Content

1. India’s global right linkages, costs and consequences
2. Work in progress

India’s global right linkages, costs and consequences

Why in News ?

• Rising discourse on global surge of right-wing populism and its challenge to the rules-based liberal international order, amid conflicts in West Asia and weakening multilateralism.

Relevance

• GS Paper II (International Relations)
  • Global governance crisis; weakening of United Nations and World Trade Organization
  • India’s foreign policy: strategic autonomy, multipolarity, ideological alignments
• GS Paper II (Polity)
  • Democratic values, constitutional morality vs global democratic backsliding
• GS Paper III (Economy & Security)
  • Impact of protectionism, deglobalisation, geopolitical conflicts
  • Rise of nationalism and its economic-security implications

Practice Question  

• “The rise of right-wing populism globally challenges the liberal international order and reshapes India’s foreign policy choices.” Critically analyse. (250 words)

Static Background & Conceptual Foundations

• Liberal World Order (post-1945) based on multilateralism, rule of law, free trade, and democratic norms, anchored in institutions like UN, WTO.
• Rise of Right-wing populism linked to backlash against globalisation, inequality, migration, and cultural anxieties.
• Concept of multipolarity vs spheres of influence central to evolving global order debates.

Historical Triggers of Systemic Shifts

• Major disruptions like French Revolution, World Wars, and 2008 Global Financial Crisis reshaped global power structures and ideologies.
• 2008 crisis intensified inequality and distrust in liberal capitalism, fuelling populist, nationalist, and authoritarian politics globally.

Nature of Emerging Right-Wing Global Order

• Promotes national sovereignty over multilateralism, weakening global institutions and cooperative frameworks.
• Advocates cultural homogeneity, anti-immigration stance, and identity politics, often linked to xenophobia and majoritarian narratives.
• Emphasises “might is right” geopolitics, favouring power politics and spheres of influence over international norms.

Mechanisms: “International Ideological Axis”

• Networks like International Democracy Union, Heritage Foundation, and CPAC facilitate ideological coordination and policy alignment.
• Use of diaspora mobilisation, funding channels, and digital ecosystems to influence elections and narratives globally.
• Manufacturing consent through media, think tanks, and coordinated messaging across nations.

Evidence of Democratic Backsliding

• 91 countries (72% population) classified as autocratic by Varieties of Democracy Institute, indicating global democratic regression.
• Rise of illiberal democracies in Europe, US, and parts of Asia reflects erosion of liberal norms.

India’s Role & Foreign Policy Debate

• India pursuing multipolarity and strategic autonomy, but debates exist on ideological alignments in global politics.
• Engagements with diverse partners reflect pragmatic diplomacy, though critics argue risks to traditional non-alignment and moral leadership.
• Shift from Nehruvian internationalism to interest-based diplomacy, reflecting changing geopolitical realities.

Structural Causes Behind Rise of the Right

• Globalisation-induced inequality, job losses, and deindustrialisation creating socio-economic discontent.
• Migration crises and cultural anxieties fuelling identity-based politics.
• Failure of liberal institutions to reform, leading to trust deficit in global governance systems.

Implications for Global Order

• Weakening of multilateral institutions (UN, WTO) and rise of unilateralism and protectionism.
• Increased geopolitical conflicts and instability, especially in West Asia, Europe, and Indo-Pacific.
• Fragmentation into regional blocs and competing ideological alliances, undermining global cooperation.

Challenges & Criticisms

• Risk of authoritarianism, erosion of civil liberties, and democratic institutions.
• Decline of rules-based order may disadvantage smaller nations and Global South.
• Over-politicisation of diaspora and identity may strain international relations and social cohesion.

Way Forward

• Reform global institutions to ensure equitable representation and responsiveness to Global South concerns.
• Balance national interests with multilateral commitments, preserving cooperative global frameworks.
• Strengthen democratic resilience, transparency, and inclusive governance domestically.
• Promote value-based partnerships and South-South cooperation for a balanced multipolar order.

Prelims Pointers

• Liberal world order emerged post-World War II.
• V-Dem Institute tracks global democracy trends.
• 2008 financial crisis triggered global populist surge.

Mains Enrichment

Intro Options

• “The rise of right-wing populism reflects a structural crisis of the liberal world order shaped by inequality and institutional inertia.”
• “Global politics is witnessing a shift from rule-based multilateralism to power-driven ideological alignments.”

Conclusion Frameworks

• “Sustainable global order requires balancing multipolarity with multilateral cooperation and democratic values.”
• “Reforming global governance while addressing socio-economic grievances is key to countering authoritarian drift.”

Work in progress

Why in News ?

• The 80th Round NSS (2025) highlights rising insurance coverage under PMJAY, but continued concerns over access, rising disease burden, and inadequate public hospital capacity in the post-pandemic healthcare landscape.

Relevance

• GS Paper II (Governance & Social Justice)
  • Public health systems, Universal Health Coverage, welfare delivery
  • Role of schemes like PMJAY, institutional capacity
• GS Paper III (Economy)
  • Health expenditure, human capital, poverty due to healthcare costs
  • Insurance vs public provisioning debate

Practice Question  

• “Expanding health insurance coverage alone cannot ensure universal healthcare in India.” Examine in the light of NSS 80th Round findings. (250 words)

Static Background & Conceptual Clarity

• Universal Health Coverage (UHC) aims to ensure equitable access to quality healthcare without financial hardship, anchored in SDG 3 and India’s National Health Policy 2017 target of increasing public health expenditure to 2.5–3% of GDP.
• India’s healthcare system is mixed but private-dominated, with nearly 65% urban and 58% rural patients relying on private providers, reflecting structural deficiencies in public health infrastructure and service delivery capacity.
• Ayushman Bharat architecture integrates PMJAY (insurance for secondary and tertiary care) with Health and Wellness Centres, which aim to strengthen primary healthcare and preventive services across rural and urban India.

Key Findings of NSS 80th Round

• Insurance coverage has tripled since 2018, signalling expansion of financial protection, yet hospitalisation rates remain below 2014 levels, indicating that insurance alone does not guarantee actual access to healthcare services.
• 13.1% population reported illness, with a clear epidemiological transition from communicable diseases to non-communicable diseases (NCDs), increasing long-term treatment costs and demand for specialised tertiary care services.
• Out-of-pocket expenditure (OOPE) shows dual trends: mean expenditure rising due to high-cost treatments, while median expenditure (~₹11,285) declines, reflecting partial protection through public sector services and insurance schemes.

Governance & Systemic Issues

• The insurance-driven model under PMJAY effectively subsidises private hospitals, but inadequate regulation of pricing leads to hidden charges for diagnostics, medicines, and consumables, undermining affordability and transparency.
• Fragmented coordination between primary, secondary, and tertiary care systems weakens continuity of care, especially for chronic illnesses, reducing overall efficiency and patient outcomes in the healthcare delivery system.

Economic Implications

• Despite increased coverage, catastrophic health expenditure persists, particularly for tertiary care and chronic diseases, continuing to push vulnerable households into poverty and financial distress.
• A dual burden exists where poor households face access barriers despite insurance, while the middle class experiences rising healthcare costs, indicating systemic inefficiencies in both public and private healthcare provisioning.

Social & Equity Concerns

• Persistent disparities in healthcare access across rural-urban, gender, and income groups highlight inequitable distribution of healthcare infrastructure and services, limiting the realisation of universal health coverage goals.
• Hidden costs and informal payments disproportionately affect economically weaker sections, while women and elderly populations face additional barriers in accessing timely and quality tertiary healthcare services.

Health System Transition

• India is undergoing an epidemiological shift toward chronic NCDs such as diabetes, cardiovascular diseases, and cancer, requiring long-term, integrated, and cost-intensive care models beyond episodic treatment frameworks.
• Existing public health systems remain oriented towards acute and infectious disease management, lacking adequate preparedness for managing chronic disease burden and ageing population needs.

Core Structural Challenge

• The dominance of private providers in tertiary care, combined with underfunded and capacity-constrained public hospitals, creates an imbalance where insurance schemes cannot substitute for robust public healthcare infrastructure.
• PMJAY risks functioning primarily as a demand-side financing tool without parallel strengthening of supply-side capacity, limiting its transformative impact on the healthcare system.

Way Forward

• Substantially increase public investment in health to at least 3% of GDP, focusing on expanding district hospitals, medical colleges, and critical care infrastructure to enhance public sector competitiveness in tertiary care.
• Reform PMJAY by ensuring adequate reimbursement rates, strict price regulation, and accountability mechanisms, preventing cost escalation and improving service quality in empanelled hospitals.
• Strengthen primary healthcare through Health and Wellness Centres, ensuring early detection and management of NCDs, reducing pressure on tertiary care and improving overall health outcomes.
• Promote integrated digital health systems under ABDM, enabling seamless patient data flow, continuity of care, and efficient monitoring of healthcare delivery across levels.

Prelims Pointers

• PMJAY (2018) provides insurance cover for secondary and tertiary care.
• NSS 80th round (2025) analyses health consumption, disease burden, and expenditure patterns.
• OOPE refers to direct payments made by households for healthcare services.

Mains Enrichment

Intro Options

• “India’s healthcare paradox lies in expanding insurance coverage alongside persistent access and affordability challenges, as highlighted by the NSS 80th round.”
• “The evolution of India’s health system reflects a shift from financial protection to the urgent need for strengthening public healthcare capacity.”

Conclusion Frameworks

• “Achieving universal healthcare requires moving beyond insurance-led models to robust public infrastructure and regulated private participation.”
• “A resilient health system must balance financial protection, equitable access, and quality care delivery to realise the vision of Viksit Bharat 2047.”