India's public health landscape has undergone substantial transformation over the past two decades driven by ambitious government programmes and progressive policy reforms. However, the translation of policy into equitable health outcomes remains uneven across states and socioeconomic strata. This study evaluates the implementation effectiveness of major national public health policies in India, examines epidemiological trends, analyses state-level disparities in health expenditure and outcomes, and identifies structural bottlenecks impeding universal health coverage. A cross-sectional, mixed-methods design was employed. Secondary data from the National Family Health Survey (NFHS-5, 2019–21), National Health Accounts (NHA) 2019–20, and the Global Burden of Disease (GBD) Study 2019 were triangulated with programmatic data from the Ministry of Health and Family Welfare. Descriptive statistics, correlation analyses, and policy content analysis were conducted. Maternal mortality decreased from 384 to 86 per 100,000 live births (2000–2023). Full immunization coverage rose to 91% following Mission Indradhanush. PM-JAY enrolled over 241 million beneficiaries by 2022–23 but hospitalization utilization remained low among the poorest quintile. Non-communicable disease (NCD) burden increased by 44–133% across categories. Substantial inter-state disparities persisted, with Bihar recording an infant mortality rate of 48 compared to 7 in Kerala. India has achieved significant gains in maternal and child health, yet equity gaps and the emerging NCD burden necessitate a reoriented policy framework that increases public health expenditure, addresses workforce maldistribution, and strengthens primary care infrastructure.