Why India’s Public Health System Is Failing — and Why Doctors Can No Longer Stay Silent

India’s healthcare crisis has become impossible to ignore. Reports of fake medicines, unnecessary surgeries, unethical clinical trials, and catastrophic out-of-pocket expenditure surface with alarming regularity. At the same time, disease risks are rising steadily — driven by policy neglect, environmental degradation, and an economic model that treats health increasingly as a commodity. For millions of Indians, access to good health and quality care remains shaped less by medical need than by class, caste, gender, religion, and geography.

A system under strain, and a population growing sicker

India today faces a dual burden of disease. Non-communicable diseases are surging, fuelled by the unchecked spread of ultra-processed foods, aggressive marketing of tobacco and alcohol, and sedentary urban lifestyles. Simultaneously, air, water, and soil pollution — compounded by climate change — are pushing vulnerable populations into chronic illness.

Yet healthcare access remains deeply unequal. For large sections of the population, even basic diagnostics or essential medicines are unaffordable. Illness often translates directly into debt, distress, and lost livelihoods, reinforcing cycles of poverty and ill health.

The crisis from the provider’s side

The pressures on those delivering care are no less severe. ASHA workers continue to struggle for fair wages, recognition, and basic labour rights. Conditions in many public hospitals remain overcrowded and under-resourced, placing enormous strain on doctors, nurses, and support staff.

Privatisation has further altered the character of care. With private equity playing a growing role in healthcare, doctors in corporate hospitals are often subjected to revenue targets, blurring ethical boundaries between care and commerce. Through schemes such as Ayushman Bharat Pradhan Mantri Jan Arogya Yojana and expanding public–private partnerships, public funds increasingly flow to private providers — often without commensurate strengthening of public infrastructure.

How medical education mirrors systemic decay

The commodification of healthcare has deeply affected medical education. With private medical colleges charging upwards of ₹40 lakh for an MBBS degree, young doctors enter the profession burdened by debt. Clinical curiosity and social responsibility are frequently displaced by the need to recover financial investment.

Training itself has narrowed. Medical education increasingly prioritises MCQ-solving and exam performance over hands-on clinical competence. “Just an MBBS” is widely viewed as insufficient, pushing doctors into a relentless cycle of post-graduate degrees and fellowships merely to secure stable employment. This environment leaves little room for engaging with the social causes of disease.

The physician beyond the clinic: a forgotten tradition

The idea that doctors should engage with society beyond hospital walls is not new. Rudolf Virchow, taught to Indian medical students for his contributions to pathology, argued that “medicine is a social science” and that physicians are the “natural attorneys of the poor.” For Virchow, disease was inseparable from poverty, housing, nutrition, education, and political exclusion.

He did not stop at theory. Virchow entered politics, challenged authoritarianism, and used legislative platforms to push for sanitation, clean water, and public education — treating these as medical interventions, not charity.

Doctors as moral actors in public life

History repeatedly shows physicians stepping into public life to confront structural violence. In 1985, the Nobel Peace Prize was awarded to International Physicians for the Prevention of Nuclear War for reframing nuclear weapons as a public health catastrophe rather than a strategic necessity.

During apartheid in South Africa, doctors exposed racial discrimination in healthcare and challenged professional complicity with state violence. In India, Muthulakshmi Reddy used her medical authority to fight child marriage, the devadasi system, and the exclusion of women from education and public life. These examples underline a shared truth: neutrality in the face of injustice is incompatible with medical ethics.

Following disease upstream to policy failure

India’s clinics today are crowded with patients presenting late in the course of disease. Oncologists see cancers linked to tobacco and environmental exposure. Trauma surgeons confront the human cost of unsafe roads. Nephrologists witness a surge in kidney failure tied to pollution, diabetes, and unaffordable care. Obstetricians still battle anaemia among pregnant women; pulmonologists grapple with tuberculosis that refuses to disappear.

Each clinical question leads upstream to the same answers: weak regulation, policy inertia, and industries prioritising profit over public health — often with state support or indifference.

From mopping floors to fixing the tap

India’s health system increasingly resembles a bucket meant to contain suffering — now overflowing. Policy debates focus on better diagnostics and advanced treatments, even as the underlying causes worsen. Public–private partnerships, unchecked privatisation, and chronic underfunding punch holes in the bucket, while attention remains fixed on finding better mops.

Doctors are uniquely positioned to ask the harder questions: Who benefits from policies that keep people sick? Why are preventive measures sidelined? Who is accountable for failure — and why is that failure tolerated?

The responsibility that comes with trust

Doctors occupy a rare position of trust in Indian society. They witness, daily, how policy decisions translate into pain, disability, and death. That proximity to suffering confers not just authority, but responsibility.

Silence, in this context, is not neutrality. It is a choice to forgo influence in a deeply unequal society where many affected communities lack voice or power. By speaking beyond clinics — in courts, classrooms, media, and policymaking spaces — doctors can help shift the focus from managing illness to confronting the structures that produce it.

India’s public health crisis is not merely a technical failure. It is a moral and political one. And physicians, by virtue of their work and trust, are uniquely placed to challenge it.