Two years turned the Indian subcontinent into Southasia. Between 14 August 1947 and 4 February 1948, India, Pakistan (its eastern part would later become Bangladesh), and Sri Lanka all gained independence from the British Empire. Amid the optimism of independence, the new states were comparable in population health and development indicators. Their progress since has been different.
Non-communicable and communicable diseases ravage Southasia. Tobacco and pharmaceutical industries are exploiting weak legislation to nurture new markets. There is little pride in the progress of surgery, health research, or postgraduate education. Yet one challenge dwarfs all these: the desperate state of maternal and child health. The scale of morbidity and mortality caused by neglect of mothers and children is driving the region to disaster. And unless regional priorities switch from nuclear weapons to maternal and child health the progress that is being made in community development, by integrating care in refugee camps, by the creators of the Jaipur foot and the Karachi ambulance service, and on cricket fields will count for nothing.
The answers to the region´s problems may already be with us. Despite a civil war, Sri Lanka has the best health indicators in the region (also beating those of most other countries with comparable incomes), with average life expectancy at 73 years, infant mortality at 16 per 1000, and maternal mortality at 30 per 100 000 live births. India´s Kerala state has achieved health and demographic indicators far ahead of Indian national averages, with similar levels to Sri Lanka; over 80 percent of infants receive all routine vaccines by 1 year, use of family planning services is high, and population growth is steady at replacement levels.
The genesis of this success is an object lesson for the entire region. Soon after independence Sri Lanka decided to invest heavily in education and health as a cornerstone of socioeconomic development. Gains in education have been impressive, with literacy rates for both sexes exceeding 90 percent. Similarly, Kerala has the highest literacy rates among all Indian states. Both have maintained policies to achieve gender and social equity, reflected in outstanding health and economic indicators for women. In Sri Lanka, women constitute over half the work force.