Health improvement in Turkey has in recent decades taken place at around twice the speed that similar transitions were achieved in northern Europe earlier in the 20th century. Most notably, infant mortality has fallen from around 150 per 1,000 live births in 1970 to under 10 per 1,000 deaths in the first year of life today.

Factors underlying such successes range from robust central planning and extended access to publicly funded health services to overall economic growth. Turkey is already far wealthier than, for example, the UK was when it established its National Health Service in the aftermath of World War II. But because of this relative prosperity, the burden imposed by non-communicable diseases (NCDs) is also rising far faster in Turkey than it did in the older industrialised nations at the equivalent stages of their population and health development.

Researchers have found, for instance, that the prevalence of diabetes has doubled in little more than a decade. NCDs already account for almost 80 percent of all deaths in Turkey. Mortality from coronary heart disease and stroke in both men and women is also amongst the highest in Europe. This is related to problems such as obesity and smoking.

The increase in the proportion of older people linked to lowered birth rates and longer life expectancies may on occasions seem more like a threat, rather than an opportunity. Some Asian countries are now facing rapidly rising numbers of older people with disabilities, supported by relatively fewer working age people. Turkey’s population is still relatively young, with only about 7-8 percent of people aged over 65. Even so, some may argue that it would be foolhardy to spend more on older people, as opposed to investing in the future by keeping birth rates as high as possible and further extending services for the young.

Priorities like enhancing education are important. However, the analysis contained in the report titled Transforming Health in Turkey: 21st century opportunities, which was produced by researchers from the University College London and the London School of Economics, indicates that devoting more resources to keeping people as fit and healthy as possible in their 50s, 60s and 70s would be productive from an economic as well as a social perspective.

There are several reasons why this is so. One is that reducing the risk of people dying from cardiovascular events, such as heart attacks in middle life and beyond, also reduces the risks of survivors living on with disabilities. Just as changes like more women entering the labour force allow societies to become more productive, increasing the numbers of healthy older people can also add to both national wealth and community stability.

Improving public health by lifestyle change and better use of medicines

Conventional medical wisdom says that the best ways to generate better public health are stopping smoking, taking more exercise and encouraging populations to avoid obesity. Use of medicines is often believed to be relatively expensive and more appropriate for treating illness than keeping people healthy.

Cigarettes kill one in every two of their long-term users and disable most of the rest. Experience in countries such as Finland (which was once as unhealthy as Russia, where today men on average live 10 years less than in modern Turkey) shows that if people can be persuaded not to use tobacco, to eat less fat and generally live healthily, major gains in healthy life expectancy will follow. But programmes designed to achieve this are often slow to work and unpopular, at least until their benefits become obvious.

That is why more interest today is focused on using low cost generic and when appropriate patented medicines to lower blood pressure and cholesterol levels and prevent heart disease and strokes, rather than treating people after they have suffered. To many doctors and members of the public, this may presently seem unnatural. Yet, promoting a wide use of protective medicines to an age-appropriate population could still be a rapid route to saving more lives and helping individuals and communities to stay productive as they age.

Giving the economic crisis facing European and some other countries, there may be fears that supplying more medicines and allied services will drive up costs unacceptably. But as the era of NCDs progresses and generic treatments become cheaper, the logic of using medicines like anti-hypertensives and diabetes treatments preventively can only grow stronger.

David Taylor is professor of pharmaceutical and public health policy at the University College London. Mehtap Tatar is professor of health economics at Hacettepe University, where she also serves as the Secretary General. This article has been reproduced from the Turkish newspaper, Today’s Zaman, with which TheNation has a content-sharing agreement.