It was December 2024. I was with Mohan Anand, the eminent Kerala born American lawyer and entrepreneur at his opulent Malibu mansion overlooking the Pacific. He said something very startling, “Kerala has a lower Maternal Mortality Ratio (MMR) than the United States”.
How could this be true? Kerala’s GDP is only $167.90 billion. United States has a GDP that is 182 times in size valued at $ 30.51 trillion.
Actually, he was right. Kerala had an MMR of only 18 deaths per 1,00,000 live births. In the United States it was higher at 22.3 deaths per 1,00,000 live births. Kerala beats the US in infant mortality rates too. In Kerala it is 5 per 1000 births and in US it is higher at 5.60.
The Kerala /US comparative metrics is both revealing and unsettling: -
| Kerala | US | |
| GDP | $67.90 Billion | $30.51 Trillion |
| Life Expectancy | 74.8 years | 79.6 years |
| Literacy | 96.2 % | 79.00 % |
| Infant mortality rate per 1000 live births | 5.00 | 5.60 (2022) |
| Maternal Mortality Rate per 1,00,000 live births | 18.00 | 22.30 |
| Multi-dimensional poverty | 0.55% | 5.68% (2024) |
This should have headlined the news. Unfortunately we are living in the age of the post-truth propaganda of the ‘Kerala story’. It is perhaps the appropriate time to retell the ‘Real Kerala Story’
A public healthcare system that is widely dispersed
To know why Kerala compares with the developed world one needs to understand the sheer expanse and quality of its public healthcare system. Kerala has 3342 general hospitals (1280 in the Public Sector and 2062 in the private sector). It is the only state to have Cath labs providing specialised heart care in all of its 14 districts.
In addition, advanced medical care is provided by 33 medical colleges, 230 community health centres and 845 primary health centres. Kerala’s hospitals and allied healthcare centres served a stupendous 11.29 crore people in the state. They provided free treatment of value of ₹ 67.8 billion.
Kerala’s key metrics when compared to rest of India
When it comes to comparison with the rest of the Indian states, the differences get starker. Kerala’s near 100% literacy rate, near zero population growth and the stratospheric Human Development Indices (HDI) leave the rest of the India’s states lagging far behind.
| Metrics | Kerala | Gujarat | Uttar Pradesh |
| Literacy | 94.00% | 78.03% | 67.68% |
| Life Expectancy | 74.80 | 70.10 | 67.20 |
| maternal mortality rates | 18.00 | 55.00 | 141.00 |
| infant mortality rates | 5.00 | 15.00 | 15.00 |
| Multi-dimensional poverty | 0.55% | 11.66% | 22.93% |
| Male female ratio | 967.00 | 909.00 | 995.00 |
| Population control | 1.50 | 2.00 | 2.70 |
| Child Under-nutrition | 22.90 | 44.60 | 42.40 |
A short history of the Kerala model
How did Kerala make all this happen in just 75 years?
It was the mid-1970s that the wage rate for labour in Coimbatore, Tamil Nadu, was ₹ 2 per day. Across the border in Kerala, wage rate was five times at ₹ 10 per day. As industries migrated to Tamil Nadu, doomsday was declared for Kerala’s industry and its population.
But something remarkable was happening in the state of Kerala which was defying conventional economics. The high wages were pushing up the Human Development Indices (HDI) in Kerala. The all-India average for life expectancy in 1976 - 1980 was just 52 years. Kerala had leapfrogged to a life expectancy of 66 years.
An UNICEF study conducted in 1985 found that while China had a literacy rate of 56 % for females and 82% for males, Kerala had overtaken China with a literacy rate of 71% of females and 86% for males. The life expectancy for women was 67.6% in Kerala, while China was trailing behind at 64.1%.
This phenomenon of high literacy rate, high life expectancy at birth, well balanced male-female ratio, low incidence of poverty and universal health care would soon earn its name in developmental economics as the ‘Kerala Growth Model’.
Contribution of land reforms to Kerala’s sterling HDI performance
The success of Kerala’s HDI was a direct result of the successful implementation of the Kerala Land Reforms Act 1963, 1.2 million tenants became owners of the land they tilled. About 1.3 lakh hectares was redistributed. This created basic economic security, mainly the conditions ripe for accelerated school enrolment and the eventual burgeoning of literacy in the State.
The credit must go to the post independent leadership of Kerala. The two political formations of left and the centre that ruled Kerala only made accretions to social democracy and the welfare state. No attempt was made to engage in fratricidal politics by attempting to dismantle the welfare state.
Seventy-five years post-Independence, Kerala built 12,644 schools (4504 government schools and 7277 aided schools). They impart education to 4 million students (2024).
Amartya Sen helps the world discover this model
It was in the mid-1990s, that the Nobel Laureate Amartya Sen took note of this economic phenomenon in his book ‘India: Economic Development and Social Opportunity’. He found many parts of India were in positions worse than sub-Saharan Africa. In stark contrast, Kerala was ahead of Indonesia, Thailand, and even South Korea in many of the significant human development indices. Sen stated the obvious truism:-
“Kerala’s success can be traced to the role of public action in promoting a range of social opportunities relating to elementary education, land reform, the role of women in society, and the widespread equitable provision of health care and other public services. Interestingly Uttar Pradesh’s failures can plausibly be attributed to the public neglect of the very same opportunities”
Role of religious co-existence
A tribute must be made to the religions of Kerala. They have a long and unblemished record of communal harmony which enabled the state to stay focussed on developmental issues. This peace among Kerala’s religions and its syncretic tradition has a lot to do with the region’s unique history.
At the heart of Kerala’s achievement in social democracy is also the transformational socio-economic messages of its great religious leaders, especially that of Shri Narayana Guru. Their philosophies of social and economic inclusion still continue to translate into the State’s policy making to this day.
Kerala in the age of ‘Trump Tariffs’
We are also right in the midst of the age of crippling ‘Trump tariffs’. How is the rupee holding forth in the midst of the crumbling export market?
Today it is estimated that 3.5 million Malayalis live outside India. Kerala’s 580 Km coastline is dotted with four of the busiest international airports in the country. They give rapid mobility to the educationally enabled Keralites to work in 182 out of 195 countries across the world. Today’s globetrotting and professionally qualified Malayalis in large measure have entrenched into the middle classes across the globe. The Kerala Migration Survey 2018 records 80.69% of Kerala’s expats are professionally qualified or are in high skilled roles.
Kerala’s expat population sent back a record-breaking ₹23.39 Billion as foreign remittances in 2023-2024. That is 19.7% of India’s total remittance inflow. NRI deposits in Kerala banks are heading towards ₹3 trillion mark. The deposits as of 31st December 2024 stood at ₹2,86,063 crores.
These geographically mobile expats from Kerala are the children of parents who voted for successive social democratic formations. These governments gave them affordable education, healthcare, nutrition and with it the power of geographical mobility. Little will they ever know that they are the products of the most spectacular human index success story on the planet.
(Santosh Paul is Senior Advocate, Supreme Court of India.)
Views are personal and do not represent the stand of this publication.
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