The healthcare system in Turkey has seen substantial improvements since the implementation of the Health Transformation Program (HTP) in 2003,Republic of Türkiye Ministry of Health. Sağlıkta Dönüşüm Programı. 2003. which sought to expand access to healthcare services and increase efficiency and equity in service delivery under the motto "Health for All." The program established the General Health Insurance Scheme, primarily financed through contributions from employers, employees, and the government via the Social Security Institution, resulting in near-universal health coverage. While overall health indicators such as life expectancy and child mortality have improved, regional disparities and challenges in reproductive health persist. As of 2023, Turkey does not conduct systematic health impact assessments, and its performance in fulfilling the right to health—particularly reproductive health—lags behind international expectations relative to its income level.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.
Background Prior to the Health Transformation Program, Turkey’s healthcare system faced limitations in accessibility, efficiency, and equity. The introduction of the HTP in 2003 marked a comprehensive reform aimed at overhauling the structure and financing of health services. By extending health insurance coverage and integrating service delivery, the program significantly improved population health outcomes. However, inequalities remain: for instance, the under-5 mortality rate in 2021 was 7.9 in Western Marmara, compared to 16.3 in Southeastern Anatolia, reflecting persistent regional imbalances. Demographically, Turkey is experiencing a shift marked by population aging and declining fertility; between 2007 and 2022, fertility rates dropped from 2.16 to 1.62, while life expectancy rose to 78.3 years (2018–2020). According to the Human Rights Measurement Initiative, Turkey fulfills 81.6% of its right-to-health obligations based on its income' performing well in child and adult health but poorly in reproductive health, meeting just 57.3% of expectations in that area.
Turkish health system
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." 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. 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. The three most common causes of mortality in the country are cardiovascular diseases (35.4%), cancer (15.2%), respiratory diseases (13.5%).
Healthcare in Turkey is majorly provided by Ministry of Health and some private health institutions.
Primary healthcare system The Turkish Public Health Association is accountable for the primary healthcare delivery in Turkey.
Services that are managed, developed and supervised by the Public Health Association are (health related units):
Primary Health Care Services 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 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 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
Occupational Safety and Environmental Health Unit Public Health Laboratory
Maternal mortality ratio
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. 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.
20002005201020152017MMR(Per 100,000 live births)4233241917
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. Even though Turkey has accomplished to reduce U5MR, it has always been higher than the Europe and Central Asia averages between 1990 and 2021. 1990199520002005201020152021U5MR (per 1000 live births)7454382618139
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%). 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. 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.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).
Top ten causes of deaths in 2019 from the most causes to the least are: Ischemic heart disease Stroke Lung cancer COPD Alzheimer's disease Diabetes Chronic kidney disease Hypertensive heart disease Lower respiratory infections Colorectal cancer However, combining death causes with disability causes is changing the top ten list and, it includes low back pain, neonatal disorders, depressive disorders, headache disorders, and gynecological diseases.
The risk factors the drive most death and disability in Turkey are tobacco use, high body-mass index and high blood pressure. WHO estimates that 42% of men are tobacco smokers.
"Multisectoral action plan of Turkey for non-communicable diseases 2017–2025" has been established by the Turkish Ministry of Health in order to halt and manage the NCDs in Turkey. The action plan 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.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). 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. Further, obesity in females (39.1%) is higher than in males (24.6%).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
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%), it is seen that the diet of Turkish people has shifted to a Western-type diet in terms of micronutrients and food groups.
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. The other social determinants of obesity are being married and having a lower educational level in Turkey. A lack of knowledge about health and the health consequences contribute to the high percentage of excessive weight.
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.
"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. 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.
In 2022 half of children ate fruit every day, and a third ate vegetables every day. Placing fruit and vegetables outside shops attracts customers. In 2022 a lawsuit was started claiming that the ban on vegan cheese was unconstitutional. Sugar beet is subsidized. Although a healthy amount of sugar is less than 50g a day for an adult the sugar production quota for market year 26/27 was 3 million tonnes, thus for the population of under 90 million about twice as much sugar is produced than is healthy. On average Turks consume 35 kilograms a year, mostly as confectionery.
Diabetes
Diabetes causes 2% of total deaths in all ages in Turkey. 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. 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. An operational action plan for diabetes, overweight and obesity exists as a national response to the diabetes.
Air pollution and climate change