Demographic and epidemiological changes in Kerala require a reorientation of the healthcare system from simply reducing mortality to improving healthy life expectancy, financial protection and quality of life. The state will need to redesign the health care system to meet the new challenges of chronic disease, aging and equity to make the state’s future health benefits sustainable, inclusive and resilient, public health experts said.
At a session on ‘Health and Nutrition’ organized as part of the ‘Vision 2031 International Conference on Development and Democracy’ here on Monday, health experts pointed out that Kerala’s health system has historically delivered strong results, supported by an extensive public healthcare network, strong primary healthcare delivery, decentralized governance and strong community participation.
However, Kerala is now at a critical point where it needs to shift from an infectious disease/maternal and child health model to a chronic care model; from mere longevity to healthy aging and improved quality of life. This requires drastic restructuring of the healthcare system rather than just systemic expansion.
While the state’s overall indicators are good, it masks within-state and urban-rural inequalities in health outcomes in tribal areas, hilly areas and coastal regions, which remain neglected as in other states, said Soumya Swaminathan, a former WHO chief scientist.
A rapidly aging population
Given the new challenges of chronic multimorbidities and a rapidly aging population, Kerala needs to focus on creating structured chronic care pathways that will reduce fragmentation and improve patient outcomes. Expanding family medicine and geriatric services, along with strengthening home care and community nursing models to support an aging population, is essential. A continuum of care framework must be institutionalized at all levels across the state, she added.
Despite strong public health provision, out-of-pocket expenditure remains considerably high in Kerala, particularly for diagnostics and specialist care. To address this problem, the diagnostic capacity of the public sector needs to be expanded and essential drug supply chains strengthened. Strategic procurement mechanisms from the private sector should be improved to improve accountability and cost-effectiveness, said Dr. Swaminathan.
Kerala’s widely celebrated health achievements have faced a significant crisis due to a spike in morbidity and rising health expenditure, public health activist and former member of the State Planning Board B. Ekbal said.
Dr. Ekbal highlighted the fact that nearly 59% of women over 60 in Kerala were widows, contributing to issues of social isolation and economic insecurity among the elderly population.
The current healthcare system, which is excessively oriented towards curative care, leads to high healthcare costs and a reduction in the quality of life, he pointed out.
Longevity without vitality
Longevity without vitality has led to high levels of cognitive dysfunction and dementia in the state’s elderly population, said MV Pillai, founder, chairman of the International Cancer Care Network and former clinical professor of oncology, Thomas Jefferson University.
Dietary diversity and nutrition are very important and it is high time that Kerala studies whether its diet is linked to the increasing cognitive dysfunction and poor mental health of its population, he stressed.
A vast amount of recent research points to how a person’s microbiome determines their susceptibility to disease or response to treatment.
The microflora of the Kerala population or the link between the Kerala diet and the microbiota or whether it has any effect on longevity or weight or vitality should be investigated, said Dr. Pillai.
Health Minister Veena George, Food and Civil Supplies Minister GR Anil, Shakuntala Haraksingh Thilsted, Director of Nutrition, Advisory Group on International Agricultural Research; Augusto Viana da Rocha, Primary Health Care Analyst, Ministry of Health, Brazil; Veena Shatrugna Former ICMR Scientist; PK Jameela, Kerala State Planning Board and Rajan Khobragade, Additional Principal Secretary (Health) also participated in the discussion.
Published – 16 Feb 2026 21:05 IST