Ranking of provinces according to the health index and health inequalities in Turkey

The aim of this study, ranking of provinces in Turkey according to health status with a composite heath index to be developed by considering health outcomes such as education, income, employment, demographics, air quailty, physical environment, housing-infrastructure, health infrastructure and health workforce and revealing the existing health inequalities between provinces. Withing the scope of the study, reports published by various institutions, public databases and various research reports were scanned as data sources. The variables to be included in the index after the screening were evaluated according to the criteria of measurability, validity, timeliness, reproducibility, sustainability, relevance and importance, and the determined 29 variables were structured in a hierarchical order as sub-dimensions, dimensions, sub-indexes and finally composite healht index. After determining the theoretical framework and structuring the variables, normalization, weighting and aggregation processes were applied respectively in the development of the composite index. The statistical consistency of the developed composite health index was evaluated with cross-correlation analyzes and the robustness of the composite index was examined with uncertainty and sensitivity analyses. The first five provinces with the highest scores in the composite health index are Bolu, Karabük, Ankara, Trabzon and Istanbul, respectively, while the last five provinces with the lowest scores are Hakkari, Şanlıurfa, Muş, Ağrı and Şırnak, respectively. However, it has been observed that the composite health index largely overlaps with the conceptual framework and the uncertainty about the ranking of the provinces is low, except for a limited number of provinces. When the provinces are classified according to the composite health index score, a difference of 44 points in absolute terms and 2,17 times in relative terms was found between the most advantageous and disadvantaged classes. Ranking the provinces with the composite health index approach shoud be considered as an important tool in determining the health statys of the society and producing evidence-based policies, and studies in this field should be increased in our country.