By any measure, the health journey of Maharashtra over the past seventy-five years is a story of transition—marked by aspiration, innovation, neglect, and paradoxes. Yet, to narrate this tale in isolation from national and global currents would be akin to understanding the tides without regard to the moon. For the evolution of public health in Maharashtra has been inseparably entwined with the larger saga of India’s post-independence metamorphosis and the world’s own flirtation with health, disease, and the marketplaces they now populate.

Let us begin, not at the beginning, but at a statistic that startles by the sheer distance we have travelled. Seventy-five years ago, the average life expectancy in India stood at a mere thirty-three years—half a life, if life it can be called. Today, it hovers around seventy. This doubling is not the consequence of divine benevolence or genetic miracle. It is the hard-won result of medical science, pharmaceutical breakthroughs, the spread of medical education, and the expansion of healthcare infrastructure. Significantly, these were all midwifed by the public sector in its earnest years.

However, as the decades passed, a subtle erosion began. Private enterprise slowly replaced public commitment, and in time, galloped ahead with astonishing, if disturbing, speed. What began as a complementary force became a dominant overlord. So much so, that rather than expanding state-run medical education and healthcare services, the trend reversed—privatisation became the norm, and public provisioning was left to languish, often mocked as inefficient and expendable.

In this climate, insurance giants and private hospitals constructed a colossal economic edifice under the gilded banner of “healthcare,” when in truth it has become a thriving marketplace of illness.

Let it be acknowledged that Maharashtra has indeed expanded its healthcare services over the last three-quarters of a century. But the question is not one of quantum alone, but of proportion and equity. When juxtaposed against the global benchmarks—especially those laid down by the World Health Organization—we fall short. The ratio of hospital beds per thousand persons is still a sobering statistic. More disconcertingly, the number of high-cost beds in private hospitals far outpaces the availability of free or affordable beds in government facilities.

Thus, we are forced to confront a deeper question: What precisely is our vision of health for the next twenty-five years? Is it merely a future of more ICUs, more MRI machines, more pharma chains, and more insurance cards? Or is it a reimagined ecosystem where health is not the absence of disease, but the presence of well-being?

Herein lies the critical philosophical chasm. What the world today calls a “health system” is, in actuality, a “disease treatment system.” Its lexicon is replete with surgical precision—patients, prescriptions, procedures. Were we honest in nomenclature, institutions such as the “World Health Organization” would perhaps be more aptly named the “World Disease Treatment Organization.” Ministries of health might be better recognized as Ministries of Medical Interventions.

This is no mere semantic nitpicking. It is a profound indictment. The entire edifice is built not to nurture the healthy, but to service the sick. Health has been commodified, the human body reduced to a site of transaction. Illness has become the currency.

Therefore, the imperative before us is not incremental reform but fundamental transformation. Maharashtra must take the lead in reversing the tide. We must abandon the reactive model of “curative health” as the centerpiece, and instead enthrone “promotive” and “preventive” health. The State must aspire not to treat more illnesses, but to create conditions in which fewer illnesses arise at all.

Imagine a policy framework where the success of a health department is not measured by how many hospital beds it adds, but by how few are needed. Where the metrics of governance celebrate fewer prescriptions, fewer operations, fewer ICU admissions—not because of denial, but because of robust public health that forestalls disease in the first place.

During my tenure as Municipal Commissioner of Pune in 2011, I had the privilege of drafting such a forward-looking health policy—not a treatment policy, mind you—but a health policy. It was embedded in the municipal budget and shared with the state and central governments. Yet, like so many meaningful ideas, it was neither embraced nor understood. Those in the higher echelons of power lacked either the intellectual gravitas or the moral courage to carry it forward. And so it was shelved—politely, quietly, irretrievably.

If we are serious about charting a new course for the next twenty-five years, our approach must be radical in the true sense of the word—returning to the root. We must identify the causes of premature death and eliminate them at source. Instead of “clinics” and “hospitals,” we must build “Centres for Healthy Living,” “Institutes of Wellness Advancement,” and “Health Promotion Nodes.”

We must regulate, with legal teeth and moral conviction, the market forces that have turned human vulnerability into profit margins. Adulterated food, unnecessary cosmetics, polluted air, and contaminated water—these are not mere externalities, they are assassins of health. The state must intervene, unflinchingly.

Laws must be enacted and enforced to ban tobacco, curb sugar and starch overconsumption, eliminate spurious food products, and improve environmental quality. Let us remember, that sugar—consumed by humans for just the last two millennia—has wrought more havoc on health than many known poisons. A regime of regular exercise, clean air, sunlight, movement, and strengthened immunity must form the bedrock of any public health strategy.

This is not idealism. It is realism—enlightened and long overdue.

We must also reassess road accidents and trauma within the public health domain, not merely as traffic concerns but as preventable epidemics of urban misgovernance. During my tenure as Commissioner of Food and Drug Administration in Maharashtra, I faced firsthand the brutal resistance of economic interests when I banned gutkha, pan masala, and scented supari. It became clear then: the economy is often an adversary to health. A government must decide—does it serve public health or private profit? Anything else is a betrayal of democracy.

Among all the threats to genuine public health, perhaps the most insidious is health insurance. Let it be stated unambiguously: insurance is not healthcare. It is a lucrative business masquerading as social protection. It does not heal, it harvests.

What good is an economic superpower if its citizens are chronically ill? If India wishes to be counted among the superpowers of happiness and human development, it must first become a superpower of health. That requires a brave policy choice—to publicly fund all health services as a matter of right and dignity.

Of course, even this commitment may soon be rendered transitional. The Fourth Industrial Revolution has already ushered in dramatic shifts. Genetic editing, stem-cell therapies, synthetic biology—these will soon render the very idea of “disease and its treatment” obsolete. Illness itself may vanish from the lexicon of advanced civilizations. Humanity will move beyond its present evolutionary constraints.

But until that Promethean leap occurs, Maharashtra must lead by example. It must transform its treatment system into a true health system. From illness management to wellness creation. From curing disease to cultivating vitality. From profit to prevention. From the sickbed to the sunbeam.

The future belongs not to those who react, but to those who reimagine.

And in this reimagining, may Maharashtra be not a reluctant follower, but a luminous pioneer.

-Mahesh Zagade