India must close nutrition gaps by reforming PDS: WHO ex-chief

Chennai: To shift from treating illness to preventing it, India must close its nutrition gaps by reforming the public distribution system, said former World Health Organisation chief scientist Dr Soumya Swaminathan, also the chairperson of the M S Swaminathan Research Foundation.At the third edition of Dr S S Badrinath Endowment Oration at Sankara Nethralaya on Tuesday, held under the theme "Well-being as a way of life," she said that while India largely succeeded in preventing starvation through the PDS, the system now focuses more on calories than on balanced nutrition.
Pulses, fruits, vegetables, eggs and milk — protein-rich foods — remain relatively expensive, she said, disproportionately burdening the poor. "We are filling our stomachs with calories, but we are not nourishing our bodies with adequate protein and micronutrients," she said.Poor nutrition, Dr Swaminathan warned, is driving a rapid rise in non-communicable diseases such as diabetes, obesity and hypertension. Diabetes prevalence in India doubled from 11% in 2011 to 22% in 2025, with a large section of the population now classified as pre-diabetic, she said.Additionally, climate change and biodiversity loss are emerging public health emergencies, she said, calling for urgent climate mitigation and adaptation. Damage to ecosystems increases disease risks, she said, noting that several planetary tipping points are already crossed, while rising temperatures are accelerating ageing, increasing cardiovascular strain and reducing work capacity among outdoor workers.Air pollution compounds these risks, she added, with fine particulate matter PM2.5 entering the bloodstream and affecting multiple organs, raising the risk of cardiovascular disease, diabetes and neurological disorders.Out-of-pocket spending still accounts for about 48% of healthcare costs, often pushing families into debt, she said. Public health spending remains around 1% of GDP, far below levels in countries such as Thailand and Sri Lanka.Citing Thailand's 30 baht universal healthcare scheme, she said political will to prioritise primary care over large tertiary hospitals reduced costs and improved outcomes.