Kerala 2005 - of Planning Commission

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30 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.
CHAPTER 2 ASSESSING DEVELOPMENT: SOME NON- INCOME DIMENSIONS 31 Box 2.3: The Extent of Problem of Mental Health Population of Kerala (2001 Census) ........................................................................................................................ 3,18,38,619 Prevalence of Psychiatry Disorders (58/1000 Population) .......................................................................................... 18,46,640 Prevalence of Severe Psychiatric Disorders (10-20/1000 Population) ......................................................... 3,18,386 - 6,36,772 Neurosis and Psychosomatic Disorders (20-30/1000 Population) ............................................................... 6,36,772 - 9,55,159 Mental Retardation (0-1% of all children up to 6 years) .................................................................................... 18,267 - 36,535 Psychiatric Disorders in Children (1-2% of all children up to 6 years) ............................................................... 36,535 - 73,071 Source: http://www.ksmha.org/kerala.htm through their need to procure a suitable job, for women, the culturally prescribed codes of conduct and roles they are expected to assume after marriage appear to be the proximate cause. However, the higher rates in Idukki and Wayanad, certainly not the most literate districts, remain unexplained. Needless to state, this is an area drawing serious concern and needs further research. In recent years, there has also been a spurt in ‘family suicides’, which has attracted tremendous publicity. Journalistic reports suggest that a major cause of family suicides is financial bankruptcy. 2.9 Nutrition The findings on this aspect are somewhat mixed. Among the States in India, nutritional input levels in Kerala are low while it presents a relatively good nutritional outcome. Table 2.8: District-wise Suicide Rate District/State 1995 2003 Thiruvananthapuram 17.2 33.4 Kollam 32.0 43.6 Pathanamthitta 23.5 32.9 Alappuzha 19.9 25.3 Kottayam 23.5 26.3 Idukki 48.6 51.7 Ernakulam 26.0 24.4 Thrissur 37.5 34.3 Palakkad 32.3 33.6 Malappuram 12.0 13.3 Kozhikode 22.0 23.3 Wayanad 44.4 46.7 Kannur 44.4 46.7 Kasaragod 24.8 24.0 Kerala 28.0 32.8 Source: State Crime Record Bureau, various issues. The 55th round of National Sample Survey, conducted in 1999-00, observes that in both rural and urban Kerala, the intake of calories is one of the lowest among the major States in India. The per capita calorie intake per day in Kerala is 1982 kcal in rural areas, which is 22 per cent below the norm, and 1995 kcal in urban areas. 6 The National Family Health Survey (NFHS) gives rich information on the nutritional outcome indicators of women and children. In Kerala, 27 per cent of children under three years of age are undernourished, according to the weight-for-age measure in 1998-99. For India, the corresponding figure is 47 per cent. With respect to height-for-age, 22 per cent of children under three years of age are stunted in Kerala, the all-India figure being 46 per cent (Appendix Table A2.1). Despite the low level of calorie intake in Kerala, the nutritional outcomes in terms of anthropometric indicators are better than for most other States. In the case of women, the NFHS II (1998-99) indicates that about 19 per cent of the women in Kerala are undernourished in terms of BMI (i.e. BMI below 18.5 kg/m2), whereas in India, it is 36 per cent. Kerala attains the second highest position among major Indian States in terms of this indicator of nutritional achievement among women, following Punjab. However, for both Kerala and Punjab, a high prevalence of obesity is reported. The per cent of women with obesity is 21 (BMI of 25 kg/m2 or more) in Kerala, which is the second highest after Punjab’s 30 per cent. But the national average is only 11 per cent. Other studies have also highlighted the growing problem of obesity among women in Kerala, which is not a good indicator of physical health. 7 The apparent paradox of low average nutritional intake leading to high nutritional outcome in aggregate can perhaps be explained to some extent in terms of the remarkable reach of the public distribution system in 6 However, the trends in calorie and protein intake over time have been increasing through the different rounds of NSS. 7 This has been highlighted by Dr.C.R.Soman, Director, Health Action by People (HAP), a well-known nutritional expert in Kerala.
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Human Development Report 2005 KERAL
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ii © Copyright 2006 Government of
Page 6 and 7: iv Location of Kerala
Page 8 and 9: vi Foreword Kerala has achieved int
Page 10 and 11: viii Message I have immense pleasur
Page 12 and 13: x It was at the invitation of the K
Page 14 and 15: xii It should be noted that the CDS
Page 16 and 17: xiv CHAPTER 8 CHAPTER 9 CHAPTER 10
Page 18 and 19: xvi CHAPTER 4 4.1 District-wise Hum
Page 20 and 21: xviii List of Figures Figure No. Fi
Page 22 and 23: xx List of Maps Map No. Map Title P
Page 24 and 25: xxii INCLEN International Clinical
Page 26 and 27: xxiv Marumakkatayam Mavilan Nambudi
Page 28 and 29: 2 that base, but primarily deals wi
Page 30 and 31: 4 further improvement on the human
Page 32 and 33: 6 functions are intimately related
Page 34 and 35: 8 2. Present Day Kerala: A Profile
Page 36 and 37: 10 to introduce the modern system o
Page 38 and 39: 12 the nationalist movement followe
Page 40 and 41: 14 2.2.5 The Post-Independence Peri
Page 42 and 43: 16 In more recent years, however, o
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Page 46 and 47: 20 2. Demographic and Health Indica
Page 48 and 49: 22 Table 2.3: Overall Sex Ratio and
Page 50 and 51: 24 Table 2.5: Marriage Indicators b
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CHAPTER 5 HUMAN DEVELOPMENT AND ECO
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CHAPTER 5 HUMAN DEVELOPMENT AND ECO
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CHAPTER 6 Reckoning Promise A CRITI
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CHAPTER 6 RECKONING PROMISE: KERALA
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CHAPTER 7 Reckoning Caution EDUCATE
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CHAPTER 7 RECKONING CAUTION: EDUCAT
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CHAPTER 8 Looking Ahead POSSIBILITI
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CHAPTER 8 LOOKING AHEAD: POSSIBILIT
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CHAPTER 9 Decentralised Governance
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CHAPTER 9 DECENTRALISED GOVERNANCE
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CHAPTER 10 By Way of Conclusion SUG
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CHAPTER 10 BY WAY OF CONCLUSION: SU
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TECHNICAL NOTE 169 An index has bee
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TECHNICAL NOTE 171 Table 3: Gender
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TECHNICAL NOTE 173 source is consid
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DISTRICT PROFILES 175 Kollam Indice
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DISTRICT PROFILES 177 Alappuzha Ind
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DISTRICT PROFILES 179 Idukki Indice
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DISTRICT PROFILES 181 Thrissur Indi
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DISTRICT PROFILES 183 Malappuram In
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DISTRICT PROFILES 185 Wayanad Indic
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DISTRICT PROFILES 187 Kasaragod Ind
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REFERENCES 189 Bloom, D. E. & Willi
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REFERENCES 191 Halliburton, Murphy
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REFERENCES 193 Keynes, J. M. (1930)
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REFERENCES 195 Nelson, Nici and Wri
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REFERENCES 197 Sen, A. (1999) Devel
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199 List of Background Papers Achin
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