Preventative healthcare: A wake-up call for India

Indian employees have found themselves on the receiving end of a debate between work ethic, productivity, and work-life balance for a couple of months now. The debate flared up again after Larsen & Toubro (L&T) Chairman S N Subrahmanyan recently advocated a 90-hour work week, suggesting employees should even give up Sundays.

This non-stop hustle culture elevates stress and anxiety, and impacts mental, emotional, and physical wellbeing. Work stresses and sedentary lifestyles have made India a hotbed for non-communicable diseases. The country is the diabetes capital of the world, with a whopping 212 million Indians affected, according to a study published in The Lancet. Despite being a developing nation, India is mirroring some ‘diseases of affluence’ in following the top global causes of death—ischaemic heart disease, chronic obstructive pulmonary disease and stroke led by COVID-19 in 2021, according to WHO data.

Historically, curative medicine has driven India’s healthcare industry, taking precedence over the preventative treatment route, according to IBEF. But the pandemic led to an increased focus on health, giving the sector a boost.  

An investor in the healthcare space says an Indian on average spends less than $15 on preventative health per year, as compared to $2,000 per person in the US. 

“Just look at the difference,” says Dilip Kumar, Lead Investor at Rainmatter by Zerodha. 

An entrepreneur, endurance athlete, and marathon runner, Kumar dived deep into this disparity in the second episode of YourStory’s podcast, The Mass Effect, along with healthcare expert Jitendra Chouksey, Founder and CEO of FITTR, and Ahana Gautam, Founder and CEO of OpenSecret. Hosted by Shivani Muthanna, Director - Strategic Content, YourStory, the episode focused on the opportunity in preventative healthcare, the white space for startups and D2C companies in healthtech, fitness and nutrition, and what makes Indians tick when it comes to health and fitness. 

According to Kumar, “In India, active gym membership is around 50 lakh [people]; that's just 0.2% of the population." 

Kumar leads investments at Zerodha-backed Rainmatter Health, which has invested in 35+ healthcare companies, including the Devil’s Circuit, Ditch The Guilt, Fittr, Niramai, The Whole Truth, and Ultrahuman. 

“We (India) created a Rs 35,000 crore [quick commerce] industry just by not choosing to cook at home and having the desire to get something in 10 minutes. If you think about the first principles, (it) should not have existed just because we just got too lazy,” he adds. 

So why are a majority of Indians ignorant of their health despite all the warning signs? 

Kumar says India is a developing country where only a fraction of the population understands macronutrients, the need for protein, and how one can improve their health. Movement comes naturally in rural India but physical activity has to be built in for urban populations.

Watch the full conversation on the second episode of The Mass Effect:

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Low scientific temperament a problem

Amid low-cost internet access and an information explosion, health and fitness content creators command millions of followers. But there is a dissonance in the quality and integrity of information with creators and opportunists creating swathes of content on “what is good for you” to game the “algorithms” of search engines and social media platforms. 

Pulled in every direction with pros and cons, how can consumers avoid getting swayed by quacks? 

Chouksey believes science can help find the way. A health educator and personal trainer, he leads Fittr, a fitness community and platform that has been providing personal coaches, workout strategies, and nutrition plans for the past nine years. 

“If somebody’s making claims driven by fear, sensationalism, or demonising food, these are usually not backed by research. These claims are made by charlatans. You should stay away,” he adds. “In India, we don't learn how to comprehend research… nutrition and training is extremely complex and it's not taught anywhere.”

Chouksey says he does an “extreme amount of research” before putting content out. It necessitates in-depth knowledge of biochemistry, physiology, statistics and probability, genetics, nutrition, kinesiology, exercise science, and research interpretation as the body “does not operate in isolation”. He adds, “When you consume content from social media, people tend to oversimplify these complexities.” 

According to Kumar, Indians have a low scientific temperament because our education system focuses on the “what” but not the “why”.

So, what’s the most practical way to take matters into one’s own hands? 

Track your health markers

Chouksey says there’s no preventative healthcare if “you're not tracking”. One must be aware to fix or prevent, experts say. Could technological intervention help us take control of our health and make it better? 

Wearables have solved a problem that would normally require one to go to the lab. He adds, “Now those parameters are available to you on your app, at a fraction of a cost… You have SPO2, HRV, and stress levels.” Real-time information and helpful cues leading to positive behaviour—simple. 

“Over time, wearables have become smaller. Rings are the new entrant [but] smartwatches still enjoy a very large market share,” he says. Fittr’s HART ring, launched in August 2024. tracks real-time heart rate, blood oxygen, temperature, sleep, and more. 

Kumar believes the future of most wearables is to go beyond the ‘what’ happening inside your body to reveal the 'why' and 'how' it is being triggered.

“AI will play a huge role. How do you extrapolate data and make sense of it? In the Indian context, we still don't have a large audience that [is aware of] nutrition and science, and who can interpret what the data means,” he says. 

Wearables are often used as an accessory so there's an opportunity for AI to analyse the data and tell users if they need to move, sleep, or focus on other parameters. 

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Snacks reign supreme

Step 1: You get the wearable...great! But can they help if we continue to eat junk food? 

Indians love biscuits and cookies the most—99% market penetration, says Gautam. “Every single household eats a biscuit almost every single day. It always came in the form of maida (refined flour) or palm oil and a lot of sugar, which is why people associated [it] with junk [food],” she says. 

The need for healthier snacking options is a massive opportunity for startups and large companies. 

Gautam's Open Secret, a “better for you” healthy foods D2C company focuses on “un-junking” India’s snacking habits. A formerly overweight teen who snacked on croissants during her stint at Harvard Business School, she returned to India from the US to make and solve for India. 

The snacks industry in India is projected to hit Rs 95,521 crore, growing at a CAGR of 9.08% in the next seven years, up from Rs 42,694 crore in 2023, according to a report by IMARC Group. Last year, soft drinks and snacks were the most bought items on quick commerce platforms. 

“People want to try ‘better for you’ products. It's not that they are going for junk (food); they just don't want to compromise [taste], and they also want it at a price where they can afford it.” 

But there is a big disparity in the prices of such products. Refined flour costs Rs 30-40 per kg while dry fruits are north of Rs 700 per kg. This is where endemic millets can come in at Rs 100 per kg, Gautam says. 

“We have built this perception that if it is tasty, it has to be junk. But it's not just India. Across the globe, when people are looking for food, (they) want to eat tasty,” she says. Her formula for cracking the snack market? The troika of taste, “better for you” or good ingredients, and affordability. “This is the answer to the health pandemic that India is facing right now.” 

OpenSecret also has a plant protein, an area where Gautam saw a nutritional deficit. “On average, India consumes about 45 grams of protein [per day]. The guideline is you need to consume 1-1.5 grams per kg of your body weight.” 

So, people who weigh 60 kg need a minimum of 60 grams of protein per day, but an average Indian is consuming 20 grams less than that, she says, adding that a protein supplement can fill that gap. 

In the last couple of years, the plant protein market alone in India has exploded and commands a market size of $1 billion as of this year, with companies such as The Whole Truth, Oziva, Cosmix, and Muscle Blaze coming in across plant and whey protein categories.

Rainmatter’s Kumar says there couldn’t have been a better time to “do something in this space” because consumer understanding, awareness and intent for health are at an all-time high. 

India’s preventative healthcare sector, with a groundbreaking CAGR of 22%, is projected to touch more than $500 billion by 2030, according to Kalaari Capital, which called it the “new frontier” in India’s health revolution. 

“Preventive healthcare is a 10-15 year horizon [for] building a sustainable company. It cannot be a quick fix for two to five years, and give an exit to an investor. You have to get like-minded partners and build a like-minded team which is there for the long endurance,” he says. 

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Creating community connections for clarity

Working alone and working on one’s health can be challenging, but studies show that fostering social connections can ease this journey. As social animals, humans can harness the power of togetherness, especially when the cause is common. 

How important is the 'community' factor? According to Chouksey, it is “of prime importance”.

A community of like-minded people working towards a personal or group goal can help one stay accountable by sharing their progress and updates. For example, with Fittr, one can educate themselves and keep track of nutrition goals, water intake, and sleep quality on ‘accountability groups’. One is more likely to adhere to one’s goals because of this small yet potent factor.

While working on one’s physical health, it's also important to keep track of one’s mental wellbeing. Working on a business can get lonely, and Chouksey says 80-90% of founders experience ‘founder’s depression’, adding that he has gone through it himself. When one finds oneself in that position, it is important to seek the help of other founders who have experienced it, lower one’s stress levels, and discipline eating and sleeping habits. 

“If you're a founder, you are three times [more] likely to commit suicide compared to normal population… because they go through so much turmoil,” he says.

Gautam adds that health is the only thing that “is irreversible; every other loss is reversible”.

No matter what stage of the life journey one is in, getting the basics right is the first step towards fixing one’s health—diet, exercise, and sleep. Follow WHO and India’s nutrition guidelines, measure your food and eat right, sleep on time, and exercise. 

Kumar finishes by saying that stress is "a part of life", but finding the right balance between stress and rest will ensure physical growth.