Sri Lanka has one of the most effective health systems among developing nations. The crude death rate in the early 1980s was 6 per 1,000, down from 13 per 1,000 in 1948 and an estimated 19 per 1,000 in 1871. The infant mortality rate registered a similar decline, from 50 deaths per 1,000 births in 1970 to 34 deaths per 1,000 births in the early 1980s. These figures placed Sri Lanka statistically among the top five Asian countries. Improvements in health were largely responsible for raising the average life span in the 1980s to sixty-eight years.

Traditional medicine ( ayurveda--see Glossary) is an important part of the health system in Sri Lanka. The basis of traditional medicine is the theory of "three humors" (tridhatu), corresponding to elements of the universe that make up the human body: air appears as wind, fire as bile, and water as phlegm. Imbalances among the humors (the "three ills," or tridosha) cause various diseases. The chief causes of the imbalances are excesses of heat or cold. Treatment of disease requires an infusion of hot or cold substances in order to reestablish a balance in the body. The definition of "hot" or "cold" rests on culturally defined norms and lists in ancient textbooks. For example, milk products and rice cooked in milk are cool substances, while certain meats are hot, regardless of temperature. Treatment may also involve a variety of herbal remedies made according to lore handed down from ancient times. Archaeological work at ancient monastic sites has revealed the antiquity of the traditional medical system for example, excavations have revealed large tubs used to immerse the bodies of sick persons in healing solutions. Literate monks, skilled in ayurveda, were important sources of medical knowledge in former times. Village-level traditional physicians also remained active until the mid-twentieth century. In the late 1980s, as part of a free state medical system, government agencies operated health clinics specializing in ayurveda, employed over 12,000 ayurvedic physicians, and supported several training and research institutes in traditional medicine.

Western-style medical practices have been responsible for most of the improvements in health in Sri Lanka during the twentieth century. Health care facilities and staff and public health programs geared to combat infectious disease are the most crucial areas where development has taken place. The state maintains a system of free hospitals, dispensaries, and maternity services. In 1985 there were more than 3,000 doctors trained in Western medicine, about 8,600 nurses, 490 hospitals, and 338 central dispensaries. Maternity services were especially effective in reaching into rural areas less than 3 percent of deliveries took place without the assistance of at least a paramedic or a trained midwife, and 63 percent of deliveries occurred in health institutions--higher rates than in any other South Asian nation. As is the case for all services in Sri Lanka, the most complete hospital facilities cb5 s and highest concentration of physicians were in urban areas, while many rural and estate areas were served by dispensaries and paramedics. The emergency transport of patients, especially in the countryside, was still at a rudimentary level. Some progress has been made in controlling infectious diseases. Smallpox has been eliminated, and the state has been cooperating with United Nations agencies in programs to eradicate malaria. In 1985 Sri Lanka spent 258 rupees (for value of rupee--see Glossary) per person to fight the disease. Although the number of malaria cases and fatalities has declined, in 1985 more than 100,000 persons contracted the disease.

Sri Lanka had little exposure to Acquired Immuno Deficiency Syndrome (AIDS) during the 1980s. As late as 1986, no Sri Lankan citizens had contracted the disease at home, but by early 1988 six cases had been diagnosed, including those of foreigners and of Sri Lankan citizens who had traveled abroad. Government regulations in the late 1980s required immediate expulsion of any foreigner diagnosed as an AIDS carrier, and by 1988 the government had deported at least one foreign AIDS victim. Government ministers have participated in international forums dealing with the problem, and the government formed a National Committee on AIDS Prevention in 1988.

Mortality rates in the late 1980s highlighted the gap that remained between the urban and rural sectors and the long way good medical care still had to go to reach the whole population. Over 40 percent of the deaths in urban areas were traced to heart or circulatory diseases, a trend that resembled the pattern in developed nations. Cancer, on the other hand, accounted for only about 6 percent of deaths, a pattern that did not resemble that of developed nations. Instead, intestinal infections, tuberculosis, and parasitic diseases accounted for 20 percent of urban deaths and over 12 percent of rural deaths annually. The leading causes of death in rural environments were listed as "ill-defined conditions" or "senility," reflecting the rather poor diagnostic capabilities of rural health personnel. Observers agreed that considerable work needed to be done to reduce infectious diseases throughout the country and to improve skilled medical outreach to rural communities.

Data as of October 1988