India has achieved one of the great public-health gains of the past century: we are living much longer. Life expectancy, around 40 years in the early years after Independence, is about 72 today. The gap with the United States, at around 79 years, has narrowed sharply.
But longevity creates a new challenge: How many of those additional years will be lived in good health?
WHO’s latest comparable estimates put healthy life expectancy at 58.1 years in India, against 63.9 in the United States and 73.4 in Japan. Japan’s achievement, therefore, is not simply longevity. It is healthy longevity.
India’s latest National Family Health Survey, NFHS-6, shows why this matters. Nearly 31% of women and 27% of men aged 15–49 are overweight or obese. Among adults over 15, high or very high blood sugar, or medication to control it, affects 17.8% of women and 20.9% of men, up sharply from NFHS-5. Hypertension affects 19.4% of women and 22.1% of men.
India has become better at improving longevity. We must now become equally good at keeping people healthy.
There is a strong case for shifting health care from rescue to prevention. Screening remains essential. Detecting diabetes, hypertension or cancer early can save lives and reduce treatment costs. But prevention can begin even before screening.
By the time high blood sugar, blood pressure or excess weight appears, risk may have been building for years. The earlier opportunity is to shape the behaviours that influence whether these risks develop: what we eat, how active we are, how we sleep and the choices we make every day.
That takes us to childhood.
Over 12 years of schooling, a child will eat thousands of meals, develop food preferences and establish patterns of physical activity and other lifestyle behaviours.
Why wait until 35 or 40 to change habits that could have been formed at eight?
Japan confronted the consequences of longevity and an ageing population much earlier. Its response focused not just on extending life, but on extending healthy life.
Health Japan 21, launched in 2000, put prevention of lifestyle-related diseases at the centre of national health policy. In 2005, Japan enacted the Basic Act on Shokuiku, or food and nutrition education.
Its proposition was simple: food education is a foundation of life. People need more than information about nutrients. They need the ability to choose appropriate food and practise healthy dietary habits throughout life.
Japan did not create another school subject. Food education was woven into everyday school life. School meals became opportunities to learn. Children connected food with health, cooking, agriculture, culture and food waste.
Nor was Shokuiku confined to schools. It extended to families and communities. The principle was simple: healthy behaviour is more likely to endure when learned early, practised regularly and reinforced by the environment.
India can learn from this principle without copying Japan.
Schools do not need another subject called nutrition, another textbook or another examination. Children need frequent, simple food, nutrition and lifestyle learning woven into everyday school life.
Five minutes around a school meal can teach a balanced plate. Mathematics can use food labels. Science can connect digestion with what children eat. Kitchen gardens can link nutrition with agriculture and sustainability. Drinking water, physical activity, hygiene, sleep and mindful eating can become daily practices rather than examination answers.
But schools must also practise what they teach. Healthy-eating lessons mean little if the food environment encourages the opposite. Hygiene lessons without working handwashing facilities send contradictory messages.
School meals, canteens, drinking water, playgrounds, gardens and classroom routines can make schools living laboratories for prevention.
The aim is to move from knowledge to capability. A child who can name nutrients has information. One who can assemble a balanced meal, choose water over a sugary drink, read a food label, stay active and eat mindfully has skills for life.
India already has the platforms. Schools reach children while habits are forming. PM POSHAN provides a daily encounter with food. Anganwadis reach younger children and families. Primary healthcare and workplaces can reinforce healthy behaviours later in life.
What is missing is the connecting thread: Foundational food, nutrition and lifestyle literacy across the life course.
The model can be simple and affordable: Learn, practise, repeat and reinforce.
India’s first great health achievement was adding years to life. The next must be adding healthy life to those years. Hospitals, medicines, insurance and screening will remain indispensable. But prevention can start long before someone becomes a patient.
Japan learnt that healthy ageing does not begin in old age. India should act on that lesson now.
The best time to prevent disease is before there is disease to detect. And one of the best places to begin is school.
(The views expressed are personal)
The article is authored by Pawan Agarwal, CEO, Food Future Foundation and former CEO, FSSAI.
