kerala is still the gold standard for public health in the country it surpasses other states on many health indicators on some it is even on a par with developed countries with this enviable record it looks set to achieve targets set under the united nations sustainable development goals 2030yet despite significant gains on several health fronts such as high life expectancy low infant mortality birth and death rates newer challenges abound mostly in the form of lifestyle diseases noncommunicable diseases ncds including diabetes hypertension coronary heart disease cancer and geriatric conditions adding to the states concern is the increasing incidence of communicable diseases like chikungunya dengue leptospirosis swine flu and now nipah feverbesides issues like mental health suicide substance abuse and alcoholism are another millstone around the neck of the states health sector the reemergence of many diseases including vaccinepreventable ones that has led to considerable morbidity and mortality is another matter of grave concern also climate change and the resultant floods of the last two years are taking their toll on the physical and mental wellbeing of the populationwhat works in keralas favour is its diseasesurveillance system with a robust mechanism for early recognition of communicable diseases as well as ncds once a problem is identified the response is quick this was established soon after the floods of 2018 as well as the nipah virus outbreak in may the same year and has been appreciated by experts in the field of communicable disease surveillance and control including the government of india and the world health organisation whohowever what we lack is preventive strategies the biggest challenge we face is to put in place preventive measures to control communicable and ncds despite our best efforts the mosquito menace remains a big problem said dr b ekbal state planning board membernationally it is estimated that 42 of total deaths are due to ncds in kerala however the situation is more serious as over 52 of total deaths in the productive age group of 30 to 59 are due to ncds in the state 148 of its population between 15 and 64 years of age is diabetic compared with the national average of 8 every year 35000 new cases of cancer are detected in kerala nearly 1 lakh people are under treatment for cancer annually genetic predisposition dietary habits and sedentary lifestyles are considered causes for this phenomenon a study found that 42 of adult males smoked and that 40 of the adult population ate diets low in fruits and vegetables while 25 were overweight the state government is now promoting exercise and healthy foods as well as ensuring availability of medicines at a reasonable pricebut despite these efforts the control rate of most ncds is as low as 15 also mortality due to road accidents is high despite initiatives to improve trauma care says dr ekbalwe have set parameters but lack in equitable health distribution and investment in health care when it comes to ncds primordial prevention is lacking