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.
