Health Security: Protecting Populations from Disease and Unhealthy Lifestyles

When we think about security, our minds often jump to armies, borders, and nuclear deterrence. But for the majority of the world’s population, the most immediate threat to a safe and dignified life is not a foreign invasion. It is illness. A single hospitalisation can wipe out a family’s savings, and a preventable infection can claim a child’s life before the age of five. This is the terrain of health security, one of the seven pillars of human security identified by the United Nations. It asks a simple but radical question: what good is a secure state if its people are not secure in their own bodies?

What is health security? 🔗

The concept of health security emerged from the 1994 Human Development Report published by the United Nations Development Programme (UNDP). This landmark report shifted the focus of security away from territories and weapons towards people and their daily lives. It argued that genuine security means safety from chronic threats such as hunger, disease, and repression, along with protection from sudden disruptions to everyday life.

The report grouped these threats into seven categories: economic, food, health, environmental, personal, community, and political security. Within this framework, health security is defined as access to personal healthcare and protective public health regimens. In other words, it guarantees a minimum level of protection against disease and the conditions that breed it. It covers both the curative side (treating people when they fall ill) and the preventive side (clean water, sanitation, vaccination, and healthy living conditions).

The two guiding ideas behind human security, “freedom from want” and “freedom from fear,” apply directly here. Freedom from want includes the assurance of basic healthcare, while freedom from fear includes protection from the anxiety of a health crisis that could push a family into ruin.

A tale of two disease burdens 🔗

One of the most striking insights of the health security framework is that disease does not strike all societies in the same way. The pattern of illness in a country closely mirrors its level of economic development. Broadly, the world’s health burden splits into two very different stories.

Developing countries and infectious disease 🔗

In poorer nations, infectious and parasitic diseases remain among the biggest killers. These are illnesses caused by bacteria, viruses, and parasites that spread through contaminated water, poor sanitation, and crowded living conditions. The scale of the disparity is stark. According to data cited by the US Centers for Disease Control and Prevention, only about 1.2% of deaths from infectious and parasitic diseases occurred in industrialised countries, compared to roughly 43% in developing countries.

The usual suspects here include tuberculosis, pneumonia and other respiratory infections, diarrhoeal diseases, malaria, and HIV/AIDS. Malaria, tuberculosis, and HIV alone cause hundreds of millions of infections each year and together kill more than five million people. These diseases are largely preventable and treatable, yet they continue to thrive where clean water, sanitation, and medicines are out of reach. Many of their victims are children, whose immune systems are still developing.

Industrialised nations and lifestyle diseases 🔗

In wealthier, industrialised countries the picture is reversed. Here, diseases of the circulatory system, such as heart attacks and strokes, are the leading cause of death. These are largely non-communicable diseases, meaning they do not spread from person to person. Instead, they build up over years as a result of lifestyle and ageing.

Poor diet, physical inactivity, tobacco use, and excessive alcohol consumption are the major drivers. As the research on disease patterns notes, circulatory diseases tend to be concentrated among adults, and many of their risk factors can be reduced through controlling blood pressure, improving diet, preventing smoking, and encouraging exercise. This is why these conditions are sometimes called “diseases of affluence”, although that label is increasingly misleading, as we will see.

The epidemiological transition 🔗

The shift from a disease burden dominated by infections to one dominated by chronic, lifestyle-related conditions is known as the epidemiological transition. As countries develop, improve sanitation, and expand vaccination, deaths from infectious disease fall, and people live longer. But longer lives and changing habits bring a rise in heart disease, diabetes, and cancer.

The trouble is that many developing countries, including India, now face both burdens at once. This is called the “double burden of disease”. A country may still be fighting tuberculosis and diarrhoeal illness in its villages while simultaneously seeing a surge in non-communicable diseases as the leading cause of death across both developed and developing nations. Health systems built to fight infections must now also cope with the slow, expensive demands of chronic illness.

Why the poor and rural populations are most at risk 🔗

Health security is not distributed evenly within a country. The threats are consistently greater for poor people living in rural areas. Several overlapping factors explain this vulnerability.

Malnutrition weakens the body’s defences 🔗

Malnutrition is both a cause and a consequence of poor health. An undernourished body has weaker immunity, making it far more likely to succumb to infection. Malnourished children are especially vulnerable to respiratory infections and diarrhoeal disease. The scale of the problem is enormous. India is home to an estimated 200 million malnourished individuals, a reality that sits at the heart of the country’s health insecurity.

Lack of access to healthcare necessities 🔗

Even when treatment exists, getting to it can be impossible for the rural poor. Public health infrastructure in remote areas is often thin: primary health centres may lack diagnostic equipment, medicines, or trained staff. Studies on rural healthcare describe overburdened hospitals, chronic shortages of medical personnel, and the long distances patients must travel for basic services. For a daily-wage labourer, a journey to a distant hospital means not just transport costs but also lost income.

The trap of out-of-pocket spending 🔗

Perhaps the most damaging feature of health insecurity is its financial dimension. When public healthcare is unavailable or inadequate, people are forced to pay for private care out of their own pockets. India has recorded among the highest out-of-pocket health expenditures of any major economy. While the share fell from over 60% in 2014 to below 40% by 2024, the figure remains heavy.

This spending pushes families into debt and poverty. Research on health-induced poverty has found that outpatient care contributes far more to impoverishment than hospitalisation, because routine doctor visits and medicines are paid for directly and repeatedly. When a household has to choose between medicine and food, health security collapses into a wider crisis of human security.

Health security in the Indian context 🔗

India’s health security challenge brings all of these strands together. Marginalised communities bear a disproportionate share of the burden. Studies suggest that Scheduled Caste and Scheduled Tribe individuals are around 50% more likely to suffer from malnutrition and chronic illness than other groups. Public health expenditure has long hovered near just 1.3% of GDP, contributing to doctor shortages and under-equipped facilities.

Government policy has tried to respond to these gaps. The flagship Ayushman Bharat programme has two arms. One establishes Health and Wellness Centres (now Ayushman Arogya Mandirs) to deliver comprehensive primary care closer to communities. The other, the Pradhan Mantri Jan Arogya Yojana, provides health insurance cover of up to ₹5 lakh per family per year for hospitalisation, targeting poor and vulnerable families. Alongside it sit the National Health Mission, free drugs and diagnostics initiatives, and Jan Aushadhi generic medicine stores, all aimed at reducing out-of-pocket expenditure through system strengthening.

However, gaps remain. Critics point out that the insurance scheme focuses largely on inpatient care, while the bulk of impoverishing spending comes from everyday outpatient costs. The digital divide also limits the reach of solutions like telemedicine in villages with poor connectivity. Ensuring health security therefore requires more than a single scheme. It demands sustained investment in primary care, a stronger rural medical workforce, and attention to the social roots of ill health, such as nutrition, clean water, and sanitation.

Bridging the gap 🔗

The core message of the health security framework is that protecting people from disease is a matter of equity, not charity. Threats are not random; they cluster around poverty, geography, and social exclusion. A genuine strategy for health security must therefore address these disparities directly, channelling adequate healthcare resources to the populations that need them most.

This means investing in preventive public health (vaccination, sanitation, nutrition programmes) just as much as in hospitals and cures. It means recognising that a heart attack in a city and a malaria death in a village are two faces of the same failure to guarantee a minimum of protection. When health security is achieved, people are freed from the constant fear that illness will destroy their livelihoods, and they can participate fully in social and economic life.

What do you think? If a country must choose where to spend limited health funds, should it prioritise fighting the infectious diseases that kill the rural poor, or preparing for the rising tide of lifestyle diseases that affect the wider population? And how far should the state go in protecting people from health risks that stem from their own lifestyle choices?

References

1. https://hdr.undp.org/content/human-development-report-1994
2. https://www.britannica.com/topic/human-security
3. https://cadmusjournal.org/node/975
4. https://wwwnc.cdc.gov/eid/article/10/11/04-0624_12_article
5. https://journalofethics.ama-assn.org/article/malaria-and-global-infectious-diseases-why-should-we-care/2006-04
6. https://pubmed.ncbi.nlm.nih.gov/2698079/
7. https://pmc.ncbi.nlm.nih.gov/articles/PMC7135337/
8. https://docboxmed.com/healthcare-access-in-rural-india/
9. https://www.ocacademy.in/blogs/7-urgent-facts-indias-out-of-pocket-health-costs-challenge/
10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10767384/
11. https://hospi.info/health-disparities/
12. https://pmc.ncbi.nlm.nih.gov/articles/PMC11142006/