Improving health outcomes: Survey suggests the need for a holistic approach

NFHS-6 shows gains in child nutrition and healthcare access, but rising obesity and diabetes underscore the need for a more comprehensive public health strategy

The key findings of the latest round of the National Family Health Survey (NFHS) 2023-24, or NFHS-6, have revealed that the country has made notable progress on several traditional health indicators. Child stunting has declined from 35.5 per cent in NFHS-5 (2019-21) to 29.3 per cent, full immunisation coverage has risen from 76.6 per cent to 82.6 per cent, institutional deliveries have increased from 88.6 per cent to 90.6 per cent, and health insurance or financing scheme coverage has expanded sharply from 41 per cent to 60.2 per cent of households. However, it also highlighted a worrying trend — the rapid rise in obesity and diabetes. Nearly one in three women (30.7 per cent) and more than one in four men (27.3 per cent) are now overweight or obese, compared to 24 per cent and 22.9 per cent, respectively, in NFHS-5. Elevated blood-sugar levels have increased sharply, affecting 17.8 per cent of women and 20.9 per cent of men. 

This trend reflects changing lifestyles marked by sedentary work, the rising consumption of ultra-processed foods, stress, and inadequate physical activities. The surge in demand for anti-obesity drugs not only highlights the growing scale of the problem but also raises concerns about affordability and over-reliance on medication. The problem also has broader socioeconomic implications. Obesity-related diseases could significantly increase overall costs of health care and reduce workforce productivity. A new report by the Organisation for Economic Cooperation and Development says that in the absence of non-communicable diseases (NCDs), India would have a healthier and more productive labour force, generating gains equivalent to an additional 19.4 million full-time equivalents through lower absenteeism and reduced presenteeism. 

At the same time, India has not fully overcome the challenge of undernutrition. Anaemia remains alarmingly widespread, affecting 49.5 per cent of women aged 15-49 years and 58.1 per cent of children aged 6-59 months. Even though India has largely achieved cereal security, it has not achieved nutrition security. Diets continue to be dominated by rice and wheat, with inadequate intake of protein and other nutrients. Part of the reason is the composition of the public distribution system (PDS). It is partly being addressed through programmes like the POSHAN (Prime Minister’s Overarching Scheme for Holistic Nourishment) Abhiyaan, but much more remains to be done. Thus, India needs to work on multiple fronts with stronger policy interventions to improve health outcomes. 

While it must make the food distributed under the PDS more nutritious, it also needs to spread awareness about the importance of a balanced diet. It is often reported that an improvement in incomes increases the consumption of processed food. In the context of rising obesity, better regulation is needed at various levels for anti-obesity drugs. Further, there is a need to implement front-of-pack food labelling, school-based fitness programmes, urban designs that encourage physical activities, and regular screening under the National Programme for Prevention and Control of NCDs through well-functioning Ayushman Arogya Mandirs (Health and Wellness Centres). The NFHS-6 findings underscore the need for a comprehensive health approach to address the double burden in which persistent undernutrition at one end of the spectrum coexists with rising obesity.