One teaching of Dr. A.P.J. Abdul Kalam that I have always tried to follow is to ‘stay in circulation’, as he put it. By this, he did not merely mean travelling, attending meetings or remaining publicly visible. He meant keeping the mind in motion—meeting people, visiting institutions, listening to new ideas and allowing one’s own convictions to be questioned and renewed. Circulation prevents intellectual stagnation. It keeps experience connected with emerging realities.

Now that my health does not permit me to travel widely, I consider myself fortunate to live in Hyderabad, a city endowed with many fine institutions. I make it a point to visit some of them whenever possible and exchange ideas with people who have accomplished meaningful work in their chosen fields. Such visits are not formal obligations for me. They are opportunities to remain a student of life.

One such visit recently took me to the Banjara Hills campus of the Administrative Staff College of India (ASCI), where Dr. Subodh Kandamuthan, Professor and Director of the Dr. Kakarla Subba Rao Centre for Health Care Management, invited me to deliver an inaugural lecture to the new Batch 21 students of the PGDM (Hospital Management) programme.

It turned out to be one of those excellent visits that immediately occupy the ‘front seat’ of memory. The ASCI campus stands at perhaps one of the highest elevations in Banjara Hills. From there, one gets a panoramic view of KBR National Park, the precious green expanse that remains a vital lung for our fast-growing metropolis. The setting itself seemed to offer a lesson. As towers, roads and commercial establishments steadily encircle this surviving forest, one is reminded that progress must be measured not only by what we build, but also by what we choose to preserve.

The audience was pan-Indian: bright young students who had arrived at ASCI after walking meritorious academic paths in different parts of the country. Their presence represented India not merely as a geographical entity but as a confluence of diverse aspirations. They chose healthcare and hospital management at a moment when India’s health system is expanding rapidly but also confronting serious questions about affordability, access, ethics, and purpose.

What stayed with me most, however, was my tête-à-tête with Dr. Kandamuthan, a health economist. A native of Kerala with an MPhil from the Centre for Development Studies, Thiruvananthapuram, affiliated to Jawaharlal Nehru University, New Delhi, and a PhD in Health Economics from the Institute of Social and Economic Change, Bengaluru, his academic rigour is enriched by a perceptive grasp of India’s social complexities. In him, one can see the enduring social conscience of Indian society—a conviction that human welfare cannot be left entirely to the seasonal tides of capitalism.

Markets are powerful instruments. They can mobilise resources, encourage innovation and improve efficiency. But they cannot, by themselves, decide what a society ought to value. If profitability alone becomes the organising principle of healthcare, illness begins to acquire greater economic value than wellness. More tests, procedures, hospital admissions and interventions generate more visible revenue than fewer illnesses. The system may then grow financially while society becomes progressively less healthy.

From the stimulating and sagacious company of Dr. Kandamuthan, I could distil the need for a decisive paradigm shift: from an illness-based healthcare ‘industry’ to health economics rooted in wellness.

He drew attention to the wrong scorecard by which healthcare success is commonly measured. We count hospital beds, surgeries, diagnostic procedures, intensive-care facilities and insurance claims. These indicators are necessary, but they mainly tell us how much illness we are managing. They do not tell us how much illness we have prevented.

A hospital may perform thousands of cardiac procedures and be celebrated as a great success. But if many of those patients could have avoided severe disease through early screening, nutritional guidance, exercise, tobacco control, stress management and timely primary care, the larger health system has not truly succeeded. It has intervened efficiently at the end of a chain of failures.

Is not the cheapest hospitalisation the one that never happens?

This question brings us to the idea of the ‘Wellness Dividend’. In simple terms, a wellness dividend is the value created when individuals and communities remain healthy for longer. That value is not abstract. It is reflected in fewer hospital admissions, lower expenditure on medicines, reduced absenteeism, greater workplace productivity, longer working lives and less emotional and financial distress for families. It also frees public resources for education, sanitation, nutrition, housing and the treatment of illnesses that cannot be prevented.

Consider a person at risk of diabetes who receives timely advice, regular monitoring and sustained support to change diet and physical activity. If the onset of diabetes is delayed by ten years—or prevented altogether—the gain is much greater than the price of a few consultations and tests. The individual gains years of healthier life. The family avoids expenditure and anxiety. The employer benefits from greater productivity. Insurers face fewer claims. Hospitals retain capacity for those who genuinely need advanced care. The nation gains from the continued participation of a healthy citizen.

That combined value is the wellness dividend.

Yet our economic system often fails to recognise the wellness dividend because those who fund prevention may not receive its eventual savings. The benefits are dispersed across individuals, employers, insurers and governments—and may appear only years later. We readily calculate the cost of vaccination, screening or nutrition, but rarely the value of the illness prevented.

Realising the wellness dividend therefore requires incentives that give prevention measurable economic value. Healthy behaviour could earn lower insurance premiums, tax benefits or credits in a Personal Health Account. Employers could be rewarded for healthier workplaces, and primary-care providers for keeping communities well—not merely for treating them.

A Personal Health Account, linked securely with the Ayushman Bharat Health Account (ABHA), could serve as a lifelong health ledger supporting screening, vaccination, nutrition, mental wellbeing and chronic risk management, while safeguarding privacy and consent. It could also recognise citizens economically for remaining healthy, rather than paying only after serious illness occurs.

Hospitals and advanced care remain indispensable, but they must rest upon a vibrant primary-care system—the economic and moral foundation of modern healthcare. Without it, patients reach specialist care too late, illnesses become costlier to treat, and expenditure rises without proportionate improvement in public health. Family physicians, nurses, community health workers, nutritionists and local diagnostic centres may prevent more suffering than sophisticated hospitals can later repair; their contribution must therefore be recognised, measured and rewarded.

The movement from the economics of illness to the economics of wellness is ultimately a change in what we choose to celebrate. Do we celebrate only the dramatic rescue in the intensive-care unit, or also the quiet work that prevented a thousand people from entering it? Do we reward only the procedure, or also the years of healthy living that made the procedure unnecessary? Do we regard health expenditure as money spent after disease appears, or as an investment in human capability?

These are not merely philosophical questions. Nor are the Personal Health Account and the Wellness Dividend utopian ideals. They are practical concepts articulated by an astute economist whose thinking remains grounded in the realities of his country and its people.

India needs many more such conversations. It must also cherish institutions such as ASCI—places where administrators, economists, healthcare professionals and young managers can meet beyond their disciplinary boundaries and reconsider the assumptions governing public systems. Institutions acquire greatness not through buildings alone, but by creating spaces where experience encounters inquiry and ideas become instruments of service.

We must equally celebrate people such as Dr. Subodh Kandamuthan: true sons of the soil whose education has taken them across institutions and disciplines, but whose hearts continue to beat with their people. Their scholarship does not distance them from society; it returns them to it with greater responsibility. In their work, knowledge remains accountable to the ordinary citizen.

As I left the high-ground ASCI College Park campus, with KBR Park spread below and a new generation of healthcare managers beginning its journey, I felt renewed by Dr. Kalam’s counsel to stay in circulation. Sometimes circulation is not about travelling far. It is about reaching the right place, meeting a thoughtful person and returning home with an idea capable of changing how we see the future.