Health at low cost: the Kerala model

This article discusses the Kerala model of good health and low income with low fertility in India. Kerala State in South India, has a life expectancy of 69 years for men and 74 years for women. The infant mortality rate is 13/1000 live births. The total fertility rate is 1.7 children/woman. These statistics surpass the national averages and are comparable to statistics in developed countries. Kerala State has accomplished social development with a gross national product of US$275/person/year. The national average is US$350 for India, and US$23,090 in developed countries. The education of girls is identified as the agent of change. Literacy is 94% for men and 86% for women. 95% of pregnant women seek prenatal care. 92% of deliveries are performed in institutions, compared to only 25% nationally. Of children aged 12-24 months, 89% are immunized for diphtheria-pertussis-tetanus, 89% receive polio vaccines, 77% receive measles immunization, and 95% received BCG immunization. These rates compare favorably with rates worldwide. Non-health care sectors contributed to the health status of Kerala, in education, food grain distribution, social reform movements, and land reform. The examples in Eastern Asia indicate that human resource development precedes economic development. Kerala has yet to experience economic development and continues to suffer from high rates of morbidity and suicide.