India's Health Paradox: Low Investment, High Disease Burden, and Critical Nurse Outflow
SDG 3: Good Health and Well-being | SDG 10: Reduced Inequalities
Institutions: Ministry of Health and Family Welfare (MoHFW) | NITI Aayog
The OECD’s “Health at a Glance 2025” report reveals a profound health paradox in India, characterized by minimal public investment alongside a rapidly growing disease burden:
Investment and Infrastructure Deficit: India ranks at the lowest end of global health spending, with per capita health expenditure in 2024 estimated at less than USD 500, significantly below the OECD average of nearly USD 6,000 per capita. This minimal spending is reflected in resource constraints, such as having only 1.9 hospital beds per 1,000 population (OECD average: 4.2) and negligible formal Long-Term Care (LTC) spending (0.0% of GDP). Access remains a challenge, with 33.6% of the rural population unable to reach a hospital within a 45-minute drive.
High Morbidity and Environmental Risk: The burden of non-communicable diseases is escalating: India’s diabetes prevalence (9.2%) is higher than the OECD average (8.6%). Risk-taking behaviors are a serious concern, with one of the highest illicit opioid use rates (2.1%) among peer countries. These internal risks are compounded by a severe environmental threat, as mean exposure to PM2.5 was 47 micrograms per cubic meter in 2020, significantly exceeding the WHO guideline of 5 µg/m³.
Equity and Human Capital Paradox: India’s life expectancy is 72.0 years, but the country exhibits an unusually small gender gap in life expectancy. This paradox is not due to better male health, but because maternal mortality, unequal healthcare access, and social/cultural barriers significantly constrain women’s survival advantage. Furthermore, India is a major global supplier of skilled health workers, with about 120,000 Indian-born nurses working abroad, highlighting a critical outflow of human capital needed domestically.
The OECD findings indicate that the foundation of current Indian health programmes is critically weak:
The high diabetes prevalence (9.2%) and the large rural access gap (33.6% lack hospital access) directly challenge the core objectives of Ayushman Bharat Health and Wellness Centres (AB-HWCs), whose primary mandate is NCD screening and primary care delivery.
The minimal LTC spending (0.0% of GDP) poses a long-term fiscal risk that will undermine AB-PMJAY’s sustainability as the population ages and demand for chronic care soars.
The high MMR (14.8) and IMR (16.7), despite past progress, highlight persistent gaps in National Health Mission (NHM) efforts that are further exacerbated by the severe nursing talent drain (120,000 nurses abroad).
The extreme PM2.5 exposure (47 µg/m³) shows that environmental policy failure is negating health system gains, increasing the prevalence of respiratory and cardiovascular diseases across the population.
Follow the full update here: OECD Health at a Glance 2025