Polio immunisation in tribal areas, Maharasthra, India (image: Richard Franco / Flickr)

While health and wealth usually do go together, that is not always the case.  Consider this tale from India: one region of that county has long enjoyed good public health, despite deep poverty.  Yet now that its residents are growing richer, overall health appears to be declining.  

The Indian state of Kerala occupies a narrow strip along the country's southwestern coast.  Its a tropical region, popular with tourists, and home to 18 million residents.  Over the past half-centry, Kerala has been a model for poor countries around the world.  It has shown that even people with little money can enjoy good health.  

Life expectancy here is about the same as the U.S., and 15 years longer than the rest of India.  Infant mortality here is six times lower than the rest of India.

Experts credit the local, no-frills hospitals with keeping the public healthy.  But, this model helath system is showing signs of strain.  Immunizations have decreased drastically in some areas.  Doctors have seen repeated epidemics of infectious disease, including typhoid.

At the same time, there has been a steep rise in chronic illness like heart disease, strokes,  and diabetus, most likely because Indians have become more prosperous, less active, and more obese.  These illnesses require different approaches to treatment than what the system was designed for.

Experts say there is a broader problem -- India's new affluence has caused a growing divide between rich and poor, and undermined support for public hospitals.  Kerala's past success was due to a populace that demanded good healthcare for all.  Politicians here knew they had to deliver on that demand, or find a different job.  

But, the middle class now depends upon the growing network of expensive private hospitals, so support for publicly healthcare is not as high.  Funding has gone down, and the system is fraying.

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