Peer-reviewed article
From ashes to numbers: the Punjab partition of 1947 as a historical social determinant of health evidence from NFHS-4, NFHS-5 and NFHS-6 (2015–2024)
Gurshan Singh Gill, Hemant Biwal ·
Summary
Written by AI, not yet AICS's view · claude-sonnet-5-5This review looks at Punjab's health profile using three rounds of India's National Family Health Survey (2015-16, 2019-21 and 2023-24). Punjab does well on institutional births and infant mortality, but has high child anaemia, a high caesarean rate and a low sex ratio at birth. The author argues that these patterns cannot be explained by current health policy alone and links them to the legacy of the 1947 Partition. The paper proposes treating Partition as a historical social determinant of health.
Key points
- Institutional delivery rate in Punjab was 94.3% in NFHS-5, the highest in the region.
- Infant mortality was about 14 per 1,000 live births in NFHS-5, one of the lowest in the country.
- Child anaemia was 71.1% in NFHS-5, above the national figure of 67.1%.
- Caesarean section rate was 38.5%, well above the WHO 10-15% optimal range.
- Sex ratio at birth was 904 girls per 1,000 boys.
Limitations
This is a descriptive secondary analysis of survey data, so the links drawn between Partition and present-day health indicators are argued rather than tested, and causation cannot be established. Only the abstract is available, so methods and details of the evidence are not visible.
Abstract
Punjab National Family Health Survey (NFHS) profile presents a paradox that contemporary health systems analysis cannot resolve. A state that leads north India in institutional delivery rates (94.3%, NFHS-5, highest in the region) and records one of its lowest infant mortality rates (approximately 14 per 1,000 live births, NFHS-5) simultaneously records child anemia at 71.1% (NFHS-5, exceeding the national figure of 67.1%), overweight or obesity in women aged 15 - 49 years at over 41% (among India five highest states), a caesarean section rate of 38.5% (far above WHO 10-15% optimal threshold), and a sex ratio at birth of only 904 girls per 1,000 boys. This review undertakes a descriptive secondary analysis of Punjab's health profile across NFHS-4 (2015 - 16), NFHS-5 (2019 - 21), and NFHS-6 (2023 - 24), integrating NFHS-6 national comparator data released in May 2026. It argues that this paradox cannot be explained by contemporary policy variables alone. The Green Revolution agricultural model itself, the product of refugee economic reconstruction after the Partition of 1947, created a dietary monoculture that underlies the present burden of anaemia. Partition-derived intergenerational trauma contributes to the chronic stress physiology measurable in community health indicators. The cultural devaluation of women entrenched during Partition's systematic gendered violence persists in a skewed sex ratio. The opioid epidemic is geographically concentrated in historically displaced border districts. Punjab NFHS data, read against its specific Partition history, establishes a case for recognizing the 1947 catastrophe as a historical social determinant of health with implications for community medicine practice and public health policy in Punjab and its diaspora.