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7.3 Health of young people

As for health outcomes, more data and analysis is needed to identify trends in the state of health of young people, and to compare the health status of young people of different backgrounds.  It would be useful for the Ministry of Health to improve its screening, monitoring and recording processes as and where required, and to ensure a regular supply of objective, comprehensive, disaggregated information to the public about nutrition, communicable and non-communicable diseases, chronic conditions, accidents and injuries, mental well-being, positive health behaviour, risk behaviour and similar matters. Greater public discussion of health issues is also desirable, together with the creation of independent think-tanks in this field.

Causes of death among 15-24 year-olds, 2008 (% of deaths)







Circulatory system disorders



Digestive system disorders



Symptoms & ill-defined conditions



All other diseases






Suicide & self-inflicted injury






Source: Turkstat: Youth in Statistics, 2011, pp.44-5 – based on Turkstat demographic data.

Available information suggests that about 70% of young people are of normal weight. Problems arising from malnutrition appear to persist in poorer parts of the population. Young people in the more affluent parts of the population are likely to enjoy more varied diets, and to engage in positive health behaviour such as deliberate physical exercise and sufficient personal care. In the WHO European Health Behaviour of School Children (HBSC) survey for 2009-10, children aged 15 in Turkey achieved a moderate score for eating fruit and regularly eating breakfast but a low score for tooth brushing. Likewise, the Turkstat 2010 Health Survey shows that 37.6% of 15-24 year-olds brush their teeth less than once a day (Turkstat: Youth in Statistics, 2011, p.34). However, the HBSC Survey also suggests that problems of excessive weight gain or obesity, which are relatively low for the population as a whole, are commonest among these more affluent groups – at least for the time being.

Body mass index of individuals aged 15-24 (%)
















Source: Turkstat: Youth in Statistics, 2011, p.132 – based on 2010 Turkstat Health Survey data.

Young persons’ perceptions of their health and well-being: There is conflicting information as to how young people in Turkey perceive their own health. The 2007 Youth Sexual Health Survey conducted by the Population Association and UNFPA showed that only 65 percent of young people aged 15-24 assessed their health as “very good” or “good in general”. Turkstat’s Health Survey for 2010 gives a much higher figure of 84.9% - 87.1% for men and 82.9% for women (Turkstat: Youth in Statistics, 2011, p.28). At the same time, however, 16.3% of young men and 15.8% of young women responding to this survey said they were “nervous” most or all the time and 14.5% of men and 17.8% of women said they were “tired” most or all the time (Turkstat: Youth in Statistics, 2011, p.29). The 2010 HBSC Survey shows that 65% of girls and 54% of boys aged 15 in Turkey had had multiple health complaints in the last week – well above the averages of 44% and 26% respectively for the mainly European and Western countries included in the survey (http://www.euro.who.int/__data/assets/pdf_file/0003/163857/Social-determinants-of-health-and-well-being-among-young-people.pdf)

In Turkstat’s Life Satisfaction survey for 2011, 87.2% of men aged 15-24 and 88.2% of women in the same age group said that they were satisfied with their health (Turkstat: Youth in Statistics, 2011, p.97). In this survey, 63.0% of young men and 75.6% of young women indicated that they were generally happy ((Turkstat: Youth in Statistics, 2011, p.92). These figures make clear that a perception of health is not sufficient for a perception of happiness among young people, especially men. In the 2010 HBSC survey, only 58% of boys and 63% of girls aged 15 in Turkey reported “high life satisfaction”.  

Addictions and other unhealthy behaviour: Alcohol consumption is much lower in Turkey than in Western countries, but both high personal consumption and drunkenness are familiar in various parts of society. There is limited age-disaggregated statistical data about high alcohol consumption and drunkenness, or about trends and causal factors. The 2007 Youth Sexual and Reproductive Health Survey conducted by the Population Association and UNFPA found that both alcohol consumption in general and “binge” drinking were more common among young people in urban areas and (especially for women) among those from more affluent socioeconomic groups – although there was also some suggestion of heavy consumption among drinkers in the poorest socioeconomic group. According to the reported initial results of the “Turkey’s Youth Profile” survey conducted by the think-tank SETA in conjunction with the Ministry of Youth and Sports in 2012, just 21.7% of respondents said that they took alcohol, with variations by region, gender, age, marital status and level of education.

Alcohol drinking behaviour within last three months among 15-24 year-olds (%)





have drunk alcohol

have binge-drunk

have drunk alcohol

have binge-drunk

Age 15-19





Age 20-24










Lowest household welfare level





Low household welfare level





Middle household welfare level





High household welfare level





Highest household welfare level





Source: Population Association/UNFPA: 2007 Turkey Youth Sexual and Reproductive Health Survey.

Use of tobacco - mostly in the form of cigarettes, but also water pipes - is very common in Turkey, including among young people,  notwithstanding widespread awareness that tobacco poses serious health risks. Turkey ratified the WHO Framework Convention on Tobacco Control in 2004 and legislation has been progressively tightened. Rules governing the content of tobacco products, their packaging, health warnings, sale to children and smoking in public places are now similar to those in Europe. Smoking in enclosed public spaces was banned in 2008-9. There is some evidence that these efforts may be having an impact on smoking among young people. In Turkstat’s 2010 Health Survey (cited in Turkstat: Youth in Statistics 2011, pp.35-8), 27.1% of men and 6.1% of women aged 15-24 reported that they were daily smokers, compared to 42.3% and 14.0% for the adult population. This appears to point to a decrease since 2008, when the Global Adult Tobacco Survey (http://www.who.int/tobacco/surveillance/en_tfi_gats_turkey_2009.pdf), which Turkstat carried out in conjunction with WHO, indicated that 34.9% of males and 9.1% of females in the same age group were daily smokers, compared to 43.8% for all men over 15 and 11.6% for all women over 15. However, further data is needed to confirm the decline in smoking, especially as other surveys - such as the 2007 Turkey Youth Sexual and Reproductive Health Survey conducted by the Population Association and the UNFPA, and the reported initial results of the SETA “Turkey’s Youth Profile” research in 2012 - paint different pictures.

Some of the studies mentioned also examine issues such as the age at which young people start to smoke, their exposure to tobacco smoke and other aspects of tobacco usage (See also the World Tobacco Atlas - http://www.tobaccoatlas.org/uploads/Images/PDFs/Tobacco_Atlas_2ndPrint.pdf). All this evidence suggests that young people smoke less than the adult population as a whole, that among adolescents and young people themselves the prevalence of smoking increases with age, that “passive smoking” is common in the home, and that young men (a) are more likely to smoke, (b) smoke more heavily and regularly, (c) start to smoke at an earlier age and (d) become regular smokers at an earlier age, than young women. Particularly among women, smoking is lower in rural areas and increases with education.

According to the Turkstat 2010 Health Survey, young people who had smoked at least once reported that their first experiments with tobacco came at the age of under 10 for 7.1% of males and 1.4% of females, 10-14 for 29.2% of males and 26.5% of females, and 15-19 for 58.1% of males and 64.3% of females. It follows that children need to be informed about the damage done by smoking from an early age, and that there may be an opportunity to encourage teenagers to give up smoking while they are still intermittent smokers due to financial reasons or family disapproval. However, more knowledge may need to be gathered together about the factors affecting smoking among young people of specific age-groups, gender and social backgrounds in order to determine the most effective ways of preventing and ending addiction.

No national survey has been carried out to estimate the number of persons, especially adolescents and young people, who use or abuse drugs and similar substances. Occasional small-scale studies, press reports, information gleaned from local drug prevention officials or treatment centres and anecdotal evidence all suggest that while substance use, especially in its most problematic forms, is not as widespread as in some neighbouring countries, it is by no means uncommon, at least in certain cities, including Istanbul, Adana and some other southern or southeastern cities. Cities like Ankara and Antalya have districts with a reputation for drug-dealing (and, typically, other forms of crime and prostitution). Cannabis, mainly from Southeast Turkey, appears to be quite widely available – and not least to high school and university students. Among more problematic, entirely-imported drugs, cocaine and amphetamine-type substances may be used more frequently by higher-income groups and tourists. Heroin has been the main source of demand for treatment. However, few young people are known to have contracted HIV/AIDS through intravenous drug use, reflecting the low prevalence of the disease and the minor role of intravenous drug use as a cause of it in Turkey. Aside from “commercial” drugs, the use of addictive substances such as adhesives and solvents is a familiar problem, especially among adolescents living on the streets or working in industry. For this reason, children living on the street are frequently referred to as ‘tinerci’ – a reference to their addiction to paint thinners – and considered dangerous or anti-social.

The ESPAD (Council of Europe/Swedish Council for Information on Alcohol and Other Drugs - The European School Survey Project on Alcohol and Other Drugs) survey conducted in six cities in 2003 by the Ministry of Health and UNODC suggested that 4% of high school students in Turkey had used cannabis, compared to a European average of 21%, while 3% had used other illicit drugs, 4% had used inhalants, and 3% had used tranquillisers and sedatives without a doctor’s prescription. Despite the intentions of the Ministry of Health, the ESPAD survey, which is conducted at four-yearly intervals, could not be repeated in Turkey in 2007 or in 2011. Without such frequent and timely monitoring of drug use - and further analysis of trends and causal factors for different types of drug-taking among young people in different cities and of different ages, gender and social groups - it is difficult to design well-targeted strategies to counter the phenomenon, or to advocate for the necessary resources and capacity building for prevention and treatment. In 2011, the Turkish Monitoring Centre for Drugs and Drug Addiction (TÜBIM) conducted surveys among the general and youth populations, apparently overcoming the objections of the Ministry of National Education by using “open questions” (A pilot study of the general population in Ankara province showed 0.8% cannabis use within the last 30 days). The results of these surveys are awaited.

TÜBIM (www.tubim.gov.tr), a branch of the Smuggling and Organised Crimes (KOM) department of the General Directorate of Security, is the body which coordinates government efforts to combat drug use in Turkey and is also the national focal point for the EU’s European Monitoring Centre for Drugs and Drug Addictions (EMCDDA). Its annual report is the main source of information on drug use in Turkey. TÜBIM drew up Turkey’s first national policy and strategy document on combating drugs and addiction in 2006, and this has been followed by two national action plans, the current one covering the years 2006-12. With a view to prevention, awareness raising is carried out among young people and information is provided to professionals by TÜBİM and the provincial coordinating committees through which it works, the Ministry of National Education, the Ministry of Health, other government ministries and departments and municipalities. In addition, some non-government organisations, notably the Yeniden Education and Health Association, conduct research, awareness-raising and guidance activities. However, these activities do not reach the whole population, and there has been no assessment of the impact of these studies or of the overall level of knowledge and awareness of adolescents and young people concerning drug-related issues.

In-patient and out-patient treatment services for addicts of drugs (or alcohol) are available in the health sector and at universities. Adolescents, parents or young people may apply of their own accord or may be directed there through the juvenile justice system or by social services. There are 22 centres in 13 provinces with inpatient facilities. A few specialise in children and adolescents or have separate departments dedicated to them. Costs are covered in the same way as the costs of other kinds of health care. Lack of capacity or distance to the centres may, however, hinder access to treatment, and the provision of post-treatment rehabilitation services is extremely limited.

A parliamentary committee formed to investigate problems regarding substance-addiction, especially drug addiction, and to make recommendations reported back in 2008. Its report, entitled “Madde Kullanımı ve Bağımlılığı ile Kaçakçılığının Önlenmesi alanlarında tespit edilen Sorunlar ve Çözüm Önerileri” [Problems determined in the area of substance use and dependence, in the prevention of drug trafficking and recommendations offered], contains many pieces of information as well as numerous recommendations for increasing and improving services, including the upgrading of TÜBİM to the level of a general directorate. The report also notes that substance addiction is perceived by society as a moral problem, leading to a stigmatising approach rather than a caring one. It points to disincentives for doctors and psychiatrists to work in this area.

Aside from the use of tobacco, alcohol and drugs, adolescents and young people are known to engage willingly in other risk-taking or self-damaging behaviour including self-mutilation, fighting, games with firearms, traffic or chemicals, driving at speed or deliberate avoidance of safety precautions in various contexts. Self-mutilation may be common among adolescents who have been abused or neglected or worked from an early age, lived on the streets and/or come into contact with the law (A rare article on the subject is:. Ögel K., Aksoy A.: Kendine Zarar Verme Davranışı Raporu. Yeniden Yayın no:18 [Self-Damaging Behaviour Report Yeniden Publications No. 18], İstanbul 2006.

Reproductive health and sex education: Officials and parents in Turkey tend to take the view that any discussion of sexual intercourse with or among young people is not only embarrassing but also likely to encourage sexual activity at an early age and/or before marriage, which for cultural reasons they consider undesirable, especially for girls. In the WHO’s Health Behaviour of School Children (HBSC) surveys, for example, the module which includes questions about sexual activity has not been implemented in Turkey. This attitude appears to have led to an unwillingness on the part of the state to provide adolescents with adequate access to sexual and reproductive information, as foreseen in General Comment No. 4 of the UN Committee on the Rights of the Child, so as to ensure their healthy social and physical development. Likewise, parents are rarely cited as sources for knowledge on sexually transmitted diseases suggesting that sexuality cannot be discussed freely in the family context. As a result, the most frequent sources of information about sexual health and sexually transmitted diseases, especially for young men, are the media and friends. These may be sources of incorrect information. In the 2007 Youth Sexual Health Survey conducted by the Population Association and the UNFPA, 39% of people aged 15-24 reported that they do not know where babies grow. 40% of young women gave the answer “I don’t know” when asked about male reproductive organs. Only 42% of respondents were aware of the existence of a specific period for a woman to become pregnant, and among those only 27.4% had the correct knowledge. The proportion of 15-24 year-olds with correct knowledge about HIV/AIDS was 11.2% among males and 9.6% among females. This lack of knowledge may also lead to discriminatory behaviour towards people with HIV/AIDS. Aside from a general increase in the level of education, there is little reason to believe that the level of knowledge of young people in this area has improved since 2007.

Information sources of young people (15-24) about sexually transmitted diseases


Almost all young people favour the provision of reproductive and sexual health services. When asked about their preferred source of information, respondents to the 2007 Survey cited doctors (49.3%) and counsellors (11.7%). Although the school is the preferred place for services to be offered, teachers were cited by only 6% of young people as their preferred source of information. This situation points to a need for cooperation between educational institutions and health institutions for information and counseling services. Information needs to be included in the formal education curriculum in line with the needs of children of different age groups, beginning at a sufficiently early age. Sex education should not be limited to schools: campaigns and parental education services are also needed to increase the transmission of correct information on reproductive and sexual behavior from parents to their children. For adolescents out of school, youth centres, non-governmental organizations and peer education may be appropriate channels.

In its Concluding Observations on Turkey issued in June 2012, the UN Committee on the Rights of the Child reiterated its concern about “the lack of comprehensive adolescent and reproductive health policy in the State party and insufficient knowledge of reproductive health, sexually-transmitted diseases, including HIV/AIDs, and frequent involvement in sexually risky behaviours among young people”. It recommended “that the State party adopt a comprehensive adolescent and reproductive health policy and take necessary measures to educate children on reproductive health and the measures to prevent STDs and HIV/AIDS.”

UNICEF Turkey Country Office, Yukarı Dikmen Mah. Alexsander Dubçek Cd. 7/106, 06450 Çankaya/Ankara. Telephone: +90 312 454 1000 Fax: +90 312 496 1461 E-mail: ankara@unicef.org