{"id":8329,"date":"2006-02-01T01:11:26","date_gmt":"2006-01-31T23:11:26","guid":{"rendered":"http:\/\/109.232.216.219\/~bilimvegelecek\/?p=8329"},"modified":"2017-07-17T11:05:28","modified_gmt":"2017-07-17T08:05:28","slug":"halk-sagliginda-40-yillik-inkarcilik-kus-gribi-buzdaginin-gorunen-yuzu","status":"publish","type":"post","link":"https:\/\/bilimvegelecek.com.tr\/index.php\/2006\/02\/01\/halk-sagliginda-40-yillik-inkarcilik-kus-gribi-buzdaginin-gorunen-yuzu","title":{"rendered":"Halk sa\u011fl\u0131\u011f\u0131nda 40 y\u0131ll\u0131k inkarc\u0131l\u0131k Ku\u015f gribi: Buzda\u011f\u0131n\u0131n g\u00f6r\u00fcnen y\u00fcz\u00fc"},"content":{"rendered":"

Bir \u00fclkedeki uzman hekim say\u0131s\u0131n\u0131n en az y\u00fczde 4\u2019\u00fcn\u00fcn halk sa\u011fl\u0131\u011f\u0131 uzman\u0131 olmas\u0131 gerekir. Bu say\u0131 \u00fclkemizde yakla\u015f\u0131k y\u00fczde 0,9\u2019dur. \u00dclkemizde uzman, doktoral\u0131 ve y\u00fcksek lisansl\u0131 olarak, 66 000 ki\u015fiye bir halk sa\u011fl\u0131k\u00e7\u0131s\u0131 d\u00fc\u015f\u00fcyor. \u00dclke b\u00fct\u00e7esinden sa\u011fl\u0131\u011fa ayr\u0131lan pay\u0131n y\u00fczde 10 civar\u0131nda olmas\u0131 gerekir. K\u0131sacas\u0131 ku\u015f gribi gibi olaylarla ba\u015f edebilmenin yolu, sa\u011fl\u0131k sistemindeki kronik hastal\u0131klar\u0131 yok etmekten ge\u00e7er. <\/em><\/h4>\n

T\u00fcrkiye\u2019de bilimsel ve \u00e7a\u011fc\u0131l halk sa\u011fl\u0131\u011f\u0131 (bilimi) uygulamalar\u0131n\u0131n ge\u00e7mi\u015fi yakla\u015f\u0131k 40 y\u0131l. Ne var ki, halk sa\u011fl\u0131\u011f\u0131 (koruyucu hekimlik) ve tedavi edici sa\u011fl\u0131k hizmetlerinin entegre edilmi\u015f bi\u00e7imde verilmesinin hukuki ve y\u00f6netimsel dayana\u011f\u0131n\u0131 (n\u00fcfus ve b\u00f6lge temelli olarak) olu\u015fturan Sa\u011fl\u0131k Hizmetlerinin Sosyalle\u015ftirilmesi Hakk\u0131ndaki Kanunu 5 Ocak 1961 gece yar\u0131s\u0131 yasala\u015ft\u0131ran \u00a027 May\u0131s \u0130htilali\u2019nin Milli Birlik H\u00fck\u00fcmeti, ertesi g\u00fcn g\u00f6revini sivil h\u00fck\u00fcmetlere b\u0131rakt\u0131 (Kaynak 1). Ve sonra Sosyalle\u015ftirme Yasas\u0131 hemen hemen hi\u00e7bir iktidar taraf\u0131ndan \u00f6z evlat sevgisi g\u00f6rmedi.<\/p>\n

Yasan\u0131n mimar\u0131 ve o d\u00f6nemin Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131 M\u00fcste\u015far\u0131 Prof. Dr. Nusret Fi\u015fek\u2019in \u00e7al\u0131\u015fmalar\u0131 sayesinde \u00fclkemizde halk sa\u011fl\u0131\u011f\u0131 bilimsel ve \u00e7a\u011fc\u0131l anlamda ba\u015flam\u0131\u015f; fakat g\u00fcn\u00fcm\u00fczde gerek uygulama anlam\u0131nda, gerek de\u011fi\u015ftirilen maddeleri nedeniyle \u2018Sosyalle\u015ftirilme Yasas\u0131\u2019n\u0131n posas\u0131 \u00e7\u0131kar\u0131lm\u0131\u015f; \u00f6nemli maddeleri uygulanmaz olmu\u015ftur. \u00d6nceki cumhuriyet h\u00fck\u00fcmetlerinin \u00f6nemli halk sa\u011fl\u0131\u011f\u0131 kurumlar\u0131 ba\u015flang\u0131\u00e7taki hedeflerinin d\u0131\u015f\u0131na \u00e7\u0131kar\u0131lm\u0131\u015f; \u00f6rne\u011fin, Refik Saydam H\u0131fz\u0131s\u0131hha Merkezi\u2019nin b\u00fcnyesindeki Halk Sa\u011fl\u0131\u011f\u0131 Okulu ve E\u011fitim Ara\u015ft\u0131rma Sa\u011fl\u0131k B\u00f6lgesi, g\u00fcn\u00fcn gereksinimlerine g\u00f6re geli\u015ftirilece\u011fine \u00f6nce g\u00fcd\u00fckle\u015ftirilmi\u015f; 1980\u2019li y\u0131llar\u0131n sonunda kapat\u0131lm\u0131\u015ft\u0131r.<\/p>\n

Halk sa\u011fl\u0131\u011f\u0131 a\u00e7\u0131s\u0131ndan T\u00fcrkiye\u2019de durum<\/em><\/strong><\/p>\n

Dar gelirli ve yoksul toplum kesimlerinin \u00e7\u0131karlar\u0131ndan ziyade, az\u0131nl\u0131ktaki g\u00fc\u00e7l\u00fclerin ve onlar\u0131n uluslararas\u0131 i\u015fbirlik\u00e7ilerinin \u00e7\u0131karlar\u0131ndan yana sa\u011fl\u0131k politikalar\u0131n\u0131n koruyucusu h\u00fck\u00fcmetler nedeniyle, \u00fclkenin halk sa\u011fl\u0131\u011f\u0131 hizmetlerinin gereksindi\u011fi hekim ve uzman hekim yeti\u015ftiren en \u00f6nemli kurum olan t\u0131p fak\u00fcltelerindeki halk sa\u011fl\u0131\u011f\u0131 anabilim dallar\u0131 da ge\u00e7ti\u011fimiz 40 y\u0131l i\u00e7erisinde di\u011fer t\u0131p bilimlerinin, \u00f6zellikle tedavi edici t\u0131p hizmetlerinin sa\u011flad\u0131\u011f\u0131 ilerlemeye, ne insan g\u00fcc\u00fc ne alt ne \u00fcst yap\u0131 kurumla\u015fmas\u0131 anlam\u0131nda ula\u015fabilmi\u015f, hatta gerilemi\u015ftir. Bir \u00fclkedeki uzman hekim say\u0131s\u0131n\u0131n en az y\u00fczde 4\u2019\u00fcn\u00fcn halk sa\u011fl\u0131\u011f\u0131 uzman\u0131 olmas\u0131 gerekir. Bu say\u0131 \u00fclkemizde yakla\u015f\u0131k y\u00fczde 0,9\u2019dur (1) (Kaynak 2).<\/p>\n

\u00dclkemizdeki 47 (1999) t\u0131p fak\u00fcltesinin sadece 34\u2019\u00fcnde (y\u00fczde 72) halk sa\u011fl\u0131\u011f\u0131 anabilim dal\u0131 vard\u0131r ve anabilim dal\u0131 ba\u015f\u0131na d\u00fc\u015fen ortalama \u00f6\u011fretim \u00fcyesi (prof., do\u00e7., yard. do\u00e7.) say\u0131s\u0131 sadece yakla\u015f\u0131k 3\u2019t\u00fcr. Kald\u0131 ki ta\u015fra \u00fcniversitelerinin t\u0131p fak\u00fcltelerinde bu say\u0131 2\u2019nin alt\u0131na d\u00fc\u015fmektedir. D\u00f6rt ileri uzmanl\u0131k alan\u0131 (okul sa\u011fl\u0131\u011f\u0131, epidemiyoloji, i\u015f\u00e7i sa\u011fl\u0131\u011f\u0131 ve \u00e7evre sa\u011fl\u0131\u011f\u0131) ve 50\u2019den fazla i\u00e7 disipline sahip halk sa\u011fl\u0131\u011f\u0131 anabilim dal\u0131nda standart akademik kadro kavram\u0131 hen\u00fcz olu\u015fmam\u0131\u015ft\u0131r, Bir halk sa\u011fl\u0131\u011f\u0131 anabilim dal\u0131nda, okul sa\u011fl\u0131\u011f\u0131, epidemiyoloji, i\u015f\u00e7i sa\u011fl\u0131\u011f\u0131 ve \u00e7evre sa\u011fl\u0131\u011f\u0131 alanlar\u0131nda uzmanla\u015fm\u0131\u015f en az bir tanesi profes\u00f6r ya da do\u00e7ent olmak \u00fczere en az d\u00f6rt \u00f6\u011fretim \u00fcyesi ve alt\u0131nda \u00e7ok daha fazla do\u00e7ent ve yard\u0131mc\u0131 do\u00e7entinin bulunmas\u0131 ve ileri uzmanl\u0131k konular\u0131nda halk sa\u011fl\u0131\u011f\u0131 e\u011fitimi ve bilimsel \u00e7al\u0131\u015fma yap\u0131lmas\u0131 gerekti\u011fini savl\u0131yorum. Oysa bug\u00fcnk\u00fc durum anabilim dal\u0131 ba\u015f\u0131na ortalama 1,5 halk sa\u011fl\u0131\u011f\u0131 profes\u00f6r\u00fcd\u00fcr. Bunlar\u0131n \u00e7o\u011fu b\u00fcy\u00fck \u015fehirlerimizdeki \u00fcniversitelerdedir ve pek \u00e7o\u011fu halk sa\u011fl\u0131\u011f\u0131n\u0131n yukar\u0131daki d\u00f6rt ileri uzmanl\u0131k alan\u0131nda diplomal\u0131 uzmanla\u015fmaya gitmemi\u015f eski hocalard\u0131r. \u00dcniversitedeki akademisyenlerin en b\u00fcy\u00fck s\u0131k\u0131nt\u0131s\u0131, alt\u0131ndan kalkamayacaklar\u0131 miktardaki e\u011fitim ve bilimsel i\u015f y\u00fck\u00fcd\u00fcr. Bu i\u015f y\u00fck\u00fc, yeterince bilgili olmad\u0131klar\u0131 toplumsal sa\u011fl\u0131k konusunda \u00fclkemiz halk sa\u011fl\u0131\u011f\u0131 akademisyenlerinin sessiz kalmas\u0131na neden olmaktad\u0131r. Sonu\u00e7 olarak, \u00fclkemizde uzman, doktoral\u0131 ve y\u00fcksek lisansl\u0131 olarak, 66 000 ki\u015fiye bir halk sa\u011fl\u0131k\u00e7\u0131s\u0131 d\u00fc\u015ferken, \u00f6rne\u011fin ABD\u2019de yakla\u015f\u0131k 5000 ki\u015fiye bir halk sa\u011fl\u0131k\u00e7\u0131s\u0131 (halk sa\u011fl\u0131\u011f\u0131nda t\u0131pta uzmanl\u0131k, doktora veya y\u00fcksek lisans yapm\u0131\u015f ki\u015fi) d\u00fc\u015fmektedir (Kaynak 3, 4, 5). May\u0131s 2004 itibar\u0131yla yap\u0131lan bir ara\u015ft\u0131rma sonu\u00e7lar\u0131na g\u00f6re, T\u00fcrkiye\u2019de hekim k\u00f6kenli ve t\u0131pta uzmanl\u0131k s\u0131nav\u0131 ile uzmanl\u0131k e\u011fitimi alm\u0131\u015f 440 adet halk sa\u011fl\u0131\u011f\u0131 uzman\u0131 vard\u0131r (Kaynak 4). Daha \u00f6nce de belirtti\u011fimiz gibi, Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131\u2019n\u0131n 2004 y\u0131l sonu verilerine g\u00f6re bu say\u0131 t\u00fcm t\u0131pta uzman hekim say\u0131m\u0131z\u0131n (yakla\u015f\u0131k 48 399 (2))\u00a0 y\u00fczde 0,9\u2019udur.<\/p>\n

T\u0131p fak\u00fcltelerinin halk sa\u011fl\u0131\u011f\u0131 anabilim dallar\u0131n\u0131n ve H\u0131fz\u0131s\u0131hha Okulu\u2019nun halk sa\u011fl\u0131\u011f\u0131 ara\u015ft\u0131rma ve e\u011fitim laboratuarlar\u0131 niteli\u011finde olan her ildeki bir veya iki il\u00e7eyi i\u00e7ine alan e\u011fitim ve ara\u015ft\u0131rma sa\u011fl\u0131k b\u00f6lgeleri, \u00d6zal H\u00fck\u00fcmetleri (Halil \u015e\u0131vg\u0131n\u2019\u0131n Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131 zamandan ba\u015flayarak) taraf\u0131ndan protokolleri yenilenmeyerek kapat\u0131ld\u0131. Bunun sonucu, son 20 y\u0131lda mezun olan hekimlerin \u00f6zellikle uygulama anlam\u0131ndaki halk sa\u011fl\u0131\u011f\u0131 e\u011fitimlerinin \u00fclke ger\u00e7eklerinden daha da uzakla\u015fmas\u0131; yap\u0131lan bilimsel ara\u015ft\u0131rmalar\u0131n \u00f6rneklem se\u00e7imlerinde g\u00fcvenilirli\u011fin azalmas\u0131 (n\u00fcfus say\u0131mlar\u0131 ve sa\u011fl\u0131k istatistiklerinin g\u00fcvenilmezli\u011fi nedeniyle) ya da ara\u015ft\u0131rmalar\u0131n kolay yap\u0131labilen konulara (ana \u00e7ocuk sa\u011fl\u0131\u011f\u0131 ve aile planlamas\u0131 vb) kaymas\u0131 olmu\u015ftur. Velhas\u0131l, \u00fclkemizin halk sa\u011fl\u0131\u011f\u0131 insan g\u00fcc\u00fcn\u00fc yeti\u015ftirmesi beklenen \u00fcniversite halk sa\u011fl\u0131\u011f\u0131 anabilim dallar\u0131m\u0131z\u0131n \u00f6nemli nitelik ve nicelik sorunlar\u0131 vard\u0131r.<\/p>\n

\u015e\u00fcphesiz, halk sa\u011fl\u0131\u011f\u0131, toplum hekimli\u011finden \u00e7ok daha geni\u015f bir konudur ve meslek uygulamalar\u0131 \u00e7e\u015fitlili\u011fine sahipitir; hekimlik d\u0131\u015f\u0131ndaki mesleklerin de e\u011fitimini ve hizmetlerini gerektirir. G\u00fcn\u00fcm\u00fczde halk sa\u011fl\u0131\u011f\u0131, yakla\u015f\u0131k 80 de\u011fi\u015fik meslek alan\u0131n\u0131n ve onlar\u0131 yeti\u015ftiren, bar\u0131nd\u0131ran bilim disiplininin \u00e7ok y\u00f6nl\u00fc (multidisipliner) ve i\u00e7 i\u00e7e ge\u00e7mi\u015f (entegre) hizmetini gerektirir. Hemen hemen b\u00fct\u00fcn bilim alanlar\u0131n\u0131n birbirinden ba\u011f\u0131ms\u0131z tek y\u00f6nl\u00fc (monodisipliner) e\u011fitim uygulamalar\u0131 ile yeti\u015fen meslek elamanlar\u0131n\u0131n halk sa\u011fl\u0131\u011f\u0131 alan\u0131nda (\u00f6zellikle de \u00e7evre sa\u011fl\u0131\u011f\u0131nda) da yeti\u015ftirilmeleri i\u00e7in biyoloji, fizik, istatistik (bili\u015fimi de i\u00e7ine alan) ve sosyal bilimler olmak \u00fczere d\u00f6rt farkl\u0131 alanda temel b\u00fct\u00fcnc\u00fc bir e\u011fitimin birlikte verilmesi gerekir. Bu e\u011fitim modelinde, sosyal bilimler i\u00e7erisinde en \u00e7ok, temel sosyoloji ve psikoloji; sosyal ekonomi (makro ekonomik ilkeler ve e\u011filimler); devlet ve h\u00fck\u00fcmet etme modelleri; \u00f6zel ve halk\u00e7\u0131 (devlet\u00e7i-kamucu) sekt\u00f6r modelleri; sa\u011fl\u0131k ve \u00e7evre ekonomisi ve sa\u011fl\u0131k ahl\u00e2k\u0131 felsefesi (eti\u011fi) \u00f6ne \u00e7\u0131kar. Bir halk sa\u011fl\u0131\u011f\u0131 (sa\u011fl\u0131k mesleklerinden olsun veya olmas\u0131n) bilim ve meslek insan\u0131ndan, temel sosyal, ekonomik ve politik yap\u0131lar\u0131 ve etkenleri bilmesi; ekonomi, toplum ve h\u00fck\u00fcmet aras\u0131ndaki ili\u015fkilerin fark\u0131nda olmas\u0131, \u00e7evre ve sa\u011fl\u0131k sekt\u00f6rlerinin y\u00f6netimini anlamas\u0131 beklenir (Kaynak 7). T\u00fcm geli\u015fmi\u015f \u00fclkelerde b\u00f6yle meslekleraras\u0131 multidisipliner halk sa\u011fl\u0131\u011f\u0131 e\u011fitimi veren halk sa\u011fl\u0131\u011f\u0131 okullar\u0131 vard\u0131r. \u00dclkemizde bu okul (H\u0131fz\u0131s\u0131hha Okulu) 1980\u2019lerin sonlar\u0131nda kapat\u0131lm\u0131\u015ft\u0131r.<\/p>\n

E\u011fitim kurumlar\u0131n\u0131n yetersizli\u011fi do\u011fal olarak halk sa\u011fl\u0131\u011f\u0131 hizmetlerinin niteli\u011fine yans\u0131r. T\u0131p d\u0131\u015f\u0131ndaki meslek dallar\u0131nda bu yetersizli\u011fin izlenebilmesi i\u00e7in elimizde yeterli bilimsel ara\u015ft\u0131rma ve bu y\u00f6nde bir y\u00f6netim ve t\u00fcketici iste\u011fi yok. Ancak akademik d\u00fczeyde g\u00f6zlemlerimiz, \u00f6rne\u011fin hava kirlili\u011fi ve onun toplumsal maliyetleri konusunda bile bir \u00fcniversitenin (3) multidisipliner bir \u00e7al\u0131\u015fma yapacak nitelikte farkl\u0131 bilim dal\u0131 elemanlar\u0131na (en az\u0131ndan sa\u011fl\u0131k, m\u00fchendislik ve ekonomi dallar\u0131nda) sahip olmad\u0131\u011f\u0131n\u0131 g\u00f6stermi\u015ftir. Bu nedenle \u00f6rneklerimizi daha iyi bildi\u011fimiz hekimlik mesle\u011fi uygulamalar\u0131ndan verece\u011fiz:<\/p>\n

Bu \u00fclke, t\u0131p fak\u00fcltelerinden yeti\u015fen hekimlerine, koyduklar\u0131 hastal\u0131k ve \u00f6l\u00fcm tan\u0131lar\u0131n\u0131 h\u00e2l\u00e2 Devlet \u0130statistik Enstit\u00fcs\u00fc\u2019n\u00fcn istedi\u011fi ve kullanabilece\u011fi bi\u00e7imde g\u00fcvenilir olarak adland\u0131rmay\u0131, kay\u0131tlara ge\u00e7irmeyi ve bunun \u00fclke halk sa\u011fl\u0131\u011f\u0131 i\u00e7in ya\u015famsal \u00f6nemini \u00f6\u011fretememi\u015ftir (Kaynak 8).<\/p>\n

Bu \u00fclke, sa\u011fl\u0131k kurumlar\u0131nda her y\u0131l bak\u0131lan hastalarda en \u00e7ok g\u00f6r\u00fclen hastal\u0131\u011f\u0131n ne oldu\u011funu ve t\u00fcm \u00f6l\u00fcm nedenlerini h\u00e2l\u00e2 bilmemektedir (Kaynak 9). \u00dcniversitelerinde bile en \u00e7ok g\u00f6r\u00fclen ve en \u00e7ok \u00f6ld\u00fcren hastal\u0131klar ve \u00f6l\u00fcm nedenleri istatistikleri bilinemezliklerle doludur (Kaynak 8).<\/p>\n

N\u00fcfusun yakla\u015f\u0131k y\u00fczde 35\u2019inin ya\u015fad\u0131\u011f\u0131 k\u00f6y ve beldelerde (il ve il\u00e7e merkezleri d\u0131\u015f\u0131ndaki yerle\u015fim yerlerinde) \u00f6l\u00fcm say\u0131s\u0131 istatisti\u011fi toplanmamakta ve ulusal istatistiklere yans\u0131t\u0131lmamaktad\u0131r (Kaynak 10).<\/p>\n

Son bir iki y\u0131l i\u00e7inde besin ve \u00e7evre sa\u011fl\u0131\u011f\u0131 hizmetlerinin b\u00fcy\u00fck \u00e7o\u011funlu\u011fu Tar\u0131m Bakanl\u0131\u011f\u0131 ve ba\u015fta b\u00fcy\u00fck \u015fehir belediyeleri olmak \u00fczere belediyelere devredilmi\u015ftir. Bu ge\u00e7i\u015fle birlikte y\u0131llarca Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131 b\u00fcnyesinde yap\u0131lan bu \u00e7al\u0131\u015fmalara, insan hastal\u0131klar\u0131 konusunda e\u011fitim ald\u0131klar\u0131 i\u00e7in sonu\u00e7lar\u0131n\u0131n vahametinin daha fark\u0131nda olan hekim a\u011f\u0131rl\u0131kl\u0131 bir y\u00f6netim ve denetim hakim iken, \u015fimdi hayvan, bitki sa\u011fl\u0131\u011f\u0131 ve fiziksel \u00e7evre ve at\u0131k ar\u0131tma e\u011fitimi alm\u0131\u015f veteriner, ziraat m\u00fchendisi ve \u00e7evre m\u00fchendisi a\u011f\u0131rl\u0131kl\u0131, yukar\u0131da s\u00f6z\u00fc edilen multidisipliner e\u011fitimi almam\u0131\u015f; \u00f6zellikle ta\u015fra d\u00fczeyinde \u00f6rg\u00fct, insan g\u00fcc\u00fc ve laboratuar deste\u011fi a\u00e7\u0131s\u0131ndan hen\u00fcz sa\u011fl\u0131k bakanl\u0131\u011f\u0131 g\u00fcc\u00fcne ula\u015famam\u0131\u015f bir kadro egemendir. \u0130nsan sa\u011fl\u0131\u011f\u0131ndan do\u011frudan sorumlu ve e\u011fitimli ki\u015fi ve kurumlar halk sa\u011fl\u0131\u011f\u0131 hizmetlerinden soyutlanm\u0131\u015f ve uzakla\u015ft\u0131r\u0131lm\u0131\u015ft\u0131r. \u00d6zellikle belediyeler her bak\u0131mdan i\u00e7ler ac\u0131s\u0131 ve kaotik durumdad\u0131r. Ne eski ne de yeni kadro ve kurumlar b\u00f6lgelerindeki s\u0131hhi ve gayr\u0131 s\u0131hhi m\u00fcessese say\u0131lar\u0131n\u0131 bilmektedir, \u00e7\u00fcnk\u00fc b\u00fcy\u00fck \u00e7o\u011funlu\u011fu \u00f6zellikle gayri s\u0131hhi m\u00fcessese olanlar sa\u011fl\u0131k a\u00e7\u0131s\u0131ndan ruhsats\u0131zd\u0131rlar. Ruhsatl\u0131 olanlar denetimsizdir.<\/p>\n

Eskiden beri kapasitelerinin \u00e7ok alt\u0131nda \u00e7al\u0131\u015fan il halk sa\u011fl\u0131\u011f\u0131 ve h\u0131fz\u0131s\u0131hha b\u00f6lge ve merkez laboratuarlar\u0131 son d\u00fczenlemelerle daha da at\u0131l duruma getirilmi\u015ftir. Ba\u015fta hava kirlili\u011fi ve su kirlili\u011fi hizmetleri olmak \u00fczere koruyucu sa\u011fl\u0131k hizmetleri \u00fclkenin her kentinde e\u015fit ve homojen olarak verilmemektedir.<\/p>\n

Sosyalle\u015ftirme uygulamalar\u0131 ve Umumi H\u0131fz\u0131s\u0131hha Kanunu gere\u011fi \u00fccretsiz olmas\u0131 gereken halk sa\u011fl\u0131\u011f\u0131 laboratuar analizleri ve kimi koruyucu a\u015f\u0131lama uygulamalar\u0131 (\u00f6rn: Kuduz a\u015f\u0131s\u0131) 80 sonras\u0131 art\u0131k \u00fccretlidir.<\/p>\n

Refik Saydam Enstit\u00fcs\u00fc\u2019n\u00fcn a\u015f\u0131 \u00fcretim \u00fcniteleri ve Tavuk\u00e7uluk Enstit\u00fcs\u00fc gibi \u00f6nemli halk sa\u011fl\u0131\u011f\u0131 kurumlar\u0131 ayn\u0131 zaman s\u00fcresinde kapat\u0131lm\u0131\u015ft\u0131r.<\/p>\n

Halk sa\u011fl\u0131\u011f\u0131 uzman\u0131 ve 10 y\u0131ll\u0131k devlet memuru olmas\u0131 gereken il sa\u011fl\u0131k m\u00fcd\u00fcrl\u00fckleri, a\u011f\u0131rl\u0131kl\u0131 olarak gen\u00e7 pratisyen hekimlerin vekaleti ile y\u00f6netilmektedir. Pek \u00e7ok halk sa\u011fl\u0131\u011f\u0131 uzman\u0131, uzmanl\u0131k konular\u0131 d\u0131\u015f\u0131nda ya da pasif g\u00f6revlerde \u00e7al\u0131\u015fmaktad\u0131r. Pek \u00e7ok koruyucu hekimlik hizmeti g\u00fcnl\u00fck olarak de\u011fil, biriktirilip kampanyalar halinde verilebilmektedir.<\/p>\n

Halk sa\u011fl\u0131\u011f\u0131 hizmetlerinin en \u00f6nemli alanlar\u0131nda birisi de sa\u011fl\u0131k e\u011fitimidir. N\u00fcfusun kentlerde yo\u011funla\u015fmas\u0131, tar\u0131m toplumlar\u0131n\u0131n homojen, toplu e\u011fitime uygun yap\u0131s\u0131n\u0131 bozarak grup e\u011fitimini zorla\u015ft\u0131rm\u0131\u015ft\u0131r. Halk\u0131n gruplar halinde e\u011fitiminin yerini okul i\u00e7i ve bireysel e\u011fitim alm\u0131\u015f olmas\u0131na ra\u011fmen, sa\u011fl\u0131k \u00f6rg\u00fct\u00fcnde bu sa\u011fl\u0131k e\u011fitimini yapacak insan g\u00fcc\u00fc ve okul sa\u011fl\u0131\u011f\u0131 planlamas\u0131 yap\u0131lmam\u0131\u015ft\u0131r. Halk sa\u011fl\u0131\u011f\u0131 ve koruyucu hekimli\u011fin hizmet \u00f6rg\u00fct\u00fc olan sa\u011fl\u0131k ocaklar\u0131nda, gerek hekim ve hekim d\u0131\u015f\u0131 sa\u011fl\u0131k personelinin yetersizli\u011fi; gerekse personelin sa\u011fl\u0131k e\u011fitimi ve di\u011fer kimi koruyucu hekimlik hizmetleri konusunda yeterince e\u011fitimli olmay\u0131\u015flar\u0131 ve tedavi edici hekimlik uygulamalar\u0131 d\u0131\u015f\u0131ndaki uygulamalar\u0131 \u00f6zendirici olmayan \u00fccret politikalar\u0131 (maa\u015fa ve emeklili\u011fe yans\u0131mayan ge\u00e7ici, de\u011fi\u015fken ve tedavi hizmetlerinden gelen d\u00f6ner sermaye paylar\u0131, performansa dayal\u0131 \u00fccretlendirme) gibi nedenlerle sa\u011fl\u0131k e\u011fitimi ve okul sa\u011fl\u0131\u011f\u0131 hizmetleri, gerekti\u011fi bi\u00e7imde yap\u0131lamamaktad\u0131r. Bu \u00fclkede i\u015f\u00e7i sa\u011fl\u0131\u011f\u0131 hizmetleri ise yok h\u00fckm\u00fcndedir. Yanl\u0131\u015f ve eksiklerle dolu, kafa kar\u0131\u015ft\u0131r\u0131c\u0131 olan yaz\u0131l\u0131 ve s\u00f6zl\u00fc bas\u0131n yolu ile yap\u0131lan e\u011fitimler ise \u00f6zellikle e\u011fitim almak istemeyenler \u00fczerinde etkili olmamaktad\u0131r.<\/p>\n

Halk sa\u011fl\u0131\u011f\u0131 ahl\u00e2k\u0131 (toplumsal koruyucu sa\u011fl\u0131k bilinci)<\/em><\/strong><\/p>\n

Pek \u00e7ok halk sa\u011fl\u0131\u011f\u0131 konusunda ve son olarak ku\u015f gribi olay\u0131nda da g\u00f6zlemledi\u011fimiz gibi, toplumda iki \u00f6nemli ahl\u00e2k\u0131n yerle\u015fmesi gerekir: Halk sa\u011fl\u0131\u011f\u0131 ahl\u00e2k\u0131 (toplumsal koruyucu sa\u011fl\u0131k bilinci) ve g\u00fcvenlik ahl\u00e2k\u0131.<\/p>\n

Halk sa\u011fl\u0131\u011f\u0131 ahl\u00e2k\u0131, sa\u011fl\u0131k personelinin uygulamas\u0131 gereken \u00f6nlemlerin toplumda \u00f6nemsenmesi ile ilgili olu\u015fmu\u015f toplumsal boyutlu bir ahl\u00e2k\u0131n var olmas\u0131 demektir. Bu ahlak, en az\u0131ndan, toplum zarar\u0131na uygulamalar yapmaya devam eden toplum bireylerinin k\u0131nanmas\u0131 ve d\u0131\u015flanmas\u0131 i\u00e7in gerekli davran\u0131\u015f\u0131n bilincini i\u00e7erir. \u00d6rne\u011fin ku\u015f gribi olay\u0131nda, a\u00e7\u0131k tavuk besleyicilerinin tavuklar\u0131n\u0131 sa\u011fl\u0131k ekiplerine teslim etmesi i\u00e7in gerekli istek ve g\u00fcvenin do\u011fmas\u0131n\u0131 sa\u011flayan bu ahl\u00e2k, \u00f6nemli bir sa\u011fl\u0131k e\u011fitimi alt yap\u0131s\u0131n\u0131 gerektirir. Sigara i\u00e7ilmeyen mekanlarda sigara i\u00e7meye devam eden bireylerin varl\u0131\u011f\u0131, bu ahlak\u0131n zay\u0131fl\u0131\u011f\u0131na bir \u00f6rnektir.<\/p>\n

Risk ileti\u015fimi, risk alg\u0131lamas\u0131 ve g\u00fcvenlik ahl\u00e2k\u0131<\/em><\/strong><\/p>\n

Risk ileti\u015fimi<\/strong>; risk de\u011ferlendirmesi ve risk y\u00f6netimi yap\u0131lar\u0131ndan, halk sa\u011fl\u0131\u011f\u0131 bilgisini kullanan anahtar ki\u015filerin ve etkilenen toplumun haberdar edilmesi i\u015fidir. Anahtar ki\u015filer, devlet y\u00f6neticilerini, sanayii, toprak sahiplerini, i\u015f\u00e7ileri, genel toplumu, meslek gruplar\u0131n\u0131 ve \u00f6zel ilgi gruplar\u0131n\u0131 i\u00e7erir. Risk ileti\u015fimi, bu anahtar akt\u00f6rler aras\u0131ndaki diyalo\u011fun geli\u015fmesini ve ilerletilmesini de gerektirir.<\/p>\n

Etkin risk ileti\u015fimi, riskin b\u00fcy\u00fckl\u00fc\u011f\u00fc ve yap\u0131s\u0131 hakk\u0131nda bilinen ve bilinmeyenlerin oran\u0131na; riskin hem do\u011fal kapsam\u0131 hem de ileti\u015fim yap\u0131lanmas\u0131ndaki farkl\u0131 par\u00e7alarca alg\u0131lanmas\u0131 anlam\u0131nda tabiat\u0131na (niteliklerine) ve yetkililerin ileti\u015fim becerilerine ba\u011fl\u0131d\u0131r. Riskin (tehlike olas\u0131l\u0131\u011f\u0131n\u0131n) arkas\u0131nda a\u00e7\u0131klanan ak\u0131l (mant\u0131k), risk ileti\u015fiminin \u00f6nemli bir \u00f6\u011fesidir. Yani teknik olmayan bir dilde ve bilimsel sesleni\u015fte uzman olmak, ileti\u015fimde y\u00fcksek standartl\u0131 bir yetene\u011fi gerektirir. Bu yetenek, \u00f6rne\u011fin ku\u015f gribi ile ilgili hoparl\u00f6r anonslar\u0131n\u0131 duymad\u0131klar\u0131n\u0131 s\u00f6yleyen halka \u201cGeberin!\u201d diye seslenen yetkilide olmayan yetenektir.<\/p>\n

G\u00fcvenlik ahl\u00e2k\u0131<\/strong> ise \u00f6zellikle afet ve salg\u0131n durumlar\u0131ndaki risk ileti\u015fimi ve alg\u0131lamas\u0131n\u0131n vazge\u00e7ilmez ko\u015fuludur. Toplumda devlet yetkililerine ve bilim insanlar\u0131na g\u00fcvenin sars\u0131lmamas\u0131 i\u00e7in g\u00fcvenlik \u00f6nlemlerinin zaman\u0131nda ve do\u011fru olarak al\u0131nmas\u0131n\u0131 ve toplumun risk hakk\u0131nda zaman\u0131nda ve do\u011fru bi\u00e7imde bilgilendirilmesini gerektirir. Demokrasi ve hukukun \u00fcst\u00fcnl\u00fc\u011f\u00fc ile \u00e7ok yak\u0131n ilgisi olan bu ahl\u00e2k, televizyon ekranlar\u0131nda radyasyonlu \u00e7aylar\u0131 i\u00e7en y\u00fcksek devlet yetkililerini yarg\u0131layamayan \u00fclkelerde pek az bulunur. Etkin risk ileti\u015fimi felaket, kaza ve salg\u0131n durumlar\u0131nda ya\u015fam kurtar\u0131r ve \u00f6l\u00fcm riskini azalt\u0131r. \u00d6l\u00fcm riskinin azalt\u0131lmas\u0131 bir yana, etkin risk ileti\u015fimi, konular\u0131n anla\u015f\u0131lmas\u0131 ve de\u011ferlendirilmesi temelinde g\u00fcvenlik ahl\u00e2k\u0131n\u0131n toplumun b\u00fct\u00fcn sekt\u00f6rlerinde en az\u0131ndan geli\u015fmesinde bir\u00e7ok yarara sahiptir (Kaynak 7). Do\u011fruyu s\u00f6ylemeyen resmi yetkililer g\u00fcvenlik ahlak\u0131na b\u00fcy\u00fck darbe vururlar ve inan\u0131l\u0131rl\u0131klar\u0131n\u0131 kaybederler. Sonu\u00e7ta toplum bireyleri resmi yetkililerin gelecekteki \u2018tehlike uyar\u0131lar\u0131\u2019 veya \u2018tehlike yok uyar\u0131lar\u0131\u2019 kar\u015f\u0131s\u0131nda ya \u00e7ok a\u015f\u0131r\u0131 pani\u011fe kap\u0131l\u0131rlar ya da hi\u00e7 umursamazlar ki, her ikisinin de \u00e7ok tehlikeli sonu\u00e7lar\u0131 vard\u0131r.<\/p>\n

Sonu\u00e7 ve \u00e7\u00f6z\u00fcm<\/em><\/strong><\/p>\n

Yaz\u0131m\u0131z, \u00e7\u00f6z\u00fcmlerin neler oldu\u011fu konusunda da ip u\u00e7lar\u0131 i\u00e7ermektedir. Kalk\u0131nm\u0131\u015f D\u00fcnya\u2019da sa\u011fl\u0131k sorunlar\u0131 b\u00fct\u00fcnc\u00fc ve multidisipliner yakla\u015f\u0131mlarla ele al\u0131n\u0131r. Halk sa\u011fl\u0131\u011f\u0131ndan sorumlu meslekler ve hizmetler, hemen hemen t\u00fcm devlet kurulu\u015flar\u0131n\u0131, ama \u00f6zellikle sa\u011fl\u0131k, \u00e7evre ve tar\u0131m bakanl\u0131klar\u0131 ile belediyeleri ilgilendirir. Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131 insan sa\u011fl\u0131\u011f\u0131ndan sorumlu olarak di\u011fer bakanl\u0131klar ve belediyelerin \u00fcst denetimini yerine getirme g\u00f6reviyle de y\u00fck\u00fcml\u00fcd\u00fcr. Sa\u011fl\u0131k bakanl\u0131\u011f\u0131n\u0131n merkez ve ta\u015fra \u00f6rg\u00fct\u00fcnde, halk sa\u011fl\u0131\u011f\u0131 uzmanlar\u0131ndan y\u00fcksek derecede yararlanan, g\u00fcnl\u00fck siyasi \u00e7eki\u015fmelerden ar\u0131nd\u0131r\u0131lm\u0131\u015f ve korunmu\u015f bir sa\u011fl\u0131k planlamas\u0131 ve denetiminin bilimsel gereklerinin yerine getirilmesi gerekir.<\/p>\n

\u201cKoruma tedaviden \u00fcst\u00fcnd\u00fcr\u201d ilkesinin gerekleri b\u00fct\u00fcn karar verme a\u015famalar\u0131nda yerine getirilmelidir. Lisans \u00fcst\u00fc halk sa\u011fl\u0131\u011f\u0131 e\u011fitiminin ger\u00e7ekle\u015fmesi i\u00e7in ulusal halk sa\u011fl\u0131\u011f\u0131 okulunun h\u0131zla ya\u015fama ge\u00e7irilmesi; sadece hekim ve sa\u011fl\u0131k\u00e7\u0131 k\u00f6kenli meslekler de\u011fil, t\u00fcm meslek gruplar\u0131 i\u00e7in halk sa\u011fl\u0131\u011f\u0131 doktora ve y\u00fcksek lisans programlar\u0131n\u0131n a\u00e7\u0131lmas\u0131 ve \u00fclke \u00e7ap\u0131nda halk sa\u011fl\u0131\u011f\u0131 ara\u015ft\u0131rmalar\u0131 yap\u0131lmas\u0131 sa\u011flanmal\u0131d\u0131r. Tek c\u00fcmleyle gelecekteki t\u00fcm halk sa\u011fl\u0131\u011f\u0131 sorunlar\u0131yla sava\u015fta T\u00fcrkiye, halk sa\u011fl\u0131k\u00e7\u0131lar\u0131n\u0131 (halk sa\u011fl\u0131\u011f\u0131 uzmanlar\u0131n\u0131 ve t\u00fcm koruyucu sa\u011fl\u0131k hizmeti veren kurumlarda \u00e7al\u0131\u015fan g\u00f6revlileri) uygun g\u00f6rev yerlerinde \u00e7al\u0131\u015ft\u0131rmal\u0131 ve ba\u015fta \u00fccretlendirme olmak \u00fczere lojman, motorlu ara\u00e7 (gezici hizmet), ara\u00e7 gere\u00e7, h\u0131zl\u0131 laboratuar sonucu gibi sorunlar\u0131n\u0131 h\u0131zla \u00e7\u00f6zmeli; onlar\u0131 saymal\u0131 ve sevmelidir. Bu sevginin en iyi g\u00f6stergesi, \u00fclke b\u00fct\u00e7esinden sa\u011fl\u0131\u011fa ayr\u0131lan pay\u0131n y\u00fczde 5\u2019in \u00fczerine \u00e7\u0131kar\u0131lmas\u0131, iyisi y\u00fczde 10 civar\u0131nda olmas\u0131 ve bu oran\u0131n s\u00fcreklili\u011finin sa\u011flanmas\u0131d\u0131r (Halen bu oran 2006 b\u00fct\u00e7esinde yakla\u015f\u0131k y\u00fczde 4,5 olarak kabul edilmi\u015ftir (4). 2005 y\u0131l\u0131nda bu oran y\u00fczde 3,55 idi) (Kaynak 11).<\/p>\n

Ku\u015f gribinin \u015fimdiki salg\u0131n\u0131n\u0131n \u00e7\u00f6z\u00fcm\u00fc k\u0131sa vadeli; korkulan \u2018insan gribine d\u00f6n\u00fc\u015f\u00fcm\u00fc\u2019 riskinin y\u00f6netilmesi ve alg\u0131lat\u0131lmas\u0131 sorununun \u00e7\u00f6z\u00fcmleri ise orta vadelidir, ama her ikisi de y\u00f6netimseldir ve halk sa\u011fl\u0131\u011f\u0131 meslekleri merkezlidir.<\/p>\n

D\u0130PNOTLAR<\/strong><\/p>\n

1) T\u00fcrkiye\u2019deki uzman hekim say\u0131s\u0131 ile ilgili en son veri 2001 y\u0131l\u0131na aittir. 2001 y\u0131l\u0131na kadarki son be\u015f y\u0131la ait verilere g\u00f6re y\u0131ll\u0131k ortalama uzman art\u0131\u015f say\u0131s\u0131 2164 adet olmu\u015ftur. 2004 y\u0131l\u0131 uzman hekim say\u0131s\u0131, bu \u00fc\u00e7 y\u0131ll\u0131k uzman say\u0131s\u0131 art\u0131\u015f\u0131 olan 6 492 say\u0131s\u0131, 2001 y\u0131l\u0131ndaki uzman hekim say\u0131s\u0131 olan 41 907\u2019e eklenerek tahmin edilmi\u015ftir.<\/p>\n

2) Bkz. 1 nolu dipnot.<\/p>\n

3) Akdeniz \u00dcniversitesi.<\/p>\n

4) Oran, taraf\u0131m\u0131zdan eldeki b\u00fct\u00e7e rakamlar\u0131ndan hesaplanm\u0131\u015ft\u0131r.<\/p>\n

KAYNAKLAR<\/strong><\/p>\n

1) T\u00fcrk Tabipleri Birli\u011fi (2001), \u201cS\u00f6yle\u015filerle Sosyalle\u015ftirme Yasas\u0131n\u0131n \u00d6yk\u00fcs\u00fc\u201d.<\/p>\n

2) T.C. Sa\u011fl\u0131k Bakanl\u0131\u011f\u0131 (2003), \u201cSa\u011fl\u0131k \u0130statistikleri 2002\u201d.<\/p>\n

3) APHA (2003), The American Journal of Public Health, February 2003, 93(2):177.<\/p>\n

4) E. Eser, P. Erbay (2004); \u201cT\u00fcrkiye Halk Sa\u011fl\u0131\u011f\u0131 Uzmanlar\u0131 Envanteri (Ara Sonu\u00e7lar)\u201d, http:\/\/www.halksagligi.org\/bildiriler.php?id=407<\/a> adresine 02.11.2004 tarihli ziyaret.<\/p>\n

5) U. G\u00fcrsoy (2003), \u201cHalk Sa\u011fl\u0131\u011f\u0131nda Ge\u00e7erli Ulusal Bilim Dergisi Nas\u0131l Olmal\u0131d\u0131r ve B\u00f6yle Bir Derginin Sorunlar\u0131 Nelerdir?\u201d, Toplum ve Hekim, Kas\u0131m-Aral\u0131k 2003, 18(6):463-70.<\/p>\n

6) http:\/\/www.saglik.gov.tr\/extras\/istatistikler\/ytkiy2004\/GR4.xls<\/a> adresine 12 Ocak 2006 tarihli ziyaret.<\/p>\n

7) M. Fitzpatrick, X. Bonnefoy (1999); \u201cGuidance on the Development of Educational and Training Curricula\u201d, Environmental Health Services in Europe 4, WHO Regional Publications, European Series, No. 84, Denmark, Holland.<\/p>\n

8) A. F. I\u015f\u0131k, B. Demirel, E. \u015eenol, (2004); \u201cBildirilen \u00d6l\u00fcm Nedenleri \u2018Ger\u00e7ek \u00d6l\u00fcm Nedeni\u2019 mi?\u201d, Adli T\u0131p Dergisi, Y\u0131l: 2004\/Cilt: 1\/Say\u0131:1.<\/p>\n

9) U. G\u00fcrsoy (2004), \u201cEnerjide Toplumsal Maliyet ve Temiz ve Yenilenebilir Enerji Kaynaklar\u0131\u201d, T\u00fcrk Tabipleri Birli\u011fi Yay\u0131n\u0131, Ankara.<\/p>\n

10) D\u0130E. (2002), \u201c\u00d6l\u00fcm \u0130statistikleri \u0130l ve \u0130l\u00e7e Merkezlerinde-1999\u201d, T.C. Ba\u015fbakanl\u0131k Devlet \u0130statistik Enstit\u00fcs\u00fc Yay\u0131n\u0131, Ankara.<\/p>\n

11) http:\/\/www.hekimlerbirligivakfi.org\/news_read.php?b=1&i=1623&s=hbv<\/a> adresine 16.01.2006 tarihinde yap\u0131lan ziyaret.<\/p>\n","protected":false},"excerpt":{"rendered":"

Bir \u00fclkedeki uzman hekim say\u0131s\u0131n\u0131n en az y\u00fczde 4\u2019\u00fcn\u00fcn halk sa\u011fl\u0131\u011f\u0131 uzman\u0131 olmas\u0131 gerekir. Bu say\u0131 \u00fclkemizde yakla\u015f\u0131k y\u00fczde 0,9\u2019dur. \u00dclkemizde uzman, doktoral\u0131 ve y\u00fcksek lisansl\u0131 olarak, 66 000 ki\u015fiye bir halk sa\u011fl\u0131k\u00e7\u0131s\u0131 d\u00fc\u015f\u00fcyor. \u00dclke b\u00fct\u00e7esinden sa\u011fl\u0131\u011fa ayr\u0131lan pay\u0131n y\u00fczde 10 civar\u0131nda olmas\u0131 gerekir. K\u0131sacas\u0131 ku\u015f gribi gibi olaylarla ba\u015f edebilmenin yolu, sa\u011fl\u0131k sistemindeki kronik […]<\/p>\n","protected":false},"author":477,"featured_media":8342,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"footnotes":""},"categories":[62,21,33,29],"tags":[198,204,202,203],"class_list":["post-8329","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-24-sayi","category-biyoloji","category-saglik-bilimleri","category-toplum","tag-cevre","tag-dogal-afetler","tag-kus-gribi","tag-tibbi-biyoloji"],"acf":[],"aioseo_notices":[],"_links":{"self":[{"href":"https:\/\/bilimvegelecek.com.tr\/index.php\/wp-json\/wp\/v2\/posts\/8329","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/bilimvegelecek.com.tr\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/bilimvegelecek.com.tr\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/bilimvegelecek.com.tr\/index.php\/wp-json\/wp\/v2\/users\/477"}],"replies":[{"embeddable":true,"href":"https:\/\/bilimvegelecek.com.tr\/index.php\/wp-json\/wp\/v2\/comments?post=8329"}],"version-history":[{"count":0,"href":"https:\/\/bilimvegelecek.com.tr\/index.php\/wp-json\/wp\/v2\/posts\/8329\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/bilimvegelecek.com.tr\/index.php\/wp-json\/wp\/v2\/media\/8342"}],"wp:attachment":[{"href":"https:\/\/bilimvegelecek.com.tr\/index.php\/wp-json\/wp\/v2\/media?parent=8329"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/bilimvegelecek.com.tr\/index.php\/wp-json\/wp\/v2\/categories?post=8329"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/bilimvegelecek.com.tr\/index.php\/wp-json\/wp\/v2\/tags?post=8329"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}