on.

Kerala is a state in flux where, despite the social progress made so far, gender still influences social mobility.
[291][292][293]
Human Development Index
As of 2011 Kerala has a Human Development Index (HDI) of 0.790 which comes under the "very high" category and it is the highest in the country.
[3]
Comparatively higher spending of the government in primary level education, health care and elimination of poverty from the 19th century onward had
helped the state to keep a very high HDI;
[294][295]
report was prepared by the central government's Institute of Applied Manpower Research.
[296][297]
However, the Human Development Report, 2005 prepared by Centre for Development Studies envisages a virtuous phase of inclusive development for
the state since the advancement in human development had already started aiding the economic development of the state.
[294]
According to a 20052006 national survey, Kerala has the highest literacy rate among Indian states; 93.91%.
[298]
Life expectancy of 74 years was
among the highest in India as of 2011.
[299]
Kerala's rural poverty rate fell from 59% (19731974) to 12% (1999-2010); the overall (urban and rural)
rate fell 47% between the 1970s and 2000s against the 29% fall in overall poverty rate in India.
[300]
By 19992000, the rural and urban poverty rates
dropped to 10.0% and 9.6% respectively.
[187]
These changes stem largely from efforts begun in the late 19th century by the kingdoms of Cochin and
Travancore to boost social welfare.
[301][302]
This focus was maintained by Kerala's post-independence government.
[125][164]:48
The United Nations
Children's Fund (UNICEF) and the World Health Organisation designated Kerala the world's first "baby-friendly state" because of its effective
promotion of breast-feeding over formulas.
[303]
Third National Family Health Survey ranks Kerala first in the list of "Institutional Delivery" with 100%
births in medical facility.
[304]
Ayurveda (both elite and popular forms),
[305]:13
siddha, and many endangered and endemic modes of traditional medicine,
including kalari, marmachikitsa and vishavaidyam, are practised. Some occupational communities such as Kaniyar were known as native medicine
men in relation with practice of such streams of medical systems, apart from their traditional vocation.
[306]
These propagate via gurukula
discipleship,
[305]:56
and comprise a fusion of both medicinal and supernatural treatments.
[305]:15
Kerala has undergone the "demographic transition" characteristic of such developed nations as Canada, Japan, and Norway.
[165]:1
as 11.2% of people
are over the age of 60,
[164]
and due to the low birthrate of 18 per 1,000.
[307]
In 1991, Kerala's total fertility rate (TFR) was the lowest in India. Hindus
had a TFR of 1.66, Christians; 1.78, and Muslims; 2.97.
[308]
The sub-replacement fertility level and infant mortality rate are lower compared to those of
other states; estimated from 12
[125][307]:49
to 14
[309]:5
deaths per 1,000 live births. According to Human Development Report 1996, Kerala's Gender
Development Index was reported to be 597; higher than any other state of India. Many factors, such as high rates of female literacy, education, work
participation and life expectancy, along with favourable female-to-male ratio, had contributed to it.
[310]
Kerala's female-to-male ratio of 1.058 is higher
than that of the rest of India.
[165]:2
. The state also is regarded as the "least corrupt Indian state" according to the surveys conducted by Transparency
International (2005)
[311]
and India Today (1997)
[312]