Users Online: 1245 Home Print this page Email this page Small font sizeDefault font sizeIncrease font size


Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 

 Table of Contents  
Year : 2022  |  Volume : 66  |  Issue : 5  |  Page : 1-2  

Contemporary Public Health Challenges for Kerala

1 Director, Department of Medical Education, Kerala, India
2 Assistant Professor, Department of Community Medicine, Government Medical College, Thiruvananthapuram, Kerala, India
3 Assistant Professor, Department of Community Medicine, Government T.D. Medical College, Alappuzha, Kerala, India

Date of Submission19-Oct-2022
Date of Decision28-Oct-2022
Date of Acceptance28-Oct-2022
Date of Web Publication11-Nov-2022

Correspondence Address:
Thomas Mathew
Director, Department of Medical Education, Kerala
Login to access the Email id

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijph.ijph_1412_22

Rights and Permissions

How to cite this article:
Mathew T, Ramakrishnan D, Bilal S R. Contemporary Public Health Challenges for Kerala. Indian J Public Health 2022;66, Suppl S1:1-2

How to cite this URL:
Mathew T, Ramakrishnan D, Bilal S R. Contemporary Public Health Challenges for Kerala. Indian J Public Health [serial online] 2022 [cited 2023 Feb 4];66, Suppl S1:1-2. Available from:

Kerala, a small state yet famous for its remarkable achievements in health-care indicators, is currently facing a wide variety of public health challenges. The prevalence of noncommunicable diseases (NCDs) is rapidly increasing along with the increasing incidence of emerging infectious diseases across the state, often referred to as twin burden or double burden of disease.[1] Three-fourth of the total disease burden in the state is being contributed by NCDs.[2] The average life expectancy of the Kerala population is on the higher side than the national average, resulting in a higher proportion of the elderly, making it more vulnerable to lifestyle diseases, and contributing to the morbidity burden of the state. Thus, low mortality and longer life expectancy with the double burden of disease make the Kerala scenario a challenging one.

Cardiovascular diseases, diabetes mellitus, cancer, and stroke contribute to the bulk of the morbidity and mortality in the state. Kerala is notorious for the high incidence of Type 2 diabetes mellitus making the state the diabetic capital of India.[3] Since 1996 the prevalence of coronary artery disease increased by three times in both rural and urban areas of Kerala.[4] Complications due to CAD and cerebrovascular accidents arising from the delayed reporting to the health facilities make the concept of golden hour treatment very difficult. These also contribute to the long hospital stay and an increase in catastrophic health expenditure, about 30% of them requiring distress financing.[5] Late diagnosis of cancers leaves no definitive treatment options except the provision of palliative care services. In this area, the establishment of a cancer grid with cancer control initiatives at the district level is yielding results.[6]

Even though the state was spending generously on public sector health institutions before the COVID-19 pandemic, more than 60% of the population depended on private sector hospitals, which in turn considerably increased the out-of-pocket expenditure.[7] However, the excellent care and follow-up provided during the COVID-19 period has resulted in a perceived increase in demand for care in government tertiary care hospitals in the state, which should be evaluated and adequately addressed.

On the other hand, emerging infectious diseases (which include the diseases addressed as re-emerging infections formerly) have become a threat to the health-care system in the state more frequently than ever. Cases of Nipah, monkeypox, Kyasanur forest disease, West Nile fever, and many more have been reported in Kerala in the last 5 years. Unplanned urbanization, change in vector habitats due to environmental factors, genetic mutations, increased susceptibility to infections, increased population density, poverty, social inequalities, globalization of the food industry, drug resistance, bioterrorism, international travel, and many other known and unknown factors contribute to the emerging infectious diseases.[8] Zoonotic diseases such as rabies, leptospirosis, salmonellosis, avian influenza, and swine fever show a rising trend in Kerala in recent years.[9] The first cases of COVID-19 and monkeypox in India were reported in Kerala, which was possible due to a better disease surveillance system. One health approach has been adopted by Kerala as the primary ammunition for fighting against zoonotic diseases and the target to “achieve zero rabies death by 2025” by the health minister of Kerala illustrates this commitment.

Introduction of new sophisticated diagnostic techniques, investing more in the public health sector, expediting the research in the field of medicine and technology, adoption of advanced real-time communicable disease surveillance systems with meticulous epidemic intelligence networks, along with the utilization of the social capital of the state, will help Kerala in facing these challenges.

Since the diagnosis of the first case of COVID-19 in India, the state has promptly tried and advocated several clinical, academic, and management models for the prevention and control of the disease. District and state administration had worked relentlessly in coordinating with other departments such as local self-government, police, fire and rescue, revenue, and mass media. The active participation of the community in establishing infrastructure and providing human resources voluntarily during the pandemic is a model worth adopting anywhere else in the country.[10]

The lessons learned from managing the COVID-19 pandemic, locally and globally, should help us to reorient ourselves with strategies for preparedness, prevention, and management of NCDs and emerging infectious diseases. We must rope in the services and support from private hospitals, self-financing medical colleges, and indigenous systems of medicine to reap maximum benefit. We can rest assured that we are on the right track if our strategies are firmly grounded on the four pillars of primary health care, namely equitable distribution, community participation, intersectoral coordination, and appropriate technology. The firm base of these pillars will also ensure that we work together as a nation toward “All for Health and Health for All.”

   References Top

Hussein AA. The “Epidemiological transmission” and “Double-burden of disease”: A focus on Africa. Majmaah J Health Sci 2014;2:3-11.  Back to cited text no. 1
FS_Kerala.pdf. Available form: [Last accessed on 2022 Oct 03].  Back to cited text no. 2
Diabetes in Kerala | Cadi. Available form: [Last accessed on 2022 Oct 04].  Back to cited text no. 3
Krishnan MN, Zachariah G, Venugopal K, Mohanan PP, Harikrishnan S, Sanjay G, et al. Prevalence of coronary artery disease and its risk factors in Kerala, South India: A community-based cross-sectional study. BMC Cardiovasc Disord 2016;16:12.  Back to cited text no. 4
Kastor A, Mohanty SK. Disease-specific out-of-pocket and catastrophic health expenditure on hospitalization in India: Do Indian households face distress health financing? PLoS One 2018;13:e0196106.  Back to cited text no. 5
Progress-Report-Kerala Government.pdf. Available from: [Last accessed on 2022 Oct 19].  Back to cited text no. 6
Dilip TR. Role of Private Hospitals in Kerala: An Exploration. CDS working papers, no.400. Trivandrum: Centre for Development Studies 2008. Available form: [Last cited on 2022 Oct 03].  Back to cited text no. 7
McArthur DB. Emerging infectious diseases. Nurs Clin North Am 2019;54:297-311.  Back to cited text no. 8
NCDC. One Health Action” Plan for Climate Sensitive Zoonotic Diseases. Government of India. Available form: [Last accessed on 2022 Oct 17].  Back to cited text no. 9
Responding to COVID-19 – Learnings from Kerala. Available form:–learnings-from-kerala. [Last accessed on 2022 Oct 19].  Back to cited text no. 10


    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

  In this article

 Article Access Statistics
    PDF Downloaded314    
    Comments [Add]    

Recommend this journal