Punjab's life expectancy is above the Indian average and its infant mortality rate is below it, and both have improved steadily for decades.
Its disease burden has shifted from infectious to non-communicable: cardiovascular disease, diabetes and cancer are the leading causes of death, in a population with a diet built for physical labour that most people no longer do.
Punjab has among the highest rates of overweight and obesity in India, and among the highest anaemia rates among women despite being the country's granary, which is the clearest single indicator that producing food and eating well are different things.
Alcohol and opioid use are substantial contributors to the burden and are discussed separately and rarely together.
Out-of-pocket health spending is a leading driver of rural debt.
A state with above-average income and above-average life expectancy also has a health profile that is deteriorating in exactly the ways a rich country's does, without a rich country's health system.
The private sector provides most of the actual care. Punjab has a dense network of private hospitals, clinics and unqualified practitioners, and the public system is used mainly for immunisation, maternity and emergencies.
Non-communicable disease is the dominant burden now, on a population that eats and works differently from how it did fifty years ago.
The state's own data collection is weak below the district level, and most of what is quoted about Punjab's health comes from national sample surveys rather than from the state's own records.