Addressing Health System Challenges in Punjab, India

A Comprehensive Review of Current Issues and Proposed Solutions

Abstract

World Health Day, observed annually on April 7th, provides an opportunity to reflect on global health issues and the progress made toward achieving health equity. Punjab, a state in northern India, faces a range of public health challenges, including the high prevalence of non-communicable diseases (NCDs), inadequate healthcare infrastructure, environmental pollution, and mental health disorders. This review synthesizes findings from various original research studies focusing on healthcare access, air pollution, chronic diseases, mental health, malnutrition, substance abuse, and other health indicators. It underscores the urgent need for strengthening healthcare infrastructure, promoting preventive healthcare, improving mental health services, and addressing environmental health risks. The paper concludes with actionable recommendations aimed at improving health outcomes in Punjab, along with future directions for research and policy interventions to ensure better health for all.

Introduction

While India faces numerous healthcare challenges, Punjab’s health issues are compounded by several unique factors. Punjab has witnessed a rapid transition from a predominantly agrarian society to a more industrialized one. This transformation has brought about changes in lifestyle and diet, contributing to the rising incidence of NCDs. For instance, urbanization and increased adoption of sedentary lifestyles have led to higher rates of obesity, diabetes, and hypertension.

In Punjab, cardiovascular diseases are the leading cause of mortality, accounting for a significant proportion of NCD-related deaths. The state also experiences one of the highest rates of diabetes in India, particularly in individuals over the age of 40 (Tripathy et al., 2017). Environmental factors, such as crop burning, which is common in Punjab’s agricultural sector, have exacerbated respiratory diseases, leading to increased hospitalizations and deaths from conditions such as asthma and chronic obstructive pulmonary disease (COPD) (Chowdhury et al., 2019).

Air pollution, pesticide exposure, and contamination of water sources have created an environment that exacerbates health problems in Punjab. Studies indicate that exposure to pesticides in agriculture has resulted in high incidences of cancers, particularly among rural populations who are directly exposed to these chemicals (Thakur et al., 2008). The rising prevalence of cancer is compounded by a lack of early detection programs and adequate cancer care facilities in rural areas.

The mental health crisis in Punjab has also attracted significant attention. Depression, anxiety, and substance abuse are on the rise, particularly among youth, largely due to socio-economic stress, familial pressures, and lack of access to mental health services. Furthermore, mental health disorders are often stigmatized, which prevents individuals from seeking help. This has been exacerbated by inadequate mental health infrastructure in rural regions, where access to trained mental health professionals is limited (Sagar et al., 2020).

Maternal and child health remain persistent challenges in Punjab, with high rates of malnutrition and gestational diabetes reported. Approximately 28% of children under five years of age are stunted, indicating insufficient nutrition in early childhood (NFHS-5, 2021). Additionally, the prevalence of gestational diabetes among pregnant women in Punjab is alarmingly high, with figures reaching 18% (Anjana et al., 2017). This reflects an urgent need for better maternal healthcare services, including early screening for at-risk populations.

The healthcare system in Punjab is further strained by issues of accessibility and affordability. Around 60% of healthcare expenditures in the state are out-of-pocket, making healthcare services inaccessible to a significant portion of the population, especially in rural areas. This financial burden on individuals leads to delayed or foregone medical care, exacerbating health disparities (Berman et al., 2010).

Health Challenges in Punjab: Key Studies

Discussion: Scientific Solutions to Strengthen Punjab’s Health System

Punjab, despite its agricultural prosperity, is grappling with a multilayered health crisis rooted in epidemiological transition, environmental degradation, and systemic gaps in healthcare delivery. This discussion elaborates on a range of scientifically validated, actionable solutions that address the structural determinants of health, focusing on preventive care, service delivery, and policy alignment.

1. Strengthening Primary Healthcare Infrastructure

Primary healthcare (PHC) is the bedrock of any resilient health system. In Punjab, however, rural PHCs remain understaffed and under-equipped. The Government of India’s Ayushman Bharat initiative envisions the transformation of 150,000 Sub-Health Centres into Health and Wellness Centres (HWCs), which offer comprehensive primary care including screening for NCDs, mental health, and maternal-child health.

Implementation Strategy: Punjab must fast-track the operationalization of HWCs, particularly in underserved districts like Mansa, Fazilka, and Barnala. Each HWC should be equipped with trained mid-level health providers (MLHPs), diagnostics, and essential drugs.

Expected Impact: By catching diseases early and reducing unnecessary referrals to tertiary care, this can substantially cut costs and improve health-seeking behavior among marginalized populations.

2. Integration of Mental Health into Primary Care

Punjab’s mental health burden—driven by substance abuse, socio-economic stressors, and family pressures—remains largely unaddressed due to stigma and poor access to care. The National Mental Health Programme (NMHP) remains under-implemented at the district level.

Evidence-Based Strategy: Adopting WHO’s Mental Health Gap Action Programme (mhGAP) can allow trained non-specialist health workers (e.g., ASHAs, ANMs) to identify, counsel, and refer individuals with depression, anxiety, and addiction.

Successful Models: The Atmiyata Project in Gujarat and Andhra Pradesh’s SMART Mental Health project have shown that task-shifting significantly improves detection and care linkage.

Systemic Reform: Mental health must be integrated into routine PHC checkups with digital case management and telepsychiatry support.

3. Addressing Environmental Health Risks Through Intersectoral Action

Punjab’s health is deeply intertwined with its ecology. Air pollution due to stubble burning, unsafe pesticide use, and groundwater contamination are among the major environmental risk factors.

Multi-sector Collaboration: Coordinated action between the Departments of Health, Environment, and Agriculture is vital. Mechanization support for Happy Seeder machines and incentives for zero-burn farming can reduce crop residue fires.

Scientific Validation: Remote sensing studies (Ghosh et al., 2020) have confirmed PM2.5 peaks during crop burning periods, directly correlating with respiratory admissions.

Policy Leveraging: Programs under the National Clean Air Programme (NCAP) and State Action Plans on Climate Change (SAPCC) must be tailored to local environmental epidemiology.

4. Expanding Cancer Screening and Care Access

Punjab’s Malwa region has been identified as a cancer hotspot, linked to environmental exposure and late-stage diagnoses. The state lacks a structured, community-based cancer screening program.

Proposed Strategy: Mobile screening units using VIA (Visual Inspection with Acetic Acid), oral checks, and breast exams can be rolled out in villages and small towns.

Capacity Building: Training frontline workers to detect early signs and establishing district-level oncology centers for referral can reduce mortality.

Community Engagement: Awareness campaigns should counter cancer-related myths and promote screening, particularly in high-incidence blocks.

5. NCD Control via Community-Based Lifestyle Interventions

The rising burden of diabetes, hypertension, and cardiovascular disease is attributable to urbanization, processed diets, and inactivity.

Effective Model: The ICMR-YRGCARE lifestyle modification trial demonstrated that structured physical activity and dietary interventions can delay or prevent diabetes.

Local Application: Panchayat-led wellness clubs, yoga camps, and diet education (especially using local, affordable foods like bajra, methi, dalia) can make a real difference.

School-Based Programs: Integrating health education in schools and incentivizing healthy mid-day meals can instill lifelong habits.

6. Improving Maternal and Child Health Through Early Screening and Nutrition

Punjab’s maternal health challenges—high GDM prevalence, low antenatal coverage, and child stunting—require a life-course approach.

Antenatal Innovations: Digital pregnancy monitoring tools, like TeCHO+, can track high-risk pregnancies and automate referrals for gestational diabetes screening.

Nutrition Focus: Initiatives like the Poshan Abhiyaan must be scaled up to ensure early-life nutrition through fortified take-home rations, breastfeeding support, and iron-folic acid supplementation.

Skilling Frontline Workers: ANMs and ASHAs must be trained to monitor maternal BMI, blood glucose, and anemia status during early ANC visits.

7. Tackling Substance Use Disorders with Comprehensive Support

Punjab’s youth face one of the highest rates of heroin and synthetic drug abuse in India, often leading to co-occurring mental health issues and social alienation.

Integrated Rehabilitation: De-addiction centers must evolve from detox units to long-term recovery hubs offering psychosocial counseling, family therapy, and skill-building.

Community Involvement: Peer-support groups (similar to AA/NA) and youth engagement platforms can prevent relapse.

School and Media Interventions: Drug education must be age-appropriate, stigma-free, and complemented with opportunities for creative expression, sports, and career counseling.

8. Enhancing Financial Protection through Insurance Literacy

Though schemes like Ayushman Bharat PM-JAY cover over 60 crore Indians, awareness and utilization remain low in Punjab, especially among rural families.

Literacy Drives: Health insurance kiosks at PHCs and monthly awareness drives through Panchayats can help people understand eligibility, e-card registration, and entitlements.

Monitoring & Grievance Redressal: Each district should have a dedicated nodal officer to ensure transparency, address fraud, and assist with empanelled hospitals.

9. Data-Driven Health Planning Using Real-Time Surveillance

Punjab lacks granular disease burden data at the block level, which hampers targeted interventions.

Recommendation: Strengthen the Health Management Information System (HMIS) by ensuring timely data entry, analytics capacity, and feedback loops at the district level.

Mobile-Based Tools: Use mobile apps for village health nurses to collect community-level morbidity and service uptake data, like in Tamil Nadu’s Makkalai Thedi Maruthuvam model.

Public Dashboard: An open-data dashboard with filters by gender, geography, and disease category can enable transparency and research.

10. Public-Private Partnerships for Innovations in Service Delivery

Strategic partnerships can fill service gaps, especially in diagnostics, telemedicine, and last-mile delivery.

Lab Services: Partner with private labs for free or subsidized diagnostics at PHCs, reducing delays in diagnosis.

NGO Linkages: Collaborate with NGOs for adolescent health outreach, migrant health support, and community mental health camps.

Monitoring PPPs: All collaborations should have clear outcome indicators, community feedback mechanisms, and periodic audits to ensure quality and equity.

Conclusion

These scientific solutions emphasize systems strengthening, community empowerment, and evidence-based interventions. Punjab’s health system challenges are multifaceted but surmountable with political will, intersectoral coordination, and sustained investment in preventive, promotive, and primary care. Public health stakeholders must also foster trust, ensure equity, and build local capacity to move from reactive care to resilient health systems. As we reflect on World Health Day, the message is clear: investing in people-centered, preventive, and inclusive healthcare is the most effective path toward “Health for All.”

References

1. Ambekar, A., Agrawal, A., Rao, R., Mishra, A. K., Khandelwal, S. K., & Chadda, R. K. (2019). Magnitude of substance use in India. Ministry of Social Justice and Empowerment, Government of India. https://socialjustice.gov.in

2. Chowdhury, S., et al. (2019). Tracking ambient PM2.5 build-up in Delhi National Capital Region during the dry season over 2016–2018 using satellite observations. Atmospheric Environment, 204, 50–64.

3. Tripathy, J. P., et al. (2017). Prevalence and risk factors of diabetes in a large community-based study in North India: Results from a STEPS survey in Punjab, India. Diabetology & Metabolic Syndrome, 9, 8.

4. Anjana, R. M., Deepa, M., Pradeepa, R., Mahanta, J., Narain, K., Das, H. K., … & Mohan, V. (2017). Prevalence of diabetes and prediabetes in 15 states of India. The Lancet Diabetes & Endocrinology, 5(8), 585–596. https://doi.org/10.1016/S2213-8587(17)30174-2

5. Dhillon, P. K., Mathur, P., Nandakumar, A., Fitzmaurice, C., Kumar, G. A., Mehrotra, R., … & Swaminathan, R. (2018). The burden of cancers and their variations across the states of India. Lancet Oncology, 19(10), 1289–1306. https://doi.org/10.1016/S1470-2045(18)30447-9

6. Ghosh, S., Lal, R., & Saraswat, S. (2020). Stubble burning in Punjab: A rising concern. Environmental Research Communications, 2(9), 095001. https://doi.org/10.1088/2515-7620/abb4c7

7. Gupta, R., Xavier, D., Hypertension Research Group. (2019). Hypertension epidemiology in India: emerging aspects. Current Opinion in Cardiology, 34(4), 331–341. https://doi.org/10.1097/HCO.0000000000000637

8. National Family Health Survey (NFHS-5). (2021). State Fact Sheet: Punjab. Ministry of Health and Family Welfare. http://rchiips.org/nfhs

9. Patel, V., Parikh, R., Nandraj, S., Balasubramaniam, P., Narayan, K., Paul, V. K., … & Reddy, K. S. (2015). Assuring health coverage for all in India. The Lancet, 386(10011), 2422–2435. https://doi.org/10.1016/S0140-6736(15)00955-1

10. Rajput, R., Yadav, Y., Nanda, S., Rajput, M., Nanda, S., & Rajput, R. (2013). Prevalence of gestational diabetes mellitus & associated risk factors at a tertiary care hospital in Haryana. Indian Journal of Medical Research, 137(4), 728–733. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705658

11. Sagar, R., Dandona, R., Gururaj, G., et al. (2020). The burden of mental disorders across the states of India: the Global Burden of Disease Study 1990–2017. The Lancet Psychiatry, 7(2), 148–161. https://doi.org/10.1016/S2215-0366(19)30475-4

12. Berman, P., et al. (2010). Government health financing in India: Challenges in achieving ambitious goals. Health Affairs, 29(9), 1679–1685.