The 2011 census shows that Kerala has undergone the highest level of urbanization (47.71%) during 2001-11, with a percentage increase of 83.2 % over the previous decade. The pace of urbanization of central and northern parts of the State was much higher than the eastern parts which have considerable forest cover. According to the State Urbanization Report prepared by the Town and Country Planning Department, the urban content of Malappuram has increased from 9.82 per cent in 2001 to 44.19 per cent in 2011 and Thrissur from 28.22 per cent to 67.19 per cent during the period. Idukki, Wayanad, and Pathanamthitta registered the lowest rate of urbanization. 
This high level of urbanization has no physical or economical manifestations in the State.The urban spread demands more investment in infrastructure development. It may result in the depletion of agricultural areas, and an increase in transportation costs and energy consumption. All the ills of unplanned and uncontrolled urbanization like poverty, congested living environments, inadequate and poor facilities for sanitation, sewage and solid waste management, and lack of drinking water supply, increased geographical spread and density of vectors like the mosquito species, Aedes Aegypti that is responsible for dengue fever, already exist in the State. The Thiruvananthapuram Municipal Corporation which handled 1.5 tonnes of plastic waste daily in 2003 is now reeling under a load of 40 tonnes everyday. 
The disparity between the growth of per capita income and the rate of urbanization has affected the quality of basic services like waste management, infrastructure, sanitation and other key facilities in the urban centres. High-quality housing, commercial establishments and public utilities will be the future requirements of the State. At present, the state generates 8,000 metric tonnes of municipal solid waste a day. In the next 50 years, this will increase five-fold. Excessive litigation has hampered the setting up of sewerage treatment plants in the state. More than 80 per cent of wells in the state are contaminated due to the lack of proper sewerage networks. 
Urban areas should be instruments for the development of rural areas so as to ensure high quality in the delivery of public services as well as to raise the standard of living. If the right policies are enacted, urbanization could do just that.