[Answered]“Besides being a moral imperative of a Welfare State, primary health structure is a necessary precondition for sustainable development.” Analyze.

Welfare state is a modern concept of state with special responsibilities for state to improve the socio-economic conditions of the citizens and provide protective measures for their development. In India, the directive principles of state policy (DPSPs) under the Constitution provide the contours of welfare state. 

Primary health structure is moral imperative of a welfare state due to following reasons: 

1. Vicious cycle of poverty is created due to high out-of-pocket health expenditure, low productivity, low skills and low income. 
2. Primary health structure is necessary for a citizen to exercise the right to livelihood and dignity as emphasized under the Universal Declaration of Human Rights for free development of her personality. 
3. Historical marginalization of scheduled castes, scheduled tribes, women in society create moral imperative on state to provide corrective action for improvement of their health and wellbeing.  
4. DPSPs such as Article 47 to raise level of nutrition and public health, and Article 42 for maternity relief create constitutional obligation on state to provide accessible primary health structures. 

Primary health structure is necessary precondition for sustainable development due to following reasons:   

1. Without an effective primary health structure, the sustainable development goal of ‘Ensuring Healthy Lives and Promotion of Wellbeing for all’ is not possible.  
2. Goal of universal health coverage requires robust primary health structure to address issues of inequities in public health. 
3. Due to climate change, range of tropical and vector-borne diseases is expected to expand, making more people vulnerable to health issues. 
4. Development is creating lifestyle diseases at rapid scale. Their management requires a working ground-level functionaries in primary health structures. 

Health is fundamental to development. Life expectancy has expanded over the 20th century by leaps, but 21st century is looking at problems of inequities that require building primary structures to bring people along for sustainable and moral growth.