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.

The 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.

Kerala 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.

The 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 measures.

According 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 in Kerala.

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.