Health in Turkey

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As of 31 December 2016, Turkish population is 79,814,871 of which %23.7 are between 0-14, %68 are between 15-64 and %8.3 are older than 65 years old.[1] Life expectancy at birth for men is 75.3 and for women is 80.7 years[2].Maternal mortality ratio has decreased from 23 to 16 per 100,000 live births between the years 2010 to 2015.[3] According to the data from 2015, Under-five mortality and infant mortality rates per 1000 live births are 13.5[4] and 11.6[5].

Geography[edit]

"Turkey occupies a surface area of 774,815 square kilometers. About three percent of the total area lies in Southeastern Europe (Thrace) and the remainder in Southwestern Asia (Anatolia or Asia Minor). Turkey has borders with Greece, Bulgaria in the Thrace and Syria, Iraq, Iran, Georgia, Armenia, and Nahcivan (Azerbaijan) in the south and east Anatolia that is also called Asia Minor. The shape of the country resembles a rectangle, stretching in the eastwest direction for approximately 1,565 kilometers and in the north-south direction for nearly 650 kilometers. The three sides of Turkey are surrounded by seas: in the north, the Black Sea; in the northwest, the Sea of Marmara; in the west, the Aegean Sea; and in the south, the Mediterranean Sea. The total coastline of Turkey is around 8,333 kilometers."[6]

Turkish Health System[edit]

"Health services in Turkey are controlled by the Ministry of Health through a centralized state system. In 2003, the government introduced a comprehensive health reform program aimed at increasing the budget rate allocated to healthcare services and ensuring that a large part of the population is healthy. The Turkish Statistical Institute announced that it had spent 76.3 billion TL in health services in 2012; 79.6% of the service fees were covered by the Social Security Institution while the remaining 15.4% were paid directly by the patients."[7] According to 2013 figures, there are 30,116 health institutions in Turkey and an average of 573 patients per doctor are falling. In addition, the number of beds per 1000 people is 2.64.[8] Life expectancy in Turkey is 71.1 years for males and 75.2 years for females, and the life expectancy of the total population is 73.2 years. The three most common causes of mortality in the country are circulatory system diseases (39.8%), cancer (21.3%), respiratory diseases (9.8%).[9]

Healthcare in Turkey is majorly provided by Ministry of Health and some private health institutions. In 2003 with the Health Transformation Programme, the social security system is converged and now called 'The General Health Insurance Scheme'[10].

Primary Healthcare System[edit]

Turkish Public Health Association is accountable for the primary healthcare delivery in Turkey.[11]

Services[12] that are managed, developed and supervised by the Public Health Association are (health related units) :

Primary Health Care Services[edit]

Supervising the Family Medicine Unit (which consists of a Family Physician and a health personnel) and General Practitioners

Immigration Healthcare Services

Communicable Diseases Control Programmes[edit]

Early warning-response field epidemiology unit

Communicable Diseases Unit

Preventable diseases -Vaccination Unit

Vector-borne and Zoonotic Diseases Unit

Tuberculosis Unit

Microbiology Laboratories Unit

Non-communicable Diseases Programmes and Cancer[edit]

Tobacco and other addictive Substances campaign Unit

Cancer Unit

Mental Health Programmes Unit

Obesity, Diabetes, Other Metabolic Diseases Unit

Chronic Diseases, Elderly and Disabled Unit

Women and Reproductive Health unit

Child and Adolescent Health Unit Health institutions

Occupational Safety and Environmental Health Unit[edit]

Public Health Laboratory[edit]

Maternal Mortality Ratio (MMR)[edit]

According to the WHO data between the years 1990 to 2015, Maternal Mortality Ratio in Turkey has decreased from 57 to 16 in 10 years[13].In 2010, Turkey was nearly on par with some of the other OECD countries such as South Korea and Hungary and had a lower maternal mortality ratio than United States.[14]

1990 1995 2000 2005 2010 2015
MMR(Per 100,000 live births) 97 86 79 57 23 16

Under-five Mortality Rate (U5MR)[edit]

Turkey’s U5MR in 2007 has reduced by 72% over 1990 levels, while in the world the total reduction was %26.9 between 1990-2007.[15] In 2010, U5MR in Turkey was highest compared to other OECD countries.[16]
1990 1995 2000 2005 2010 2015
U5MR(per 1000 live births) 74.5 55.2 39.6 27.7 19.1 13.5

Causes of death[edit]

"In 2013, 39.8% of deaths were caused by circulatory system diseases. The first six disease groups causing death were respectively; circulatory system diseases (39,8%), benign and malignant tumors (21,3%), respiratory system diseases (9.8%), endocrine, nutrition and metabolism related diseases (5,6%), causes of external injury and poisoning (5,5%) and nervous system and sensory organs diseases (4.1%). When the diseases causing death are examined on a gender basis; deaths from circulatory system diseases were found mostly in women and deaths from benign and malignant tumors were seen in men."[17]

2013 (%) circulatory system diseases benign and malignant tumors respiratory system diseases endocrine, nutrition and metabolism related diseases causes of external injury and poisoning nervous system and sensory organs diseases
Male 35.8 25.3 10.7 4.3 7.3 3.4
Female 44.6 16.5 8.8 7.2 3.3 7.9

The first three ranks of deaths did not change in 2016.[18]

YEARS (%) circulatory system diseases benign and malignant tumors respiratory system diseases endocrine, nutrition and metabolism related diseases causes of external injury and poisoning nervous system and sensory organs diseases
2015 40.1 19.9 11.0 5.0 4.9 4.8
2016 39.8 19.7 11.9 5.0 4.8 4.4

NCDs already account for over 70 percent of all mortality in Turkey[19].Reported mortality from coronary heart disease (CHD) amongst Turkish women is the highest in Europe. Despite the public health programmes already in place, risk factor levels for NCDs are high in Turkey. Clinically significant hypertension exists in at least a third of the adult Turkish population[20].

Top ten causes of deaths in 2016[21]from the most frequent to the least are;

1.Ischemic Heart Disease

2.Cerebrovascular Disease

3.Alzheimer Disease

4.COPD

5.Lung Cancer

6.Diabetes

7.Chronic Kidney Disease

8.Road Injuries

9.Hypertensive Heart Disease

10.Lower respiratory infections

WHO estimates that 42% of men are tobacco smokers. One in 5 adults is obese and just under a quarter of adults have hypertension.[22]

'Multisectoral action plan of Turkey for non-communicable diseases 2017–2025'[23]has been established by the Turkish Ministry of Health in order to halt and manage the NCDs in Turkey. The action plan[23] is coordinated with the Sustainable Development Goals.

Vaccine-preventable Diseases[edit]

Vaccines that are on the existing immunization schedule of the government are free of charge.

According to the recent 'WHO vaccine-preventable diseases: monitoring system' reported cases for Diphtheria were 0, Measles were 9, Rubella were 7, Mumps were 544 and Tetanus(total) were 16 cases in 2016.[24]

Immunization Schedule[24][edit]

HepB_pediatric : birth;1, 6 months

BCG : 2 months

DTaPHibIPV : 2,4,6,18 months

Pneumo_conj : 2,4,6,12 months

MMR :12 months, 6 years

TdaPIPV : 6 years

OPV : 6, 18 months

Td : 14 years

HepA_pediatric : 18,24 months

Varicella : 12 months

Influenza_Adult : >=65 years

Influenza_Pediatric : 6 months

Diabetes[edit]

Diabetes causes %2 of total deaths in all ages in Turkey.[25]

In 2016 it was estimated that 13.2% of the population had diabetes and there is an increasing trend in the prevalence of diabetes.[26]

Diabetes has been described as “one of the top priorities” for the Turkish government.[27] An operational action plan for diabetes, overweight and obesity exists as a national response to the diabetes.[28]

Obesity[edit]

In 2016, 66.1 % of the population was overweight and 29.4 % was obese.[29]The occurrence of diabetes is higher among women than men.[30] Turkey had the highest rate of obesity in Europe in 2015. 29.3% of the adult population had a body mass index of 30 or more.[31]

Obesity and being overweight is higher among women for several reasons. A majority of women do not have jobs outside of the home and lead more sedentary lifestyles as a result. Housework is often the only source of physical activity for women, as there is no prior tradition of women participating in sports. Individuals living in urban areas are more likely to be overweight or obese because of the availability of public transportation and the sedentary lifestyle. A lack of knowledge about diabetes and the health consequences also contribute to the high percentage of excessive weight.[30]

HIV/AIDS in Turkey[edit]

Between 2000 and 2016, new HIV infections fell by 39%, and HIV-related deaths fell by one third with 13.1 million lives saved due to ART in the same period. This achievement was the result of great efforts by national HIV programmes supported by civil society and a range of development partners.[32] HIV stands for human immunodeficiency virus. This new disease of the human immuna system was named 'Acquired Immuno Deficiensy Sydndrome' (AIDS), when first described in United States in August 1981.[33] It harms your immune system by destroying the white blood cells that fight infection. This puts you at risk for serious infections and certain cancers. AIDS stands for acquired immunodeficiency syndrome, it is the final stage of infection with HIV. Not everyone with HIV develops AIDS.[34] AIDS is a disease that is increasingly dangerous in Turkey as it is in the world. The facts about AIDS in our country, prejudice and lack of knowledge among the public, are quite frightening. Analyzes of nearly 7000 cases reveal data about HIV in Turkey.[35] AIDS in our country; "Gay disease", "African disease", "Natasha disease" is evaluates. So people tend to hide their illness. However, the data obtained show that the danger is quite different. "According to the United Nations HIV / AIDS Theme Group's 2002 HIV / AIDS Situation Analysis report in Turkey, between 7,000 and 14,000 people have been infected with AIDS since the beginning of pandemic. Figures released by the SB (T.C. Sağlık Bakanlığı) in June 2002 show that a total of 1,429 HIV / AIDS cases have been reported since 1985."[36] Due to problems in the registration and notification system, obtaining reliable numerical information about AIDS cases is very difficult in Turkey.[37]

Transmission[edit]

"HIV is transmitted by the direct transfer of bodily fluids—such as blood and blood products, semen and other genital secretions, or breast milk—from an infected person to an uninfected person. The primary means of transmission worldwide is sexual contact with an infected individual. HIV frequently is spread among intravenous drug users who share needles or syringes. The virus can be transmitted across the placenta or through the breast milk from mother to infant; administration of antiretroviral medications to both the mother and the infant about the time of birth reduces the chance that the child will be infected with HIV (see below HIV and pregnancy). Antiretroviral therapy can reduce the risk of transmission from infected persons to their uninfected sexual partners by some 96 percent when prescribed immediately upon diagnosis."[38]

"HIV is not spread by coughing, sneezing, or casual contact (e.g., shaking hands). HIV is fragile and cannot survive long outside the body. Therefore, direct transfer of bodily fluids is required for transmission. Other sexually transmitted diseases, such as syphilis, genital herpes, gonorrhea, and chlamydia, increase the risk of contracting HIV through sexual contact, probably through the genital lesions that they cause."[39] "The disease is seen in 20-45 groups. It is estimated that approximately 2,000 people have been treated with this disease in Turkey. Marmara region where the most case report is made to the current. These are followed by Ankara, Izmir, Antalya, Mersin, Adana and Bursa respectively. Foreign nationals who make up about 16 percent of cases are from Ukraine, Moldova and Romania."[40]

See also[edit]

References[edit]

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