Chapter Essence
Chapter 11 examines India's twin pillars of human capital — education and health. It tracks gains in school enrolment, learning outcomes, and higher education access; evaluates progress in maternal, child, and communicable disease health; and then pivots to three emerging crises: the obesity-NCD nexus driven by ultra-processed foods (UPFs), the rising nutritional complexity, and the fast-growing challenge of digital addiction among youth. The overarching message: structural programmes are working, but new behavioural and lifestyle threats require urgent, multi-pronged, evidence-based policy responses.
24.69 cr
Students in Schools (UDISE+ 2024-25)
70,018
Higher Education Institutions
29.5%
GER in Higher Education
42.78 cr
AB PM-JAY Cards Issued
24%
Women Overweight/Obese (NFHS 5)
96.96 cr
Internet Connections (2024)
32 lakh+
Tele-MANAS Calls Since 2022
UDISE+ 2024-25 Snapshot: 24.69 crore students | 14.71 lakh schools | 1.01 crore teachers. India has achieved near-universal enrolment at the preparatory level (GER 95.4) and middle level (GER 90.3), but secondary GER (68.5) and the foundational stage GER (41.4) highlight gaps at the two extremes.
💡 Concept: NEP 2020 — The 5+3+3+4 Curricular Structure
The National Education Policy 2020 replaced the old 10+2 model with a developmental stage-based architecture aligned with cognitive science:
- Foundational (5 years): Age 3–8; pre-primary (3 yrs) + Grades 1–2. Focus: play-based, multilingual learning
- Preparatory (3 years): Grades 3–5. Concept learning through activity
- Middle (3 years): Grades 6–8. Subject teachers, critical thinking, vocational exposure
- Secondary (4 years): Grades 9–12. Multidisciplinary, flexible, no hard stream divisions
This aligns curricula with the developmental stages of a child, ensuring age-appropriate pedagogy from age 3 to 18.
| Stage | Grades | GER (2024-25) | Policy Target |
|---|
| Foundational | Pre-primary to Gr. 2 | 41.4% | Universal 3–8 yr coverage |
| Preparatory | Grades 3–5 | 95.4% | Near-universal achieved |
| Middle | Grades 6–8 | 90.3% | Near-universal |
| Secondary | Grades 9–12 | 68.5% | Needs improvement |
💡 Concept: PARAKH — Performance Assessment for Holistic Development
PARAKH (Performance Assessment, Review and Analysis of Knowledge for Holistic Development) is NCERT's national assessment body established under NEP 2020. It moves away from rote-based testing toward competency-based assessment.
- PARAKH Rashtriya Sarvekshan 2024 (Grade III): 65% students proficient in Mathematics — up from 42% in 2021. Significant improvement in foundational learning.
- Complements ASER (Annual Status of Education Report) as an independent civil-society benchmark
- ASER 2024: Reading and arithmetic skills of rural youth (14–18 age group) surveyed — 91.94% of out-of-school adolescents (2 crore total) had no skilling exposure
Community Innovation — World's Best School 2025: Jalindarnagar ZP School (Maharashtra) won the World's Best School Prize in the Community Collaboration category — a remarkable recognition of grassroots education transformation driven by local participation.
School-to-Skill Gap: Of the ~2 crore out-of-school adolescents aged 14–18, 91.94% have received no skilling — a critical human capital risk that must be addressed through vocational integration in school curricula per NEP 2020.
India's higher education ecosystem has expanded from 51,534 to 70,018 HEIs, with a Gross Enrolment Ratio (GER) of 29.5%. The system now hosts 23 IITs, 21 IIMs, and 20 AIIMS — a major institutional expansion over the past decade.
💡 Concept: Vishwavidyalaya Bharati Shodh Abhiyan (VBSA) Bill, 2025
The VBSA Bill 2025 is a proposed legislative framework aimed at strengthening research and innovation in Indian universities. It focuses on:
- Creating a national research ecosystem linked to universities and HEIs
- Enabling interdisciplinary research collaboration
- Aligning India's higher education with global research standards
- Complementing the National Research Foundation (NRF) established under NEP 2020
Internationalisation
Indian Students Abroad
- Indians studying abroad: 6.85 lakh → 18 lakh
- Outward education remittance: USD 3.4 billion (FY24)
- Policy goal: Attract foreign students to India; reduce outflow
- India-specific course content and foreign campuses being invited
Faculty Innovation
Professor of Practice
- A NEP 2020 initiative bringing industry practitioners into academia
- 18,000+ Professors of Practice registered nationally
- Bridges the gap between academic theory and real-world application
- Enhances employability of graduates through industry-aligned curriculum
GER Target
50% GER by 2035
- Current GER: 29.5% (target: 50% by 2035 per NEP 2020)
- Open and distance learning (ODL) key to scaling
- SWAYAM MOOCs and digital platforms expanding reach
- Focus on equity: SC/ST, women, first-generation learners
Quality
NAAC & Rankings
- NAAC accreditation reformed with binary score system
- India improving in QS, THE global rankings
- IIT Bombay, Delhi, Madras in global top-200
- NIRF Rankings expanded to assess research output, patents, startups
Landmark Progress: IMR declined from 40 to 25 (2013→2023). Maternal Mortality Ratio (MMR) fell by 86% since 1990. India achieved the UN SDG 3 target on MMR ahead of schedule. Under-5 mortality rate also shows consistent decline.
💡 Concept: Epidemiological Transition
India is undergoing a classic epidemiological transition — the shift in disease burden from communicable/infectious diseases to non-communicable diseases (NCDs) as populations age, urbanize, and adopt modern lifestyles.
- Stage 1: Pestilence & famine — high mortality, infectious disease dominates
- Stage 2: Receding pandemics — improved sanitation, vaccines reduce deaths
- Stage 3: Degenerative diseases — NCDs (CVD, cancer, diabetes) emerge
- India now: NCDs account for >57% of all deaths, with cardiovascular diseases the leading cause (SRS COD Report 2021-23). Yet India still faces a double burden from infectious diseases.
| Health Indicator | Earlier | Latest | Source |
|---|
| Infant Mortality Rate (IMR) | 40 (2013) | 25 (2023) | SRS 2023 |
| Maternal Mortality Ratio (MMR) | ~550 (1990) | ~97 (2022) — 86% reduction | RGI |
| NCDs share of deaths | ~40% (2000s) | >57% (2021-23) | SRS COD 2021-23 |
| TB Incidence | Baseline (2015) | Down 21% | MoHFW 2025 |
| TB Treatment Coverage | ~70% (2015) | 92% (2025) | National TB Programme |
| AB PM-JAY Cards Issued | — | 42.78 crore | NHA 2025 |
| AB PM-JAY Admissions | — | 10.98 crore | NHA 2025 |
| AAMs Operational | — | 1,82,944 | MoHFW 2025 |
🎯 Policy Concept: Ayushman Bharat — India's Comprehensive Health Architecture
Ayushman Bharat is a three-part universal health coverage framework:
- AB-HWC / AAMs: 1,82,944 Ayushman Arogya Mandirs (renamed HWCs) — comprehensive primary care for all, including NCD screening, maternal health, mental health
- AB PM-JAY: Health insurance of ₹5 lakh/family/year for 55 crore beneficiaries (bottom 40%). 42.78 crore cards issued; 10.98 crore hospitalisations covered
- AB-HID / ABDM: Ayushman Bharat Digital Mission — digital health ID, health records, doctor/facility registry. Enables data-driven health planning
- NP-NCD: National Programme for Prevention & Control of NCDs — over 31.5 crore adults screened; 8.47 crore identified as overweight/obese
SRS Cause of Death 2021-23: Cardiovascular diseases are India's #1 killer. Higher proportion of ill-defined causes in women's deaths signals poor diagnostic access and healthcare utilisation — a gender equity gap in health systems.
Obesity Alert: 24% of women and 23% of men in India are overweight/obese (NFHS 2019-21). Childhood obesity: 3.3 crore children in 2020 — projected to reach 8.3 crore by 2035 (World Obesity Atlas 2024). Obesity prevalence nearly doubled in a decade, mirroring the 40× rise in UPF retail sales.
💡 Concept: Ultra-Processed Foods (UPFs) — The Nova Classification
UPFs are industrial food formulations made from substances extracted from foods (oils, starches, sugars, proteins) with added cosmetic additives (flavourings, emulsifiers, colours, preservatives). The NOVA classification groups foods into 4 categories:
- Group 1: Unprocessed/minimally processed foods (vegetables, fruits, milk)
- Group 2: Processed culinary ingredients (oils, butter, sugar, salt)
- Group 3: Processed foods (canned vegetables, cheese, cured meats)
- Group 4 (UPFs): Soft drinks, packaged snacks, noodles, breakfast cereals, chips — made almost entirely from industrial ingredients, with little or no whole food
India's UPF retail sales grew from USD 0.9 billion (2006) → USD 38 billion (2019), a 40-fold rise. UPF sales grew 150% from 2009–2023.
Health Evidence (Lancet UPF Series): High UPF consumption is associated with obesity, chronic heart disease, respiratory issues, diabetes, and mental health disorders. "There should be no delay in implementing public health policies while further research continues to unfold."
Economic Cost: Rising UPF consumption imposes costs through higher healthcare spending, lost productivity, and long-term fiscal strain. India is one of the fastest-growing UPF markets globally.
🎯 Policy Concept: India's Multi-Pronged UPF Policy Framework
India's response operates across regulation, taxation, awareness and labelling:
- NMAP 2017: National Multi-sectoral Action Plan for NCDs — 39 departments, targeting HFSS foods; set 2025 obesity halt target
- ICMR-NIN Dietary Guidelines 2024: Explicitly warn against UPFs; recommend limiting HFSS products
- FOPL (Front-of-Pack Labelling): Warning labels proven more effective than Health Star Ratings (Nutri-Score type) in discouraging UPF purchase
- Marketing Restrictions: Proposed ban on UPF ads 06:00–23:00 on all media. Global precedent: UK bans junk food ads before 9 PM
- Nutrient-Based GST Surcharge: Exploring highest GST slab + surcharge on UPFs exceeding sugar/salt/fat thresholds; revenue earmarked for public health
- FSSAI regulation: Bring UPFs under clear definition and standards using NOVA or cosmetic additive identification
- Government initiatives: POSHAN 2.0, Fit India Movement, Khelo India, Eat Right India, "Aaj Se Thoda Kam" campaign (10% oil reduction), NP-NCD screening (31.5 crore adults screened)
Nutritional Progress: Daily per capita calorie and protein intake has increased in both rural and urban areas (2009-10 to 2023-24). Rural-urban calorie convergence observed across MPCE deciles. EAC-PM study: dietary diversity of micronutrient intake improved significantly for bottom 20% households (2011-12 to 2022-23).
💡 Concept: Double Burden of Disease / Malnutrition
India simultaneously faces two extremes of nutritional disorder:
- Undernutrition: Stunting (31.8% in Rajasthan, NFHS 5), wasting, micronutrient deficiencies — especially in children under 5, adolescent girls, pregnant/lactating mothers
- Overnutrition: Rising obesity, overweight, and UPF-driven NCDs — affecting all age groups and urban-rural populations
- Policy challenge: Interventions must address both simultaneously without creating trade-offs (e.g., high-calorie food distribution can worsen obesity)
- Response: POSHAN 2.0, NFSA, PMMVY, Saksham Anganwadi, mid-day meals — but need to shift from quantity to quality and diversity
🎯 Policy Concept: Rajasthan Cash Plus Model (SBCC Strategy)
A landmark state-level innovation converging cash transfers with Social & Behaviour Change Communication (SBCC) to tackle maternal and child undernutrition in tribal districts:
- Converged PMMVY + Mukhya Mantri Matritva Poshan Yojana; piloted in 5 tribal districts
- Custom 'Margdarshika' guideline for AWWs; ANMs for antenatal counselling
- Targeted husbands, mothers-in-law, community — not just mothers
- 'Bahubali' digital campaign on Facebook/YouTube — reframed masculinity around shared household nutrition responsibility
- Results (2022→2025): 54% more women using cash for nutrition; proportion using cash for food: 30% → 89%; 35% reduction in myths/taboos; awareness among men: 18% → 62%
Lesson: Financial transfers alone are insufficient; SBCC as a core programme component ensures aid is used as intended.
India's Digital Scale: Internet connections grew from 25.15 crore (2014) → 96.96 crore (2024). 85.5% of households own at least one smartphone (2025). ~40 crore users on OTT/food delivery; ~35 crore on social media. The binding constraint is no longer access — it's behavioural health.
💡 Concept: Digital Addiction
Digital addiction is defined as a behavioural pattern of excessive or compulsive engagement with digital devices or online activities that leads to distress and functional impairment (APA Dictionary of Psychology). It encompasses:
- Social media addiction: Associated with anxiety, depression, low self-esteem, cyberbullying stress (age 15–24 most affected)
- Gaming disorder: Recognised by WHO under ICD-11 — sleep disruption, aggression, social withdrawal, depression
- Online gambling/real money gaming: Financial stress, depression, anxiety, suicidal ideation
- Streaming/short video compulsion: Poor sleep hygiene, reduced concentration, heightened stress
- Economic costs: Lost study hours, reduced productivity, cyber fraud losses, reduced lifetime earnings
Global Responses
International Regulatory Actions
- Australia: Nationwide ban on social media for under-16
- South Korea: Cinderella Law (2011) — gaming ban after midnight; repealed 2021 in favour of parental controls
- China: 1 hr/day gaming limit (weekends/holidays); real-name registration
- Singapore: Media Literacy Council — digital citizenship in schools
- UK: Digital Resilience Framework + junk food ad ban before 9 PM
- Seoul: 'I Will Centres' for addiction prevention and recovery
India's Response
India's Policy Ecosystem
- CBSE: Safe internet use guidelines for schools/buses
- Pragyata: MoE's digital education framework with screen-time attention
- Tele-MANAS: 24/7 toll-free helpline (14416); 32 lakh+ calls; app launched 2024
- SHUT Clinic, NIMHANS: Specialised care for compulsive tech use; free parent sessions
- Online Gaming (Regulation) Act, 2025: Bans wagering games; advertising restrictions; licensing framework for skill-based games
- Karnataka: Digital Detox Centre 'Beyond Screens'
💡 Concept: Social Connectedness Index (SCI) & Suicide Rates
The Facebook Social Connectedness Index (SCI) measures the relative probability of a Facebook friendship link between two users in different locations. Economic Survey 2025-26 used district-level SCI data (60+ million pairs of geographic linkages) to study the relationship between social connectedness and suicide death rates (SDR).
- Key finding: Inverse correlation — states with higher within-district connectedness (more local, in-person social bonds) tend to have lower SDRs
- Bihar: Sparse cross-district chords, thick within-district arcs → SDR 0.7 (very low)
- UP: Similar pattern → SDR 3.9
- Kerala: Highly dispersed, diffuse digital social fabric → SDR 30.6 (high)
- Tamil Nadu: Similarly dispersed → SDR 25.3
- Implication: As digital social networks displace in-person friendships, mental health risks (including suicide) may rise — reinforcing the need for offline community building alongside digital expansion
🎯 Policy Concept: Tele-MANAS — India's National Tele-Mental Health Programme
Tele Mental Health Assistance and Networking Across States (Tele-MANAS) was launched by MoHFW in October 2022:
- 24/7 toll-free helpline: 14416 — available across all states and UTs
- Connects callers to trained mental health professionals at no cost
- Tele-MANAS app launched 2024 for enhanced digital access
- Over 32 lakh calls received since launch
- Way forward: Expand scope to explicitly address digital addiction; integrate with schools and colleges; train dedicated digital addiction counsellors
Way Forward on Digital Addiction: Develop comprehensive national prevalence data (Second NMHS by NIMHANS). Metrics: screen time, sleep quality, anxiety levels, academic performance, cyberbullying exposure. Promote offline youth hubs, Digital Wellness Curriculum in schools (cyber safety + mental health awareness), age-based access limits, and family-level screen-time education.
India's health and education sectors face interconnected new-age challenges: double burden of CDs and NCDs, rising digital addiction, mental health crisis, poor nutrition quality, and climbing obesity. Together, they threaten the demographic dividend by perpetuating cycles of unemployment, inequality, and lost productivity.
Tech-Driven Surveys
Data & AI for Health Hotspots
- UDISE+, AISHE, ABDM integration with AI tools
- Identify 'health hotspots': obesity in urban slums, digital addiction in peri-urban schools
- ASHABot, ASHA Kirana's M-CAT, ASHA Digital Health — frontline worker empowerment via mobile apps and AI chatbots
PPP Models
Public-Private Partnership in Health
- Frontline worker-led initiatives using technology for chronic disease management
- AI chatbots for diabetes monitoring, COVID-19 tracking, MCH outcomes
- Doordarshan + social media campaigns with relatable role models
Holistic Vision
Resilient Citizens for Viksit Bharat
- Prioritise education, skilling, digital wellness, health, nutrition through open dialogue
- Feedback surveys, success stories, role models to drive behaviour change
- Normalise conversations on mental health, screen time, lifestyle diseases
- Whole-of-life approach for nutrition; integrate AYUSH for NCD management
Practice MCQs — Chapter 11
Q1. As per UDISE+ 2024-25, what is India's Gross Enrolment Ratio (GER) at the secondary level (Grades 9–12)?
- A. 95.4%
- B. 68.5%
- C. 90.3%
- D. 41.4%
Explanation: GER at the secondary stage (Grades 9–12) is 68.5%, revealing a significant dropout challenge compared to the preparatory (95.4%) and middle (90.3%) levels. The foundational stage (pre-primary to Gr. 2) GER stands at 41.4%, highlighting the need for Balvatika expansion.
Q2. The PARAKH Rashtriya Sarvekshan 2024 found that Grade III students' proficiency in Mathematics stood at:
- A. 42%, unchanged from 2021
- B. 42% in 2021, declined in 2024
- C. 65% in 2024, up from 42% in 2021
- D. 85% in 2024
Explanation: PARAKH 2024 showed significant improvement — 65% Grade III students are now proficient in Mathematics, up from 42% in 2021. This reflects the impact of foundational learning interventions under NEP 2020 and NIPUN Bharat.
Q3. Which of the following correctly describes India's epidemiological profile as per the SRS Cause of Death Report 2021-23?
- A. Communicable diseases still account for more than 60% of deaths
- B. Diabetes mellitus is the single largest cause of death
- C. Cardiovascular diseases are the leading cause; NCDs account for over 57% of all deaths
- D. Respiratory infections and fever are the top causes
Explanation: India has completed an epidemiological transition. NCDs now account for >57% of deaths, with cardiovascular diseases as the #1 killer. The higher proportion of ill-defined causes in female deaths highlights gender gaps in diagnostic access.
Q4. India's retail sales of Ultra-Processed Foods (UPFs) grew from USD 0.9 billion in 2006 to nearly USD 38 billion in 2019. This represents:
- A. A 10-fold increase
- B. A 20-fold increase
- C. A 40-fold increase
- D. A 150-fold increase
Explanation: Retail sales of UPFs surged ~40-fold from USD 0.9 billion (2006) to USD 38 billion (2019). Separately, UPF sales also grew by more than 150% from 2009 to 2023. This mirrors the near-doubling of obesity rates in the same period.
Q5. The Online Gaming (Regulation) Act, 2025 primarily addresses:
- A. Regulation of video game exports from India
- B. Taxation of e-sports tournaments
- C. Banning online money games involving wagering, restricting advertising, and licensing skill-based games
- D. Setting age limits for video game purchase in physical stores
Explanation: The Online Gaming (Regulation) Act 2025 addresses digital addiction and financial harm by banning wagering-based online money games, restricting their advertising, and creating a licensing framework for permissible skill-based games — targeting compulsive use, debt, and related mental health concerns.
Q6. The Rajasthan 'Cash Plus' Model for maternal nutrition achieved which of the following results between 2022 and 2025?
- A. 10% increase in women using cash for nutrition purposes
- B. Complete elimination of stunting in 5 tribal districts
- C. Proportion of women using cash for food increased from 30% to 89%; awareness among men rose from 18% to 62%
- D. 100% increase in PMMVY fund disbursement
Explanation: The Cash Plus model combined DBT with SBCC strategy targeting husbands, mothers-in-law, and community — not just beneficiaries. Results: 54% more women using cash for nutrition; food use of cash 30%→89%; myths/taboos reduced 35%; male awareness 18%→62%.
Q7. The Social Connectedness Index (SCI) study in the Economic Survey 2025-26 found that:
- A. States with higher digital connectivity have lower suicide rates
- B. States with higher within-district (local, in-person) connectedness tend to have lower suicide death rates
- C. Social media use is positively correlated with mental well-being
- D. Bihar and UP have the highest suicide death rates in India
Explanation: The SCI study using Facebook data showed a broad reverse correlation — states like Bihar (SDR 0.7) and UP (SDR 3.9) with thick within-district connections had very low SDRs; Kerala (SDR 30.6) and Tamil Nadu (SDR 25.3) with diffuse inter-district digital networks had higher SDRs.
Q8. Which of the following statements about front-of-pack nutrition labelling (FOPL) is consistent with the findings cited in Economic Survey 2025-26?
- A. Health Star Ratings are the most effective system globally
- B. The Nutri-Score system is recommended for India as it is scientifically superior
- C. Warning labels are the most effective option for discouraging UPF consumption compared to ranking-style labelling schemes
- D. FOPL has no significant impact on consumer purchasing behaviour
Explanation: Studies show warning labels outperform ranking systems (Nutri-Score, Health Star Ratings) in discouraging UPF purchase. A multi-sector consensus of 29 organisations recommended replacing the proposed Indian Nutrition Rating (Health Star Rating) system with warning labels. Prohibition of health claims on UPFs is also recommended.
