By Nishant Aggarwal
The right to health has become central to modern constitutionalism, representing the intersection of dignity, life, and equality. Though not explicitly enumerated in the Indian Constitution, the Supreme Court has interpreted Article 21 guaranteeing life and personal liberty as encompassing the right to health. In Consumer Education and Research Centre v. Union of India and State of Punjab v. Mohinder Singh Chawla, the Court held that the right to health and medical care is fundamental to the right to life.
Despite this expansive jurisprudence, India’s public health infrastructure remains chronically underdeveloped. Government hospitals, relied upon by the majority of citizens, particularly the poor, suffer from insufficient funding, manpower shortages, and lack of essential medical facilities. These persistent deficiencies undermine not just governance efficiency but the constitutional guarantee of life with dignity. The COVID-19 pandemic exposed these structural weaknesses, revealing how inadequate healthcare infrastructure can directly cause preventable deaths.
This study investigates whether such failures amount to a breach of constitutional duty, examining the contours of State accountability under Article 21 and related constitutional principles.
The Constitutional Foundation of the Right to Health
Article 21’s interpretation has evolved from the narrow reading in A.K. Gopalan v. State of Madras to the expansive vision in Maneka Gandhi v. Union of India, where “procedure established by law” was held to include fairness and reasonableness. This paved the way for health to be subsumed within the meaning of life with dignity. The judiciary’s consistent approach—seen in Paschim Banga Khet Mazdoor Samity v. State of West Bengal and Parmanand Katara v. Union of India affirms that denial of timely medical aid violates Article 21.
Directive Principles further reinforce this interpretation. Article 47 obliges the State to improve public health and raise the standard of living. While non-justiciable, these principles, when harmonized with fundamental rights, create enforceable obligations. Thus, the State’s duty to ensure adequate healthcare is not merely policy-oriented but constitutionally rooted.
State Obligation and Healthcare Accessibility
Judicial precedents underscore that healthcare cannot be denied on grounds of financial incapacity or administrative convenience. In Paschim Banga, the Supreme Court held the State liable for failing to provide emergency treatment to an accident victim due to lack of facilities, emphasizing that resource constraints cannot justify rights violations. Similarly, Mohinder Singh Chawla reaffirmed that maintaining healthcare standards is part of the State’s fundamental duty.
Empirical evidence paints a stark picture. India has approximately 1.3 hospital beds per 1,000 people, far below the WHO’s benchmark of 3. Nearly 80% of community health centers lack specialist doctors, and public expenditure on health remains around 2% of GDP. Such deficiencies disproportionately affect the economically weaker sections who rely entirely on public hospitals. The situation worsens when medicines are unaffordable and hospital capacities limited, effectively excluding vast sections of the population from accessing basic healthcare.
This violates the principle of equality under Article 14 and the dignity aspect of Article 21. Reliance on the private sector for essential healthcare, when public facilities fail, deepens socio-economic inequality. The State’s constitutional obligation, therefore, extends beyond creating policies—it entails ensuring functional, affordable, and accessible public healthcare infrastructure for all citizens.
International and Comparative Constitutional Perspectives
Global human rights frameworks reinforce the enforceability of the right to health. Article 12 of the International Covenant on Economic, Social and Cultural Rights (ICESCR) obligates States to ensure “the highest attainable standard of physical and mental health.” General Comment No. 14 elaborates that States must at least guarantee a “minimum core obligation,” including access to essential medicines and basic health services.
South Africa’s Constitution explicitly guarantees the right to healthcare, and in Treatment Action Campaign v. Minister of Health, the Constitutional Court compelled the government to provide life-saving HIV medication, rejecting resource constraint arguments. Colombia’s Constitutional Court, through the tutela mechanism, recognized health as an enforceable fundamental right, ensuring judicial remedies for denial of medical treatment.
India’s jurisprudence mirrors these trends, but its enforcement mechanisms remain weak. Recognizing health as a justiciable right beyond a policy objective would align domestic practice with international commitments and comparative constitutional standards.
Systemic Failures and Constitutional Negligence
State accountability for healthcare failures arises under the doctrine of constitutional torts, developed through cases such as Nilabati Behera v. State of Orissa and Municipal Council, Ratlam v. Vardichand. These judgments established that the State can be held liable in public law for failure to discharge constitutional obligations. When systemic inadequacies such as shortage of hospital beds, lack of medicines, or non-functional facilities result in avoidable deaths or suffering, such omissions constitute constitutional negligence.
The judiciary has also applied this principle beyond direct healthcare contexts. In Bandhua Mukti Morcha v. Union of India, socio-economic rights were read into Article 21, linking the Directive Principles with enforceable fundamental rights. Extending this reasoning, chronic neglect of public healthcare amounts to dereliction of a constitutional duty, inviting not only declaratory relief but potentially compensation under public law remedies.
Arguments that courts should refrain from policy interference fail when fundamental rights are at stake. Judicial oversight does not intrude upon policy-making; it ensures that minimum constitutional obligations are upheld. The courts’ role, therefore, is not legislative substitution but constitutional enforcement.
Healthcare Affordability and the Right to Life with Dignity
Access to affordable medicine and hospital care is intrinsic to the right to life. The high cost of essential medicines, often unaffordable even in government facilities, undermines the principle of universal access. Out-of-pocket expenditure forms nearly two-thirds of total health spending in India, pushing millions into poverty annually. This economic exclusion directly contradicts the vision of Article 21.
The Supreme Court’s recognition in Paschim Banga that lack of treatment due to inadequate facilities violates Article 21 can be extended to include denial caused by unaffordability. Ensuring access to essential drugs and adequate infrastructure thus becomes a constitutional, not merely administrative, responsibility.
Reconceptualizing the Right to Health as a Justiciable Entitlement
The right to health in India has transitioned from a welfare directive to a fundamental entitlement, but implementation remains inconsistent. Constitutional interpretation, comparative jurisprudence, and empirical realities all affirm that healthcare must be treated as a non-derogable constitutional duty. Recognizing the State’s liability for healthcare failures would not only strengthen accountability but also align governance with constitutional morality.
A reconceptualized framework should:
Treat minimum healthcare standards as enforceable obligations.
Introduce statutory codification of the right to health to define accountability mechanisms.
Strengthen judicial remedies, including public law compensation, for denial of essential healthcare.
Such measures would convert judicial recognition into actionable governance reform, bridging the persistent gap between constitutional promise and institutional performance.
Conclusion
The inadequacy of India’s public healthcare system constitutes more than administrative inefficiency it represents a continuing constitutional breach. The right to health, embedded in Article 21 and supported by Directive Principles, imposes a direct, positive duty on the State to ensure accessible, affordable, and quality healthcare. Judicial precedents unequivocally hold that financial incapacity cannot excuse such failure.
Comparative constitutional experiences demonstrate that even resource-constrained nations have enforced health rights effectively. India, with a well-developed jurisprudence on socio-economic rights, must now move from recognition to realization. Systemic failures whether in the form of bed shortages, medicine unavailability, or medical negligence should be treated as constitutional negligence attracting State liability.
Ultimately, the health of citizens is inseparable from the legitimacy of the State. A government that cannot safeguard the basic conditions of life undermines the very foundation of constitutional democracy. Ensuring healthcare as a justiciable and enforceable right is therefore not an act of welfare, but an indispensable constitutional obligation.
—Nishant Aggarwal is third-year law student of Christ University
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