Beyond the Brochure: Whose Lives Get Counted in Kerala’s Healthcare Miracle?

Kerala’s healthcare story is one of paradox and pageantry. From robotic surgeries in public hospitals to Ayurvedic wellness rituals packaged for global elites, the state projects an image of seamless progress - a biosocial utopia where tradition and technology dance in harmony. But every image excludes. Every statistic forgets.

This blog peels back the glossy layers of “God’s Own Country” to ask: who gets to be healed, and who gets left out of the healing narrative? Drawing on the critical frameworks of biopolitics, necropolitics, caste critique, and environmental justice, the blog interrogates the structures that make some lives visible and others expendable. It traces the quiet violence of omission, the slow poison of environmental neglect, and the caste-coded pathways through which care circulates - or does not.

A scalpel in hand does not always mean justice in practice. And when care becomes a mere spectacle, it risks becoming just another mode of exclusion.

The Spectacle of Health and the Violence of Abstraction

Kerala is often celebrated as India’s exceptional state - a beacon of public health, education, and gender development in an otherwise uneven national landscape. Its technocratic health infrastructure, from AI-powered stroke units to robotic surgeries in public hospitals, have been showcased both in domestic policy circles and global health discourses. Yet this celebration is not without its exclusions.

Drawing from Michel Foucault’s theory of biopolitics, Kerala’s health success can be read as an example of the modern state’s ability to “make live” through meticulous management of bodies and populations. But, as Veena Das reminds us, the everyday life of suffering unfolds not only in state documents and hospital reports but also in homes, villages, and silences. In this blog I argue that Kerala’s celebrated health model is undergirded by structural exclusions, caste-coded inequalities, and the slow violence of environmental degradation and policy neglect. The state heals, yes - but selectively, and often by rendering others invisible.

The Brochure as Biopolitical Tool: What Gets Measured, Gets Valued

Kerala’s development story is often visualised in infographics: low infant mortality, high life expectancy, near-universal institutional births. These indicators function as what James Ferguson calls anti-politics machines - technocratic abstractions that obscure deep social fissures.

Public hospitals now offer cutting-edge care: neuro-cath labs, AI-assisted diagnostics, and free rare-disease treatment under the KARE project. Simultaneously, the state markets its traditional medicine heritage, positioning Ayurveda as a wellness commodity for international elites. This dual system - modern biomedicine for statistical legitimacy, Ayurveda for soft power - generates an alluring brand identity: “Kerala Cares.”

But biopolitical governance also means racialised, caste-marked and classed exclusion. As Foucault reminds us, ‘making live’ often depends on the corollary — letting die. And in Kerala, who is allowed to thrive and who is abandoned to precarity remains stratified along caste, gender, and geographical faultlines.

Attappady and the Silent Necropolitics of Care

In the tribal hamlets of Attappady, maternal and neonatal deaths are not exceptional. They are systemic, cyclical, and largely uncounted. Adivasi women routinely walk 10–20 km for antenatal checkups. Ambulances do not arrive. Ration cards have expired or are irrelevant. Anaemia is endemic and, child mortality is routine.

Here, healthcare is not absent - it is withheld. Borrowing from Achille Mbembe’s concept of necropolitics, these are zones where the state decides who is disposable, not through spectacular violence but through bureaucratic neglect. These are zones of abandonment, where the right to health remains aspirational, not constitutional.

The image of a baby dying of ventriculomegaly while AI powers surgeries in Kochi is not an anecdote. It is a telling sign of epistemic injustice - where the suffering of the subaltern never enters the ledger of development.

Development as Caste Capitalism

Kerala’s so-called egalitarianism obscures the persistence of caste hierarchies within health access. As scholars like Gopal Guru and Anand Teltumbde argue, caste is not merely a social identity but a structural determinant of access, dignity, and risk management. . Even in Kerala, where land reforms and literacy campaigns were once radical interventions, the health system remains stratified:

Savarna patients dominate urban private hospitals or seek care abroad.

Dalits and Adivasis are routed through overburdened, underfunded public systems.

Fisherfolk, especially women, continue to face hazardous working conditions, with no occupational health rights.

These are structural exclusions embedded in the very architecture of development. To call Kerala's system caste-blind is to underline what Spivak terms the ‘sanctioned ignorance’ of dominant discourses.

Environmental Slow Violence and Health

Rob Nixon’s notion of slow violence - the gradual, invisible violence of toxic exposure, pollution, and ecological decay -  are patently clear in Kerala’s environmental healthscape.

Endosulfan still lingers in the soil and bodies of Kasaragod.

The Periyar river, once Kerala’s lifeline, now flows black with industrial effluents.

The fire at Brahmapuram was not an accident - it was the logical outcome of policy failure, state-corporate collusion and environmental racism.

These issues are not peripheral to health - they are central. In this sense, Kerala’s development is both spectacular and unsustainable - an ironic contradiction where eco-apartheid ensures that those who benefit from the state's bio-capital do not suffer from its toxic externalities.

The Crisis of Epistemology: What the State Refuses to Know

Kerala’s health data systems often exclude non-metro illnesses, fail to disaggregate by caste, and do not track the slow violence effects such as long-term reproductive toxicity from pesticides or industrial emissions.

As Gayatri Spivak has argued, the subaltern cannot not only speak - they cannot even be seen. The denial of endosulfan’s continuing effects, the erasure of tribal women’s pain, and the absence of cancer registries near industrial zones are all examples of epistemic erasure. They are mechanisms through which the state refuses to know what might challenge its ‘success’ narrative.

Toward a Critical Ethics of Care

A truly inclusive healthcare system must go beyond curative models and ribbon-cutting rituals. It must centre care as a political and ethical relation - one that refuses to separate healing from justice.

This requires:

Redistributive Justice: Prioritising marginalised regions and communities in budgeting and infrastructure.

Ecological Justice: Recognising the health impacts of environmental degradation as part of public health.

Abolition of Health Casteism: Ensuring equal dignity of access, irrespective of social location. 

As feminist scholars have long argued, care is not apolitical. It must be decolonised, de-Brahminised, and democratised.

Conclusion: The Right to Be Counted is The Right to Be Healed

Kerala already has the tools — trained health workers, participatory institutions, and global credibility. What it requires now is a deep sense of commitment  to ensure equity and justice. 

Let us not stop asking 

Whose lives are made visible in Kerala’s health-care success?

Whose deaths remain statistically invisible?

Can a state truly heal, if its rivers gasp, its forests weep, and its women walk 70 km for medicine?

Before we part with these thoughts:

Health is not just a biological condition. It is a political question of whose life is grievable, livable, and worth saving.

Let us move beyond the brochure.

Towards a Kerala that not only heals - but heals foregrounding justice.