Prof. Kayıhan Pala teaches public health to the Ministry of Health

The Ministry of Health arrived at the parliamentary budget commission like an orchestra determined to prove that, with the right sheet music, everything in the health system is in perfect harmony. The Minister spoke confidently of a Healthy Türkiye Century, a phrase repeated just often enough to suggest that merely saying it outloud might somehow lift life expectancy by a year or two. PowerPoint slides marched triumphantly across the screen: millions of screenings, millions of outpatient visits, millions of this, millions of that—proof, apparently, that when you count in large enough numbers, outcomes will eventually look impressive.

According to the Ministry’s presentation, the past year had been one of extensive legislative productivity: seventy-nine new pieces of health-related legislation had been adopted, and teams from the Ministry had visited all eighty-one provinces to assess existing structures, determine which practices should be preserved, and identify where improvements were needed — a nationwide tour de force so impressive that one could almost forget how little of this admirable mobility ever translates into the improvements allegedly being identified. It was, in other words, a year of heroic kilometre accumulation, if not necessarily of measurable progress: a kind of administrative pilgrimage where the journey itself is the achievement, and the destination — well, the destination can presumably wait for next year’s presentation.

Then came the familiar hymn of the “city hospitals,” the government’s beloved megastructures. They were portrayed as the shining cathedrals of Turkish healthcare—great vaults of marble and glass where efficiency, technology, and cost overruns walk hand in hand. No mention was made of the small detail that their daily operating cost could run an entire mid-sized European clinic for a month. But such numbers, the Ministry implied, should not distract from the grand vision: modernity requires monuments, and monuments require money—preferably a steady river of it.

When the presentation turned to prevention, the tone softened into something like aspiration. Yes, prevention was important; yes, they were investing. But somehow 58 percent of the entire ministry budget still flowed towards hospitals, because, as everyone knows, treating illnesses is always more glamorous than preventing them. Prevention does not cut ribbons; hospitals do.

Yet the opposition’s response—led most prominently by CHP’s Prof. Dr. Kayıhan Pala—painted a very different picture.

If the Ministry’s presentation had the tone of a motivational political speaker, Pala’s intervention felt more like the sudden appearance of a stern auditor who has read the footnotes. In simple terms, he there was to teach public health to the Health Ministry officials. He began gently, noting that life expectancy in Türkiye lingers four years below the OECD average—“a modest gap,” if one is being generous, or “a canyon,” if one is being honest. He continued by reminding everyone of the small, inconvenient detail that after the pandemic's “excellent management,” Turkey is the OECD country where life expectancy has shortened the most. Not the ideal trajectory for a country proclaiming itself on the brink of a “Healthy Century.”

Dr. Pala by acknowledging—very graciously—that the Minister had at least established a newborn branch commission. Then, with equal graciousness, he pointed out the peculiar detail that the Minister never actually attended the commission to explain anything. “Committees cannot function as empty chairs,” he implied. “Especially when the empty chair is the Minister’s.”

He moved to child mortality rates, the numbers slicing through the optimistic narrative like a cold wind: Artvin at a respectable 3.7 per thousand, Gaziantep at a staggering 16.7 per thousand. A newborn in Türkiye, it seems, might want to check the map before being born. Such inequalities, Pala argued, do not merely persist; they are entrenched. These, Pala hinted, are inequalities not of fate but of policy.

Then came the matter of vaccination coverage. Measles coverage in İstanbul at around 92 percent and under 95 percent nationally—“the perfect threshold,” Pala implied, “if the goal is to politely invite outbreaks.” One could almost see the virus packing its suitcase. Such a drop, he argued, is not merely a statistic but a public-health risk that demands urgent attention and more investment in preventive health services, not less.

He also reminded the commission that the Ministry’s obsession with hospitals—especially the city hospitals—had taken the budget hostage. With daily operating costs reaching 373 million lira, these great complexes resembled not so much hospitals as vast, elegant vacuum cleaners permanently attached to the public purse. In his framing, the Ministry’s continued reliance on public-private partnership hospital megaprojects reveals more about political and economic preferences than public-health logic.

All of this led to his larger point: the Ministry’s budget, with its monumental spending on hospitals and its modest crumbs for prevention, could not possibly deliver the extended life expectancy and healthier population the government loved to promise. Prevention is cheaper; prevention is effective; prevention, unfortunately, is not photogenic.

Dr. Pala could not resist pointing out the Ministry’s curious relationship with its own data—a relationship best described as exclusive but not inclusive. “Look,” he said, “2025 is almost over and you still haven’t published the 2024 health statistics.” The irony, of course, is that while the public patiently waits for these figures to emerge from whatever vault they’ve been locked in, the Deputy Minister—Dr. Birinci himself—somehow has full access, happily publishing academic articles based on data that officially does not exist. It is, Pala implied, a remarkable achievement: a Ministry that cannot release its own statistics, yet manages to have them cited in scholarly journals. Transparency, it seems, is optional; selective illumination is the new norm.

Dr. Pala also reminded the room—gently, but with the charm of a surgeon removing a bandage—that some figures are not the kind one frames and hangs on office walls. Emergency-room visits six times higher than the OECD average? Diabetes rates doubling in a decade? Hardly achievements to brag about unless the goal is to turn waiting rooms into national cultural heritage sites. While countries like Sweden, Norway, and Portugal enjoy longer, healthier lives with just two or three doctor visits a year, Türkiye appears determined to break world records by pushing that number toward thirteen. “If you manage that,” Pala warned, “only pharmaceutical companies, tech vendors, and private hospitals will celebrate.” The message was clear: you can multiply doctor visits as much as you like, but it won’t add a single day to the nation’s life expectancy—just to someone else’s profit margins.

Taken together, the Ministry’s optimistic framing and Pala’s data-driven critique revealed a profound tension at the heart of Türkiye’s health debate: a system heavily focused on expanding hospitals and infrastructure versus one that invests in prevention, equity, and long-term population health outcomes. The Ministry presented itself as forward-looking and reform-minded; Pala countered that without addressing core structural weaknesses—and without redirecting investment toward prevention and primary care— Türkiye risks maintaining a system that is modern in appearance but uneven and underperforming in its results.

There, in the commission hall, the contrast was almost theatrical: a Ministry proudly narrating its achievements in broad strokes, and an opposition MP quietly pointing at the areas where the paint is cracking. The Minister spoke of vision; Pala spoke of outcomes. The Minister spoke of infrastructure; Pala spoke of mortality. The Minister praised the nation’s health; Pala asked whether the nation was actually healthier.

The hearing concluded with the usual ritual politeness: the Ministry reaffirmed its grand vision, the opposition reiterated its misgivings, and the budget—like every year—marched forward with the calm inevitability of a well-rehearsed play.

And there, inside the chamber, the “Healthy Türkiye Century” continued floating in the air— beautiful, full of promise, and yet, unfortunately, merely decorative.