Subjects & Issues

Non-communicable diseases, especially cardiovascular diseases, cancer, chronic respiratory diseases and diabetes are among the leading causes of death in the world. While non-communicable diseases lead to more than 36 million deaths each year, 14 million of these deaths are between 30 and 70 years and called as premature death. %86 of these untimely deaths are seen in low and middle-income countries. And this situation will lead to a cumulative economic loss of $7 million over the next 15 years, and to millions of people remaining in the poverty line.

Most of these premature deaths from non-communicable diseases can be prevented to a large extent by making health system’s responses more effective and equitable to healthcare requirements for these diseases and influencing public policy concerning non-health sectors working on common risk factors such as tobacco use, unhealthy diet, physical inactivity and harmful alcohol use. 

The Moscow Declaration on Non-Communicable Diseases approved by the ministries of health of member states of the World Health Organization in May 2011 and United Nations Non-Communicable Diseases Political Declaration approved by the presidents and head governments in September 2011; commitments have been made about extensive knowledge and experience savings concerning preventing non-communicable diseases, developing and strengthening multi-sectorial national politics and plans concerning preventing and controlling these diseases and developing national objectives and indicators appropriate for national provision.

In order to realize these commitments, World Health Assembly has approved 2013-2020 Global Action Plan concerning preventing and controlling Non-Communicable Diseases in May 2013. With this Global Action Plan; if implemented as a whole between years 2013 and 2020; a route map and policy options menu has been presented to member states, international partners and WHO that will contribute making progress oriented 9 global N-CD targets to be reached by the year 2025, including reducing relatively 25% of untimely deaths due to non-communicable diseases till 2025.

WHO’s N-CD Global Monitoring Framework will be monitoring Global Action Plan applications by monitoring and reporting the 9 global N-CD target achievement till 2015; and the basic situation in 2010 will be taken for comparison. Within this framework; considering The Global Action Plan, governments are encouraged to;

  1. Determine national N-CD targets of year 2025 depending upon national conditions
  2. Reduce exposure to risk factors in order to achieve the target until 2025 and developing multi-sectoral national plans to make health systems responsive
  3. Measure results according to Global Action Plan

WHO and other United Nations organizations will be subsidizing advanced technical support like helping to set national targets concerning taking simple steps that can make huge differences such as political advices, increasing the taxes on tobacco products, reducing salt rates in food, improvement of access to expensive medicines to prevent heart attacks and stroke.

In this platform which United Nations prepared to support national work on struggling non-communicable diseases, it is necessary to raise awareness that non-communicable diseases are one of the most important difficulties of 21th century and to raise awareness of the existence of new opportunities to make progress at global level in the post-2015 development agenda. 

With a consciousness of the role of civil society in the context of achieving national and global goals of non-communicable diseases, our association also improves and carries out projects aimed at reducing risk factors and increasing awareness of non-communicable diseases and risk factors; as a part of this this development.

WHO defines physical activity as any bodily movement requiring energy, produced by skeletal muscles (while working, playing, doing housework and free time movements). The description of physical activity should not be confused with the planned, structured, repetitive ‘exercise’ which is subcategory of physical activity, and intended to improve or protect one or more components of the physical health. Physical activity in both moderate and severe intensity brings health benefits.

Significant global data about physical activity are as below;

  • Inadequate physical activity is one of the 10 outstanding causes of death in the world.
  • Inadequate physical activity is a key risk factor for non-communicable diseases such as cardiovascular diseases, cancer and diabetes.
  • Physical activity has significant benefits on health and contributes preventing N-CD.
  • On the global level, one of the four adults is inactive.
  • The physical activity of 80% of the world’s adolescent population is inadequate.
  • 56% of WHO member states follow a policy on inadequate physical activity.
  • WHO member states have agreed to reduce inadequate physical activity by 10% till 2025.

In 2013, WHO member states agreed on reducing inadequate physical activity by 10% target and ‘Prevention and Control of Non-Communicable Diseases Global Action Plan 2013-2025’.

Policies aimed to increasing physical activity:

  • In cooperation with relevant sectors, physical activity should be supported as a daily life activity,
  • Walking, biking and all other forms of active transportation should be accessible and safe,
  • Labor and workplace policies should encourage physical activity,
  • Schools should have safe areas and facilities where students can actively spend their free time,
  • High quality physical education supports children to form active behavior patterns throughout life,
  • Sports and recreation facilities provide a sporting opportunity for everyone.
Even the policies and plans dealing with physical inactivity have been developed in approximately 80% of WHO member states; they have been operationalized in 56% of these states. National and local authorities are adopting a range of policies in the sectors that will facilitate and encourage physical activity. 

‘Global Diet, Physical Activity and Health Strategy’ adopted by World Health Assemblies in 2014, defines the necessary actions for increasing the physical activity worldwide. The strategy calls for stakeholders to act at global, regional and local levels to increase physical activity.

‘Global Physical Activity Proposals for Health’ published by WHO in 2010, focus on the prevention of non-communicable diseases by physical activity.

In order to achieve globally recommended levels of physical activity, different policy options are proposed, for example;

  • Developing and implementing national guidance for increasing the health promoting physical activity 
  • Integration of physical activity into other policy sectors in order to ensure that policies and action plans are consistent and complementary
  • The use of mass media to increase awareness of the benefits of being physically active
  • Monitoring and supervising actions that promote physical activity

WHO has developed a Global Physical Activity Questionnaire to measure physical activity in adults. This questionnaire helps countries to monitor inadequate physical activity which is one of the basic risk factor of non-communicable diseases.  Global Physical Activity Questionnairehas been integrated to the basic risk factors monitoring system WHO Stepwise approach. 

One modul has been integrated to Global School-Based Student Health Survey (GSHS) to evaluate the inadequate physical activity of students. This research has been developed as a WHO/US CDC monitoring project to help evaluate and measure behavioral risk and prevention factors in 10 key areas of adolescents aged 13-17 years.

In 2013, World Health Assemblies have agreed upon global voluntary objective series including reducing premature death arose from non-communicable diseases by 25% and inadequate physical activity by 10% till 2025.

‘Prevention and Control of Non-Communicable Diseases Global Action Plan 2013-2020’, leads the member states, WHO and United Nations Agencies about how they can achieve these targets effectively. A sector-specific toolkit is in development process by WHO in order to help member states implement actions and achieve targets. WHO has established different partnerships in order to support efforts of member states to promote physical activity (UNESCO, UNOSPD, IOC).

Therefore, our organization has started Promoting Active Life Project in line with global and national strategies; in order to increase awareness of physical activity and reducing inadequate physical activity across the community and is carrying out the project successfully. 

Sufficient vegetable and fruit consumption reduces the risk of cardiovascular diseases, stomach cancer and colorectal cancer. Most people consume more salt than recommended by WHO for disease prevention; excessive salt consumption is an important determinant of high blood pressure and cardiovascular risk. Excessive consumption of saturated fats and trans fatty acids is associated with heart disease. Unhealthy nutrition rises rapidly in scarce source environments. The available data shows that oil consumption has increased rapidly in low and middle income countries since 1980.

At least 2,8 million people die every year due to overweight and obesity. The risk of heart disease, stroke and diabetes is increasing due to increased body mass index (BMI). 50% of women in European Region, American Continent and The Eastern Mediterranean Region are overweight. The highest overweight prevalence among infants and children is in the high-middle income group. The heavy increase in overweight can be seen in low-middle income group.

The overweight and obesity prevalence is increasing all over the world and the prevalence of obesity has increased higher than two-fold since 1980. In 2008, over 20 years old and over 1.4 billion adults are overweight or obese, of which 200 million are males and 300 million are females. In 2010, 40 million of children below 5 years old are overweight.

Many international organizations, especially WHO develop and pioneer several programs in order to change dietary habits and form adequate and balanced dietary habits to fight obesity. And by many countries in the world, these efforts are being transmitted to individuals with different strategies and action plans. ‘Global Nutrition, Physical Activity and Health Strategy’ development by WHO, Second European Nutrition Action Plan including especially children and adolescence obesity, ‘White Paper’ preparation by European Commission including strategy about dietary, overweight and obesity related diseases in Europe, composing ‘Nutrition, Physical Activity and Health Platform’ by European Union can be given as examples.

Also in our country, fight against obesity has been included in various publications on national health policy. ‘To inform and raise awareness of healthy nutrition, obesity and physical activity  in the community, to create programs with supportive environments to gain healthy nutrition and regular physical activity habits’ are some of the targets in the Ministry of Health’s 2013-2017 Strategic Plan.

To accelerate activities to prevent obesity, to reach the specified goals, to determine new goals and strategies in line with needs and to ensure that activities are carried out in a specific framework, ‘Turkiye Struggle with Obesity and Control Program (2010-2014)’ has been prepared and first edition has been published in 2010. The program has changed the name to ‘Turkiye Healthy Nutrition and Active Life Program’ in September 29th 2010 because it includes measures to provide adequate and balanced nutrition in the fight against obesity as well as the subjects about encouragement of regular physical activity in the community. Besides, within the scope of ‘Turkiye Healthy Nutrition and Active Life Program’, Reduction of Turkiye Excessive Salt Consumption Program (2011-2015) has been prepared and implemented. Labeling, collaboration with the food sector and public awareness campaigns are in progress. The labeling regulation has entered into force on December 29th 2012 for the labeling adjustment and public campaigns and educations have been arranged for voluntary Guideline Daily Amounts (GDAs). GDA information can be involved in food labels optionally. 

The other program performed is Turkiye Diabetes Prevention and Control Program (2011-2014). Also under this program, obesity is being tackled and public awareness training studies, appropriate treatment and rehabilitation studies and monitoring and evaluation studies are carried out. 

Our association is developing and performing projects about eliminating information pollution in food, nutrition and increasing awareness in parallel with global and national policies in Turkiye. In this respect, the first project we have initiated is Enhancing Nutrition Standards Project in order to prepare viral, impressive and no-didactic awareness videos for the correct consumption of fiber foods and to transmit these videos effectively to the target audience.

Tobacco use is an important and preventable public health problem. The tobacco use which is the most important cause of death and illness in the world has been accepted as a global struggle arena by WHO. 6 million people die annually due to tobacco-related diseases worldwide. In our country, the number is 100 thousand people per year and 23% of all deaths are due to tobacco-related diseases. 1.2 billion people in the world over 15 years of age are using tobacco (one out of every three adults) and in our country, 16 million people over 15 years of age are using tobacco. Global tobacco-related data can be listed as;

Currently, 50% of men and 10% of women are using tobacco in the world. The quitting rate of smoking is very low and it is estimated that about 5 million deaths due to tobacco use will increase by around 10 million in 20-30 years. 

  • It is estimated that around 1 billion people will die depending on the use of tobacco during the century we are living if tobacco use continues this way. Most of the deaths will be in developing countries and half of them will be less than 70 years of age.
  • At the 2013 annual meeting of the World Health Assembly, countries reducing tobacco consumption by one-third till 2025 has been proposed. In this way, around 200 million deaths worldwide will be possibly prevented.
  • The most important determining factor in starting and stopping smoking is the price. A double increase in inflation for the price of cigarettes reduces cigarette use by a third.   In low-income countries, the price increase should be three times the inflation rate.
  • While other MPOWER strategies are important in reducing cigarette use, it is not possible to reduce cigarette use by one-third without price increase. 
  • Efforts to reduce tobacco use are also the most effective application in reducing deaths from non-communicable diseases. 

There are three basic data on cigarette smoking and especially on smokers;

  • The risk is big: The odds of smokers of middle-aged people dying for any reason are 2-3 times higher than those of non-smokers. The smokers die 10 years earlier than non-smokers.
  • Most tobacco-related deaths are middle-aged deaths, so many years of life are lost: The smoker and middle-aged people die 20 years earlier than non-smokers. 
  • Quitting smoking is beneficial: If smokers quit smoking 30-40 or50 years of age, there is an increase in life span by 10 years, 9 years and 6 years in return.

The first legal regulation in the fight against tobacco in our country was made in 1996. The Tobacco Control Framework Convention also accepted by WHO, was accepted and entered into force in Turkish Grand National Assembly in 2004. In 2006, the program - which was prepared for the planning of all activities to be carried out and the control of tobacco consumption - under the Tobacco Control Framework Convention, was published in the annex of the Prime Ministry Circular. And in 2007, Provincial Tobacco Control Boards were established in 81 provinces to implement and follow-up the National Tobacco Control Program as a whole and carry out the related activities in the provinces.

In 2007, the National Tobacco Control Program Action Plan was introduced to the public with the participation of the Prime Minister. In 2008, law no. 5727 ‘Law on the amendment of the law regarding the prevention of Tobacco Products Damage’ amending the law no. 4207 was adopted and entered into force. In order to create a smokeless Turkiye and to protect passive smokers, cigarette consumption were banned in all indoor areas (except restaurants, bars and cafes) and ‘Smokeless Airfield’ campaign was launched.

In 19th July 2009, with the inclusion of all indoor areas (restaurants, bars and cafes) all indoor areas in Turkiye were rendered smoke-free.

As a result of all the services provided as a part of fight against tobacco; while the smoking rate of population over 15 years was %33,4 in 2006, it decreased to %27,1 in 2012. Approximately 2 million 200 thousand people quit smoking compared to 2008, the passive exposure rate in closed areas decreased by 60%, and the number of smokers in the households decreased by 35% even though there was no prohibition. According to the criteria determined by The World Health Organization in the fight against tobacco, our country is one of the first four successful countries in the world.

Our association has not yet developed a project for this important risk factor of non-communicable diseases. In the following periods, it is planned to carry out project studies on tobacco and alcohol consumption which will be developed in the same direction with global and national policies as it is in other risk factors.

Alcohol use disorder is known to be as old as human history. Throughout history, starting from Hippocrates many physicians talked about the harm of alcoholic beverages to human health. However, taking the addiction because of alcohol use as a disease dates 150 years ago. 

The importance of alcohol use disorders from the point of mortality and morbidity increases day by day. Alcohol use is prevalent in many west countries. In a study in USA in 1977, it had been detected that the 86,6% of men and 77,5% of women consumed alcoholic beverages.

  • Most of the young people start alcohol with anxiety during adolescence. The age of first use of alcohol has decreased up to 12-14 years of age. 
  • Alcohol-related problems begin to rise between the ages of 18-25.  Appealing for treatment is usually about 40 years of age and deaths arise from heart disease, accidents, suicide and cancer at 55-60 years of age.
  • It is reported that alcohol dependence in the USA is 10%.
  • Alcohol dependence is thought to be a male disease (1/5-6 ratio) but this distinction is now gone (1/2 ratio).
  • In our country, small-scale epidemiologic studies in large cities show that alcohol age is reduced to 12 years. The age of starting alcohol is the most between 15-22 years and males start drinking alcohol at an earlier age. The data obtained for alcohol dependence gives 0,8-1,6-2% figures.
  • We still can say that male consume alcohol more.
  • The prevalence of suicide, homicide, traffic accidents, assault, rape, drowning and child abuse is high in people with alcohol use problems. 

Patient empowerment is a relatively new emerging concept in health terminology all over the world. The patient empowerment programs, which are conducted through patient associations around the world, aim to remove patients and their relatives from health care services as passive beneficiaries. In throughout these programs, patients and their relatives are actively prioritized to raise awareness of their health and their quality of life, which is a natural extension of it, and of the diseases they are fighting. In a further step of these programs, patients and their relatives are supported to:

  1. Follow health care and medical developments,
  2. Actively demand research and developments for their diseases,
  3. Be involved as active stakeholders in health policies development at national level,
  4. Be a premise, an instructor, a leader and a power union for their peers in their own disease.

In Turkiye, such patient-centered approach has not yet developed. In Turkiye, patients are acting only as the beneficiaries of health services. Like patient associations, the awareness and anticipation of the benefits that can be born from unity are not yet available. 

For this reason, it was decided to start the ‘Diabetes Patients and Their Relatives Empowerment Program’ between Turkiye Public Health Institutions and Promoting Healthy Life and Health Policies Association on April 5, 2016, under the Tackling Chronic Diseases Cooperation Protocol. This program aims to imbue sense of responsibility for diabetes-fighting patients and their relatives and to raise awareness of their primary responsibility in this war. This project will also play a processor role in laying the foundation for patient empowerment in Turkiye and creating the patient associations. 

1 - Dünya Sağlık Örgütü, Sağlığın Teşviki ve Geliştirilmesine Yönelik Dönüm Noktaları: Global Konferanslardan Bildiriler, Geneva, 2009.

http://apps.who.int/iris/bitstream/10665/70578/2/9789755903620_tur.pdf (access date: May 4, 2011)

2 - World Health Organization, Global Status Report on Noncoummunicable Diseases, Geneva, 2014. http://www.who.int/nmh/publications/ncd-status-report-2014/en/ (Erişim Tarihi: 23 Ekim 2014)

3 - World Health Organization, Global Action Plan concerning preventing and controlling Non-Communicable Diseases 2013-2020, Geneva, 2013 http://www.thsk.gov.tr/dosya/birimler/kronik_hastaliklar/dokumanlar/2015-kuresel_eylem_plani/kuresel_eylem_plani.pdf (Access date: 7 2015)

4 - Turkiye Ministry of Health Public Health Agency of Obesity, Diabetes and Metabolic Diseases Department, Turkiye Public Health Agency, WHO 2015 – Physical Activity  http://fizikselaktivite.gov.tr/tr/fiziksel-aktivite-dunya-saglik-orgutu-2015/ (Access Date :13 January 2016)

5 - Turkiye Ministry of Health Public Health Agency of Obesity, Diabetes and Metabolic Diseases Department, Turkiye Public Health Agency, Turkiye Health Nutrition and Active Life Program (2013-2017), Publication number: 773, Ankara, 2013  (Access Date: 8 March  2013)

6 - Turkiye Ministry of Health, Tobacco Control in Turkiye, http://www.saglik.gov.tr/TR/belge/1-15787/turkiyede-tutun-kontrolu-calismalari.html (Access Date 30.September 2015)7 - Tobacco Use, Quiting Smoking and Global Effects of Tobacco Tax (Access Date 16 March 2014)

8 - World Health Organization, (2015), Alcohol, http://www.who.int/mediacentre/factsheets/fs349/en/ (Erişim Tarihi:2 Şubat 2015)

9 - World Health Organization, Global Strategy to Reduce Harmful Use of Alcohol, Geneva, 2010. http://www.who.int/substance_abuse/activities/gsrhua/en/ (Erişim Tarihi:2 Şubat2015)

10 - World Health Organization, Global Status Report on Alcohol and Health 2014, Geneva, 2014, p.157. http://www.who.int/substance_abuse/publications/global_alcohol_report/msb_gsr_2014_2.pdf?ua=1 (Erişim Tarihi:2 Şubat2015)