REPUBLIC of TURKEY MINISTRY of HEALTH DIRECTORATE GENERAL PRIMARY HEALTH CARE Policies for Tackling Non-Communicable Diseases and Risk Factors in Turkey EDITORS Yasin ERKOC, MD Nazan YARDIM, MD MoH, Deputy Undersecretary MoH, GDPHC, Head of NCD Department Ankara 2011 © All publication rights of this document belong to the Ministry of Health, Directorate General Primary Health Care. No quotation is allowed without reference. The proper reference for quoting is “Republic of Turkey Ministry of Health, Directorate General Primary Health Care Ankara, place and date of publication”. In accordance with No. 5846, this publication cannot be duplicated partly or completely without the approval of Directorate General Primary Healthcare. ISBN : 978-975-590-340-8 Ministry of Health Publication No : 809 For More Information T.C. Ministry of Health, Mithatpaşa Caddesi No: 3, Sıhhiye 06430, Ankara, Türkiye Phone:+90 (312) 585 10 00 e-mail: [email protected], [email protected] web: www.saglik.gov.tr Press Information Anıl Matbaası, Özveren Sok. No:13/A Kızılay/ANKARA Phone: +90 (312)2293741/42 Fax:(312)2293742 web:www.anilmatbaasi.com AUTHORS and INSTITUTIONS (Alphabetical) Harun ARSLAN,MD Turkish Ministry of Health, DG Health Education Berrak BAŞARA, MD RSHCP School of Public Health Gültekin BAYRAKTAR Turkish Ministry of Health, DG Curative Services, Head of Hospital Services Elif BOR EKMEKÇİ,MD Turkish Ministry of Health, Head of EU Department Nejla CAN GÜLER,MD Turkish Ministry of Health, DG Health Education, EU Expert Biriz CAKIR Turkish Ministry of Health, DGPHC, Department of Nutrition and Physical Activity Nevin ÇOBANOĞLU Turkish Ministry of Health, DGPHC, NCD Department Abdurrahman ÇOHAZ Turkish Prime Ministry, DG Social Services for Child and Elderly 3 People Yasin ERKOC, MD Turkish Ministry of Health Deputy Under- Secretary Levent GÖÇMEN, MD Turkish Ministry of Health, DGPHC, Health Promotion Department Ertuğrul GÖKTAŞ Turkish Ministry of Health, DGPHC, NCD Department Ünal HÜLÜR,MD Turkish Ministry of Health, Department of Administration and Financial Affairs Hasan IRMAK, MD Turkish Ministry of Health, DGPHC, Deputy General Directorate Hüseyin İLTER, MD Turkish Ministry of Health, DGPHC, Head of Tobacco and Alcohol, Drugs Prevention Department Akfer KAHILOGULLARI,MD Turkish Ministry of Health, DGPHC, Head of Mental Health Department M. Nezir KAHRAMAN Ministry of Education, Head of Department of Health Kağan KARAKAYA, MD Turkish Ministry of Health, DGPHC, Head of Health Promotion Department Cengiz KESİCİ Turkish Ministry of Health, DGPHC, Department of Nutrition and Physical Activity Orhan KOC, MD Turkish Ministry of Health, DG Curative Services, Deputy Director Erol KOÇ,MD Turkish Ministry of Health, DG Health Education, Head of Research and Development Unit Emine KURTLUK Turkish Ministry of Health, DG Curative Services 4 Emire OLCAYTO Turkish Ministry of Health, Department of Cancer Nejat ÖZGÜL Turkish Ministry of Health, Department of Cancer Halil POLAT Ministry of Education,Department of Health Gülay SARIOĞLU Turkish Ministry of Health, DGPHC, NCD Department Meltem SOYLU Turkish Ministry of Health, DGPHC, NCD Department Murat TUNCER Turkish Ministry of Health, Head of Cancer Department Nefise Burcu ÜNAL Ministry of Labour Nazan YARDIM, MD Turkish Ministry of Health, DGPHC, Head of NCD Department Turkish Union of Healthy Cities DIRECTORATE GENERAL PRIMARY HEALTH CARE PUBLISHING COMMISSION Bekir KESKİNKILIÇ, MD MoH DGPHC Deputy General Director Kağan KARAKAYA, MD DGPHC Head of Health Promotion Department Şefik KUTLU MoH, DGPHC Head of Publication Department Hakime ZAL MoH, DGPHC Branch Director TRANSLATORS Ferişte ZARALİ MoH, Project Management Support Unit 5 Özlem BÜYÜKYUMAK MoH, Project Management Support Unit Başak TELLİ MoH, Project Management Support Unit Sadullah DEDE MoH, Project Management Support Unit 7 8 9 ABBREVIATIONS EU European Union RSHCP Refik Saydam Hygiene Center Presidency DG Directorate General PHC Primary Health Care NCD Non-Communicable Diseases WHO World Health Organization MoE Ministry of Education MoH Ministry of Health SSI Social Security Institution IGOs International Governmental Organisations 11 NGO Non-Governmental Organization ST Strategic Target TAPDK Regulatory Committee for Tobacco and Alcoholic Beverages Market TNSA Turkey Demographic and Health Survey TURKSTAT Turkish Statistical Institution STRC The Scientific and Technological Research Council of Turkey ODA Official Development Aid OECD Organization Economic Cooperation and Development UNICEF United Nations Children’s Fund BTK Information of Technology Coordinator HTP Health Transformation Program FOREWORD In parallel to the changes in our demographic structure and Tertiary Prevention and the Action Plan, Program and changing socioeconomic structure, the health for Prevention and Control of Chronic Respiratory Tract agenda in Turkey is shifting from communicable and Diseases in Turkey (Asthma, COPD) (2009-2013) vaccine preventable diseases to non-communicable Action Plan and Program for Diabetes Prevention and diseases and complications. Besides the successful Control in Turkey shall play an important role in the efforts put into achieving Millennium Development control of diseases and risk factors. Goals in terms of always prioritized maternal and infant mortality, Ministry of Health also gave speed to the studies The Ministry of Health put special emphasis on the aiming at controlling the burden of diseases caused by compatibility of its strategic plan and action plans, non-communicable diseases and complications. as well as compatibility of tackling approaches with contemporary tackling techniques and the strategic A new organizational structure has been formed within and action plans of World Health Organization. In this Primary Healthcare Services General Directorate to context, the approach adopted for the development of carry out studies for the control of non-communicable related strategy and action plans includes contributions diseases, which resulted in the establishment of from all stakeholders such as public organizations Departments of Control of Tobacco and Other Addictive and institutions, local administrations, universities, Substances; Nutrition and Physical Activities; Mental and NGOs, and private sector; and studies are carried out Environmental Health, as well as Non-communicable to implement the plans and to ensure monitoring and Diseases and Chronic Conditions and Health Promotion evaluation. 13 Departments. Cancer Control Department provides freestanding service in terms of tackling with cancer, the This book, sharing the non-communicable disease leading non-communicable disease. tackling studies in Turkey, is intended to contribute to the policy development efforts. For the preparation of It is expected that the population with non-communicable this book, the publication of WHO European Region diseases will increase due to the increasing frequency of covering Albania, Finland, France, Greece, Hungary, the risk factors in parallel to the alternating life styles. It is Ireland, Kyrgyzstan and Lithuania has been followed as also considered that costs related to the diagnosis, care an example. and rehabilitation of these diseases and complications I would like to extend my thanks to the Project will increase. It is very important to provide protection Management Support Unit for their contributions for the from diseases by enabling behavioural change translation of this book. The efforts of the contributors towards healthy life styles in the community, to provide to this book, which I believe will provide valuable cost-effective, efficient, and evidence-based service contributions to our health policy developed in parallel approach, as well as providing early diagnosis, effective to the principle of equitable, quality, and sustainable treatment, and follow up for the management of these healthcare for all, is thankfully acknowledged. diseases. The activities developed in parallel to National Program Prof. Dr. Recep AKDAĞ for Prevention and Control of Cardiovascular Diseases Minister of Health in Turkey-Risk Factors; Strategic Plan for Secondary 1. INTRODUCTION communicable diseases constitute important financial and economic risk in both developed and Increase in the level of education and income, developing countries’ economies, threatening the changes in nutrition habits, and other factors like sustainability of healthcare provision systems, and communicable diseases control in the 20th century create productivity loss which is four times higher have led into an increase in life expectancy. than the direct health costs they generate. Though longer life expectancy is a desired effect, there is also seen an increase in the incidence of There are proven solutions related to prevention non-communicable chronic diseases. The fact that of tobacco use and smoking, unhealthy nutrition, the elder population in increasing compared to the physical inactivity, and alcohol consumption younger population caused that the community for the purpose of preventing undue deaths health problems have shifted from childhood from preventable non-communicable diseases. diseases to non-communicable chronic diseases Moreover, the approach related to strengthening of elder population. health systems for responding more effectively to the needs of the public plays an important role in Alarming findings of the studies state that chronic this respect. To this end, WHO has prepared the diseases are gradually increasing regardless of the