Why CLAT Aspirants Must Know This
India’s cities are home to nearly 500 million people, yet urban public health infrastructure remains critically underfunded. The Indian Express (March 23, 2026) highlights the widening gap between urban health demand and supply — a crisis that intersects constitutional law, administrative federalism, and social justice. For CLAT aspirants, this topic connects directly to Article 243W, the 74th Constitutional Amendment, the 12th Schedule, and the right to health under Article 21.
Historical & Constitutional Context
| Year | Milestone |
|---|---|
| 1992 | 74th Constitutional Amendment Act — empowers Urban Local Bodies (ULBs) |
| 1993 | Constitution (74th Amendment) comes into force; 12th Schedule lists 18 functions for municipalities |
| 2005 | National Urban Health Mission (NUHM) proposed; implemented from 2008 |
| 2013 | NUHM merged into National Health Mission (NHM) as a sub-mission |
| 2026 | Urban Primary Health Centres remain underfunded; doctor-patient ratio in cities lags global benchmarks |
Key Definitions & Acronyms
| Term | Full Form / Meaning |
|---|---|
| ULB | Urban Local Body — municipalities, municipal corporations, town panchayats |
| NUHM | National Urban Health Mission — targets healthcare for urban poor, especially slum dwellers |
| UPHC | Urban Primary Health Centre — first point of public healthcare contact in cities |
| 12th Schedule | Added by 74th Amendment; lists 18 functions that States MAY devolve to ULBs (health is item 6) |
| Article 243W | Mandates State Legislatures to endow ULBs with powers for functions listed in 12th Schedule |
Constitutional & Legal Framework
- Health — State Subject (List II, Entry 6): “Public health and sanitation” is a State subject under the Seventh Schedule.
- Article 21: Right to life includes the right to health (Supreme Court in Paschim Banga Khet Mazdoor Samity v. State of West Bengal, 1996).
- Article 243W + 12th Schedule: Item 6 of the 12th Schedule is “Public health, sanitation conservancy and solid waste management.” States must legislate to devolve this to municipalities — but most haven’t.
- Directive Principles (Article 47): The State shall raise the level of nutrition and standard of living and improve public health.
- DPSP vs. Fundamental Rights: Article 47 is non-justiciable, but courts have read health rights into Article 21 (justiciable).
Why Urban Health Fails: Structural Causes
- Devolution gap: Most States have not transferred health functions to ULBs despite Article 243W, leaving cities dependent on State health departments not designed for urban complexity.
- Slum blindspot: Urban PHCs are designed for planned areas; 65 million slum dwellers fall through the coverage gap.
- Dual burden of disease: Cities face both communicable diseases (TB, dengue, cholera) AND non-communicable diseases (diabetes, hypertension) simultaneously.
- Finance deficit: ULBs receive minimal central/state health transfers; their own tax revenues are insufficient.
CLAT Quick Takeaways
- MUNICIPAL = 74th Amendment (Village Panchayats = 73rd Amendment)
- 12th Schedule has 18 functions; 11th Schedule (villages) has 29 functions
- Health under municipalities = Article 243W + Item 6, 12th Schedule
- Article 47 (DPSP) + Article 21 (FR) = Constitutional basis for right to health
- NUHM is a sub-mission of NHM (not a standalone mission)
Memory Aid
74-ULB-12-18: 74th Amendment → Urban Local Bodies → 12th Schedule → 18 functions (including health). Compare: 73-PR-11-29 (73rd → Panchayati Raj → 11th Schedule → 29 functions).
Source: Indian Express, March 23, 2026 | Category: Constitutional Law / Public Health
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