India’s medical and public health services have improved dramatically since independence. As a result, average life expectancy at birth has risen by more than 25 years since World War II, although it still lags behind expectancies in the world’s more affluent societies.

While death from starvation has become rare, malnutrition has remained widespread. Much of the population lacks access to safe drinking water, seasonally if not year-round. Dysentery and other diseases caused by waterborne organisms are major killers, especially of children. Poorly treated and improperly disposed sewage pose serious health problems. Most diseases endemic to tropical regions are significant causes of morbidity in India. The rate of tuberculosis is high, and the incidence of blindness, mainly caused by trachoma, is even higher. Great strides, however, have been made in combating certain diseases. Smallpox, once a leading cause of death, was declared eradicated in 1977. The vigorous National Malaria Eradication Programme, launched in 1958, almost succeeded in ridding India of this once very common disease, but the development of resistance to DDT among mosquitoes caused a resurgence of the problem. This led to renewed public health efforts and, subsequently, to a slow but steady decline in the number of affected individuals. AIDS and HIV infection have increased; although the overall proportion of the population affected is quite tiny, the number of people infected is one of the highest for any country in the world.

Apart from numerous programs directed against specific diseases, there has been a considerable expansion in the number of union- and state-maintained hospitals and rural primary health centers. The latter generally are staffed by minimally trained paramedical personnel and are poorly equipped. Many are visited each week by a trained government doctor. Supplementing these government services are private medical practitioners, a great many of whom follow a variety of traditional medical systems. Of these, the ancient Ayurvedic system is by far the most widespread. Several dozen colleges teach Ayurvedic medicine, often with government support. Throughout India, the government uses its network of hospitals and clinics for immunizing children against various diseases and for promoting family planning. Family planning efforts, including the encouragement of voluntary sterilization of both males and females, have met with mixed success.

Welfare services have proliferated in number and type since independence. Many programs target specific sections of the population, such as Scheduled Castes, Scheduled Tribes, nomadic populations, women, children, and the disabled. The resources for such services, however, are inadequate, and a large proportion of the budgets for specific programs goes toward maintaining the service staff and their generally meagre facilities. Pension plans for retirees exist only for government workers and a portion of the organized sector of the economy.

Housing

Existing housing stock does not meet India’s current needs and is continually challenged by the country’s growing population. Homelessness is common, particularly in major urban centers, and large numbers of city dwellers reside in unregistered and makeshift slums. Housing prices in the largest cities—Delhi, Kolkata, and Mumbai—are among the highest in the world, and even modest apartments are beyond the means of many residents. Despite government efforts to alleviate these problems, relatively few government housing projects have been undertaken.

Rural housing is somewhat less pressed, despite the fact that most of the country’s population continues to live in the countryside. Traditional building materials vary from region to region; adobe edifices are common in arid regions, for example, and high-roofed thatch buildings are standard in areas with greater annual precipitation. These are often augmented with walls and roofs made of such materials as sheet metal, cinder blocks, or stone. Throughout the country, the use of materials such as concrete, blocks, and stucco has become common in more affluent villages, towns, and cities.

Piped water is mainly limited to large towns and cities, but even there it seldom reaches all neighbourhoods and cannot be depended on in all seasons. Otherwise, reliance is on wells, rivers, reservoirs, and tanks (usually inundated borrow pits), with minimal, if any, treatment. Sewage facilities are even more limited. Professional scavengers, publicly and privately employed, fill the need for waste disposal in most urban areas and, along with pigs, in many villages as well. Piped gas is a rarity. Those who cook with gas generally rely on purchased gas cylinders. An increasing number of villages, however, have installed simple cow-dung gas plants, which enable them to generate methane and still utilize the fermented dung for fertilizer.

Education

The provision of free and compulsory education for all children up to age 14 is among the directive principles of the Indian constitution. The overall rate of literacy has increased markedly since the late 20th century, but a noticeable disparity has remained between males and females (roughly three-fourths and about half, respectively). There is also a considerable disparity in literacy rates between the states. According to the 2011 census, the state of Kerala has the highest rate, where nearly all are literate, in contrast to Bihar, where the proportion is about half.

Preuniversity education generally consists of five years of primary education (classes I through V), normally for pupils aged 6 to 11; middle level (classes VI through VIII); lower secondary (classes IX and X); and higher secondary (classes XI to XII). The great majority of all children of primary-school age are enrolled, though many, especially girls, may not attend regularly. Enrollment thereafter falls off precipitously, to about half of all children aged 11 to 14, despite the fact that education is free in most states for students of both sexes at least until class X.

Formerly a state responsibility, education was made a joint responsibility of the union and state governments by constitutional amendment. The union government has subsequently played a larger role in promoting the education of girls and other socially disadvantaged groups, largely through fiscal grants for the support of particular programs (e.g., reimbursement of tuition, where it is charged, for girls in classes IX–XII), and in launching a variety of progressive educational initiatives. In addition to publicly financed schools, there are at all levels private and church-run schools (largely by Christian missions), for which tuition is required. Entrance into these often prestigious, predominantly English-language institutions is eagerly sought for the children of those parents who can afford them.

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Numerous key universities, institutes of technology, and other specialized institutions of higher education are under union government control, while a much larger number of universities are controlled by the state governments. The government recognizes a number of “Institutes of National Importance” (INIs) across the country: Indian Institutes of Technology (IITs), Indian Institutes of Management (IIMs), National Institutes of Technology (NITs), All India Institutes of Medical Sciences (AIIMS), and National Institutes of Design (NID) are some key INIs. There are over 20 IITs and IIMs each, more than 30 NITs, and close to 20 AIIMs in the country, with many more under development. A disproportionate share of India’s total educational budget goes toward higher education. The number of universities and equivalent institutions increased more than sevenfold in the first four decades after independence, while the number of students enrolled increased more than 15 times during the same period. Each of those numbers has continued to grow dramatically since then. At the same time, funding for libraries, laboratories, and other facilities has been a constant and serious problem. Critics of the unabated growth of higher education have asserted that the quality of university education has steadily declined and have noted the increasingly large proportion of graduates who are unable to find employment, especially among those with liberal arts degrees. Among the established universities are three founded by the British in 1857, at Kolkata, Mumbai, and Chennai.

In the past, virtually all higher instruction was in English, but, as new universities and their thousands of affiliated colleges have spread out to smaller cities and towns, state languages increasingly have been used, notwithstanding the paucity of textbooks in such languages. Reserved quotas in universities and lower admission standards for members of Scheduled Castes and Scheduled Tribes—whose prior education often has been less than adequate—have put additional stress on the system. The fact that India’s best students often take their higher degrees abroad, many never to return, further exacerbates the problem of quality. Nevertheless, elite institutions continue to exist, and, in absolute terms, the output of well-educated individuals is substantial.

Cultural milieu

India is a large and diverse polyglot nation whose tempo of life varies from region to region and from community to community. By the early 21st century the lifestyle of middle-class and affluent urban families differed little from that of urbanites in Europe, East Asia, or the Americas. For the most part, however, the flow of rural life continued much as it always had. Many small villages remained isolated from most forms of media and communications, and work was largely done by hand or by the use of animal power. Traditional forms of work and recreation only slowly have given way to habits and pastimes imported from the outside world. The pace of globalization was slow in much of rural India, and even in urban areas Western tastes in food, dress, and entertainment were adopted with discrimination. Indian fashions have remained the norm; Indians have continued to prefer traditional cuisine to Western fare; and, though Indian youths are as obsessed as those in the West with pop culture, Indians produce their own films and music (albeit, strongly influenced by Western styles), which have been extremely popular domestically and have been successfully marketed abroad.

Throughout India, custom and religious ritual are still widely observed and practiced. Among Hindus, religious and social custom follows the samskara, a series of personal sacraments and rites conducted at various stages throughout life. Observant members of other confessional communities follow their own rites and rituals. Among all groups, caste protocols have continued to play a role in enforcing norms and values, despite decades of state legislation to alleviate caste bias.