Academic journal article International Public Health Journal

Bandage It or Write It. Experiences with Health Inequalities of Hospital Social Workers in Turkey

Academic journal article International Public Health Journal

Bandage It or Write It. Experiences with Health Inequalities of Hospital Social Workers in Turkey

Article excerpt


The World Health Organization (WHO) defines health inequalities as differences in health status or in the distribution of health determinants between different groups (1). Certain models were developed in order to present the dynamics of health inequalities such as psychosocial theories, political economy of health (2) and eco-social model (3). Additionally, the Commission on Social Determinants of Health (CSDH) initiated by WHO proposed a model of social determinants of health which contains three groups of variables that effect health directly or indirectly. These are socio-economic and political context; structural determinants for individual socioeconomic position (e.g., education, income, gender, occupation, social class race/ethnicity) and intermediary determinants which point out the "underlying social stratification and, in turn, determine differences in exposure and vulnerability to health-compromising conditions" (2). As can be inferred from this model, health inequalities are closely linked with social inequalities (4) and thus, health inequalities of a country reflect the overall inequalities occurring in its socioeconomic system.

Health inequalities in Turkey

Turkey is an upper-middle income country with Gross National Product of $789.3 Billion, as reported by the World Bank (5). The population is 75,627,384 million in the year 2012, with a population increase rate of 12% (6). As a developing nation, Turkey experienced multiple challenges associated with income and other socioeconomic disparities (7). After the economic crises of 2001, health inequalities intensified. Despite relative progress in the economy over the last 10 years, Turkey ranked 29 of 30 among countries with high rates of unequal income distribution. Within Turkey, income disparities were exacerbated by crossregional differences (7-8) especially between eastern and western part of the country.

A closer look at inequalities burdening specific segments of the population, presents a less than optimistic picture. In comparison to other nations, Turkey experiences inequalities in child-youth and elder poverty, as well as among those who work but do not earn a living wage (9-10). For example, 29 percent of those who work fall at or below poverty line (11). The poverty of those who are disabled is not fully known due to lack of data (12).

Health inequalities in Turkey need to be considered within a historical framework. This historical view will reflect both improvements and persistent problems among the indicators of health inequalities such as data on life expectancy, infant and child mortality and health expenditures. In the 1940s, the life expectancy was 30 years for men and 33 years for women (13). However in 2012, life expectancy for women increased to 77 years, compared with 72 for men (14). Infant and child mortality is another important indicator of health inequalities. High rates of infant mortality point out lack of effective maternal and child health services and it can also be seen as a result of poverty. Turkey had a significant problem of infant and child mortality, despite its increasing economic level. In the past years, while adult mortality rates were not considerably different from similar-income countries, the life expectancy from birth were lower due to high infant and child mortality rates. In 1960's the infant mortality rate was 163%, in 1980s 121% and in 1990s 66% (13). After 2000s, with high awareness of the policy makers, it started to decrease. In 2011, Turkey succeeded in decreasing the infant mortality rate to7.7% (6). With this success, Turkey is considered as one of the few countries to accomplish the Millennium Developmental Goals on infant mortality, as set forth by United Nations Children's Fund (UNICEF) (13). In the same year, the mortality rate for children <5 years was 11.3% and maternal mortality rate was 21.2% (6).

Finally, the expenditures in health is the another indicator of the health of a particular society. …

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