Kerala is a pioneer in implementing the universal health care program. The sub-replacement fertility level and infant mortality rate are lower compared to those of other states, estimated from 12 to 14 deaths per 1,000 live births; as per the National Family Health Survey 2015–16, it has dropped to 6. According to a study commissioned by Lien Foundation, a Singapore-based philanthropic organisation, Kerala is considered to be the best place to die in India based on the state's provision of palliative care for patients with serious illnesses. However, Kerala's morbidity rate is higher than that of any other Indian state—118 (rural) and 88 (urban) per 1,000 people. The corresponding figures for all India were 55 and 54 per 1,000 respectively . Kerala's 13.3% prevalence of low birth weight is higher than that of many first world nations. Outbreaks of water-borne diseases such as diarrhoea, dysentery, hepatitis, and typhoid among the more than 50% of people who rely on 3 million water wells is an issue worsened by the lack of sewers. As of 2017, the state has the highest number of diabetes patients and also the highest prevalence rate of the disease in India.