communities can be attributed specifically to the crowding of entire groups of people on the narrow strip of line along the length of Kerala's coastline: a total of 222 fishing villages along the state's 590 km coastline—none more than a half kilometer wide. Population density in marine fishing villages was measured to be around 2113 persons per square kilometer in 1981, compared to a state figure of 655 per square kilometer. Basic amenities such as electric lighting, access to running water, toilet facilities, etc. are also at far lower standards in these fishing villages when compared to the state as a whole. The lack of basic facilities and hygiene has led to rapid spread of contagious diseases in these areas which express high levels of respiratory and skin infections, diarrheal disorders and hook worm infections to state a few. Though the all-Kerala infant mortality rate was 17 per 1000 live births in 1991, the corresponding rate is 85 per 1000 births in marine fishing communities. There is also a clear gender bias evidenced by the sex ratio of 972 females to 1000 males in these communities, compared to the all-Kerala 1084:1000 ratio of females to males. Thus, marine fishing communities clearly represent an outlier community that has faced restricted levels of capabilities while the state of Kerala has seen progress overall. Opinions British Green activist Richard Douthwaite interviewed a person who remembers once saying that "in some societies, very high levels – virtually First World levels – of individual and public health and welfare are achieved at as little as sixtieth of US nominal GDP per capita and used Kerala as an example". Richard Douthwaite states that Kerala "is far more sustainable than anywhere in Europe or North America". Kerala's unusual socioeconomic and demographic situation was summarized by author and environmentalist Bill McKibben: Kerala continues to lead low-income areas compared to the rest of India. Recent criticisms of the Kerala Model suggest that Kerala is losing its lead within India. K. K. George cites figures indicating that Punjab spends more per capita on education and that both Rajasthan and Punjab spend more per capita on health than Kerala. He also compares Kerala unfavorably with Maharashtra, Haryana, Madhya Pradesh, Nagaland, Rajasthan, and Uttar Pradesh in pension payments to destitutes. These weaknesses should not be overlooked, but they remain minor compared with Kerala's continuing overall ability to deliver a high material quality