Health · Sub-pillar 2.2

Prevention and public health

Sanitation, clean drinking water, the prevention of lifestyle diseases such as diabetes and heart disease, and preparedness for epidemics and other public health emergencies.

What is prevention and public health?

Prevention and public health is sub-pillar 2.2 of the 47 BH framework for a developed Bharat by 2047, the second of five sub-pillars under the Health pillar. It asks whether Indians have clean drinking water and sanitation, whether the country is checking the rise of diabetes, high blood pressure and other lifestyle diseases, and whether it is prepared for epidemics and other public health emergencies.

Why it matters for 2047

Much illness is kinder and cheaper to prevent than to treat. A village with safe tap water and working toilets sees fewer children with diarrhoea; an adult whose blood pressure is found and controlled at forty does not arrive with a stroke at fifty-five; a district that detects an outbreak in days rather than weeks spares everyone else.

India is living through a change in what makes its people ill. Infections and the diseases of poverty have not gone away, but diabetes, heart disease, cancers and respiratory illness now account for a large and growing share of deaths, and they often start earlier here than elsewhere. A health system built for infections has to learn to prevent and manage conditions that last a lifetime.

The Covid-19 pandemic showed how much a country's health depends on public health: surveillance, laboratories, trained field staff and the trust of citizens. 47 BH treats readiness for the next emergency as part of everyday health, not as an afterthought.

Where India stands

  • 82.1%

    of rural households, about 15.89 crore of 19.36 crore, had a tap water connection on 18 July 2026, up from 16.7% when the Jal Jeevan Mission began in August 2019.[1]

  • 11.4%

    of Indian adults have diabetes and a further 15.3% have prediabetes, about 101 million and 136 million people, according to the ICMR-INDIAB national study published in 2023.[2]

  • 35.5%

    of adults have hypertension, about 315 million people; 28.6% are obese by body mass index and 39.5% carry abdominal obesity.[2]

  • 42.8

    out of 100 was India's score on the 2021 Global Health Security Index of readiness for epidemics across 195 countries, with prevention (29.7) and rapid response (30.3) its weakest areas.[4]

On water and sanitation, the change in a decade is large. More than 12 crore household toilets have been built since 2014, and over 83% of villages had declared themselves ODF Plus Model by December 2025, with solid waste arrangements in more than 5.27 lakh villages. [3] Tap water reached four in five rural homes by 2026, from one in six in 2019, and the mission has been extended to December 2028 to reach the rest. [1] The open question is whether the taps run and the toilets are used every day, which no connection count can show.

On lifestyle disease, the picture is sobering. More than one adult in ten has diabetes, more than one in three has high blood pressure, and a quarter has high cholesterol; the study estimates that roughly 136 million more are on the way to diabetes. [2] Screening has expanded, with 39.5 crore hypertension and 36.7 crore diabetes screenings recorded at Ayushman Arogya Mandirs by November 2025, but screening is the start of care, not the end. [5]

On epidemic readiness, India's 2021 Global Health Security Index score of 42.8 placed it in the middle of the world, with its weakest scores on prevention and rapid response. [4] A note on the numbers: the diabetes and hypertension figures come from a single large survey of 1.13 lakh adults, the water figures from a government dashboard, and the sanitation figures from village self-declaration followed by verification.

On the 47 BH report card

Every 15 August, 47 BH reports how far India has come on each sub-pillar. For this sub-pillar, the headline indicators are:

  • Share of households with tap water at home and with a toilet in use (Jal Jeevan Mission dashboard; National Family Health Survey).
  • Prevalence of diabetes and hypertension among adults, and the share who are diagnosed and controlled (ICMR-INDIAB; National Family Health Survey).
  • Readiness for epidemics: Global Health Security Index score, and time to detect and contain outbreaks (IDSP).

Two lenses on prevention and public health

City and village

47 BH asks whether a family in a city slum has the same safe water and drainage as one in a gated society, and whether a village has a working toilet in every home and a health worker who checks blood pressure. Lifestyle disease is no longer a city problem: the ICMR-INDIAB study drew most of its sample from rural India, where diabetes and hypertension are rising fast. [2]

Learn, avoid, protect

Learn
What can India learn from countries that cut salt, sugar and tobacco use across whole populations, from cities that treat drainage and waste as public health, and from disease surveillance systems that report in real time?
Avoid
Which mistakes should it avoid, such as declaring a village or a city clean on paper, screening millions without follow-up treatment, or dismantling surveillance once an emergency passes?
Protect
What of its own should it protect, such as the community health workers who know every household, the habits of home-cooked food and daily movement, and the public health laboratories and vaccine manufacturing that served the world during the pandemic?

What this sub-pillar does not cover

Each topic has one home in the framework. These related topics sit elsewhere:

Questions about prevention and public health

How many Indians have diabetes?

The ICMR-INDIAB national study, published in The Lancet Diabetes and Endocrinology in 2023, estimated that 11.4% of adults, about 101 million people, have diabetes, and a further 15.3%, about 136 million, have prediabetes. [2]

How many Indians have high blood pressure?

The same study estimated that 35.5% of adults, about 315 million people, have hypertension. [2]

How many rural homes in India have tap water?

About 15.89 crore rural households, 82.09% of the total, had a tap water connection on 18 July 2026, according to the Ministry of Jal Shakti. In August 2019 the share was 16.71%. [1]

Is India prepared for the next pandemic?

The 2021 Global Health Security Index, produced by the Nuclear Threat Initiative with Brown University and Economist Impact, scored India 42.8 out of 100, with its weakest scores on prevention and rapid response. India has since expanded laboratories and surveillance, and 47 BH will track how the score and outbreak response times change. [4]

Why is sanitation a health question?

Because contaminated water and open defecation spread diarrhoea, typhoid, hepatitis and worm infections, which stunt children and kill the very young. Clean water and toilets in use are among the most cost-effective health measures a country can take.

Sources

  1. Ministry of Jal Shakti, "Extension of the Jal Jeevan Mission and Transfer of Rural Water Supply Schemes", Rajya Sabha written reply, Press Information Bureau, 27 July 2026. Coverage as of 18 July 2026. https://www.pib.gov.in/PressReleasePage.aspx?PRID=2290048&reg=3&lang=1
  2. Anjana RM, Unnikrishnan R, Deepa M et al., "Metabolic non-communicable disease health report of India: the ICMR-INDIAB national cross-sectional study (ICMR-INDIAB-17)", The Lancet Diabetes and Endocrinology, 2023, vol. 11, pp. 474-489; figures as summarised in The National Medical Journal of India. https://nmji.in/lessons-learnt-from-the-icmrindiab-study
  3. Department of Drinking Water and Sanitation, Ministry of Jal Shakti, "Year End Review 2025", Press Information Bureau, January 2026. Figures as of 16 December 2025. https://static.pib.gov.in/WriteReadData/specificdocs/documents/2026/jan/doc202611750301.pdf
  4. Nuclear Threat Initiative, Brown University School of Public Health and Economist Impact, "Global Health Security Index 2021", India country profile. https://ghsindex.org/country/india/
  5. Ministry of Health and Family Welfare, "Initiatives and Achievements 2025", year-end review, Press Information Bureau, January 2026. Screening figures cumulative to 30 November 2025. https://static.pib.gov.in/WriteReadData/specificdocs/documents/2026/jan/doc202611749801.pdf

47 BH cites every figure so that it can be checked. If you find an error, it will be corrected openly and the date below will change.

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