It was Benjamin Disraeli, a two-time Prime Minister of the UK and a notable writer, who famously said: “The health of the people is really the foundation upon which all their happiness and all their powers as a State depend.” This thought process and its finer distillation—that public health is not charity or benevolence but a core function of governance—find their echo in many chambers of our Constitution, particularly in Article 47, Article 39(e), Article 39(f), Article 41, and Article 42. One has to thank the Supreme Court for recognising the gap between a moral-political directive and an enforceable fundamental right and expanding the scope of Article 21 (right to life) to include the right to medical treatment (Paschim Banga Khet Mazdoor Samity v. State of West Bengal).

But, as is often the case, what ails India is not the lack of a legal framework that enjoins the government to care for the sick and the elderly, ensure the safety of the weak and the vulnerable, and provide access to medical facilities and drugs to the millions who often remain faceless and voiceless but the absence of a working model that will not leave people to the mercy of market forces.

As my colleague T.K. Rajalakshmi points out, India has made laudable gains over the years. Thanks to initiatives by successive governments, including ongoing schemes such as the Ayushman Arogya Mandirs and the e-Sanjeevani telemedicine platform, there has been a significant improvement in healthcare access. This comes on top of other achievements, such as the huge jump in life expectancy (from around 32 years at Independence to about 70 years now); the eradication of polio, smallpox, and maternal and neonatal tetanus; and a sharp reduction in both the infant mortality rate and the maternal mortality ratio. These speak of strong strides in immunisation, disease control, nutrition, institutional deliveries, and primary care access.

But a country with hundreds of millions still in economic precarity cannot afford to rest on its laurels. The truth remains that for millions of Indians healthcare still means delayed treatment, long travel, and crushing out-of-pocket costs—often compounded by weak regulation, opaque pricing, and a growing collusion between insurers and private hospitals that leaves patients with little real protection. And it is a matter of national shame that a country so consumed by its Viksit Bharat ambitions is still struggling for something as basic as safe drinking water, as my colleague Vedaant Lakhera highlights in his article.

The state’s response to these challenges has been anaemic at best. If the minimal public funding of healthcare, which is around 1.9 per cent of the GDP against the stated goal of 2.5 per cent by 2025 (National Health Policy 2017), is proof of the abdication of responsibility by the state—which, given its strong neoliberal stance, seems keen to clear the field for private players—the continuing deaths due to contaminated drugs and poor upkeep of government facilities point to the corrosive influence of corruption and institutional apathy.

Against this sombre backdrop, the advancement of technology, particularly AI and concepts like telemedicine, does offer a beacon of hope. But technology can only be a tool. As the public health consultant Abhay Shukla argues, it is the responsibility of those who steward it to ensure that it does not become the privilege of a chosen few and accentuate the fault lines of an inequitable society.

In this special issue of Frontline, our staff writers and commissioned experts also examine other critical concerns: the continuing urban-rural divide in healthcare access, the inequities faced by women, and how front-line workers are the fulcrum of our public health system but still remain marginalised.

It has been a solemn yet deeply rewarding task to edit this issue, and I hope it will serve both as a catalogue and a catalyst for change.