In brief, Kerala has made significant advances in health transition in terms of the rate of mortality and pattern of morbidity. True, high morbidity rates still persist. What are the causes of this apparently paradoxical phenomenon? Of the different factors governing the health status, spread of education, especially female education, and of medical care facilities have emerged as the most important. The role of the State government as the principal agent in the promotion of education, universal literacy, and expansion of medical care facilities aimed at ‘health for all’, has to be duly acknowledged. The high rate of prevalence of acute communicative diseases, despite these advances is a cause for concern. The causes for the persistence of infectious diseases - the diseases of poverty - are not far to seek. They are unfavourable environment, lack of access to safe drinking water, and sanitary facilities for the majority of the households in the State.

* Prof. P. G. K. Panikar prepared this survey paper for KRPLLD a few months before his demise in August 1999. The author of several research papers and monographs on the economics of health care and nutrition in Kerala, Prof. Panikar had an illustrious career as Head of the Department of Economics, University of Kerala (1970-’76) and Director, CDS (1971-1982).

The health of a nation is a sum- total of the health of its citizens, communities and settlements as well as the overall climate within which the citizen and communities live. A healthy nation, therefore, is possible only if there is total participation of its citizens, communities and the government in this goal.

In the last five decades, there has been a significant progress in various aspects of health in the country. But sadly, this advancement has been uneven and restricted to few selected states. A very large part of Hindi speaking areas of the country as well as the states of Orissa and Assam remain under shadows. Interestingly, even in the better off states like Kerala, Maharashtra, Punjab, etc., there are pockets where health status of the people has remained stagnant over the years. The Malabar Coast and the High-ranges of Kerala are examples of this situation.

We have also noticed with considerable dismay the rising incidence of communicable diseases like malaria over the last few years. It is also doubtful whether the health services of most of the country are geared up sufficiently to meet the health problems due to modernization like heart diseases, accidents, traumas, sexually transmitted diseases, etc.
Given the above situation, it is imperative that in the coming Five Year Plan, sufficient emphasis is given to health care needs of the people living in vulnerable regions, by ensuring that the pockets of darkness in the advanced states are adequately taken care of and the systems and infrastructure available in the country are totally revitalized to competently deal with the newer challenges in the health care. This task cannot be done just by the government and its functionaries alone. It requires enthusiastic and sustained participation of all the citizens of the country in taking responsibility for their own health as well as that of their communities. We also need to ensure active and responsible participation of the private and voluntary sectors.

There is a considerable challenge for optimising the existing rural health infrastructure throughout the country. Keeping in view the potentiality of the Panchayati Raj, it is proposed that health infrastructure in the rural areas are gradually but surely made accountable to village panchayats, panchayat samities and Zila Parishads at their respective levels. There are good examples of this approach from Maharashtra, West Bengal and few other states. This will considerably improve the functioning of the infrastructure and will ensure participation of the people.