Health and nutrition indicators: reading the numbers

Detail

1. Why health numbers matter in measuring development

• Income alone does not show well-being. Two countries can have the same per capita income and still differ a lot in how long people live and how many babies die.
• So the Human Development Index (HDI), the UNDP's index of health, education and income, uses life expectancy at birth as its health measure.
• The Human Development Report (HDR) 2025, using 2023 data, puts India's life expectancy at 72.0 years.
• Health indicators fall into three groups:
• Mortality: IMR, crude death rate, maternal mortality.
• Longevity: life expectancy.
• Nutrition and environment: undernourishment, BMI, water and sanitation.

2. The long view: India, 1951 to 2018-22 (Class 11, Table 4.1)

Indicator	1951	1981	1991	2001	2018-22
Real per capita income (Rs)	7,651	12,174	15,748	23,095	94,054
Crude death rate (per 1,000)	25.1	12.5	9.8	8.1	6.0
Infant mortality rate	146	110	80	63	28
Life expectancy, male	37.2	54.1	59.7	63.9	68.6
Life expectancy, female	36.2	54.7	60.9	66.9	71.4
Literacy rate (%)	16.67	43.57	52.21	65.20	78

How to read the table:

• Real per capita income rose about 12 times (Rs 7,651 → Rs 94,054).
• IMR fell about 81% (146 → 28).
• The crude death rate fell about 76% (25.1 → 6.0).
• Life expectancy nearly doubled for both men and women.
• Crossover: in 1951 men lived longer (37.2 vs 36.2 years). By 1981 women had overtaken men (54.7 vs 54.1). Today the gap is 71.4 vs 68.6 years.
• Women outliving men is the normal biological pattern.
• The 1951 reversal pointed to gender discrimination and high maternal deaths.

3. Infant Mortality Rate (IMR)

• Definition: IMR is the number of babies who die before their first birthday, for every 1,000 live births in a year.
• Formula: IMR = (infant deaths in the year ÷ live births in the year) × 1,000
• Worked example: a district has 2,00,000 live births and 5,200 infant deaths in a year.

• IMR = 5,200 ÷ 2,00,000 × 1,000 = 26.

• Trend:

• Colonial period: about 218.
• 1951: 146.

• 2018-22: 28 (NCERT).

• Latest official data: IMR fell from 39 per 1,000 live births (2014) to 27 (2021), based on the Sample Registration System (SRS) [2].

• The latest SRS figure may be about 25–26 (verify against the newest SRS bulletin).

• Between 1990 and 2023 India cut [2]:

• IMR by 71%
• the Under-Five Mortality Rate (U5MR) by 78%
• the Neonatal Mortality Rate (NMR) by 70%

• (U5MR counts child deaths before age 5. NMR counts baby deaths in the first 28 days of life.)

• Comparison (keec108, World Development Indicators data): India 25.5, China 4.8, Pakistan 51.

• Why it matters: IMR is very sensitive to clean water, vaccination, mothers' education and institutional deliveries (births in hospitals or health centres). This makes it one of the best single measures of a society's welfare.

4. Crude death rate (mortality rate)

• Definition: the number of deaths for every 1,000 people in a year.
• Formula: CDR = (total deaths ÷ mid-year population) × 1,000
• Worked example: a town of 5,00,000 people has 3,000 deaths in a year.

• CDR = 3,000 ÷ 5,00,000 × 1,000 = 6.0. This matches India's 2018-22 level.

• Trend: it fell from 25.1 (1951) to 6.0 (2018-22).

• Trap: the CDR is "crude" because it ignores age structure.
• A young country can have a low CDR even with weak health services.
• An ageing country's CDR can rise even as its health improves.
• So never compare CDRs across countries without thinking about age structure.

5. Life expectancy at birth

• Definition: the average number of years a newborn baby would live if today's death rates at each age stayed the same all through its life.

• It is a snapshot of today's death rates, not a forecast.

• Trend:

• About 32 years in colonial India.
• 37.2 (male) and 36.2 (female) in 1951.
• 68.6 (M) and 71.4 (F) in 2018-22.

• 72.0 (HDR 2025, data year 2023).

• Link to HDI: life expectancy is the health dimension of the HDI.

• Key driver: falling infant and child deaths add the most to life expectancy. A death at age 0 removes a whole lifetime from the average.

6. Maternal mortality: ratio versus rate

• Maternal death: a woman dies while pregnant or within 42 days after the pregnancy ends, from causes linked to the pregnancy.
• Maternal Mortality Ratio (MMR): maternal deaths for every 1,00,000 live births.
• Formula: MMR = (maternal deaths ÷ live births) × 1,00,000
• Worked example: a state has 10 lakh live births and 930 maternal deaths.

• MMR = 930 ÷ 10,00,000 × 1,00,000 = 93. This is India's SRS 2019-21 level.

• Maternal Mortality Rate: it uses women aged 15–49 as the denominator, not live births.

• It shows both the risk in each pregnancy and how often women become pregnant.

• NCERT terminology error: keec108 says "Maternal Mortality Rate per lakh births". A figure per 1,00,000 live births is strictly the ratio.

• SRS trend (SRS is the Registrar General's large sample survey of births and deaths):
• 130 (2014-16)
• 97 (2018-20) [3]
• 93 (2019-21), a fall of 37 points [2]

• Check for a newer SRS bulletin (verify latest).

• UN estimates: the UN Maternal Mortality Estimation Inter-agency Group (UN-MMEIG) is a separate source from SRS.

• Its estimate for India fell from 384 (2000) to 103 (2020) [4].
• This 103 matches keec108's India figure.
• Its report for 2000-2023 (published 7 April 2025) shows India's MMR fell by 23 points from 2020 to 2023 [2], which puts it at about 80.

• From 1990 to 2023, India's MMR fell 86%. The world's fell 48% [2].

• Targets:

• SDG target 3.1: global MMR below 70 by 2030.

• National Health Policy 2017: 100 by 2020. India met this target.

• Comparison (keec108, 2017-2023): India 103, China 23, Pakistan 154.

• Exam caution: SRS (India's own data) and UN-MMEIG (modelled estimates) give different numbers for the same year. Always name the source.

7. Nutrition: undernourishment

• Undernourishment: a person's usual food intake does not give enough dietary energy (calories) for a normal, active, healthy life.
• How FAO measures it: as the Prevalence of Undernourishment (PoU), published in its State of Food Security and Nutrition in the World (SOFI) report.
• Where it is used:
• As the indicator for SDG 2.1 (end hunger).

• As one of the four Global Hunger Index (GHI) indicators. The other three are child stunting, child wasting and child mortality.

• keec108: India 17%, China 3%, Pakistan 19%.

• Caution: PoU measures calories only. A person can get enough calories and still lack iron, vitamins or protein. This is called hidden hunger.

8. Body Mass Index (BMI)

• Formula: BMI = weight (kg) ÷ [height (m)]²
• Adult cut-offs:

BMI	Category
Below 18.5	Underweight
18.5–24.9	Normal
25 or above	Overweight
30 or above	Obese

• Worked examples:
• A woman weighs 45 kg and is 1.60 m tall: BMI = 45 ÷ 2.56 = 17.6, so she is underweight.

• A man weighs 80 kg and is 1.70 m tall: BMI = 80 ÷ 2.89 = 27.7, so he is overweight.

• Children and teenagers: they are judged on BMI-for-age charts, not the adult cut-offs, because normal body shape changes as they grow.

• NCERT Activity 3: a girl aged 14 years 8 months with BMI 15.2 is undernourished.

• A boy aged 15 years 6 months with BMI 28 is overweight.

• The double burden of malnutrition: India has undernutrition (low BMI) and overnutrition (high BMI) at the same time, often in the same state.

9. Adult undernutrition by state (Class 10, Ex. 13)

Adults aged 15–49 with BMI below 18.5:

State	Male %	Female %
Kerala	8.5	10
Karnataka	17	21
Madhya Pradesh	28	28
All India	20	23

• NCERT labelling error: the table says NFHS-5 (2019-21), but its figures match NFHS-4 (2015-16).
• The Health Ministry reports that women (15–49) with BMI below normal fell from 22.9% (NFHS-4) to 18.7% (NFHS-5) [5].
• So the table's "23%" for women is the NFHS-4 figure.

• For men, NFHS-5 gives about 16.2% (verify).

• Child nutrition, NFHS-4 → NFHS-5 [5]:

Indicator	NFHS-4 (2015-16)	NFHS-5 (2019-21)
Stunting (too short for age)	38.4%	35.5%
Wasting (too thin for height)	21.0%	19.3%
Underweight (too light for age)	35.8%	32.1%

• Stunting and wasting are covered in detail in human-capital.

• Anaemia: in NFHS-5 Phase I, more than half of children and women were anaemic in 13 of the 22 States/UTs surveyed. Anaemia among pregnant women rose in half of these States/UTs, even though more of them took iron-folic acid (IFA) tablets [6].

• Newer data: PIB has reported findings from NFHS-6 [7]. Check its figures before using them to replace NFHS-5 data.
• Reading the table:
• Kerala has the lowest rate (8.5% of men, 10% of women). It has strong public health services, a working PDS and high female literacy.
• Madhya Pradesh has 28% for both.
• The gap between states shows that public action matters, not just income.

10. Ex. 13(ii): why is one-fifth undernourished when India has enough food?

The answer is access, not availability.

• Poverty and prices: poor households cannot buy enough food, even when the market has plenty.
• A weak Public Distribution System (PDS) in some states: the PDS is the ration-shop network that sells subsidised grain. Where it works badly, poor families lose a safety net.
• Poor sanitation and disease:
• Dirty water and open defecation → frequent diarrhoea and gut infections.
• → The body cannot absorb nutrients.

• → The person stays undernourished even after eating enough.

• Amartya Sen's entitlement approach:

• Hunger comes from the failure of a person's command over food (through income, production, trade or state support), not only from a shortage of food.
• This is why famines have happened even when food stocks were adequate.

11. Water and sanitation (WASH)

The measuring tool: the WHO/UNICEF Joint Monitoring Programme (JMP) service ladder, used for SDG 6.

• Improved sanitation facility: one that keeps human waste away from human contact in a hygienic way [8].

• Examples: a flush or pour-flush toilet connected to a sewer, septic tank or pit latrine; a ventilated improved pit latrine; a pit latrine with a slab; a composting toilet.

• "At least basic" sanitation: an improved facility that is not shared with other households.

• An improved facility that is shared counts only as "limited" service [8].

• Improved drinking-water source: a source likely to be protected from outside contamination, especially from human and animal waste [8].

• Examples: household pipe connections, public standpipes, boreholes, protected dug wells, protected springs, rainwater collection.

• "At least basic" drinking water: an improved source where collecting water takes 30 minutes or less for a round trip, including queuing [8].

• "Safely managed" drinking water is the top rung. The water must be [9]:
• on the premises,
• available when needed, and

• free from contamination.

• Ladder order:

• Water: safely managed > basic > limited > unimproved > surface water.

• Sanitation: safely managed > basic > limited > unimproved > open defecation.

• keec108 (India / China / Pakistan):

• Sanitation: 78% / 96% / 71%
• Drinking water: 93% / 98% / 91%

Indian programmes:

• Swachh Bharat Mission-Gramin:
• All villages were declared ODF (open defecation free) on 2 October 2019.

• It is now in the ODF-Plus phase, which covers solid and liquid waste management and keeping villages ODF.

• Jal Jeevan Mission (JJM):

• Launched on 15 August 2019 to give every rural home a functional household tap connection.
• At launch, only 3.23 crore rural households (16.71%) had tap water [10].
• By 1 February 2025: 15.44 crore (79.74%) [11].
• By 22 October 2025: more than 15.72 crore (over 81%) [10].

• 11 States/UTs have reached 100% coverage, including Goa, Haryana, Telangana, Gujarat, Himachal Pradesh, Punjab, Mizoram and Arunachal Pradesh [10].

• Caution: a tap connection is not the same as "safely managed" water under the JMP definition. The water must also be available when needed and free from contamination.

Prelims Hooks

• IMR = deaths of infants under 1 year per 1,000 live births. MMR = maternal deaths per 1,00,000 live births. Crude death rate = deaths per 1,000 population.
• Trap: a "maternal mortality rate" uses women aged 15–49 as the denominator. A figure per lakh live births is the ratio. NCERT keec108 mislabels it.
• SRS MMR: 130 (2014-16) → 97 (2018-20) → 93 (2019-21). SDG 3.1: global MMR below 70 by 2030.
• UN-MMEIG estimate for India: 384 (2000) → 103 (2020). It is a different source from SRS.
• BMI = kg ÷ m². Adult underweight is below 18.5, overweight 25 or above, obese 30 or above. Children use BMI-for-age charts.
• Prevalence of Undernourishment (PoU): published by FAO in SOFI. It is the SDG 2.1 indicator and one of the four GHI indicators.
• JMP "basic" water: an improved source within 30 minutes round trip, including queuing. "Basic" sanitation: an improved facility not shared with other households. A shared facility is "limited".
• NFHS-5: women with low BMI 18.7% (NFHS-4: 22.9%). Stunting 35.5%, wasting 19.3%, underweight 32.1% (children under 5).
• Jal Jeevan Mission (launched 15 August 2019): rural tap coverage went from 16.71% at launch to over 81% by October 2025.
• Life expectancy is the health dimension of the HDI: 72.0 years (HDR 2025, data year 2023).

Mains Points

• Income is not health: real per capita income rose about 12 times from 1951 to 2018-22. Yet Kerala and Madhya Pradesh differ sharply in undernutrition. Public provisioning matters as much as growth: health services, the PDS, female literacy and sanitation. This is Sen's entitlement and capability view, and it is the basis of the HDI.
• The hunger paradox: India has surplus food, yet about one adult in five is underweight. Hunger is a problem of access (poverty, prices, PDS gaps) and of absorption (sanitation, disease), not of supply. So WASH programmes such as SBM-G and JJM are also nutrition programmes.
• Know the data source: SRS and UN-MMEIG give different MMR numbers. The NCERT table mixes up NFHS-4 and NFHS-5. PoU counts calories and misses hidden hunger. A tap connection is not "safely managed" water. Good policy needs indicators that are consistent over time and match the right definitions (GS-II/III).
• Double burden of malnutrition: undernutrition (stunting, anaemia, low BMI) exists alongside rising overweight. Policy has to move from calories to nutrition quality, for example through dietary diversity, fortification and the anaemia problem that persists despite IFA supply.