Prevention And Control Program For Cardiovascular Diseases

Objectives

The plan aims to reduce the substantial and growing burden of cardiovascular and other chronic diseases in Türkiye through prevention, health promotion and equitable, sustainable health services. It prioritises cardiovascular disease prevention by addressing shared, modifiable risk factors, particularly tobacco use and passive smoking, unhealthy nutrition, obesity, excessive salt intake, physical inactivity, raised blood pressure and cholesterol, and diabetes.[1][2][3][4][5]The strategy combines population-wide action with individual support, seeks lasting behavioural change, and recognises that economic, social, environmental, political and gender-related conditions shape health risks.[2][3][6][7]

• Reduce tobacco consumption and exposure to tobacco smoke, including through smoke-free public and workplace environments, prevention of youth access, advertising controls, public education and cessation support.[8][9][10][11][12]
• Promote healthy nutrition by increasing fruit and vegetable consumption, reducing salt, sugar, fat and unhealthy food marketing, supporting breastfeeding, improving food labelling and healthier food environments, and developing obesity prevention measures.[9][13][14][15][16]
• Increase regular physical activity and reduce sedentary behaviour through accessible playgrounds, sports facilities, cycle paths, walking routes, school activity, workplace opportunities and age-appropriate exercise.[17][18][19][20]
• Improve cardiovascular prevention and care across the life course through early risk identification, primary prevention, secondary and tertiary prevention, case-management standards, timely emergency intervention, rehabilitation and lifestyle counselling.[21][22][7][23]
• Reduce health inequalities by prioritising children, adolescents, disadvantaged communities and lower socioeconomic groups, and by making healthy choices accessible and affordable.[4][6][23]

Implementation

Implementation is designed as a multisectoral, preventive and community-based programme led by the Ministry of Health. The Undersecretary is responsible for execution on behalf of the Minister, while the Directorate General of Primary Health Care Services is responsible for implementation; health promotion and non-communicable disease functions are located within the primary health-care directorate.[17][3]Annex A provides the action plan.[17]Delivery combines legislation, regulation, fiscal measures, primary-care counselling, education, environmental change, service strengthening, research and public communication rather than relying on information alone.[14][7]

• Coordinate action across health, education, agriculture, finance, labour, interior, transport, urban planning, youth and sport, defence, religious affairs, municipalities, universities, professional bodies, civil society, media, employers, food producers and international partners.[14][16][18][24]
• Implement tobacco control through the 2008-2012 National Tobacco Control Programme Action Plan, using demand reduction, supply reduction, monitoring, education, cessation services, price and taxation measures, smoke-free regulation and enforcement.[9]
• Strengthen cessation support through quit lines, evidence-based nicotine-dependence treatment, clinical brief interventions, school and workplace support, mass campaigns, professional training and coordination with cardiovascular programmes.[25][26][27][28]
• Deliver nutrition action through dietary guidance, school curricula, healthy catering standards, food-labelling measures, counselling in health facilities, community dietitian services, food-consumption research, breastfeeding promotion and fiscal measures affecting unhealthy and basic foods.[29][14][30][15][16]
• Improve physical-activity opportunities through local infrastructure, safe pedestrian routes, cycle paths, public access to sports facilities, school clubs, summer camps, workplace activity and public communication.[18][19][20]
• Develop emergency and specialist capacity through command and control centres, equipped ambulances, ambulance stations, telemedicine and tele-training; ambulance services are free for people without social security.[22]
• Use monitoring arrangements that include annual reports, semi-annual reporting by executive units for relevant activities, research, surveys, audits, implementation records and defined performance measures.[31][32][18]
• Track tobacco-control performance through smoking and cessation rates, passive-smoking exposure, complaints, fines, enforcement actions, campaign activity, programme reach and research findings.[10][33][34][11]
• Track nutrition and physical-activity performance through food-consumption data, salt intake, body mass index, waist circumference, breastfeeding, compliant food outlets, activity infrastructure, exercise participation and sedentary-behaviour studies.[13][14][16][19]

Monitoring & Evaluation

The plan combines baseline epidemiological evidence with activity-level monitoring across tobacco control, nutrition, physical activity and cardiovascular prevention. It uses mortality, disability-adjusted life years, risk-factor prevalence and disease-burden evidence from national studies, household surveys and World Health Organization estimates, but does not present one consolidated plan-wide indicator framework or surveillance governance model.[4][35][36][37][38][39]

• Monitor tobacco control through smoking prevalence, tobacco consumption, passive-smoking exposure, attributable deaths, years of life lost and disability-adjusted life years, alongside programme-level monitoring, evaluation and reporting.[8][9]
• Measure passive-smoking implementation through training activities and materials, complaints, procedures, circulars, fines, research results, attitude assessments and changes from baseline; require executive units to report semi-annually for relevant activities.[31][40][33][41]
• Track smoking cessation through population surveys, a planned tobacco-use study, five-yearly research, quit-line utilisation, medicine licensing and insurance decisions, campaign participation, non-smoking workplaces and schools, and monitoring-committee reports.[34][42][26][27][28]
• Enforce youth tobacco protections through inspections, audits, fines, age-checking violations, regulated points of sale, media messages, audit reports and corrective action on deficiencies.[11][43][44]
• Monitor nutrition through food-consumption studies, body mass index, waist measures, salt intake, dietary behaviours, food sales, catering audits, school-canteen compliance, training activity and national surveys at five- or ten-year intervals where specified.[38][39][14][30][15][45][46]
• Report breastfeeding, counselling, media, school and community nutrition activities annually, using counts of exclusively breastfed infants, activities, participating institutions, counselling recipients, restricted products, sermons and military lectures.[16][47][48]
• Track physical-activity delivery through annual reports on recreational infrastructure, cycle paths, walking routes, school lessons, camps, workplace facilities, awareness activities, television programmes, body mass index monitoring and cross-sector meetings.[18][19][20]
• Assess inter-sectoral cooperation and access to physical activity through annual reporting, and develop surveillance methods for major cardiovascular risk factors and prevention activities.[21][22]
• Apply regulatory accountability through broadcast inspections and regular submission of programme copies, tobacco-industry information requests, written warnings, administrative fines and other legal sanctions.[49][50]
• Review national cardiovascular policies and risk-factor prevalence regularly under the European Heart Health Charter, supported by meetings with the European Commission and the World Health Organization; detailed reporting timetables and formal accountability procedures are not specified.[51]

Costing & Financing

Financing is recognised as necessary for health-service delivery and for secondary and tertiary cardiovascular prevention, including workforce, technology, medicines and emergency services. However, the available material provides no costed national implementation plan, programme budget, funding allocation, financing gap or resource-mobilisation framework for Türkiye.[1][52][22]

• Use price and taxation among tobacco-demand reduction measures, although no tax rate, revenue estimate or allocation is specified.[9]
• Apply fiscal measures that propose additional taxation of foods with adverse health effects and reduced value added tax on basic foods required for healthy nutrition; no monetary values or implementation costs are specified.[53][29][14]
• Allocate budgetary resources through the Ministry of Health and Ministry of National Education for tobacco-harm broadcasts, school curricula, tobacco-prevention programmes and treatment for tobacco addiction, without specifying budget size, source, timing or allocation formula.[50]
• Increase investment in cardiovascular and chronic-disease prevention, effective medicines, medical devices and specialised procedures; ambulance services are to be free for people without social security, but associated funding arrangements are not specified.[22]
• Recognise economic consequences of chronic disease, including costly and prolonged cardiovascular treatment, reduced labour resources and productivity losses; prevention is presented as reducing treatment costs and work loss.[2][4]
• Note that adult overweight and obesity in the World Health Organization European Region are associated with up to 6% of health-care expenditure, while indirect losses from premature death, productivity and income are at least twice direct health-care expenditure.[54]
• Record European Union-wide cardiovascular disease costs of EUR 169 billion annually, or EUR 372 per person annually; production losses exceed EUR 35 billion, including EUR 24.4 billion from deaths and EUR 10.8 billion from illness among working-age people. These figures are contextual evidence rather than a Türkiye budget.[5]
• Call for adequate trained personnel, reasonable insurance reimbursement and research funding under the European Heart Health Charter, while leaving funding sources, resource mobilisation and expenditure amounts unspecified.[51]