Health and Nutrition Justice — Basic Structure

Basic Structure

Health and Nutrition Justice in India is rooted in the constitutional mandate of a welfare state, evolving into a rights-based approach. At its core, it asserts that every citizen has an equitable right to quality healthcare and adequate nutrition, essential for a dignified life.

This principle is primarily derived from Article 21 (Right to Life), which the Supreme Court has expansively interpreted to include the right to health and nutrition. Article 47, a Directive Principle, explicitly tasks the State with improving public health and raising nutrition levels, while Article 39(e) and (f) focus on protecting the health and development of workers and children.

Key legislative frameworks include the National Food Security Act (NFSA) 2013, which provides legal entitlements to subsidized food grains through the Public Distribution System (PDS) and maternity benefits.

Major schemes like the Integrated Child Development Services (ICDS) and Mid-Day Meal Scheme (now PM POSHAN) address child and maternal nutrition, while the National Health Mission (NHM) and Ayushman Bharat (PMJAY and Health & Wellness Centres) aim to strengthen healthcare infrastructure and achieve universal health coverage.

Despite significant policy efforts, India faces persistent challenges, as evidenced by NFHS-5 (2019-21) data, showing high rates of stunting (35.5%), wasting (19.3%), and anaemia (57% among women, 67% among children).

These challenges are exacerbated by intersectional factors like caste, gender, economic status, and geographic disparities. India's performance in the Global Hunger Index (GHI 2023 ranking 111th) further highlights the urgency.

Achieving health and nutrition justice requires a multi-sectoral approach, robust implementation, and addressing systemic inequities to ensure that constitutional promises translate into tangible improvements for all citizens.

Important Differences

vs National Health Mission (NHM)

Aspect	This Topic	National Health Mission (NHM)
Primary Objective	Strengthening public health systems, especially RMNCH+A services, and addressing communicable/non-communicable diseases.	Achieving Universal Health Coverage (UHC) through two pillars: comprehensive primary healthcare (HWCs) and health insurance for secondary/tertiary care (PMJAY).
Scope	Broader public health interventions, infrastructure development, human resource strengthening, disease control programs.	Specific focus on service delivery through HWCs and financial protection against catastrophic health expenditures through PMJAY.
Target Beneficiaries	General population, with a focus on vulnerable groups (women, children, rural populations).	HWCs for all; PMJAY for the poorest 40% of the population (based on SECC 2011 data), now extended to ASHA/Anganwadi workers.
Funding Mechanism	Central assistance to states/UTs for strengthening public health systems, often with a matching state share.	Jointly funded by central and state governments, with a significant central share for PMJAY and HWCs.
Implementation Approach	Programmatic approach, supporting states in achieving health goals through flexible funding and technical support.	Insurance-based model for tertiary care and a service delivery model for primary care, with a strong emphasis on digital integration.

NHM is a foundational mission focused on strengthening the entire public health system, from infrastructure to human resources and disease control. Ayushman Bharat, while building on NHM's efforts, is a more recent, targeted initiative aimed at achieving Universal Health Coverage through comprehensive primary care via Health & Wellness Centres and financial protection for secondary/tertiary care via PMJAY. NHM provides the backbone, while Ayushman Bharat provides specific service delivery and financial protection mechanisms.

vs Public Distribution System (PDS)

Aspect	This Topic	Public Distribution System (PDS)
Primary Objective	Ensure food security by providing subsidized food grains (wheat, rice, coarse grains) to eligible households.	Holistic development of children (0-6 years) and pregnant/lactating mothers, focusing on nutrition, health, and early education.
Target Beneficiaries	Households identified under NFSA (up to 75% rural, 50% urban population).	Children aged 0-6 years, pregnant women, and lactating mothers.
Services Provided	Distribution of food grains at highly subsidized prices through Fair Price Shops.	Supplementary nutrition, pre-school education, health check-ups, immunization, referral services, nutrition & health education.
Implementing Agency/Platform	State Food & Civil Supplies Departments, Fair Price Shops.	Ministry of Women & Child Development, implemented through Anganwadi Centres.
Focus Area	Addressing calorie deficiency and food access for households.	Addressing malnutrition, promoting child development, and improving maternal health outcomes.

PDS is primarily a food security program, ensuring access to staple food grains for eligible households. ICDS, on the other hand, is a comprehensive child development program with a strong nutrition component, targeting young children and mothers with a range of health, nutrition, and educational services. While PDS focuses on household food access, ICDS focuses on individual-level nutritional and developmental outcomes, particularly for the most vulnerable during critical early life stages.