HEALTH STATUS OF KERALA
The population of Kerala is uniformly scattered through
out the state and is fairly well advanced in its demographic
transition. The rapidly declining growth rate, highest mean
age at marriage especially of families, a very high level
of acceptance and awareness of family planning methods and
fertility control, a moderate decline in the mortality rate
etc are the commendable achievements in health standards
which are almost comparable to that of developed countries
in the world. Low birth rate and death rate along with higher
female life expectancy, low infant mortality with negligible
gap between rural and urban and lower levels of disability
are the special characteristics of Kerala’s Health Status.
The major factors contributing to such a unique situation
are a wide network of health infrastructure and manpower,
policies of successive state government and other social
factors like women’s education, general health awareness
and clean health habits of the people.
density of population of Kerala, which is 749 per sq.km
in the 1991 census is second only to West Bengal and is
almost three times that of India today.
Till 1971, Kerala had the highest population growth rate
in India and there after it showed a declining tread. This
is mainly because of a substantial drop in the mortality
rate, without a corresponding decline in fertility rate.
While the death rate declined from 29 in 1930’s to 9 in
1970’s, the birth rate declined from 40 to only 31 during
the same period. However during the subsequent period there
was a substantial decline in both birth and death rates.
While the birth rate declined from 31 in 1970 to 19.6 in
1990, the decline in death rate during the same period was
from 9 to 6 only. Thus for the first time, Kerala’s population
growth registered a lower rate than at the all India level.
ha undergone a demographic transition since the mid sixties.
Since 1966 there has been a perceptible downward trend in
the growth rate of population and is now continuing steadily.
As a result of fall in birth rate the total fertility also
shows a declining tread from 4.1 1971 to 2.1 in 1990 and
1.8 in 1992.
Another significant feature of the population of Kerala
is that it has a unique position in regard to sex ratio
which is expressed as the number of females per 1000 males.
In all previous censuses females out numbered males in Kerala
which is just contrary to the all India pattern. According
to 1991 census, there were 1036 females per 1000 males.
The fertility and mortality rates have declined significantly
over a period of time. The impact of this decline is reflected
clearly in the age structure.
population distribution by broad age group:
In 1961, the children accounted for 43 percent of the total
population and declined to less than 30 percent, the percentage
of decline being 13 point during 30 the decline being sharp
during the last two decades.
The expectation of life at birth in Kerala is the highest
in India and the death rate lowest. Precisely for that very
reason, the proportion of population above 60 years in Kerala
according to 1981 census was 7.55 percent compared to the
all India average of 6.27 percent. According to a study
made by the Centre for Development Studies, the proportion
of the aged (those above 60 years of age) in Kerala in 2001
will be 10.2 percent as against the all India percentage
of 8.0. This situation would call for more commitments in
future in areas like old age security, pension to weaker
sections medical care facilities and similar other welfare
tot he available morbidity statistics the morbidity rate
in Kerala is much more than at the All India level. With
increasing levels of literacy and extension of medical services,
it is conceivable that even minor ailments are reported
as illness. State like Bihar and UttarPradesh lagging far
behind in terms of literacy and medical services, have also
the lowest morbidity rates. It may also be noted that morbidity
correlates with density of population and that Kerala having
the highest density thus has high morbidity too. The increase
in old age population is also a factor for high morbidity
The Infant mortality is an index to measure the physical
quality of life, in any given population. In 1995 it is
16 per thousand live births in Kerala – the lowest in the
country as compared to the all India figure of 74. The continuous
decline in the infant mortality rate from a high of 242
during 1911 – 1920 to as low as 16 in 1995 has contributed
to the rapid increase in expectation of life at birth in
Kerala. The projected figures are over 73 years of females
and 68 for males during 1996-2000 and since again form an
important indicator for assessing the overall health situation
and quality of life in the state.
The health status of any state can be measured in terms
of birth rate, death rate, infant mortality rate, expectation
of life at birth etc. Kerala is far ahead of other states
in the country and ranks first in attaining low birth rate,
death rate, total fertility rate, infant mortality rate
and in attaining high expectation of life especially of
females. The literacy in Kerala is high and people are aware
of their needs, conscious of their status and are generally
demanding the services. They are enjoying a better healthier
life than their counter parts in the country.
Another contributory factor for the attainment of high health
standards is the clean health habits of the people. The
earnest efforts put in by the Government in building up
a sound health infra structure, capable of delivering health
care at different socio economic levels even in remotest
rural areas along with those of private sector have been
significant in raising the health status of the state and
in enabling the state to play a leadership role.
Traditionally, Kerala is famous for its Ayurvedic system
of treatment. Homoeopathy is preferred for certain types
of diseases and ailments peculiar to the infants and the
aged. The present policy of Government is to promote all
these systems of medicine keeping in view the acceptability
of the people and their preferences.
The family welfare programme which is now being changes
as Reproductive Child Health programme with more emphasis
on mother and child health care, management of RTI / STI
including HIV/AIDS adopting a client oriented approach to
improve quality of services is sure to open up new vistas
in the implementation of the integrated package scheme.
A close study of the situation in Kerala would show that
family planning has been accepted as a way of life. Kerala
has achieved all the major health indicators targeted for
“Health for All by 2000 AD”. It would be worth while to
look at this juncture beyond 2000 AD in the context of the
global discussion of ‘Zero Population Growth’. Kerala may
attain birth rate of about 10 per thousand in another 20
to 25 years. The death rate has almost stabilised around
6 per thousand. The economic and social development factors
leading to women’s emancipation and the tendency to avoid
child birth as far as possible and limitation to one child
not be a distant dream in the demographic profile of Kerala.
The achievements of Kerala in terms of the health status
of its people is indeed impressive. At the same time there
is need to wake up to the emerging challenges also. It can
be expected that the innovative schemes adopted in Kerala
and the leadership role played by the state in the implementation
of various health and family welfare programmes will serve
as a model for other states.