Kerala is reputed for its high quality health care infrastructure and renowned medical personnel, some of whom are guest faculty at medical schools like Harvard and Sloan Kettering. Alongside the modern medical facilities are equally reputed facilities for Homoeopathy and Ayurveda ( An age-old Indian system of medicine based on herbs, oils and other natural ingredients). Little wonder, Kerala enjoys India's highest life expectancy and lowest infant mortality and birth rates.

Health Transition in Kerala (Abstract) P.G.K. Panikar*

Kerala has achieved remarkable progress in human development, as reflected in the high levels of education and health of its population. The level of literacy among Keralites is far higher than the national average. Crude death rate, infant mortality rate, and life expectancy at birth in Kerala are comparable even to those in the developed countries. However, the question whether low mortality rates signal better health has generated heated debate in the light of the sequence of changes in the health profile, termed as "health transition, which the developed countries have experienced. Apparently, Kerala also has been passing through an advanced phase of health transition, despite remaining economically backward". In this paper, we shall attempt a survey of the sources and the stages of Kerala’s health transition and discuss its policy implications.

Health is a multi-dimensional and multi-causal variable. It is defined as a "state of complete physical, mental, and social well being" (World Health Organisation). Being a holistic concept, it is beyond measurability in terms of mortality and morbidity prevalence rates (Basch; 1978, pp. 204-206). The health status of a community depends on its socio-economic, environmental, biological, and political factors.

Health transition is a complex process comprising demographic (mortality), epidemiological, and health care transitions. It is manifested in rising life expectancy at birth due to changes in the fertility, mortality, and morbidity profile of a population. Demographic (mortality) transition brings down birth and death rates and changes the age structure; epidemiological transition reflects changes in the causes of death, from infectious (pandemic) diseases to non-communicable (degenerative, human-made) diseases (Caldwell: 1990; Mc Namera; 1982, p.147). However, the causal mechanisms of demographic changes are unclear and distinct variations in patterns, places, determinants, and consequence of population changes are observed in the case of epidemiological transition (Omran: 1982, p.172). Three fundamental changes in the configuration of a population’s health profile take place during epidemiological transition: (i) mortality decline due to infectious diseases, injuries, and mental illness; (ii) shift of the burden of death and diseases from the younger to the older groups; and (iii) change in health profile from one dominated by death to one dominated by morbidity. Epidemiological transition implies change in the morbidity profile from acute, infectious, and parasitic diseases (eg plague, smallpox, and cholera) to non-communicable, degenerative, and chronic diseases (eg cardiovascular diseases, cancer, diabetes, and neoplasms) (Mercer: 1990, p.262; Albala, 1995; Prata: 1992; Crews: 1987; Reis: 1978). A third component of health transition is health care transition brought about through changes in the patterns of the organised social response to health condition.

Kerala has apparently entered the third or final phase of the demographic transition characterised by low death rate and declining birth rate leading to a slow down in the growth rate of population. Thus, as of 1991, the birth rate in Kerala was estimated as a little over 18 (per 1000 population), as against 30 for all-India and an average of 28 for low-income and 24 for middle-income countries.