BMI View : The rise in obesity levels in Turkey poses a problem for healthcare spending by the state and presents a potential drag on the country's economic development. As the country's labour force moves away from traditional primary and secondary sectors for employment and into more sedentary tertiary sector roles, the obesity trend will only accelerate. This presents significant challenges for the state but also major opportunities for drugmakers.
The number of overweight and obese people in Turkey is at its highest point since the country began recording healthcare statistics, and rising. Healthcare experts have warned that if levels of obesity continue to rise at current rates, the cost to the public healthcare system will become unsustainable within a decade.
According to the Turkish Statistics Institute (TurkStat), 34.8% of Turkish citizens over the age of 15 are overweight; almost double the figure a decade ago. The primary contributor to this growth has been the rapidly growing Turkish economy. Structurally, the Turkish economy has moved away from a reliance on agriculture and industry towards the services sector, and the dynamics of the labour force have evolved over the last two decades to reflect this. In 2010, almost half the labour force (48.4%) worked in services and some 26.2% in industry. While agriculture still employs a large portion of the labour force compared to developed countries, rising incomes, changing dietary preferences and an increased observance of sedentary lifestyles have all accelerated obesity levels in the country.
Rising obesity levels are closely correlated with increasing incidences of cardiovascular diseases, type I and II diabetes, specific cancers and musculoskeletal disorders and data from TurkStat confirms these links. 13.2% of Turkish citizens over the age of 15 have been diagnosed with hypertension, which increases chances of cardiovascular disease in later life, 12.8% of citizens have been diagnosed with musculoskeletal disorders and 6.8% have been diagnosed with diabetes. The cost of treatment and support for these diseases is a significant burden on the Turkish healthcare system, as these diseases often require frequent hospital visits, expensive and lifelong medications, physiotherapy and surgeries.
The obesity epidemic threatens to present a significant drag on Turkey's economic development and its healthcare system. According to a study by Duke University, obese workers are far more costly than healthy employees in terms of healthcare benefits, lost productivity and absenteeism. When measured from a macroeconomic perspective, the net effect on the Turkish economy is the loss of billions of dollars in output. Similarly, since its inception, the Turkish healthcare system under the Social Security Administration (SGK) has run a structural deficit as demand for healthcare has outstripped revenues raised for social security contributions. In our previous article highlighting the opportunities within the private healthcare market in Turkey,  we noted the very high level of dependents (unemployed, children, pensioners, spouses etc.) who drew from the healthcare system and the smaller contribution base of 17mn employees who fund the system.
|Structural Deficit Set To Widen|
|SGK Healthcare Expenditure and Revenues, TRYbn|
There have been moves by the Turkish government to shift the burden onto the private sector by introducing complementary health insurance and co-payments, but in the long term, raising revenues through taxation, increasing the contribution base as part of broad-based economic growth and providing tax incentives for consumers to take on private health insurance plans are the only viable solution to moderate the SGK's deficits.
These developments present a growing opportunity for drugmakers and medical device makers; sales of statins, stents, pacemakers, insulins and insulin analogs, angiotensin converting enzyme (ACE) inhibitors and a host of other medicines are poised to grow in long-term within Turkey. There will undoubtedly be a much greater opportunity for generic drugmakers but in the medium term, we believe uptake of patented drugs will present an opportunity for multinational drugmakers with more expensive and innovative drugs. And at a time when neighbouring eurozone countries are clamping down on pricing and exercising leverage on large orders, Turkey will undoubtedly provide the growth that companies are looking for.
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