Need to redirect Kerala’s health focus from mere mortality reduction to improving healthy life expectancy, financial protection, and quality of life, say experts at Vision 2031 meet

Kerala’s demographic and epidemiological shifts demand a reorientation of the health system from mere mortality reduction to improving healthy life expectancy, financial protection, and quality of life. The State will have to redesign the health system to meet the new challenges of chronic disease, aging, and equity, so that the State’s future health gains are sustainable, inclusive and resilient, public health experts have said. At the session on ’Health and Nutrition’, organised as part of the ’’Vision 2031 International Conference on Development and Democracy’ conference here on Monday, health experts pointed out that Kerala’s health system has historically delivered strong outcomes, supported by an extensive public healthcare network, a strong primary healthcare delivery, decentralised governance, and strong community participation. However, Kerala now stands at a critical point wherein it has to transition from infectious diseases/maternal and child health model to a chronic care model; from mere longevity to healthy aging and enhancement of quality of life. This calls for a drastic health system restructuring rather than just systemic expansion. While the overall indicators of the State are good, it is masking the intra-State and urban-rural inequities in health outcomes in tribal areas, hilly regions and coastal belts, which remain pockets of neglect as in other States, Soumya Swaminathan, former Chief Scientist, WHO, said. Rapidly ageing population Given its new challenges of chronic multimorbidities, and a rapidly ageing population, Kerala has to focus on establishing structured chronic care pathways which will reduce fragmentation and improve patient outcomes. Expansion of family medicine and geriatric services is essential, alongside strengthening home-based care and community nursing models to support an aging population. The framework of continuum of care has to be institutionalised at all levels across State, she added. Despite strong public health provision, out-of-pocket expenditure remains significantly high in Kerala, particularly for diagnostics and specialist care. To address this, public sector diagnostic capacity must be expanded, and essential medicines supply chains strengthened. Strategic purchasing mechanisms from the private sector should be refined to improve accountability and cost-effectiveness, Dr. Swaminathan said. Kerala’s widely celebrated health achievements were facing a significant crisis because of the sharp rise in morbidities and the increasing out-of-pocket expenditure on health, public health activist and former member of the State Planning Board, B. Ekbal, said. Dr. Ekbal drew attention to the fact that almost 59% of women over 60 years in Kerala were widows, which was adding to the issues of social isolation and economic insecurities among the aged population. The current health system, which is excessively oriented to curative care, is leading to high healthcare costs and declining 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, M.V. Pillai, founder chairman, International Cancer Care Network and former Clinical Professor of Oncology, Thomas Jefferson University, said. Dietary diversity and nutrition is very important and it is high time Kerala studied whether its diet is linked to the increasing cognitive dysfunction and poor mental health in its population, he pointed out. A vast body of recent research points to how one’s microbiome determines one’s susceptibility to disease or response to treatment. The microbiota of Kerala’s population or the link between Kerala’s diet and the microbiota or if it has any effect on longevity or weight or vitality should be explored, Dr Pillai said. Health Minister, Veena George, Food and Civil Supplies Minister G.R. Anil, Shakuntala Haraksingh Thilsted, Director for Nutrition, Consultative Group on International Agricultural Research; Augusto Viana da Rocha, Primary Healthcare Analyst, Ministry of Health, Brazil; Veena Shatrugna former Scientist, ICMR; P.K. Jameela, Kerala State Planning Board and Rajan Khobragade, Additional Chief Secretary (Health) also participated in the discussions.