March 12, 2026
In his Hindustan Times column, Vital Signs, OHT’s Dr. Ramanan Laxminarayan writes that while much attention has been given to the economic wealth extracted from India during colonial rule, far less discussion has focused on how little the colonial state invested in the health of the population. He argues that many of the institutions, laws, and administrative systems that influence India’s health sector today were originally designed to serve colonial priorities; protecting British troops, port cities, and trade routes rather than improving population health.
These priorities created lasting inequalities in public health infrastructure and services. Regions that were directly ruled by the British often had weaker investments in education, health facilities, and roads compared to princely states, and these disparities have continued decades after independence.
Dr. Laxminarayan suggests that India’s health system still carries the legacy of these choices. Moving forward, he argues, the country must shift toward stronger, equitable public health investments that prioritize the health and well-being of the entire population.
He writes, “India did not begin in 1947 with a blank slate. We inherited laws, institutions, hierarchies, and disparities forged under colonial rule. Many remain embedded in our system. The challenge is to rethink our commitment to this core element of human well-being, by shifting from extraction-oriented vertical systems toward equitable, population-wide public health investment.”
Read it here.
