Worldwide public policies for celiac disease: are patients well assisted?

Int J Public Health. 2020 Jul;65(6):937-945. doi: 10.1007/s00038-020-01451-x. Epub 2020 Aug 5.


Objectives: To evaluate public policies (PP) to celiac disease (CD) patients and classify countries regarding the level of assistance provided by the Public Policies for Celiac Disease Score.

Methods: Countries were scored from 0 to 6 according to the existence of PP regarding industrial food and meal regulations, health service support, food allowance/financial incentive, gluten-free (GF) food certification, and CD associations. Subsequently, countries were allocated to continents. In total, 192 countries are registered as members of the World Health Organization.

Results: The European continent (score 3.63) is the most advanced in CD patient care, followed by South America (2.86), North America (1.05), Asia (0.53), Oceania (0.5), and Africa (0.27). Industrial food regulations were the most frequent PP (40.6%). 15.6% of the countries display regulations for meals; 13.5% have health service support; 13.5% have policies of food allowance/financial incentive; 19.3% have GF certification; and 34.4% have celiac associations.

Conclusions: Policies regarding GF meals and food safety certification, health service support, and financial incentives need improvement to ensure correct treatment and reduce the diseases' financial burden for celiac patients and governments.

Keywords: Celiac disease; Legislation; Public health; Regulation.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Celiac Disease / diagnosis*
  • Celiac Disease / therapy*
  • Female
  • Global Health / legislation & jurisprudence*
  • Global Health / standards*
  • Health Policy / legislation & jurisprudence*
  • Humans
  • Male
  • Middle Aged
  • Practice Guidelines as Topic*
  • Public Policy / legislation & jurisprudence*