Turkey: Why are rates of diabetes soaring?

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Over the past 20 years, there has been a 67% rise in diabetes cases in Turkey, meaning that overall prevalence has almost doubled, to more than 16% of the population. The International Diabetes Federation now lists Turkey as the country with the highest diabetes prevalence in the European region. According to data from the World Health Organisation’s (WHO) Global Health Observatory, the age-standardised prevalence of diabetes in Turkey in 2022 was 16.6% of the adult population (aged over 18): 16% of men and 17.1% of women. In comparison, the EU average is about 7–8%. Rates in Turkey are thus almost double the European median.These statistics follow a consistent trend. WHO data shows that diabetes in Turkey has been steadily increasing for the past 20 years. In 2002, the age-standardised prevalence in people over 18 was 9.9%. In 2008 it was 11.4%, rising to 14.1% in 2015, 15.9% in 2020, and 16.6% in 2022.Around one in six people are now affected. The risk is particularly apparent in people over the age of 30. In this group, the prevalence is 22.2% — more than one in five. Rates in the European Union in 2022 were far lower: 2.7% in France, 6.6% in Germany, 7.2% in Italy.

Criticism of health policy

Experts in the field say the responsibility for this negative development lies primarily with politicians. “The biggest problem behind the rise is food policy,” says Kayihan Pala, a parliamentarian with the opposition Republican People’s Party (CHP) who is also a professor of public health. “The health ministry is not living up to its responsibilities.”In Pala’s view, the main reasons for the increase in cases of diabetes are not genetic factors, but lifestyle and diet: lack of exercise, as well as the consumption of large quantities of carbohydrates and various sugars.According to a 2014 OECD report, around 45% of those diagnosed as diabetic knew nothing about their illness. This indicates that millions more remain undiagnosed, or are diagnosed late. A conspicuously high number of people in Turkey are admitted to hospital with what’s called uncontrolled diabetes, when a poor management of the condition leads to various complications. This ratio was 402.6 for every 100,000 inhabitants — eight-and-a-half times the OECD average of 47.3.The latest OECD figures from 2023 show no improvement. While the number of people with diabetes in Turkey remains far higher than average, the reverse is true for the statistics of successful treatment. Kayihan Pala says this demonstrates the failure of the Turkish health system. Early diagnosis and systematic control of the disease are urgently needed, he says, as is the political will to encourage changes in lifestyle.

Survey reveals inadequate treatment

A study done by the Turkish health ministry confirms the OECD’s findings: Many newly diagnosed patients have high levels of blood sugar. How well the disease is kept under control also varies. A patient’s age, gender, and region of living may all make a difference. Women and men in low-income regions are especially disadvantaged. Diabetes is therefore not just a medical, but also a social and economic problem.Pala says the situation will not change without improved medical care and a better provision of medication. “Some patients have difficulty accessing their medications,” he says. “And post-diagnosis communication between patients and doctors is often poor.”

Obesity and ineffective campaigns

Pala believes combating obesity would prove decisive in reducing the prevalence of diabetes, but that Turkey’s strategies for doing this are insufficient. Although obesity is one of the most important risk factors, the measures being implemented by the health ministry are not yet effecting permanent solutions.The ministry has now presented an action plan for the next three years. It aims to encourage healthy eating, regulate canteens in schools and offices, and increase physical activity. Some 7.7 million people were assessed as part of a campaign entitled “Discover your ideal weight, live healthily.” However, the results were not published, nor were regional variations in the prevalence of obesity made known.According to the WHO European Regional Obesity Report 2022, the percentage of people in Turkey who are overweight and obese is the highest in Europe, with 66.8% of the population falling into this category.

Debate around starch-based sugars

Turkey’s food standards are contributing to the problem. Statutory requirements for healthy nutrition are inadequate, and there are no restrictions on the advertising of unhealthy foods.The Turkish food scientist Bulent Sik described the problem in an interview with DW: “The increase in the consumption of cheap, easily available snacks and sugary soft drinks is directly linked to the increase in obesity. As long as the production of these goods is not restricted, many measures are no more than symbolic policies,” he said.Public health expert Kayihan Pala points to starch-based sugars as another contributing factor. “It’s scientifically proven that consuming large quantities of corn syrup, which is high in fructose, increases the prevalence of type 2 diabetes. People who aren’t obese are also more likely to get sick if they consume these sugars,” he warns.The issue of starch-based sugars has been under discussion in Turkey for years. The country’s Sugar Law, passed in 2001, established production quotas of 10%. In 2008 the quota was raised to 15%, and in subsequent years it went up as high as 50%. In 2018 it was lowered again, to 5%. Since then, following a decree from President Recep Tayyip Erdogan, it has dropped to 2.5%.

Children and school meals

Pala is calling for a fundamental policy shift in diabetes prevention in Turkey. “We need science-based, socially far-reaching programs for nutrition, prevention, and the fight against diabetes and obesity. Show projects alone won’t get us anywhere.”The problem must be nipped in the bud, says Pala. Measures to combat diabetes have to focus on children, too. Healthy nutrition in childhood is a decisive factor. Pala is calling for free school meals for all children, describing it as one of the most effective measures in combating obesity and the risk of diabetes. Go to Source