Why is Violence in Health a Public Issue?

The State's Reason for Existence is Public Service:

Dear friends, the reason for the existence of states is the provision of public service. The political organization we call the state provides a service to the public in all its activities. The concept that forms the backbone of the public service is the public interest. It is a public service for a municipal worker to sweep the streets, the police to inspect traffic, the doctor to examine the patient, the teacher to prepare a lesson plan, the ambassador to represent the state abroad, the soldier to train, the deputy to participate in the legislative activity, the president to fulfill the duties and responsibilities written in the Constitution. Therefore, the existence of public interest in each of these activities constitutes the material condition of public service (1).

The administrative nature of some public services necessitates that these services must be provided by the state, and we can give examples of these services as education, health and security services. Of course, its administrative nature does not mean that a public service cannot be provided by a private legal entity, but it does mean that the state must provide this service. Issues such as the supervision of the public service allowed to be provided by the private law legal entity and its results can be discussed at the political level. As a result, the decisions on how the public service will be given are the public policy preferences of the political powers. The topic we will deal with today will be to look at the issue of violence in health from a different perspective, on which much has been written and said.

Civil Service Officials

There are narrow or broad definitions in terms of scope in various laws about those in charge of public service provision. In Article 128 of the Constitution; "The essential and permanent duties required by the public services that the state, state economic enterprises and other public legal entities are obliged to carry out in accordance with the principles of general administration are carried out by civil servants and other public officials." (2) is included.

This definition is narrow. In Article 4 of the Civil Servants Law No. 657; "Public services are provided by civil servants, contracted personnel, temporary personnel and workers." (3) is included and is a broader definition than the Constitution in terms of the scope of the law and the definition.

In Article 6 of the Turkish Penal Code No. 5237, the definition of "Public official means a person who participates in the conduct of public activity through appointment or election or in any way permanently, temporarily or temporarily" (4) is a very broad definition.

The state is a political organization with a monopoly on the use of force. The purpose of keeping the definition so broad is to differentiate the evaluation if the subject or object of the crime has a public character. In other words, it is the inclusion of public power privileges in the text of the law. Aggravating the punishment for crimes committed against a public official is a regulation for the protection of the public official who represents the public interest. We can say that the main protected element is the concept of public interest. For example, in Article 125, which regulates the crime of "insult", imprisonment from 3 months to two years is foreseen. However, it has been stated that the lower limit cannot be less than one year if the crime is committed "against a public official due to his duty". In Article 131, it is emphasized that if the crime is committed against a public official, an investigation and prosecution will be made regardless of the complaint of the victim.

When it comes to violence against a public official, in Article 265 of the TCK; The provision "Anyone who uses force or threat against a public official to prevent him from doing his duty is sentenced to imprisonment from six months to three years". Regarding the crime of "injury by negligence" in Article 89, no distinction was made regarding the directing of the act to a public official. Considering the violence in health, the necessity of making new regulations here shows itself. Changes can be made not only in the TCK, but also in the CMK (Criminal Procedure Code) or other legislation. However, it is necessary to see the results in order to ensure deterrence. Laws are the embodiment of public policy. From this point of view, it would be appropriate to focus on policy processes rather than discussing which laws and what changes will be made. Because once the policy processes are understood, it will become clear what is/is not seen as a public issue. In this case, an account will emerge that the political power responsible for public policy processes will have to give to the public.

Violence in Health

The health transformation program can be seen as a radical transformation in health policy in Turkey. Increasing inclusiveness, reducing costs and solving financing problems were suggested as reasons for this policy change (5).

However, when we look at the policy results, it is seen that the costs have increased and the expected improvement in inclusiveness has not been achieved. In addition, a structure has emerged in which private hospitals have become an important part of the health system, the referral chain cannot be established, and therefore people can go to hospitals at the slightest discomfort. After the unhappiness caused by the quantitative inadequacy, this structure was widely accepted by the public, although it did not provide a great improvement in quality. This policy change, which has a very important place in the election success of the political power, seems to have decreased the professional reputation of health workers as well as increasing the workload. Because, qualified employees were asked to perform as if they were making mass production on a production line, and the carrot-stick technique was used for this.

Although the workload of health workers increased exponentially with the pandemic, there were significant increases in disruptions in public service when not enough personnel were included in the system. While the disruptions experienced at this stage were seen as a public problem and a policy had to be developed for their solution, the problems were almost ignored. This approach brought the public service provider and the service area face to face. The government, which has already achieved relative success in the elections over health, at this point preferred to legitimize the attitude of the people (whose opinion was formed by political discourse), not the public officials, but the people who think they are the owners of the public service given, which is purely a policy choice. There is a relationship between this choice and violence that feeds and produces each other. In other words, unless violence against healthcare workers is seen as a problem, it is not possible to produce a policy for a solution, and the public inertia against crime creates new crimes and criminals.

However, public service should not be considered as a service given to anyone unconditionally. For example, when you go to a tax office, you wait your turn and receive service within the framework of specified procedures. This situation is the same at the police station, the civil registry office, the municipality, the bank, or any ministry. No one can put his priority forward in a way that disrupts the order of the public service given. Moreover, if there is an injustice that is thought to have been committed, the judicial remedy is open. So what's different in a healthcare facility? If the country is the same country, the law is the same law and the government is the same government, there should be no difference between violence against the police and violence against the healthcare worker. For this reason, it is not possible to attribute the problem of violence in health to a single factor. However, it is worth emphasizing that the issue is handled as a public issue here.

Conclusion

Violence is a phenomenon that should be considered as a whole. However, violence against healthcare workers has ceased to be individual and has become a public issue. Because, in terms of its results, this phenomenon has passed the level that will prevent the public service from being provided properly. In other words, the answer to the question we used in the title has emerged. A public policy process begins with acknowledging the existence of a public issue. Starting this process is the responsibility and duty of political power. The function of the media in this regard is to draw the attention of the political power to the public problem by creating public opinion with the support of professional organizations, universities and non-governmental organizations. However, a publication ban on the doctor and secretary who lost their lives in the attack in Konya can be seen as an attitude that prevents the issue from being accepted as a public issue. In addition, the attitudes and attitudes of universities and some non-governmental organizations (trade unions and associations) that are insensitive to the issue can/should be criticized.

Of course, while trying to make a political assessment here, we must accept that the guilt of those who perpetrate brutal violence against healthcare workers is an indisputable fact. However, what needs to happen first is to accept this violence against public officials as a public problem. Otherwise, there will be a situation where the crime will remain "without punishment / insufficient punishment". The priority of all professional organizations, universities, non-governmental organizations and the media should be to put pressure on the political power and to contribute to the policy process in this regard. It is a direct policy choice that a political power that is capable enough to determine the national education policy of the country overnight and enact a law that has no scientific basis, should not accept a problem that negatively affects the public service delivery as a public problem. Unless the problem is looked at from this angle, the public interest will continue to suffer.

References:

(1) Kemal Gözler, İdare Hukukuna Giriş, Ekin Kitabevi, (7. Basım), Bursa, 2007.

(2) Türkiye Cumhuriyeti Anayasası, Madde 128.

(3) 657 Sayılı Devlet Memurları Kanunu

(4) 5237 Sayılı Türk Ceza Kanunu

(5) Sağlık Bakanlığı, Sağlıkta Dönüşüm, Aralık 2003, https://www.saglik.gov.tr/TR,11415/saglikta-donusum-programi.html