ISTANBUL METROPOLITAN MUNICIPALITY PUBLIC HEALTH SERVICES

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ISTANBUL METROPOLITAN MUNICIPALITYPUBLIC HEALTH
SERVICES

• Saime Batirel, MD, PhD
• Director,
• Directorate of Health and Sanitation, Istanbul
  Metropolitan Municipality
• On behalf of Department of Health and Social
  Services.

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THE WORLD HEALTH ORGANIZATION DEFINITION OF HEALTH

• Health is a state of complete physical,
  mental and social well-being and not merely the
  absence of disease or infirmity.

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THE ROLE OF THE COMMUNITY HEALTH IN THE PUBLIC
HEALTH

• Public health services aim to alleviate the
  burden of diseases on the individual and the
  state, thus improve the quality of life and
  prolong life.

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ORGANIZATION OF PREVENTIVE PUBLIC HEALTH

• Preventive public health policies should be
  formed and instituted by the central government.
  However, local institutions should also
  contribute to preventive public health services.

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SERVICES IN METROPOLITAN AREAS

• Major metropolitan areas such as New York,
  London, Berlin have similar services on
  mother-child health, family planning,
  environmental, occupational, and school health,
  home care, elderly health and etc.

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PUBLIC HEALTH SERVICES IN METROPOLITAN AREAS

• New York
• Mammography, School Health, Immunizations,
  Infectious Disease Control, Anti-Drug Campaigns.
• London
• Combating Infectious Diseases, Environmental
  Health, Mental Health, Veterinary Services,
  Children and Family Care, Anti-Drug Campaigns.

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HOW DID WE DECIDE WHAT ISTANBUL NEEDS?

• Istanbul is the largest city in Turkey.
• Population continues to increase due to
  migration.
• Major industry and trade center, with many
  educational institutions and organizations
• Increased population density.
• So which public health services should we provide?

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AIMS of ISTANBUL METROPOLITAN MUNICIPALITY

• Istanbul Metropolitan Municipality will
  provide public health services to make Istanbul
  a world city that has a high quality of life and
  the unique example of Turkey in the world.

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THE COMMUNITY HEALTH PERSPECTIVE OF ISTANBUL
METROPOLITAN MUNICAPILITY

• Istanbul Metropolitan Municipality, with its
  public health services aims,           to
  provide protective, preventive health and social
  services as well as rehabilitation services in
  order to improve quality of life in Istanbul.
• to achieve this through identification of risk
  groups, effective and scientific collaboration
  with professionals and high quality standards.

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THE COMMUNITY HEALTH PERSPECTIVE OF ISTANBUL
METROPOLITAN MUNICAPILITY

• We aim to provide services for all, but
  especially taking into consideration, the general
  health issues in the country, the people without
  any social security insurance and the individuals
  with hardship (disabled or very poor) to reach
  preventive services.

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PUBLIC HEALTH SERVICES OF ISTANBUL METROPOLITAN
MUNICAPILITY
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WOMEN AND FAMILY HEALTH SERVICES
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WOMEN AND FAMILY HEALTH SERVICES

• Is a preventive service.
• Aim to inform, to increase awareness and to
  diagnose early the common diseases with important
  health impact.
• Is being implemented since 2003.
• Target audience women and children over the age
  of 15 living in Istanbul.
• Services are provided in 35 Women and Family
  Health Centers and 5 Imaging Centers.
• Works through online scheduling system and
  regular phone line (153).

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WOMEN AND FAMILY HEALTH CENTER SERVICES

• Cancer screening
• Breast cancer screening
• Cervical cancer screening
• Genital infection (STD) screening
• Cardiovascular risk screening
• Anemia screening
• Bone scan (osteoporosis)
• Educational Activities for Women and Children
• Psychologic Counseling
• School health

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SERVICES IN SCREENING CENTERS

• Digital Mammography
• Breast ultrasound
• Bone density measurement (DEXA)

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BREAST CANCER SCREENING

• Screening service for women who are over the age
  of 15.
• Risk Assessment
• Breast examination
• Referral to screening center
• Mammography (BIRADS Categorization)
• (For women 40 years and above , once every year)
• Ultrasound (BIRADS Categorization)
• (Women under the age of 40 for screening and / or
  family history of breast cancer )
• Breast cancer screening was performed in 400,445
  women,
• ultrasound in 35,276 and mammography in 101,063
  women.
• (2003-2009)

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UltrasoundWOMEN AND FAMILY HEALTH CENTER 2009
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RESULTS OF MAMMOGRAPHY SCREENING
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CERVICAL CANCER AND GENITAL INFECTION SCREENING

• Providing screening services for women aged
  15 and up who are sexually active
• Risk assessment
• Gynecologic examination
• Cytology (for genital infection screening)
• Gram staining (for genital infection screening)
• Smear testing (evaluated by Bethesta 2001)
• Overall
• 349.937 women was screened for cancer, 312.992
  screened for genital infections.
• (2003-2009)

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DISTRIBUTION OF SMEAR RESULTS TO AGE ()
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OSTEOPOROSIS SCREENING

• With this service,
• It is planned to follow progress of bone growth
  in young women
• To inform and to protect risk groups and provide
  early diagnosis.
• Assessment
• Analyze the risks
• Bone density measurement from heel (by X
  RayLazer)
• DEXA application for women who have risk
• 640.256 women screened, 38.859 were applied DEXA.
• (2003-2009)

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Bone Density ScreeningWomen and Family Health
Center2009
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DISTRIBUTION OF T- SCORE LEVEL UNDER 35 TO AGE
()
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DISTRIBUTION OF DEXA LEVEL UNDER 35 TO AGE ()
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DISTRIBUTION OF T- SCORE LEVEL OVER 35 ()
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DISTRIBUTION OF DEXA RESULTS LEVEL ABOVE 35 TO
AGE ()
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BODY MASS INDEX DISTRIBUTION
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DISTRIBUTION OF BMI LEVEL BY AGE ()
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CARDIOVASCULAR RISK SCREENING

• Women who are over 20 are screened. Framingham
  Method is used to evaluate risks.
• Application is done by
• Risk evaluation
• Laboratory examinations. (Fasting Blood Glucose,
  HDL Cholesterol, Total Cholesterol, Triglyceride)
  
• 174.283 individuals evaluated for risks.
• (2008-2009)

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DISTRIBUTION of CARDIOVASCULAR RISK BY SEX ()
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DISTRIBUTION of CARDIOVASCULAR RISK BY AGE ()
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DISTRIBUT ION of CARDIOVASCULAR RISK BY BMI ()
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HEALTHY NUTRITION AND DIET

• Healthy nutrition suggestion and diet services
  are provided for the women whose cardiovascular
  risk are high.
• 741 people has used this service in 2009

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ANEMIA SCREENING

• Anemia screening service is provided for
  women and chidren.
• Application is done by
• Evaluating risk and,
• Complete Blood Count. (22 Parameter)
• 175.679 women and 53.720 children were screened
  for anemia.
• (2008-2009)

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Anemia Screening of ChildrenWomen and Family
Health Center2009
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DISTRIBUTION OF HEMOGLOBIN PARAMETERS BY AGE
()
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PSYCHOLOGICAL COUNSELING

• Adults (Psychological evaluation, Psychotherapy,
  Group work)
• Children and Teenagers (Psychological evaluation,
  Psychotherapy, Denver Development test, Group
  work)
• Field Services / Group Therapies
• 128.427 consultancy service were provided.
• (2007-2009)

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Women and Family Health Center 2009
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HEALTH EDUCATION

• It is provided for men, women and children
  who are benefited from other services or apply
  directly.
• Application is done with materials such as
  (brochures, posters, etc.), Individual training
  Group training 699.580 health education
  sessions has been done
• (2003-2009)

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DISTRIBUTION OF EDUCATION SERVICES BY SUBJECT
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DISTRIBUTION OF EDUCATION SERVICES BY SUBJECT
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HOME CARE SERVICES
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HOME CARE SERVICES

• It is a preventive, protective and supportive
  health service.
• Objectives are to inform, diagnose, support and
  care.
• It is being implemented since 2003.
• Target groups are individuals who live in
  Istanbul and without social security insurance,
  suffering an acute or chronic illness, In need
  of care, Disabled and elderly people. Services
  are conducted in 3 units.

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Home Care Service2009
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HOME CARE AIMS

• With this service
• Basic health services to be provided at home
• Coordination of hospital services to those who
  are in need
• Improvement of the social conditions and the
  living environment
• Health education to the patients and their
  relatives.

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HOME CARE AIMS

• At the same time
• Improve health or to maintain a certain level,
• By taking health services to the patient's home,
  to prevent unnecessary admissions to the
  hospitals,
• Reduction in hospital stay, thus reduce the cost
  of treatment.

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Physiotherapy at Home Home Health Service2008
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HOME CARE SERVICES

• Application by the patient/relatives/local
  authorities.
• Analysis of living environment, social and
  economic assessment.
• Physician assessment
• Nursing Support (wound care, catheter
  applications, infusions, phlebotomy, providing
  medications and monitoring the situation of
  chronic patients, etc.)

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Nurse Care at HomeHome Health Service2009
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HOME CARE SERVICES

• Physiotherapy (Exercise and physiotherapy
  devices)
• Personal / Household Care (includes personal care
  and household maintenance for those who cannot
  take care of themselves),
• Psychological support,
• Coordination of hospital services,
• Transportation / Support services, X-ray
  services at home.

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Medicine Delivery VisitHome Health Service2009
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HOME CARE SERVICES by NUMBERS

• 80.077 People
• 227.425 Physical examination by physicians,
• 308.837 Nurse Care,
• 44.144 Physiotherapy,
• 3.300 Psychotherapy,
• 24.847 Hospital services are coordinated.
• (2002-2009)

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DISTRIBUTION OF DISEASES BY ICD CODES AND AGES
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DISTRIBUTION OF DISEASES BY ICD CODES AND SEXES
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HYGIENE LABORATORY SERVICES
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HYGIENE LABORATORY SERVICES

• Accredited by TURKAK, Hygiene Laboratory
  Services take measures to ensure safe water and
  food consumption before any danger that threatens
  public health
• Analysis of samples related to public health,
  such as, private / government food, water and
  cosmetic products,
• Drinking water and sea water analysis done
  byProvincial Health Directorate in partnership
  with ISKI to control Istanbul's drinking water.

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Hygiene Laboratories 2009
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SERVICES FOR DISABLED PEOPLE
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SERVICES FOR DISABLED PEOPLE

• Services provided for people with disabilities in
  Istanbul,
• Medical rehabilitation, Social
  rehabilitation, Provide equal and full
  participation in social life.
• As of 2009, 71.217 disabled people are on record
  by us.
• (2004-2009)

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HANDICAP TYPES AND DISTRIBUTION TO GENDER
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GROUPING OF AGES AND EDUCATIONAL LEVEL OF DISABLED
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71,217 disabled registered with ISOM as of 2009.
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MEDICAL REHABILITATION

• The service is to ensure increasing the
  functionality and independence of the disabled,
  performing daily living activities and social
  life.
• Provided with specialized personnel in the
  appropriate environment according to competence
  and development of the disabled.
• Includes physiotherapy and hydrotherapy
  services..
• 29.399 sessions of medical rehabilitation
  services were given.
• (2004-2009)

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Medical Rehabilitation ISOM2009
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SPORTS REHABILITATION

• Sports Rehabilitation
• The service carried out to support the
  physiological development of children with
  disabilities, and to make them feel that they can
  be successful in order to contribute to their
  psychological development.
• 195.331 sessions of sports rehabilitation service
  were provided.
• (2004-2009)

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Sports Rehabilitation Service ISÖM2009
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PSYCHOSOCIAL SERVICE

• With expert staff and suitable environment for
  the competence and development of disabled
• Psychological counseling and therapy services,
  Educational counseling, Special education
  studies, Speech and language disorders services
  are provided

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Educational ServicesISÖM2009
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MEDICAL, MEDICAL ASSISTANCE AND ORTHESIS
-PROSTHESIS WORKSHOP

• Medical Assistance
• It is provided for who are disabled, in need and
  does not have social security. (The white cane,
  wheelchair, battery operated car, hearing aid,
  orthesis/ prosthesis, sick gland, etc.)
• Orthesis-Prosthesis Workshop
• Created by the Institution, the workshop produces
  and repairs ortehesis and prostheses for
  applicants and for the disabled who are followed
  outside.

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PERFORMED PROJECT

• ÖSHA Project (the project of integrating disabled
  people sociableto socail life)
• This project aims to make students and
  youngsters understand being disabled
• Little Paces Early Education Project
• It is an education program for the families who
  have disabled children (0-4 years old).

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VETERINARY SERVICES
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VETERINARY PUBLIC HEALTH

• Veterinary services are very important for
  public health activities and individual
  preventive medicine services
• We work with the other institutions in harmony in
  order to fight against contagious diseases
  effectively

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VeterinaryServices2009
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ISTANBUL METROPOLITAN MUNICIPALITY VETERINARY
SERVICES

• We fight against diseases such as Rabies, Bird
  Flu and to rehabilitate stray animals
• To make sure that reliable food is delivered to
  consumers by providing all necessary health and
  sanitary standards for food businesses

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Microchip ApplicationVeterinary Services2009
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CONCLUSIONS

• There is a significant need for public health
  services.
• On site, easy access programs provide quality
  health services with utmost individual
  satisfaction.
• These services can be coordinated effectively
  even in very large cities like Istanbul.

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THANK YOU