Health in Punjab, India

Health in Punjab involves the state of complete physical, mental and social well-being of the people in Punjab, India. Data of medical facilities, diseases and nutrition is used to determine the state of health of the population.

History
Between 1896 and 1921, 12 major cholera outbreaks were recorded in Punjab province, which killed about 250,000 people. In 1901, riots were recorded in some plague-hit areas, like Gurdaspur, Patiala and Sialkot as some people refused compulsory hospitalisation and quarantine. From 1897 to 1947, more than 3,000,000 people died due to plague in Punjab province. In 1896, plague came from Hong Kong in India. In October 1897, first death from plague was reported in Punjab. Initially, the plague spread in Jalandhar and Hoshiarpur districts. By 1903, it had spread to almost all districts and caused large-scale causality in the province.

In March 1902, in Mulkowal village in Punjab province, 19 people died from tetanus after receiving plague vaccine. Initial investigation blamed Dr. Waldemar Haffkine, who had discovered the plague vaccine, and he was fired from his position as a director of plague lab. But later investigations found that a bottle was accidentally contaminated at the inoculation site in the village and not in the lab. Haffkine was finally exonerated and allowed to return to India for employment, but he was not allowed to carry out any trials and limited to theoretical research.

Between in 1953 and 1960, an influential research called 'Khanna study' was conducted in seven villages of Ludhiana district, with field headquarters in Khanna town. Its aim was to study population dynamics and to measure the effects of population control program on birth rate. The study is generally considered a failure because very few people accepted or used contraceptive methods like vaginal foam tablets. This lead to the conclusion that the mere availability of contraceptives does not ensure their use. According to anthropologist Mahmood Mamdani, this was because most people considered children as an economic necessity, as needed large families for labour and physical security.

By March 2020, Covid-19 pandemic reached Punjab. On 22 March 2020, government of Punjab imposed state-wide lockdown to combat Covid-19 pandemic in Punjab.

Birth
In 2019–21, 94.3% of the births were institutional births in Punjab, which was an increase from 90.5% in 2015–16. Of this, 53.9% were institutional births in public facility, which was up from 51.7% in 2015–16. In rural areas, the births in public facility were 57.6%, compared to 47.0% in urban areas, for year 2019–21. The percentage of home births that were conducted by a skilled health personnel was 2.6%, it was 3.0% for urban areas and 2.3% for rural areas. In 2015–16, this percentage was 4.5%. Of the total, 95.6% births were attended by a skilled health personnel, in 2019–21. For urban areas, this rate was 93.7% and 96.6% for rural areas.

Of the total births in Punjab, 38.5% were delivered by caesarean section in 2019–21. This number was 24.6% in 2015–16. For private health facilities, 55.5% of the births were by caesarean section, in 2019–20, compared to 29.9% for public health facilities. In 2015–16, this number was 39.7% for private and 29.9% for public health facilities. For private health facilities, the rate was 57.0% for rural areas and 53.4% for urban areas in 2019–21. For public health facilities, the rate was 29.1% in rural areas and 31.1% in urban areas, in the same year.

Life Expectancy
Between 2013 and 2017, the life expectancy at birth in Punjab was 72.4 years. It was 74 years for females and 71 for males.

The table below shows the life expectancy in Punjab by gender and residence in 2013–17.

Estimated from civil registration and vital statistics system (CRVSS) data, the table below shows the life expectancy in the districts of Punjab, in 2012.

Children
According to the national family health survey of 2020–21, anaemia rate in Punjab was 71.1% for children between the ages of 0 to 57 months. This was a significant increase compared to 56.6% in 2015–16. According to the National Family Health Survey (NFHS) data from 2015 to 2016, the rate stunting (low height for age) for children between the ages of 0 and 59 months was 26%, which was lower than the national average of 38%.

The table below shows the data from the state nutrition profile of Punjab of children below the age of 6, by years.

Women
As of 2020, the percentage of deaths due to heart disease was higher in women than men, 41.8% for females compared to 32.2% for males. In the same year, the percentage of deaths due to covid-19 was lower for women compared to men, 13.4% for males and 9.9% for females.

The table below shows the state nutrition profile of Punjab for women between the ages of 15 and 49 years.

In 2019, the female cervical cancer incidence rate in Punjab was 13 per 100,000 women in all ages. This was less than the rate of 14.75 in 1990. The female cervical cancer mortality rate was 7.14 per 100,000 women of all ages in 2019. This was lower than the rate of 9.34 in 1990.

Reproductive Health
The table below shows the current use of family planning methods by currently married women between the age of 15 and 49 years, in Punjab.

The table below compares the reproductive health statistics women between the ages of 15 to 45 years in Punjab at the national level.

Caste
As per National Family Health Survey (NFHS-4, 2015–16), the infant mortality rate was 40 per 1000 live births before the age of one year for scheduled castes, compared to 29 per 1000 births for the state as a whole. The infant mortality rate for other backward castes (OBC) was 21 per 1000 live births and 22 per 1000 for those who are not from SC and OBC classes.

Although the prevalence of anaemia (low levels of haemoglobin in the blood) has been found quite high among all population groups in Punjab, it was still higher among the SC population than other groups. For the women between the ages of 15 and 49 years, the prevalence of anaemia among SC women was 56.9%, compared to 53.5% for the state as a whole. Among the children between the ages of 6 and 59 months, the rate of anaemia for SC children was 60%, compared to 56.9% for the state as a whole.

The table below compares the health status of Scheduled Caste population of Punjab, according to NFHS-3.

The table below shows the early childhood mortality rates in Punjab by caste, according to NFHS-4 (2015-16).

Obesity
According to the National Family Health Survey 2020–21, the percentage of males in the age group of 15–49 who were obese or overweight was 32.2% in 2020–21, which an increase from the 27.8% in 2015–16. For women in the same age group, the number in 2020–21 was 40.8% which was an increase from 31.3% in 2015–16. Moreover, according to the same report, 63.1% of the men and 72.8% of the women have high risk waist-to-hip ratio, as of 2020–21.

The table below shows the overweight/obesity rate of men, women and children in Punjab.

During the covid-19 pandemic, it was asserted that the high death rate of covid patients in Punjab is because of the prevalence of Obesity and other diseases associated with it, like hypertension and diabetes, in the state.

As of December 2023, there were 3,473 recorded gyms in Punjab. Ludhiana was the city with most number of recorded gyms in Punjab at 449.

Diseases
As of 2022, hypertension was the most prevalent non-communicable disease in Punjab, followed by diabetes and cancer. High trans-fat consumption is considered to be the main cause of heart diseases in Punjab. Out of the total medically certified deaths in 2020, 36.2% were due to diseases of circulatory system, which higher than due to Covid-19.

The burning of crop stubble by farmers, after harvesting, has been shown to be a major cause of many respiratory diseases in Punjab. As of October 2013, there were around 30 lakh arthritis patients in Punjab. Of which, around 5 lakh were at an advanced state, which required surgery. The main factors contributing to the growth of arthritis in Punjab were obesity and sedentary lifestyle. Higher levels of stress and modern lifestyle were the main reasons for the increase in arthritis among young people.

The tuberculosis (TB) rate in Punjab came down from 196 per lakh population in 2019 to 163 in 2021, which was a decline of 17%. Only Sri Muktsar Sahib district witnessed a growth of 4.26%, from an incident rate of 141 to 147 per lakh population.

Cancer
Punjab recorded 38,636 cases of cancer in 2020. This number had been gradually rising since the previous few years. It was 37,744 in 2019 and 36,888 in 2018. By 2024, the number of cancer patients had risen to 42,288, which was a 7% increase from 39,521 in 2021. The numbers increased steadily from 40,435 in 2022 to 41,337 in 2023.

In February 2013, there were 90 cancer patients for every 100,000 people in Punjab, which was higher than the national average of 80. In that year, Muktsar district had the highest cancer rate among all district, at 136 per 100,000. Muktsar was closely followed by Mansa, Bathinda and Firozpur districts. Taran Taran district had the lowest rate at 41 per 100,000 people.

In April 2024, Punjab health department decided to formulate standard treatment guidelines (STGs) for cancer care services, to control rising cancer cases. It includes standard treatment protocols that will help doctors and patients to make informed decisions about suitable healthcare for specific clinical condition. Preventative healthcare in the form of lifestyle modifications, vaccination programmes and public health initiatives was stressed.

The table below shows the number of cases and estimated mortality of Breast cancer in Punjab.

HIV/AIDS
As of 2017, there were 40,600 estimated adult cases of HIV infection (AIDS) in Punjab, which comprised 0.18% of the population. As of July 2019, Amritsar district have the highest number of HIV positive cases at 16,619.

The table below shows shows the number of HIV positive cases in Punjab by district.

Differently Abled
According to the 2011 census, there were 654,043 differently abled persons in Punjab, which comprised 2.35% of the population. Out of these, 3,76,087 people have been provided with the 'disability' certificate. During 2016–2017, a total of 57,713 'disability' certificates were issued.

The table below shows the percentage of differently abled people in rural and urban areas of Punjab.

Under the Deendayal Disabled Rehabilitation Scheme, grant-in-aid is provided to the volunteer organizations working for the welfare of the differently abled people. The aid is given to the NGOs that work for rehabilitation of differently abled persons, including providing them education, artificial limbs, etc.

Under the Assistance to disable persons for purchase of fitting of Aid Appliances (ADIP Scheme), good quality prosthetics and assistive devices are provided to the differently abled persons with the help through voluntary organizations. Under this scheme, prosthetic devices are provided for free to the low income persons, who suffer from more than 40% disability. Ministry of Social Justice and Empowerment, provides a grant-in-aid for a cochlear implant for the children from lower income households.

There are 3 vocational training rehabilitation centers and one workshop in Punjab, where differently abled persons between the ages of 18 and 40 years are given training in different types of trades like tailoring, cutting, embroidery, typing/stenography, etc. to make them economically self-reliant. The rehabilitation centers are located in Ludhiana, Bathinda and Hoshiarpur and the workshop in Shimlapuri in Ludhiana district.

The differently abled persons with more than 40% disability can travel for free or with concession in state buses. For a blind person, travel is free within the state on state buses. For differently abled persons other than blind, there is 50% concession within the state in these buses.

Drug Use
According to the National Family Health Survey 2020–21, the percentage of people in Punjab above the age of 15 who consume alcohol was 22.8% for men and 0.3% for women. The rate of tobacco usage in the same age group was 12.9% for men and 0.4% for women. A study conducted by PGI Chandigarh revealed that, as of March 2022, around 1.7 lakh people consume opioids in Punjab.

Mental Health
According to a survey conducted in four districts of Punjab, in 2016, the current rate of mental morbidity was 13.42%. That means about 1,283,000 people were suffering from a mental illness in Punjab that year. The lifetime prevalence of mental morbidity was 17.94%. The number of people with high suicide risk was 51,600 and people with moderate suicide risk were 28,700.

It is asserted that, as of 2016, only about 20% of people suffering from mental illness had access to treatment. This is attributed to the low number of psychiatrists, which was only 0.45 per lakh people in Punjab. An increase of 20 to 25% was witnessed in the number of mental health cases in Punjab due to Covid-19 pandemic. The lockdown also had long term effects on the mental health of people from medical background, students, teachers or working professionals.

Punjab government runs 4 homes, called SEHYOG (Half Way Home), for persons suffering from mental illnesses from lower-income families. There the inmates are provided with free accommodation, food, health care, recreation and education. The Homes in Amritsar and Kapurthala are only for females and the Homes at Ludhiana are only for males. Each home has a capacity of 40 inmates.

According to the report by National Crime Records Bureau (NCRB), a total of 2,600 suicides were reported in Punjab in 2021, which was lower than the 2,616 in 2020. This was a rate of about 8.1 suicides per 1 lakh population in 2021, which was lower than the national average of 12.

Prisons
As of 2016, Punjab has the second highest prison suicide rate in India. In 2019, there were 13 such cases, second only to Uttar Pradesh at 20. In 2017 and 2018, Punjab reported maximum cases in the country at 13 and 27 respectively. A study of prison suicides between 2017 and 2019 found that about 42% of the victims died within a month of incarceration and 15% within 48 hours. About 54 percent of the victims were aged between 25 and 35 years. 71% of the victims were first time inmates and 79% were from rural background. Majority of the victims were held for drug smuggling.

In November 2023, Punjab government launched a mental health intervention program in four state jails. It would provide screening, counseling and referral services to the inmates. Councellors will conduct councelling to improve the mental health of the detainees and prisoners. According to the health and family welfare minister, later this project will also be implemented in other jails.

In October 2022, Punjab became the first state in India to allow conjugal visits to prisoners. According to a senior official, this decision was taken to keep the stress levels of inmates under control and ensure their re-entry into society, and this also fulfil a basic biological need. Under this scheme, prisoners who exhibited good conduct would be allowed to spend two hours in private with their spouses after every two months. Some categories of prisoners are kept out of this program, which includes high–risk prisoners, terrorists, gangsters and those imprisoned for domestic violence, child abuse and sexual crimes. Moreover, both spouses must be free from infectious diseases like HIV, STDs and Tuberculosis, to avail this program.

Medical Facilities
The hospitals in Punjab with facilities for cancer treatment are Government Medical College in Amritsar and a tertiary cancer care center at the civil hospital in Fazilka. On February 25, 2024 an AIIMS in Bathinda and a Postgraduate Institute of Medical Education and Research (PGIMER) satellite centre in Sangrur was opened. On the same day, foundation for a PGIMER satellite centre was also laid in Firozpur.

As of February 2023, at least 600 specialist doctors were required at various community health centers in Punjab, but only 151 were available. On 29 March 2024, first institute of Liver and Biliary Sciences was inaugurated in Mohali.

In October 2019, Punjab government and Post Graduate Institute of Medical Education and Research (PGIMER) jointly decided to promote Artificial Intelligence in healthcare in Punjab, to address health related issues. In May 2023, the health department in Punjab decided to use A.I. technology in the treatment of tuberculosis (TB), initially in 10 districts on a pilot basis. It will be used in analysing chest x-ray images and generating reports, which will help in early diagnosis. In April 2023, Parhar hospital in Phagwara became the first hospital in Punjab to get advanced technology for Robot Joint Replacement Surgeries.

As of June 2022, there were 51,689 allopathic doctors registered with the Punjab Medical Council.

The table below shows the district wise number of registered doctors and other registered medical personnel in Punjab, in year 2018. Note:- The ranks of the districts in this table are in the descending order of the number of registered doctors.

The table below shows the population served per doctor, per nurse and per midwife by districts of Punjab, in the year 2018. Note:- The ranks of the districts in the table are in the ascending order of the population served per doctor.

The table given below shows the population served per doctor in Punjab, by years.

The table below shows the district wise population served per bed.