KERALA HEALTH SCENARIO
Kerala, ‘the God’s Own Country’, is unique in several counts,-socialy, culturaly, ethnicaly educationaly, geographically and climatically .
All the provinces of Kerala, Travancore, Cochin and Malabar had passed through radical transformations in Social, cultural, educational and economic fields. Literacy, especially female literacy shot up and probably was the single largest factor responsible for this. The health scenario also benefited considerably from this phenomenon. The health awareness among Keralites went high proportionately. Institutions started coming up in the fields of Health and Education. The average Malayalee Psyche got augmented and we started venturing into all the nook and corner of the world, and Kerala ,the Global citizen got born gradually.
The Health Scenario accordingly got transformed into the best available in the country, with Primary Health care occupying the Central slot, on top of which secondary care consequently got established. Later Tertiary care also came into health care system,, initially through District Hospitals and subsequently via, Medical College as well. So the three- tier system in Health Care, which was like a pyramid, with Primary care as the broad base, got into reality.
The issues plaguing the community, at the outset were malnutrition and communicable diseases,. With the support of a well structured public distribution system, amply backed up by high levels of health awareness, the magnitude of Malnutrition could be brought down, which later got covered in Tribal Hamlets and slums in and around cities.
With the effective implementation of Primary Health Care, the preventive and propagating components of the system were given maximum thrust and with the dedicated workforce comprising of field staff and supervisors, who ensured the successful implementation of National Health Programmes, especially the MCH (Maternal and Child Health) Services, the Public Health Challenges and mortality poised by communicable diseases were reduced to tolerable levels. As a result, the Infant mortality, Maternal Mortality, Death Rate, Birth Rate all were brought down to the best in the country and later on, on par with then prevalent in most of the developed countries, and along with the Life expectancy of an average Keralite got extended to the 7th decade.
All these achievements in the area of Health Indices were garnered with a relatively low per capita income, when compared with the situation in the developed world. Thus a new model health sector, with excellent Health Indices at low costs, was introduced, not only in India, but before the whole world, especially the developing countries. That was the ‘Kerala Model’ –much acclaimed by the WHO and noticed the world over.
But unfortunately this spring didn’t last long. The society got metamorphosed again and new trends, priorities and social definitions crept in knowingly or unknowingly, and drastic changes followed suit, especially in socio- economic domain.
Nuclear family system got established, and Joint family now became a non entity. Agriculture gradually varnished from Kerala’s psyche and consumerism became the order and started strangling the society. Life style centered on sedentary habits and work culture once upheld in the society disappeared. New eating habits got acceptance especially among the adolescents and youth, which was more of Non-Vegetarian, mostly with red meat. Over weight and obesity started affecting large chunk of people, and as usual adolescents and youngsters, were no exception.
The Gulf boom which started blessing Kerala, from early societies, brought in a lot of money, and this nouveaux riches was the single most factor which aided and abetted these phenomena aforesaid and many unforeseen to follow later.
Consumerism became at its best in Kerala, and its tentacles started embracing all the sectors of Society. Competitiveness and stress attained monstrous dimensions, leading to deteriorating mental health and unleashing a multihued of related mortalities. Alcohol use and drying nuisance still compounded the situation. High incidences of suicides, Matrimonial disharmony, violence against women, Criminalization of Public life, rampant valuelessness and unrest, all became daily affair in our Society.
Along with the social melodies, the near total lack of civic sense among the people led to one of the most preposterous disposal systems and the environmental pollution reached disastrous proportions, and now commenced to take its toll. The communicable diseases which were conquered and reduced to negligible levels have re-emerged with new striking force e.g. Malaria, Filaria and Water borne diseases.
Some other communicable diseases which were of insignificant public Health importance have landed in our Society resulting in considerable mortality and morbidity. E.g. Leptospirosis, Chicken Guinea, Dengue, Falciperum Malaria, Jap. B. Encephalitis etc.
With this the callousness among certain Sections of Society in strictly pursuing immunization schedule has resulted in resurfacing of some of the vaccine Preventable diseases eg. Diphtheria.
But the negative reputation Kerala, has of late annexed, is in the area of Life Style diseases.
Unhealthy eating habits, sedentary life, stress, alcohol use and genetic predisposition, all have jointly ushered in, the ignominy to Kerala as the World’s Capital of Life Style diseases, i.e. Type 2 Diabetes, Hypertension, Heart attacks (especially among the younger individuals), Degenerative diseases, certain cancers, alcoholism centered and mental health issues.
So the paradox of communicable diseases usually seen among under developed societies, co-existing with life style disorders, once upon considered to be the possessions of developed societies, is prevailing in Kerala, for all to see and interpret.
To cap all, the spiraling incidence of Road Traffic Accidents, in which a lot of precious lives are lost, a good climate belonging to the youngsters, and scores of others are left handicapped, also is a grave public health issue warranting aggressive containment measures.
Health problems faced by Senior Citizens are another area, which is going to be a major concern in our Society. Against a national average of 7.5%, the elderly population in Kerala is as much as 11.5%. And they are the largest group, among the marginalized sections of society. The physical, mental and social health issues of old age have already evoked considerable attention among health policy makers. Protocol based new tools and measures may have to be implemented in the field of elderly empowerment and rehabilitation. In other words, in Public Health Sector, Geriatric care is going to be a major domain to be focused along with the conventional areas like MCH and other national programmes.
Therefore this is a clearest case of less mortality and morbidity, and one strong reason, as to why this paradox or phenomenon does occur, is the gradual loss of thrust occurred in the area of Primary Health Care.
Instead of revamping and re-equipping the Primary Care to address the existing, expectant and emerging issued complex or otherwise, we knowingly or unknowingly distanced from and disowned the Primary care and moved gradually into the tertiary care system, even circumventing secondary care, which explains in unambiguous terms, the mushrooming of tertiary care hospitals, catering mainly to the diverse needs in the areas of life style disorders, with turnovers running into crores and crores of rupees, and medical science completing its journey from an art of science and technology and later to pucca commercial.
Therefore in order to recapture the lost ground, we must go for paradigm shift and primary care must be reviewed, revamped and re-written and the three tier health care systems & institutions to be appropriately equipped to address to the diverse needs of the society, with timely updating and modifications.