Individuals should be entitled to a ‘fair innings’, and the primary role of health systems should be the prevention of premature mortality.

In India, 66 percent of all deaths during 2010-15 were premature. Over the decades, the burden of premature mortality has shifted from child (0-5 years) to adult (30-69 years) level – 65 percent of premature deaths happened at the adult and 22 percent at the child level during 2010-15.

Primary health systems, however, continue to focus almost exclusively on child mortality. They need to make a health system transition and engage in prevention of chronic diseases – the major cause of adult mortality – together with their original focus on child mortality.

This policy brief analyzes some of the major challenges in terms of governance, manpower and financing that such a transition will be faced with, and develops a number of actionable policy recommendations to address them.

It does so based on extensive desk and field research in 4 Indian states – Uttar Pradesh, Rajasthan, Kerala, Tamil Nadu – and 4 countries – Japan, Canada, United States, Sri Lanka – involving interactions with close to 200 stakeholders from policy, industry, international organizations, civil society and the academia.

In less than a decade, the burden of chronic diseases will overwhelm health systems in India –89 percent of mortality will happen at 30+ year level by 2025-2030.

A reorientation of national and state health policies, systems and resources is urgently required.

The Central government should accept its moral responsibility, strengthen its regulatory capacity, and provide technical together with financial support to state / UT governments.

The latter, on their part, would have to embrace their legal responsibility of being the primary agents for survival and health of their populations. Their role is critical because prevention of chronic diseases requires a sustained, long-term engagement.