Hyderabad: Kerala is not supposed to have a hunger problem.
The Southern State has long been held up as proof that a low-income region can achieve health outcomes that rival those of wealthy nations. Its infant mortality rate, literacy levels and life expectancy sit comfortably alongside European benchmarks. Policymakers across India and beyond have studied the so-called Kerala model for decades, looking for lessons they can take home.
But a recent study conducted in the flood-prone panchayats of Alappuzha district is asking an uncomfortable question: what happens to that model when the climate stops cooperating?
A number that should not exist
The study surveyed 400 children, aged 12 to 59 months, across five panchayats identified as flood-prone by the Kerala State Disaster Management Authority. What it found was striking.
Nearly one in three children (31%) was stunted, meaning their height was significantly below what it should be for their age. More than one in four (28.25%) was underweight.
One in five was wasted, a sign of acute, recent hunger.
These figures exceed Kerala’s own state averages from the National Family Health Survey-5 (2019-21), which recorded stunting at 23.4 per cent, underweight at 19.7 per cent and wasting at 15.8 per cent.
In a state that compares itself to Scandinavia on health metrics, these are numbers that should not exist.
The flood that does not leave
To understand why they do, it helps to understand what flooding actually means for families in Alappuzha.
The district sits at the heart of Kerala’s backwater region, barely above sea level in parts, threaded through with rivers and canals. Since 2018, when Kerala experienced its worst floods in nearly a century, the rains have kept coming.
The study found that 99 per cent of the households surveyed had been flooded at least once since 2018. Over 70 per cent had been displaced to relief camps, staying away from home for an average of more than 24 days.
Childhood disrupted
The authors of the study are direct about what this means for children.
“Disruption due to displacement and limited access to food, clean water and healthcare during floods could be contributing factors leading to undernutrition,” they write.
Relief camps are emergency shelters, not nutrition centres. They are not equipped to provide age-appropriate food for infants, support breastfeeding mothers or monitor children who were already at nutritional risk before the flood arrived. And when families return home, they return to damaged houses, lost income, and depleted food stocks, often just months before the next monsoon season begins.
Displaced and at risk
The study’s most arresting finding concerns what happens specifically to children whose families sought shelter in relief camps.
Those children had an adjusted odds ratio of 8.43 for being underweight compared to children whose families had managed to stay elsewhere during the floods. For overall anthropometric failure, a composite measure of nutritional status, the odds were nearly double.
The authors note this may partly reflect the fact that the most economically vulnerable families were the ones most likely to end up in camps in the first place. But displacement itself compounds the damage.
“Those from severely affected and resource-constrained households were more likely to have sought shelter in relief camps during floods,” the study observes.
Road transport was cut off for 86.5 per cent of households during flooding, severing access to hospitals, health workers and food markets at precisely the moment families needed them most.
Girls pay a higher price
The nutritional burden in these communities is not distributed equally.
Across every measure, underweight, stunting, wasting and composite anthropometric failure, girls fared worse than boys. The study found girls had an adjusted odds ratio of 3.16 for underweight and 1.66 for stunting compared to boys.
“This finding is consistent with other studies in India and is widely attributed to gender-based inequalities that limit girls’ access to nutritious food, healthcare and education,” the authors write. “Climate variability and its consequences, such as floods, are also known to exacerbate social disparities.”
This is perhaps the most troubling dimension of the findings. Kerala has historically outperformed the rest of India on gender equity. Its female literacy rate is among the highest in the country. And yet, in these flood-prone communities, girls are bearing a disproportionate share of the nutritional cost of climate disruption.
The paradox of the double burden
Kerala is simultaneously dealing with a very different nutrition crisis at the other end of the spectrum.
The state has among the highest rates of obesity, overweight, and type 2 diabetes in India. Non-communicable diseases have become the dominant concern in public health conversations, drawing policy attention and resources towards lifestyle-related conditions affecting a largely urban, relatively affluent population.
This creates a blind spot. While health planners focus on cholesterol and blood sugar, children in Alappuzha’s flood-prone villages are not growing tall enough and not gaining enough weight. District and state-level averages—the kind cited in national surveys and government reports—smooth over exactly the kind of localised crisis the Alappuzha study has uncovered.
“Findings show a higher prevalence of underweight, stunting and wasting among children in the flood-prone study area compared to the nationally representative NFHS-5 survey,” the authors write. The implication is clear: the numbers that Kerala presents to the world may not reflect what is happening in its most vulnerable pockets.
A model built for a stable climate
The Kerala model was designed for the 20th century. It rested on assumptions of relative environmental stability, that schools would open, that roads would be passable, and that health workers could reach the communities they served.
Climate change is dismantling those assumptions one monsoon at a time.
The authors of the Alappuzha study call for longitudinal research, targeted interventions in flood-prone regions and a rethinking of how nutrition programmes are designed for communities facing repeated displacement.
“Targeted interventions to address child malnutrition in flood-prone regions are a critical need,” they conclude.
But the window for designing such interventions may be narrowing faster than policymakers appreciate.
Alappuzha district alone was home to an estimated 3,88,000 wasted children under five, according to NITI Aayog projections based on NFHS-5 data. That figure was recorded before the most recent cycle of floods. It has almost certainly not improved since.