Turkish pediatrician listens to a child's heartbeat.
The healthcare system in Turkey has improved in terms of health status especially after implementing the Health Transformation Program (HP) in 2003.[1] "Health for All" was the slogan for this transformation, and HP aimed to provide and finance health care efficiently, effectively, and equitably.[2] By covering most of the population, the General Health Insurance Scheme is financed by employers, employees, and government contributions through the Social Security Institution.[1] Even though HP aimed to be equitable, after 18 years of implementation, there are still disparities between the regions in Turkey. These discrepancies can be seen in terms of infant mortality between rural and urban areas and different parts of the country, although these have been declining over the years.[3] While the under-5 mortality rate in Western Marmara is 7.9, the under-5 mortality rate in Southeastern Asia is two times higher than Western Marmara, with the rate of 16.3 in 2021.[4]
Population by age group in Turkey between 1950 and 2021
In 2022, the population of Turkey calculated at more than 85 million by showing the trend in the population of old people increasing.[5] The causes of the changes between population pyramids in 2007 and 2022 are that the fertility rate decreased from 2.16 to 1.62[5][6] and the life expectancy reached 78.3 years between 2018 and 2020 in Turkey.[7]
The Human Rights Measurement Initiative[8] finds that Turkey is fulfilling 81.6% of what it should be fulfilling for the right to health based on its level of income.[9] When looking at the right to health with respect to children, Turkey achieves 95.5% of what is expected based on its current income.[9] In regards to the right to health amongst the adult population, the country achieves only 92.0% of what is expected based on the nation's level of income.[9] Turkey falls into the "very bad" category when evaluating the right to reproductive health because the nation is fulfilling only 57.3% of what the nation is expected to achieve based on the resources (income) it has available.[9] As of 2023 health impact assessment is not done in Turkey.[10]:50
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; the Social Security Institution covered 79.6% of the service fees while the remaining 15.4% were paid directly by the patients."[11] According to 2013 figures, there are 30,116 health institutions in Turkey and per one doctor there are an average of 573 patients. In addition, the number of beds per 1000 people is 2.64.[12] Life expectancy in Turkey is 75.6 years for males and 81.3 years for females, and the life expectancy of the total population is 78.3 years.[7] The three most common causes of mortality in the country are cardiovascular diseases (35.4%), cancer (15.2%), respiratory diseases (13.5%).[13]
Healthcare in Turkey is majorly provided by Ministry of Health and some private health institutions.[14]
The maternal mortality ratio in 2000 and 2017, Turkey and other countries behindAcibadem Hospital in Istanbul
According to the WHO data between the years 2000 to 2017, Maternal mortality ratio (MMR) in Turkey has decreased from 42 to 17 in 17 years.[16] 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 the United States.[17]
2000
2005
2010
2015
2017
MMR(Per 100,000 live births)
42
33
24
19
17
Under-five Mortality Rate (U5MR)
Turkey's U5MR in 2021 was reduced by 88% over 1990 levels, while in the rest of the world the total reduction was %59 between 1990 and 2021.[18] Even though Turkey has accomplished to reduce U5MR, it has always been higher than the Europe and Central Asia averages between 1990 and 2021.[18]
1990
1995
2000
2005
2010
2015
2021
U5MR (per 1000 live births)
74
54
38
26
18
13
9
Causes of death
The top 5 causes of death are cardiovascular diseases (35.4%), cancer (15.2%), respiratory diseases (13.5%), endocrine and nutritional diseases (4.5%), and others (13%).[13] When the diseases causing death are examined on a gender basis; deaths from circulatory and endocrine diseases were found mostly in women and deaths from cancers and external causes were seen in men.[4]
YEARS (%)
cardiovascular system diseases
benign and malignant tumors
respiratory system diseases
endocrine, nutrition and metabolism related diseases
COVID-19
nervous system and sensory organs diseases
2021
33.5
14.0
13.4
4.2
11.5
3.3
2022
35.4
15.2
14.4
4.5
4.4
3.6
NCDs already account for over 89 percent of all mortality in Turkey.[19]
Top ten causes of deaths in 2019[19] from the most causes to the least are:
"Multisectoral action plan of Turkey for non-communicable diseases 2017–2025"[21] has been established by the Turkish Ministry of Health in order to halt and manage the NCDs in Turkey. The action plan[21] is coordinated with the Sustainable Development Goals.
Obesity and Dietary Behaviors
One of the risk factors that causes death and disability is a high body-mass index, which increased the DALYs (per 100.000) +453.9 between 2009 and 2019 in Turkey. The other risk factors that are on the top ten list, many of them related to eating behaviors.[22] Turkey has the highest rate of obesity in the WHO European Region; according to the European Obesity Report 2022 by WHO, more than 65% of adults are overweight or obese in Turkey.[23] Further, obesity in females (39.1%) is higher than in males (24.6%).[24]
The increased prevalence of obesity in Turkey is attributed to the changes in dietary behaviors. Turkish people eat fewer grains, bread, vegetables, and fruits than before. This causes an increase in fat intake and energy percentage from fats and a decrease in vitamin C intake. Although the energy and macronutrient intakes are within the recommended ranges (carbonhydrates: 50%, protein: 15%, and fat: 35%),[24] it is seen that the diet of Turkish people has shifted to a Western-type diet in terms of micronutrients and food groups.[25]
Additionally, one of the determinants of obesity is urbanization in Turkey due to sedentary lifestyle in the cities, availability of public transportation, working more at office jobs, and changes in social and economic structure. Migrating to big cities is popular and causes high unemployment rates, which might also cause less physical activity.[26][27] The other social determinants of obesity are being married and having a lower educational level in Turkey.[28] A lack of knowledge about health and the health consequences contribute to the high percentage of excessive weight.[27]
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.[27]
"Turkey Health Nutrition and Active Life Program (2014–2017)" is implemented by the Ministry of Health in Turkey in order to prevent obesity and reduce obesity-related diseases (cardiovascular diseases, diabetes, some types of cancer, hypertension, and musculoskeletal diseases) by encouraging people to have adequate and balanced nutrition and regular physical activity habits.[29] In 2019, the Ministry of Health in Turkey extended the program and introduced the "Adult and Childhood Obesity Prevention and Physical Activity Action Plan (2019-2023). One of the actions in the program addresses the decreased purchasing power problem in Turkey by minimizing inflation on healthy products such as fish, milk, fruit, and vegetables and taking actions to increase purchasing power.[30]
In 2022 half of children ate fruit every day, and a third ate vegetables every day.[31] Placing fruit and vegetables outside shops attracts customers.[32] In 2022 a lawsuit was started claiming that the ban on vegan cheese was unconstitutional.[33]Sugar beet is subsidized.[34]
Diabetes
Learjet 45 air ambulance of the Ministry of Health
Diabetes causes 2% of total deaths in all ages in Turkey.[35] Furthermore many more Turks die from Diabetic Kidney disease, a complication of Diabetes and non-diabetic High blood sugar, and some say that the consequences of Diabetes could cause up to 20% of all deaths in Turkey.
In 2016 it was estimated that 13.2% of the population had diabetes and there is an increasing trend in the prevalence of diabetes.[35] The main cause of this could be the fact that over Nearly 2 in 3 Turks are overweight and that 1 in 3 are obese.
Diabetes has been described as "one of the top priorities" for the Turkish government.[36] An operational action plan for diabetes, overweight and obesity exists as a national response to the diabetes.[35]
Air pollution and climate change
Renewable energy reduces health costs in Turkey
Air pollution in Turkey is estimated to be a cause of 8% of deaths in 2019.[37]Coal is a major contributor to air pollution, and damages health across the nation, being burnt even in homes and cities.[38] It is estimated that a phase out of coal power in Turkey by 2030 instead of by the 2050s would save over 100 thousand lives.[39]Climate change in Turkey may impact health, for example due to increased heatwaves.[40][41]
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.[42]
Between 2006 and 2017, new HIV infections increased by 465%.[43] AIDS is a disease that is not decreasing as in much of the rest of the world. Analysis of nearly 7000 cases reveal data about HIV in Turkey.[44] AIDS in Turkey is often described as a "Gay disease", "African disease", or "Natasha disease",[45] so people tend to hide their illness. "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 the pandemic. Figures released by the (Ministry of Health) in June 2002 show that a total of 1,429 HIV / AIDS cases had been reported since 1985."[46] Due to problems in the registration and notification system, obtaining reliable numerical information about AIDS cases is very difficult in Turkey.[47]
"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."[48]
The virus reached Turkey in May 2009. A U.S. citizen, flying from the United States via Amsterdam was found to be suffering from the swine flu after arriving at Istanbul's Atatürk International Airport.[57] Turkey is the 17th country in Europe and the 36th country in the world to report an incident of swine flu.
The Turkish Government has taken measures at the international airports, using thermal imaging cameras to check passengers coming from international destinations.[58]
The first case of person to person transmission within Turkey was announced on 26 July 2009.
On 2 November, the Turkish Health Ministry began administering vaccines against H1N1 influenza, starting with health workers.[59]
After a slow start, the virus spread rapidly in Turkey and the number of cases reached 12,316. First death confirmed on 24 October and death toll reached 627.[60]
COVID-19 pandemic in Turkey
Yeşilköy Emergency Hospital constructed for the COVID-19 pandemic
The COVID-19 pandemic in Turkey is part of the ongoing COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease was confirmed to have reached Turkey on 11 March 2020, after a man who had returned to Turkey from Europe, tested positive.[61] The first death due to COVID-19 in the country occurred on 15 March 2020 and by 1 April, it was confirmed that COVID-19 had spread all over Turkey.[62] On 14 April 2020, the head of the Turkish Ministry of Health Fahrettin Koca announced that the spread of the virus in Turkey has reached its peak in the fourth week and started to slow down.[63] The disease is exacerbated by air pollution,[64] for example from burning coal in Turkey for residential heating.[65]
As of 22July2020[update], the total number of confirmed cases in the country is over 222,400. Among these cases, 205,200 have recovered and 5,500 have died.[66] On 18 April 2020, the total number of positive test results surpassed that of Iran, making it the highest in the Middle East.[67][68] Turkey also surpassed China in confirmed total cases on 20 April 2020.[69] The rapid increase of the confirmed cases in Turkey did not overburden the public healthcare system,[70] and the preliminary case-fatality rate remained lower compared to many European countries.[71][72] Discussions mainly attributed these to the country's relatively young population and high number of available intensive care units.[73][74]
Swine influenza is an infection caused by any of several types of swine influenza viruses. Swine influenza virus (SIV) or swine-origin influenza virus (S-OIV) refers to any strain of the influenza family of viruses that is endemic in pigs. As of 2009, identified SIV strains include influenza C and the subtypes of influenza A known as H1N1, H1N2, H2N1, H3N1, H3N2, and H2N3.
Flu season is an annually recurring time period characterized by the prevalence of an outbreak of influenza (flu). The season occurs during the cold half of the year in each hemisphere. It takes approximately two days to show symptoms. Influenza activity can sometimes be predicted and even tracked geographically. While the beginning of major flu activity in each season varies by location, in any specific location these minor epidemics usually take about three weeks to reach its pinnacle, and another three weeks to significantly diminish.
Influenza A virus subtype H1N1 (A/H1N1) is a subtype of influenza A virus (IAV). Some human-adapted strains of H1N1 are endemic in humans and are one cause of seasonal influenza (flu). Other strains of H1N1 are endemic in pigs and in birds. Subtypes of IAV are defined by the combination of the antigenic H and N proteins in the viral envelope; for example, "H1N1" designates an IAV subtype that has a type-1 hemagglutinin (H) protein and a type-1 neuraminidase (N) protein.
An influenza pandemic is an epidemic of an influenza virus that spreads across a large region and infects a large proportion of the population. There have been six major influenza epidemics in the last 140 years, with the 1918 flu pandemic being the most severe; this is estimated to have been responsible for the deaths of 50–100 million people. The 2009 swine flu pandemic resulted in under 300,000 deaths and is considered relatively mild. These pandemics occur irregularly.
The 2009 swine flu pandemic, caused by the H1N1/swine flu/influenza virus and declared by the World Health Organization (WHO) from June 2009 to August 2010, was the third recent flu pandemic involving the H1N1 virus. The first identified human case was in La Gloria, Mexico, a rural town in Veracruz. The virus appeared to be a new strain of H1N1 that resulted from a previous triple reassortment of bird, swine, and human flu viruses which further combined with a Eurasian pig flu virus, leading to the term "swine flu".
The 2009 flu pandemic in the United States was caused by a novel strain of the Influenza A/H1N1 virus, commonly referred to as "swine flu", that was first detected on 15 April 2009. While the 2009 H1N1 virus strain was commonly referred to as "swine flu", there is no evidence that it is endemic to pigs or of transmission from pigs to people; instead, the virus spreads from person to person. On April 25, the World Health Organization declared a public health emergency, followed concurringly by the Obama administration on April 26.
The 2009 swine flu pandemic in Canada was part of an epidemic in 2009 of a new strain of influenza A virus subtype H1N1 causing what has been commonly called swine flu. In Canada, roughly 10% of the populace has been infected with the virus, with 428 confirmed deaths ; non-fatal individual cases are for the most part no longer being recorded. About 40% of Canadians have been immunized against H1N1 since a national vaccination campaign began in October 2009, with Canada among the countries in the world leading in the percentage of the population that has been vaccinated. The widespread effect of H1N1 in Canada raised concerns during the months leading to the XXI Olympic Winter Games, which took place in Vancouver in February 2010.
This article covers the chronology of the 2009 novel influenza A (H1N1) pandemic. Flag icons denote the first announcements of confirmed cases by the respective nation-states, their first deaths, and relevant sessions and announcements of the World Health Organization (WHO), the European Union , and the U.S. Centers for Disease Control (CDC).
The 2009 swine flu pandemic was a global outbreak of a new strain of influenza A virus subtype H1N1, first identified in April 2009, termed Pandemic H1N1/09 virus by the World Health Organization (WHO) and colloquially called swine flu. The outbreak was first observed in Mexico, and quickly spread globally. On 11 June 2009, the WHO declared the outbreak to be a pandemic. The overwhelming majority of patients experienced mild symptoms, but some persons were in higher risk groups, such as those with asthma, diabetes, obesity, heart disease, who were pregnant or had a weakened immune system. In the rare severe cases, around 3–5 days after symptoms manifest, the sufferer's condition declines quickly, often to the point of respiratory failure.
This article deals with the status and efforts regarding the 2009 swine flu pandemic by country and continent/region.
The pandemic H1N1/09 virus is a swine origin influenza A virus subtype H1N1 strain that was responsible for the 2009 swine flu pandemic. This strain is often called swine flu by the public media due to the prevailing belief that it originated in pigs. The virus is believed to have originated around September 2008 in central Mexico.
The 2009 flu pandemic in Asia, part of an epidemic in 2009 of a new strain of influenza A virus subtype H1N1 causing what has been commonly called swine flu, afflicted at least 394,133 people in Asia with 2,137 confirmed deaths: there were 1,035 deaths confirmed in India, 737 deaths in China, 415 deaths in Turkey, 192 deaths in Thailand, and 170 deaths in South Korea. Among the Asian countries, South Korea had the most confirmed cases, followed by China, Hong Kong, and Thailand.
The 2009 swine flu pandemic in North America, part of a pandemic in 2009 of a new strain of influenza A virus subtype H1N1 causing what has been commonly called swine flu, began in the United States or Mexico.
The 2009 swine flu pandemic vaccines were influenza vaccines developed to protect against the pandemic H1N1/09 virus. These vaccines either contained inactivated (killed) influenza virus, or weakened live virus that could not cause influenza. The killed virus was injected, while the live virus was given as a nasal spray. Both these types of vaccine were produced by growing the virus in chicken eggs. Around three billion doses were produced, with delivery in November 2009.
Cardiovascular disease is the principal cause of death in the UAE, constituting 28 percent of total deaths; other major causes are accidents and injuries, malignancies, and congenital anomalies.
The 2009 swine flu outbreakinMalaysia was part of a larger flu pandemic involving a new type of influenza A virus subtype H1N1 (A/H1N1). As of 11 August 2009, the country had over 2,253 cases, beginning with imported cases from affected countries, including the United States and Australia, from 15 May 2009 onwards, and the first identified local transmission on 17 June 2009. On 12 August 2009, the Malaysian Health Ministry announced that it had discontinued officially updating the total number of H1N1 cases within Malaysia in line with guidelines issued by the World Health Organization. As of 21 August 2009, the unofficial number of cases reported in the media was 5,876. The first death related to the (A/H1N1) virus was reported on 23 July 2009, and there have been 78 deaths reported so far. On 6 July 2009, Malaysia announced a shift from containment to mitigation to tackle the spread of the virus. The federal government declared a national health emergency in Malaysia due to the (A/H1N1) outbreak and was considering imposing a health curfew similar to the week-long shutdown of non-essential services and industries in Mexico.
The 2009 swine flu pandemic in New Zealand was caused by a novel strain of the A/H1N1 influenza virus. A total of 3,175 cases and 69 deaths were recorded, although a seroprevalence study estimated that around 800,000 individuals may have been infected during the initial wave of the pandemic.
The 2009 swine flu pandemic was a global outbreak of a new strain of influenza A virus subtype H1N1, first identified in April 2009, termed Pandemic H1N1/09 virus by the World Health Organization (WHO) and colloquially called swine flu. The outbreak was first observed in Mexico, and quickly spread globally. On 11 June 2009, WHO declared the outbreak to be a pandemic. The overwhelming majority of patients experience mild symptoms", but some persons are in higher risk groups, such as those with asthma, diabetes, obesity, heart disease, or who are pregnant or have a weakened immune system. In the rare severe cases, around 3–5 days after symptoms manifest, the person's condition declines quickly, often to the point respiratory failure.
The 2009 swine flu pandemic was a global outbreak of a new strain of influenza A virus subtype H1N1, first identified in April 2009, termed Pandemic H1N1/09 virus by the World Health Organization (WHO) and colloquially called swine flu. The outbreak was first observed in Mexico, and quickly spread globally. On the 11th of June 2009, the WHO declared the outbreak to be a pandemic. The overwhelming majority of patients experience mild symptoms, but some persons are at higher risk of suffering more serious effects; such as those with asthma, diabetes, obesity, heart disease, or those who are pregnant or have a weakened immune system. In the rare severe cases, around 3–5 days after symptoms manifest, the sufferer's condition declines quickly, often to the point respiratory failure. Although Ukraine was not (very) affected at first there was on outbreak of the virus in Western Ukraine in early November 2009 that led to the closing of public buildings and cancellation of meetings for three weeks.
The 2015 Indian swine flu outbreak refers to an outbreak of the H1N1 virus in India, during early 2015. The states of Gujarat and Rajasthan were the worst affected.
References
1 2 Tatar, Mehtap; Mollahaliloğlu, Salih; Sahin, Bayram; Aydin, Sabahattin; Maresso, Anna; Hernández-Quevedo, Cristina (2011). "Turkey. Health system review". Health Systems in Transition. 13 (6): 1–186, xiii–xiv. ISSN1817-6127. PMID22455830.
↑ Republic of Türkiye Ministry of Health. Sağlıkta Dönüşüm Programı. 2003.
↑ Tatar, Mehtap; Mollahaliloğlu, Salih; Sahin, Bayram; Aydin, Sabahattin; Maresso, Anna; Hernández-Quevedo, Cristina (2011). "Turkey. Health system review". Health Systems in Transition. 13 (6): 1–186, xiii–xiv. ISSN1817-6127. PMID22455830.
1 2 Republic of Türkiye Ministry of Health General Directorate of Health Information Systems. The Ministry of Health of Türkiye Health Statistics Yearbook 2021. Ankara: Ministry of Health Publication; 2023. 274 p.
1 2 3 Institute for Health Metrics and Evaluation (IHME). GBD Compare. Seattle, WA: IHME, University of Washington, 2015. Available from http://vizhub.healthdata.org/gbd-compare (retrieved 14 September 2023).
↑ Institute for Health Metrics and Evaluation (IHME). GBD Compare. Seattle, WA: IHME, University of Washington, 2015. Available from http://vizhub.healthdata.org/gbd-compare (Accessed 14.09.2023).
1 2 Türkiye Ministry of Health General Directorate of Public Health, Türkiye Nutrition and Health Research (Türkiye Beslenme ve Sağlık Araştırması (TBSA)). Ankara: Türkiye Ministry of Health General Directorate of Public Health, 2019 [cited 2023 Sep 16]. Available from: https://krtknadmn.karatekin.edu.tr/files/sbf/TBSA_RAPOR_KITAP_20.08.pdf
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