Public Health under the Seventh Schedule

The Seventh Schedule divides health-related legislative responsibilities through the Union, State and Concurrent Lists. Read with Article 246, it makes ordinary public health and healthcare institutions primarily a State responsibility, while assigning cross-border health matters to the Union and permitting shared legislation in specified fields.

Constitutional allocation

The distribution combines a State-led health system with Union responsibility for matters having inter-State, international or national dimensions.

• State List Entry 6 assigns public health and sanitation, hospitals and dispensaries to the States.
• Union List Entry 28 covers port quarantine and connected hospitals, while Entry 81 covers inter-State migration and inter-State quarantine.
• Concurrent List Entry 29 enables both levels to prevent infectious or contagious diseases from spreading from one State to another.
• Other Concurrent List subjects supporting health governance include drugs and poisons, population control and family planning, and medical education.

Legislative operation

Under Article 246, Parliament legislates on Union subjects, State legislatures ordinarily control State subjects, and both may legislate on Concurrent subjects. Under Article 254, a valid parliamentary law generally prevails over an inconsistent State law on a Concurrent subject.

• Parliament may legislate on State subjects through the exceptional mechanisms in Articles 249, 250, 252 and 253, including national interest, emergency, State consent and implementation of international obligations.
• Consequently, routine public-health administration and service delivery primarily rest with States, while the Union addresses cross-border risks and shared regulatory fields.

Role of local governments

States may devolve implementation functions to local bodies under Articles 243G and 243W. The Eleventh Schedule includes health, sanitation, hospitals, primary health centres and dispensaries for Panchayats, while the Twelfth Schedule includes public health and sanitation for Municipalities.