The Politics and History of Health in Kerala: From Social Reform to Lifestyle Disease

Fifty years ago, Kerala, like much of India, was gripped by infectious diseases — malaria, cholera, tuberculosis, and many others. Malnutrition was widespread, and large sections of the population lived in deprivation. Yet today, even by NITI Aayog’s own statistics, Kerala’s health indicators stand well above the national average. How did a small state, once burdened by epidemics, come to represent a model for health and human development?

The answer lies not in medical miracles but in politics and social reform. Kerala’s health achievements are inseparable from its political history, its progressive social movements, and the spread of education. Together, these forces reshaped the state’s social consciousness, creating a citizenry that demanded and sustained public health as a right, not a privilege.

In the early decades after Independence, the fall in infant and maternal mortality was not the result of sophisticated healthcare infrastructure but of improved living standards, literacy, and community awareness. These gains were the fruit of long political struggles — the movements for land reform, workers’ rights, and education — that transformed Kerala into a society with a deep sense of social accountability.

However, by the late twentieth century, this equation began to shift. The same modernity that uplifted the population also brought lifestyle diseases. Diabetes, hypertension, heart and kidney ailments began spreading rapidly, and by the 1990s, Kerala had already earned the label of India’s “diabetes capital.” Today, a growing share of the state’s population suffers from complex, chronic conditions. Cancer incidence too has risen, placing Kerala among the leading states in the country.

Parallel to this epidemiological shift was an economic transformation. When Kerala was formed, its per capita income was below the national average. Today, it ranks among the highest GDP growth states in India. This rise was built on the foundations laid by the first Communist government’s land reform and education policies, which redistributed wealth and built a skilled, aware population.

But prosperity also created new vulnerabilities. From the 1990s onward, corporate and multinational capital began to view healthcare as a profitable field for investment. Corporate hospitals mushroomed across Kerala, catering to an educated middle class with the means — and expectation — to pay for premium care. Illness itself became an economic opportunity.

In response, successive Left Democratic Front (LDF) governments worked to restore the primacy of the public health system. When the National Health Mission (NHM) was launched by the UPA government in 2005, the LDF government that took power in 2006 utilized those funds most effectively. The ASHA programme was rolled out, and Hospital Maintenance Grants (HMC) were used to upgrade Primary Health Centres (PHCs).

A key reform of this era was the abolition of private practice for medical college doctors, whose salaries were then aligned with UGC pay scales. This redirected their focus toward teaching and patient care within public hospitals, which in turn revived research and improved the quality of care.

The Aardram Mission (2016) marked a second transformative phase. It redefined Kerala’s health goals in line with the Sustainable Development Goals (SDGs) and sought to make care more accessible and patient-friendly. Under Aardram, PHCs were upgraded into Family Health Centres (FHCs), working hours were extended into the evening, and specialty services were introduced even at local levels. Staffing, laboratory facilities, and the supply of medicines were significantly strengthened. Since 2021, specialty care has become available in every government hospital, enabling ordinary citizens to seek treatment for chronic and lifestyle diseases without turning to the private sector.

These developments have allowed government hospitals in Kerala to compete effectively with private institutions — a major achievement that directly benefits the middle class, offering quality healthcare without financial ruin.

Yet, challenges remain. Kerala’s per capita healthcare expenditure is now among the highest in India, at over ₹10,000 — far above the national average. On average, a person spends around ₹10,000 annually in public hospitals and over ₹25,000 in private ones. The path forward lies in strengthening the public sector further so that more citizens who currently depend on private hospitals can confidently turn to state-run facilities.

Kerala’s health story is thus a deeply political and historical narrative — a journey from epidemics to lifestyle diseases, from social reform to corporate medicine. Its future will depend on whether we can preserve the egalitarian foundations of healthcare built through decades of struggle and reaffirm the idea of health not as a commodity, but as a collective right shaped by social justice and democratic politics.