SOSYAL EŞİTSİZLİĞİN BİR YANSIMASI: TÜRKİYE’DE ÇOCUKLUK DÖNEMİNDE YETERSİZ BESLENME

Öz

Türkiye’de son 20 yıldır çocukluk dönemi yetersiz beslenme azalmaktadır. Düşük kilolu çocukların oranı 1993 yılında yüzde 9,5 iken, 2008 yılında yüzde 2,8’e gerilemiştir. Binyıl Kalkınma Hedefleri’nden bir tanesi 1990 ve 2015 yılları arasında açlığın yarı yarıya azaltılması olarak belirlenmiştir. Türkiye’de açlık, halk sağlığı gündeminde bir sorun olarak yer almazken, Türkiye kronik yetersiz beslenme göstergesini yarı yarıya düşürerek söz konusu hedefin ötesine geçmiştir. Bununla birlikte, yetersiz beslenme, her on çocuktan birinin yaşına göre kısa olmasının gösterdiği üzere halen bir sorun olarak göze çarpmaktadır. Daha da önemlisi, alt nüfus grupları arasında eşitsizlikler gözlenmektedir. Bulgulara göre yaşına göre kısa olan çocukların oranı, genellikle sosyo-ekonomik göstergeler açısından daha dezavantajlı konumda bulunan Doğu bölgesinde daha yüksektir. Yaşına göre kısa olan çocukların oranı en düşük refah düzeyindeki hanelerde yüzde 22’ye kadar yükselmektedir. Bu çalışmada çocukluk dönemi yetersiz beslenmenin zaman içinde değişimi demografik bölgeler ve refah düzeyleri ayrımında incelenmektedir; böylece eşitsizliklerin zaman içindeki değişimi gözlenebilmektedir. Buna ek olarak çocukluk dönemi yetersiz beslenmenin risk grupları da verisine erişilebilen son Türkiye Nüfus ve Sağlık Araştırması kullanılarak belirlenmeye çalışılmıştır. Bulguların politika yapıcılıkta yararlı olması hedeflenmiştir.

Anahtar Kelimeler

• yetersiz beslenme, eşitsizlik, yoğunlaşma endeksi, TNSA, Türkiye

A REFLECTION OF SOCIAL INEQUALITY: CHILDHOOD MALNUTRITION IN TURKEY

Öz

Malnutrition among children has been on the decrease in Turkey for the last two decades. The proportion of underweight children under age five has decreased from 9.5 percent in 1993 to 2.8 percent in 2008. One of the aims of the Millenium Development Goals (MDG) was to halve, between 1990 and 2015, the proportion of people who suffer from hunger. Not having hunger as a problem in its public health agenda, Turkey reached beyond the target of halving the chronic malnutrition indicator. However, malnutrition remains an important problem, since one in ten children is still stunted. Even more importantly, inequalities persist among subpopulations. Our findings showed that the proportion of stunted children is higher in the Eastern region of Turkey – a region typically characterized by poorer socio-economic indicators. The proportion of stunted children is as high as 22 percent for households with the lowest household wealth levels. Our study focused on the changes in childhood chronic malnutrition over time for main demographic regions and wealth levels to see how inequalities evolved over time. We further attempted to identify the risk groups of childhood chronic malnutrition from the latest available Demographic and Health Survey (DHS) data. We aimed to provide insight for policy implementation

Anahtar Kelimeler

• malnutrition, inequality, concentration index, DHS, Turkey

Kaynakça

1. Barros, F. C., Victora, C. G., Scherpbier, R., & Gwatkin, D. (2010). Socioeconomic inequities in the health and nutrition of children in low/middle income countries. Revista de Saşde Pşblica, 59(4): 1-16.
2. Bredenkamo, C., Buisman., L.R., Van de Poel, E. (2014). Persistent inequalities in child undernutrition: evidence from 80 countries, from 1990 to today. International Journal of Epidemiology, 43(4): 1328-1335.
3. Doğan, E. Türkiye’de yoksulluğun ölçülmesi. (2014). T.C. Kalkınma Bakanlığı Uzmanlık Tezi. Nisan 2014, Ankara.
4. EUROSTAT. (2012). Gini coefficient. Retrieved October 18, 2012, from http://epp.eurostat.ec.europa.eu/portal/page/portal/statistics/search_database
5. Hacettepe University Institute of Population Studies. (2009). Turkey Demographic and Health Survey 2008. Ankara: Hacettepe UniversityInstitute of Population Studies, TR Ministry of Health General Directorate of Mother and Child Health, TR Prime Ministry State Planning Organization.
6. Hong, R., & Mishra, V. (2006). Effect of wealth inequality on chronic under-nutrition in Cambodian children. Journal of Health, Population and Nutrition, 24(1): 89-99.
7. Hong, R., Banta, J. E., & Betancourt, J. A., (2006). Relationship between household wealth inequality and chronic childhood under-nutrition in Bangladesh. International Journal for Equity in Health, 5(15).
8. Jehn, M., & Brewis, A., (2009). Paradoxical malnutrition in mother–child pairs: Untangling the phenomenon of over- and under-nutrition in underdeveloped economies. Economics and Human Biology, 7(1).

9. Kanjilal, B., Mazumdar, P. G., Mukherjee, M., & Rahman, M. H., (2010). Nutritional status of children in India: household socio-economic condition as the contextual determinant. International Journal for Equity in Health, 9(19): 1-13.
10. Kılıç, B., (2012). Health financing (in Turkish: Sağlık Finansmanı) in HASUDER Türkiye Raporu 2012. Retrieved October 18, 2012, from http://hasuder.org.tr/anasayfa/images/stories/dosyalar/salk_politikalar_1.pdf.
11. Monteiro, C. A., Benicio, M. H. D. A., Conde, W. L., Konno, S., Lovadino, A. L., Barros, A. J. D., & Victoria, C. G., (2010). Narrowing socioeconomic inequality in child stunting: the Brazilian experience, 1974-2007. Bulletin of the World Health Organization, 88(4): 305- 311.
12. Mussa, R., (2011). Explaining Urban Rural Malnutrition Inequality in Malawi, in Conference on Measuring National Income, Wealth, Poverty, and Inequality in African Countries Cape Town, South Africa.
13. Mussa, R., (2011). Intrahousehold and interhousehold child nutrition inequality in Malawi. Munich Personal RePEc Archive Paper, 33498.
14. Omilola, B., (2010). Patterns and trends of child and maternal nutrition inequalities in Nigeria. International Food Policy Research Institute (IFPRI) Discussion Paper 00968.
15. Pebley, A. R., & Goldman, N., (1995). Social inequality and children's growth in Guatemala. Health Transition Review, (1)20.
16. Popkin, B., & Gordon-Larsen, P., (2004). The nutrition transition: worldwide obesity dynamics and their determinants. International Journal of Obesity28(3): 2-9.
17. Rutstein, S.O., & Jonhson, K., (2004). The Wealth Index. DHS Comparitive Reports No: 6 Calverton: ORC Macro.
18. Singh, A., (2011). Inequality of opportunity in Indian children: the case of immunization and nutrition. Population Research and Policy Review 30(6): 861-883.
19. Ssewanyana, S., & Kasirye, I., (2012). Addressing the Poor Nutrition of Ugandan Children. EPRC Policy Brief, 19.
20. Ssewanyana, S., & Kasirye, I., (2012). Causes of health inequalities in Uganda: Evidence from the Demographic and Health Surveys: 1995-2006. CSAE Conference 2012: Economic Development in Africa. Retrieved October 18, from https://editorialexpress.com/cgi- bin/conference/download.cgi?db_name=CSAE2012&paper_id=267.
21. Subramanyam, M. A., Kawachi, I., Berkman, L. F., & Subramanian, S., (2010). Socioeconomic inequalities in childhood undernutrition in India: analyzing trends between 1992 and 2005. PloS one, 5(6): e11392.
22. TR Ministry of Education, (2012). Project for Increasing Enrolment Rates Especially For Girls (ISEG). Retrieved October 18, 2012, from http://kizlarinegitimi.meb.gov.tr/en.
23. TR Ministry of Health, (2012). Promoting Breastfeeding and Baby Friendy Health Facilities Program and Supplemental Feeding Program (in Turkish: Anne Sütünün Teşviki ve Bebek Dostu Sağlık Kuruluşları Programı ve Tamamlayıcı Beslenme Programı) Retrieved October 18, 2012, http://www.saglik.gov.tr/TR/belge/1-11574/anne-sutunun- tesviki-ve-bebek-dostu-saglik-kuruluslari-.html.
24. TR Prime Ministry State Planning Organization, (2010). Millenium Development Goals Report, Turkey 2010. Retrieved September 15, 2012, from http://www.undp.org.tr/publicationsDocuments/TR%202010%20MDG%20Report_TR. pdf: TR State Prime Ministry Undersecreteriat of State Planning Organization, Office of the United Nations Resident Coordinator.
25. TURKSTAT, (2012a). Number of poors and regional poverty rates by relative poverty thresholds (calculated for Turkey) based on income (SR, Level 1). Retrieved October 18, 2012, http://www.tuik.gov.tr/PreIstatistikTablo.do?istab_id=1394.
26. TURKSTAT, (2012b). Gini coefficient by equivalised household disposable income (Turkey, Urban, Rural, SR, Level 1). Retrieved October 18, 2012 http://www.tuik.gov.tr/PreIstatistikTablo.do?istab_id=1369.
27. TURKSTAT, (2015). Population by province, age group and sex, 2007-2014. Retrieved July 14, 2015 http://tuik.gov.tr/PreIstatistikTablo.do?istab_id=945.
28. Wagstaff, A. and Watanabe, N., (2009). Socioeconomic inequalities in child malnutrition in the developing world. World Bank Policy Research Working Papers.
29. Van de Poel, E., Hosseinpoor, A. R., Speybroeck, N., Van Ourti, T., & Vega, J., (2008). Socioeconomic inequality in malnutrition in developing countries. Bulletin of the World Health Organization, 86(4): 282-291.
30. World Health Organization. (2014). WHA Global Nutrition Targets 2025: Stunting Policy Brief. Retrieved July 14, 2015, from http://www.who.int/nutrition/topics/globaltargets_stunting_policybrief.pdf
31. Yiğit, E. K., Tezcan, S., Adalı, T., Özbaş, S., (2010). Nutritional Status of Mothers and Children in Turkey and the Prevelance of Obesity (in Turkish: Türkiye’de Annelerin ve Çocukların Beslenme Durumu ve Obezite Prevelansı) in Futher Analysis Study, Turkey Demographic and Health Survey 2008: Fertility, Reproductive Health and Ageing in Turkey (Türkiye Nüfus ve Sağlık Araştırması 2008, İleri Analiz Çalışması: Türkiye’de Doğurganlık, Üreme Sağlığı ve Yaşlılık). Ankara: Hacettepe University Institute of Population Studies.