Kerala 2005 - of Planning Commission

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survey conducted in 1996 also finds that the rate of
prevalence of tuberculosis is 4 per 1,000 persons, and
reported morbidity due to asthma is 48 per 1,000, which
is the highest among major Indian States. The number of
acute respiratory infection cases is also reported to be
the highest in Kerala – 163 per 1,000 persons – whereas
the all-India average is only 16. The incidence and
prevalence of malaria and jaundice in Kerala, however,
is the lowest.
However, although Kerala shows a high tuberculosis
morbidity rate, the case fatality rate is low in Kerala,
compared to other States – 5 per 1,000 cases for Kerala as
against 9 for all-India, which suggests better care facilities
and greater use of those facilities. The highest case fatality
rate was reported in West Bengal (25) followed by Himachal
Pradesh (18) and Karnataka (14).
In the more recent period, lifestyle related disease is on the
rise in Kerala, as it has entered the fourth stage of health
transition. A study conducted by Health Action by People,
Thiruvananthapuram reveals that the prevalence of risk
factors is highest for hypertension, diabetes and coronary
heart diseases (HAP 2002-03). 5 The rise in lifestyle diseases
in Kerala may have implications on the burden of treatment,
as the cost involved for these treatments is significantly
high. It is also surprising to note the reporting of certain
communicable diseases among the vaccine prevented
childhood diseases, like measles. This seems to indicate that
the success of immunisation against measles is incomplete
in Kerala (John et al, 2004). Also, the most frequently
reported diseases as monitored by disease surveillance
in a district in southern Kerala were leptospirosis, acute
dysentery, typhoid fever and acute hepatitis.
Another area of concern is the growing level of alcohol
consumption in Kerala, which is highest among States
in per capita terms. The cause for worry is the spread
of consumption among the younger age groups and its
implications for health, domestic harmony and increasing
road accidents (Box 2.2).
The high morbidity in Kerala will continue to attract more
studies, as it constitutes an emerging health issue. From
a human development point of view, it should invite
the attention of all concerned, especially policy-makers,
because it throws up important questions with respect to
quality and affordability of health care.
It also needs to be noted that while on the one hand,
the State scores very high in terms of physical health
achievements (notwithstanding high levels of morbidity),
on the other, increasing mental ill health is drawing
considerable attention (Box 2.3). Kerala has one of
the highest suicide rates in the country, manifesting
extreme mental distress, 30 per lakh population in 2002
(up from 17 per lakh population in the 1970s), compared to
11 per lakh population all-India, i.e. almost three times
the national average. Within the State, Idukki, Wayanad
and Kollam have the highest rates of male and female
suicides, almost one-and-a-half times the State average
(Table 2.8). It is interesting to note that some attempts
to understand why Kerala has the highest suicide rates
explain it in terms of her unique achievements in literacy
– high proportion of matriculate work seekers with higher
career expectations which are not fulfilled, creating
a mismatch between levels of education and types of
jobs available, causing frustration and extreme distress
(Halliburton, 1998). While for men, it appears to work
Box 2.2: Alcohol Consumption
Between 15 and 20 per cent of Indian people consume alcohol and, over the past 20 years, the number of drinkers has
increased from one in 300 to one in 20. The per capita consumption of alcohol for India is 4 litres. Kerala stands first in
per capita consumption of liquor at 8.3 litres, followed by Punjab 7.9 litres. Fifteen per cent of the population consumes
alcohol. Over the years, the age at which youngsters begin to consume liquor has come down in Kerala. In 1986 the
age was 19, by 1990 it had dropped to 17, and by 1994, the age was 14. Most drinkers are in the 21 to 40 age group,
the same group where the maximum number of suicides also takes place. A study conducted by the Alcohol & Drug
Information Centre (ADIC)- India revealed that around 40 per cent of road accidents occurred because the driver was
under the influence of alcohol. In the case of accidents on national highways, more than 72 per cent were related to
drunken driving. Domestic violence is also on the increase due to high alcohol consumption. Alcohol related diseases
are growing leading to high occupancy of hospital beds in hospitals.
Source: Global Alcohol Policy Alliance, http://www.ias.org.uk
5 From the survey conducted by the Health Action for People in 2002-03.