1. Introduction
Chapter summary Sri Lanka is an island in close proximity to the southernmost tip of India. It is home to 21.4 million people. It has a multiethnic society comprising Sinhalese (75%), Sri Lankan Tamils (15%) and Sri Lankan Moors (9%). The country’s population is rapidly ageing and the percentage of those over 65 years of age increased from 3.7% in 1970 to 10.8% in 2019, with an increasing feminization. The country, had achieved upper-middle-income status although it was downgraded to lower-middle-income in July 2020. The earlier predominantly export-oriented agricultural economy has been transformed to a freemarket economy. It recorded an average annual growth rate of around 6.4% during the period 2003–2012, but this had slowed down to 3.1% in 2017. The country remained a parliamentary democracy since Independence in 1948 till 1972, when it declared itself an independent republic. A new constitution adopted in 1978 provided for an elected executive president and a unicameral parliament. A major amendment in 1987 decentralized power to nine elected provincial councils. Sri Lanka had achieved a relatively high standard of health while it was still a low-middle-income country. An effective maternal and child health (MCH)care system dating back to 1926 produced significant gains in terms of infant mortality rate (IMR), neonatal mortality rate (NMR), under-5 mortality rate (U5MR) and maternal mortality ratio (MMR), but the rate of decline has slowed during the past decade. The country has eradicated polio, neonatal tetanus, malaria, filariasis and leprosy, and has achieved near elimination of other diseases covered by the Expanded Programme on Immunization (EPI). It is in the late stage of the epidemiological transition. However, an epidemic of noncommunicable diseases (NCDs) and emerging new infections such as dengue and re-emergence of old infections such as tuberculosis pose challenges to health. Risk factors that underlie the disease burden are high fasting plasma glucose, dietary risk, high blood pressure and tobacco consumption, in that order. It is estimated that 90% of Sri Lankan adults (18–69 years) have at
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