Life expectancy in Kerala is 73 years — which is comparable with Europe and the U.S. Photo: © World Bank / Curt Carnemark (flickr)

India's southern state of Kerala has received international attention not only for its beaches and temples, but also for statistics that suggest people of limited means can live long, healthy lives. (Its life expectancy of over 73 years puts it on par with some of the world's most advanced countries.)

But Kerala's rising affluence has challenged the stability of a once-thriving public health system. Indications are that wealthy patients are increasingly turning to high-tech, private clinics for care, putting the public health care system at risk.

PRI’s The World reports an emergence of “lifestyle ailments” like diabetes and heart disease in Kerala, a tropical state on India’s southwestern coast with 18 million residents. Kerala's per capita annual income is a mere $300, but like the whole of India, recent economic growth has meant a booming middle class. At the same time, its population, according to the program, has become less active and more prone to obesity.

The demand for specialized care for a new set of health issues has put a strain on Kerala’s public health system. Public hospitals are losing experienced doctors to better-paying jobs at private clinics.

“People no longer see the government health institution as a place where they would go by choice,” explains Dr. V Raman Kutty at Kerala’s Centre for Health Science Studies. “They would go only if there is no other option.”

As the gap between rich and poor widens, is Kerala’s exceptional status sustainable? Academics will wrestle with that question in January, when the state's Centre for Development Studies hosts a conference on Challenges of Human Development in India. "The pervasive social and economic inequalities," reads the conference announcement, "are a matter of concern for India."