's 40 per cent in 1996 was of plan funds devolved to panchayats, not the entire budget.
- Costa Rica abolished its army in 1948 and is in Central America.
- The book's chain has no Community Health Centre tier.
- ASHAs do not conduct deliveries; they accompany and counsel women.
How to strategise
Prelims — what UPSC asks
- From this chapter: the ASHA's tasks (2012 — village health worker in the book's chain; NRHM †) and whether India's public healthcare is mainly curative while States organise services (2023 — the book's ‘prevention’ function and health as a State subject; key disputed, see trap).
- Elsewhere: Concurrent-List entries such as population control and family planning (1993) on keps207; Ayushman Bharat Digital Mission (2022) and maternal-health schemes (2023 Janani Suraksha, 2024 PMSMA) are current-affairs facts not taught here; Article 21's widening on keps202 and hess304.
Mains — where it appears and how to answer
- From this chapter: GS2 2015 (public health's limits for universal coverage; can the private sector bridge the gap?) and GS2 2024 (the State against marketisation) — the positions table and ‘Cost of a Cure’; GS2 2021 (primary health structure as a welfare-state imperative) and GS2 2018 (community-level care for ‘Health for All’) — the public chain, prevention with people's participation, Kerala's panchayats; GS2 2016 (Amartya Sen on primary health) — Kerala and Costa Rica; GS2 2026 (malnutrition as equity and governance) — the poverty–illness loop and the book's ‘half of all children’ updated with NFHS-5.
- Elsewhere: water and sanitation (GS2 2017 WASH) on hess307; health MDGs (GS2 2013) and geriatric and maternal health (GS2 2020) need current data beyond this book.
- Keep answers neutral: data with year and source; public provision and private purchase attributed side by side; no characterisation of any present-day party or government.
Self-check
Tap an option. NCERT's own exercise questions come first; the rest test the figures and common confusions.
1. According to the book, which of these is part of health beyond freedom from illness?
2. The book's ‘paradox’ in Indian healthcare is that:
3. In ‘The Cost of a Cure’, what did Aman receive at the government hospital?
4. In the book's public health chain, who supervises the village health workers?
5. The quotation on p. 23 — the duty of the State to raise the level of nutrition and the standard of living and to improve public health — is:
6. What did Kerala do in 1996, according to the book?
7. Costa Rica could spend more on health, education and basic needs mainly because it:
UPSC questions from this chapter
Open any question to attempt it in the Question bank — your attempt is saved to your progress.