The Kerala Regime and Regional Disparities in Health Infrastructure Versus Outcomes

Conventional wisdom holds that although at the time of Kerala state formation in 1956 the northern region (Malabar) lagged behind the southern region (Travancore-Cochin) in development indicators, inter-regional disparities reduced considerably in ensuing decades. The reduction in regional disparities is typically attributed to modern Kerala's welfare policy regime, which emphasized greater growth of infrastructure facilities in Malabar. This study presents evidence for health that suggests that while disparities in outcomes reduced over time, disparities in key infrastructural inputs did not reduce. These differing trends for infrastructure and outcomes are consistentwith a diminishing returns argument that may have little to do directly with the Kerala regime. Rather, the potency of the Kerala regime lays in its ability to increase development inputs throughout the state (albeit without favoring the lagging region) and consolidate the conditions for “public action” to effectively demand and utilize these inputs.