Türkiye has expanded its welfare regime significantly in the last two decades. Contrary to the welfare retrenchment agenda worldwide, the country has achieved an exponential increase in its social transfers and welfare allocations despite great challenges that occurred, even during the Great Recession of 2007-2013, in the COVID-19 pandemic and the 2022 Russian war, resulting in an extreme increase in global food and energy prices. It wouldn't be exaggerating to say that Türkiye has undergone a silent revolution in social policies in the last two decades.

Türkiye's total per capita health care expenditure with current PPPs has increased from $470 in 2002 to $1,088 by 2016 and $1,827 as of 2022 (as of the latest data), according to the Organization for Economic Co-operation and Development (OECD) statistics. Although not the best, Türkiye has climbed the ladder and has surpassed nine OECD members, including South Africa, Brazil, Mexico, Indonesia and India. The total contributory and non-contributory retirement payments of the country, which was TL 46 billion in 2007, increased to TL 185 billion as of 2016 and climbed up to approximately TL 1.2 trillion as of 2022. According to the latest data, Türkiye allocates 7.5% of its gross domestic product (GDP) to pensions, which is similar to the OECD average (7.7%). Türkiye has allocated 12.4% of its GDP to social spending as of 2019 (as the latest comparable data from the OECD). While in 2002, only 69% of the society was under the protection of the social security umbrella, by 2023, 99.5% is within the scope, including General Healthcare Insurance.

Additionally, the recent statistics of the Turkish Statistical Institute (TurkStat) show that this increase is continuing despite the recent financial fluctuations. Türkiye has tripled its total social protection expenditure from TL 334 billion in 2016 to TL 1.257 trillion (approx. $40 billion) as of 2022. Despite the recent retreat at the Gini Coefficient of Türkiye in 2023 (declined to 0.433 in 2023 from 0.415 in 2022), these welfare investments significantly contributed to the increase of well-being of the society, preventing income inequality and avoiding extreme poverty. It should be noted that the recent increase of the Gini coefficient of the country was primarily the result of the exchange rate crisis of 2022 and the accompanying decline in the purchasing power of the Turkish lira, not a result of policy changes or retrenchment of the Turkish Welfare Regime.

Disabled population on the rise globally

Different sections of society have benefited significantly from this welfare expansion in Türkiye. The disabled are primarily among them. But before delving into explaining the Turkish experience with the disabled, let's have a general look at the phenomenon.

Disabled people constitute an important segment of the society. Despite their relative invisibility in social life, they are not a negligible small social group at all. Rather, their population is very high and growing every day. Based on 2023 global population data, the World Health Organization (WHO) estimates that 1.3 billion people – or 16% of the global population – are living with some form of extreme disability. This was 15% in 2011; since then, 300 million more have been added. It has to be underlined that this is significantly higher than previous WHO estimates made in the 1970s, which suggested around 10%. As a result of the development of health care services, orthopedic devices, advances in medical science, expansion of R&D in pharmaceuticals and developments in early childhood care, the rate of the world's disabled population continues to increase steadily.

Disabled people are among the most vulnerable sections of any and every society. They experience more hardship, participate less in society, can access education and employment to a lesser extent, are treated unequally and die younger. Referring again to the latest WHO data, people with disabilities are constantly facing many health inequities, including access to health care services, and some die up to 20 years earlier than those without disabilities. WHO underlines that people with disabilities have twice the risk of developing conditions such as depression, asthma, diabetes, stroke, obesity or poor oral health.

WHO underlines that people with disabilities find inaccessible and unaffordable transportation 15 times more difficult than those without disabilities worldwide, which is a primary indicator of effective social exclusion. Health inequities arise from unfair conditions faced by persons with disabilities, including stigma, discrimination, poverty, exclusion from education and employment, and barriers faced in the health system itself.

Subjected to extended risk of poverty

Disability is a specific type of risk for poverty and exclusion. In the World Report on Disability of 2011, the WHO underlines that, as a worldwide phenomenon, people with disabilities have poorer health outcomes, lower education achievements, less economic participation and higher rates of poverty than the rest of the society. These outcomes are a direct result of barriers in front of disabled people to access health, education, employment, transport, information and other basic needs of social life. In sum, disabled people are severely obstructed from participating in society as we design it.

Therefore, ensuring that disabled people participate in social life should be a major aim. In many disadvantaged regions, the disabled, specifically those with severe disabilities, are literally trapped in the house where they receive care. The United Nations Office for Disaster Risk Reduction (UNDRR) underlines that 80% of disabled are living in the Global South, in other words, in societies that are already disadvantaged due to global inequalities. Disabled are frequently the most affected by economic crises, natural hazards, urban calamities, climate-induced disasters and global health emergencies, such as witnessed during the COVID-19 pandemic.

Yet the problem is not the disability itself but the barriers. The problem is not with people with disabilities but with our design of social life. With a disability-sensitive perspective, while building all sections of social life, disabled people can fully enjoy their social and economic rights. The slogan of the OECD for this required transformation is "transforming disability into ability."

Ensuring care for the disabled

Türkiye also has a significant disabled population. According to the results of the 2022 Population and Housing Survey, approximately 6.9% of the population aged 3 and above in Türkiye has at least one disability, equating to around 4.9 million people, predominantly comprising severely disabled individuals. Applying the WHO ratio, the disabled population in the country could potentially reach up to 13 million.

As previously inferred, Türkiye has provided significant welfare for vulnerable sections of society in the last two decades, and the elderly and disabled are principally among them. Türkiye has started several welfare provision programs for the disabled, especially after the Disabled Act 2005. The most significant of these programs can be summarised as home monthly care assistance (for the carer), monthly disability allowance (paid directly to the disabled individual), monthly allowances for disabled relatives under 18 years of age, in-home mobile health care provisions, in-home care provisions, free public transportation, tax deductions and exemptions, discounts in utility bills, early retirement chance from the contributory-social insurance system, recruitment of civil servants through disabled public personnel selection exam, imposition of compulsory employment quotas in workplaces and application of special working hours for disabled employees.

As of 2024, the government gives home care assistance of TL 7,608 (approximately 44% of the net minimum wage) monthly to disabled caring houses and more than 750,000 families are benefiting from this. Additionally, the disabled are paid disability allowances of between TL 2,797 and TL 4,196, according to the disability rate.

Justice and Development Party (AK Party) governments have made many improvements regarding disabled people, from education to care services, from employment to prevention of discrimination and services such as removing bureaucratic obstacles that prevent disabled people from accessing social services and provision of home care and home health care services were among the top which has improved the quality of life of disabled citizens. According to the statistics of the Ministry of Family and Social Services, by 2023, annually approximately 600,000 people are getting an in-home caring allowance. While only 28,000 citizens benefited from in-home care services in 2007, this has almost reached 600,000 as of May 2023, with a twentyfold increase. Moreover, 858,000 people are getting paid disability/incapacity allowance, and more than 1.5 million people (including the disabled) are benefiting from in-home mobile healthcare services as of 2023.

Institutional vs. in-home care

As for comparative welfare research, interesting programs have been launched for the disabled in Türkiye, although rarely subjected to scholarly research. As a striking example, due to the nature of the AK Party's pro-family welfare stance, the Family and Social Services Ministry favors informal care over institutional. Home care is being supported and is suitable for the social construct of Türkiye. Likewise, instead of large care institutions, small-scale, residential area-based institutions called "hope houses" are being established (149 hope houses established by 2021).

Discussions over institutional care versus informal care constitute one of the main debates in social policy scholarly studies. Emerging from the approach of T.H. Marshall, some argue that establishing core institutional care would establish a welfare state accessible for all citizens in an equal treatment manner and defend that informal care is uncontrolled and leaves the individual at the mercy of society. This approach offers established large-scale institutions funded by taxes and accessible to all citizens. On the other side, many argue that institutional care creates unsustainable burdens over welfare regimes and defends that whenever possible, informal care should be encouraged where the individual feels at home/at his organic environment. This approach defends that institutions deteriorate inevitably, and institutionalizing the individuals results in alienation.

Welfare regimes are required to fit into the sociocultural construct of society to be effective, cost-efficient, applicable and sustainable. Social policy is never a culture-free universal prescription; a formula that may fit Japan best may have catastrophic results, let's say, in Mexico. Thus, culture-sensitive social policy is always essential.

Turkish culture advises that elderly and disabled people should be cared for at home by their families and moreover, it considers it shameful for children to leave elderly parents or disabled members in nursing homes or care institutions. Thus, the Turkish culture of supporting in-home care and policy experiments in this regard requires significant attention from social welfare studies as an out-of-Western welfare state experience.

Nonetheless, compared to the mature welfare states, Türkiye's baby-step efforts are yet experimental. The country is required to implement significant further steps, without omitting focusing on the changing social realities, to become a fully-fledged welfare state.

However, they require attention and scrutinization by scholars in the field. Ensuring the disabled access to all sections of social life, such as education, career, work-life, arts, culture, etc., still presents itself as a challenge for the country. Disabled people are required not to be cared for but to be supported to be self-sufficient and contribute to society. If proper mechanisms were established, 16% more of the population would contribute to the economy and society rather than being a burden for the welfare regimes.