Worldwide public policies for celiac disease: are patients well assisted?
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ORIGINAL ARTICLE
Worldwide public policies for celiac disease: are patients well assisted? Ana Luı´sa Falcomer1 • Bruna Arau´jo Luchine1 • Hanna Ramalho Gadelha1 • Jose´ Roberto Szelmenczi1 Eduardo Yoshio Nakano2 • Priscila Farage3 • Renata Puppin Zandonadi1
•
Received: 24 March 2020 / Revised: 21 July 2020 / Accepted: 23 July 2020 Ó Swiss School of Public Health (SSPH+) 2020
Abstract 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 Public health Celiac disease Legislation Regulation
Introduction Celiac disease (CD) is an immune-mediated enteropathy triggered by gluten ingestion in genetically predisposed individuals (Sapone et al. 2012), and the gluten-free diet (GFD) is the only available safe treatment. Following a GFD is hard due to several factors such as lack of information and guidance to healthy gluten-free meal preparation, high food cost, and need for health support and information. The adjustment of long-rooted habits of consuming food prepared with wheat flour to a new diet style,
& Ana Luı´sa Falcomer [email protected] 1
Department of Nutrition, School of Health Sciences, University of Brasilia, Brası´lia, DF, Brazil
2
Department of Statistics, University of Brasilia, Brası´lia, DF, Brazil
3
Faculty of Nutrition, Federal University of Goia´s (UFG), Campus Colemar Natal e Silva, Setor Leste Universita´rio, Goiaˆnia, Brazil
combined with lack of cooking skills, favors treatment transgression impairing the health and quality of life of celiacs and their family (Ha¨user et al. 2007). Since food and nutrition are elements included in the Human Right to Adequate Food, the support of public policies (PP) is primordial to help increase celiacs diet adherence, promoting the reduction in symptoms and secondary outcomes (Nadal et al.
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