A Royal Caribbean cruise ship docked in Labadie. Photo: Rob Inh00d (flickr)

It's not an uncommon theme in the Caribbean: Beyond the most beautiful shorelines exists some of the most extreme poverty in the world.

The poorest country in the Western Hemisphere, Haiti boasts an exclusive beach resort in the northwest coastal town Labadie. The Haitian Government sold the land to cruise giant Royal Caribbean years ago to boost tourism, but PRI's The World reports that the fishing village remains poor despite the flock of tourists who come ashore twice a week.

Labadie's 5,000 residents reap little benefit from the cruise ships — one of which is ironically called "Freedom of the Seas" — that dock in their town. Tourists rarely venture past the private beaches and only a handful of locals work for Royal Caribbean. A few years ago, the community developed its own non-profit to deliver the services it needs. Their organization, Vwa Ayiti (Voice of Haiti), built composting toilets that turn waste into fertilizer. Community members are developing a water treatment system, and are partnering with Canadian NGOs to set up a Haitian-run medical clinic in a neighboring village.

Tourists have little idea what life is like in Labadie, preferring to stay close to the pristine shoreline, free from signs of a difficult life. “I don’t want to see poverty,” an American woman told The New York Times. “I’m on vacation. I don’t want to think that these people don’t have enough to eat.”

Vwa Ayiti's efforts can't take on all of the community's problems, but according to The World, the organization has strengthened the identity of Labadie's residents. An elder in the community shared his view on the program: "In Labadie, life depends on God's help and on your neighbors and friends. Without them, you can't survive here."

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."