Today’s post is the third (and last) in this week’s graph-tacular series looking at celiac disease awareness trends. (Here are part 1 and part 2 if you missed them.) Since it’s National Celiac Awareness Month in the United States—and we often hear about how progressive some other countries are when it comes to celiac awareness, medical care, gluten-free standards, and financial support for those adhering to a gluten-free diet—it seemed only fitting to conclude this week’s posts with a look at how gluten and celiac awareness in the U.S. compares to our fellow English-speaking countries: Canada, Australia, and the United Kingdom.
The first graph above shows the Google search term popularity for “gluten” in each of the four countries. Not surprisingly, it shows an exponential uptick in recent years. With the exception of Australia (green), which started with a higher baseline ten years ago, “gluten” was an equally prominent search term in each of the countries. Then Australia, Canada, and the U.S. surged while the poor United Kingdom lagged behind. Or so it seems.
Countries like the U.K., Canada, and Australia have populations one-fifth to less than one-tenth that of the U.S., so it’s not fair to simply graph the raw popularity of a Google search term like “gluten.” If the search term is equally popular superficially in the U.S. and Canada, but the U.S. has nearly 320 million people and Canada just 35 million, then “gluten” isn’t really equally popular. If ten times as many people are generating the same number of search results as a much smaller population, it says something about awareness.
And so I’m sure you can predict what I did. I pulled the most recent available population estimates from the federal governments of the United States, United Kingdom, Canada, and Australia. Then I re-scaled the Google search trend data so that it now shows “gluten” searches per capita, a much better apples-to-apples comparison of awareness in the various countries.
This much more informative view really blows the doors off. Australia and, to a similar degree, Canada show themselves to be leading the pack in a pretty substantial way. The U.K., which initially appeared a laggard above, actually proves to be ahead of the U.S. And the United States? I’m afraid we’re the true laggards with an awareness far below some of our English-speaking peers.
Of course, this is about celiac awareness and not gluten awareness, so let’s shift gears and look at the “celiac” side of things. When you graph only the raw search term data, the countries are much more clustered. The United States appears to be right in the mix, the United Kingdom (again) appears to be lagging, and all countries exhibit small but definite upward trends in celiac awareness over time.
But when you convert the data to per capita values, it’s truly eye opening. Australia and Canada show themselves to be far ahead when it comes to celiac awareness. The United Kingdom, meanwhile, is making real progress. For a number of years, its per capita celiac awareness tracked exactly with that of the United States, but starting in mid-2009 the U.K.’s awareness began climbing and has continued since. And the U.S.? We’re caught standing next to the tracks while the celiac awareness train has left the station.
As the U.K. shows, though, a nation can alter the trajectory of its celiac awareness and make real headway closing the gap to the leaders. It’s time for the U.S. to follow suit.
Update: 5/16/14
Prompted in part by a reader comment noting that in the U.K. “coeliac” is also a prevalent term (vs. “celiac”), I did a bit of extra behind-the-scenes data manipulation to take alternate English language spellings into account. In the U.S. and Canada, “celiac” accounts for essentially 99.99% of all searches, so that was a non-issue. In both the U.K. and Australia, “coeliac” used to be the dominant term, though “celiac” has been gaining ground such that it now ranks equally with “coeliac” in those countries. Taking the influence of “coeliac” into account, it further differentiated awareness across the four countries, so that their four curves no longer have significant overlap. The U.K.’s and Australia’s awareness both improved as a result, leaving the U.S. that much further behind.
–Pete
P.S. For those readers who live in these other countries or have traveled to them, what do you think? Do these graphs match your perception and experience of celiac and gluten-free awareness in these places? Please comment and let us know!
Did you account for the variant spelling in the UK? We spell it coeliac, not celiac here.
Anecdotally there’s been a rise in awareness here, and more products in the shops, but it’s not really made a difference to availability of places to eat out safely. Most will say they can do gluten-free food, but know nothing about cross-contamination.
Hi Sophie,
Thanks for weighing in. Unfortunately, Google Trends doesn’t allow you to pull data for multiple search terms (i.e., coeliac, celiac) AND multiple geographies (i.e., US, UK) at the same time. I would have liked to include “coeliac,” not to mention other terms such as “glutine” so I could also pull in countries such as Italy.
Though it’s not represented in my graphs, I did look at the relative popularity of coeliac vs. celiac in the UK. “Celiac” has gained significant ground against “coeliac,” so that for the past two years they’ve been equally prominent search terms in the UK. If you thus combined the popularity of celiac plus coeliac, it’d make the uptick toward the right side of the graph about twice as high for the UK, further leaving the US behind.
A similar trend is true in Australia, so its performance would be even more impressive if you took the combined effect into account.
The fact that looking at “celiac” alone already shows the US lagging, and here in the US “coeliac” is a basically non-existent spelling, further underscores how much ground we have to make up against other countries.
Cheers,
Pete
Another perspective is Universal Health Care, poverty, and access to practitioners could affect awareness. I see a grant application for that!
Monica,
Agreed. There’s the question of a) how to best measure awareness, and b) what factors influence that awareness. Because I have access to the data, I’ve used Google search prominence as a proxy for awareness, but there are many other ways to think about the issue, too.
Thanks,
Pete
It has always seemed to me that the U.S. trails in getting on the band wagon for things such as this. I wonder how much of this awareness trend in other countries is fueled by the same fad factor that we have in the U.S. That is one statistic that marketers rely on heavily and it doesn’t take cross-contamination into account at all.
What an excellent series of article, Pete. Thank you!
Hi there, I’m in Australia and I would agree that there is a huge awareness of coeliac disease and gluten-free. In the last 5 yrs or so since I’ve been wheat free (due to having to avoid fructans), the availability of GF products in supermarkets has increased from virtually nothing to nearly a whole aisle devoted to them (inc. GF grains, biscuits, cakes, pastas, muesli bars and other snacks, breakfast cereals, breads and in the freezer section ready-made meals and pies/pizzas/hot chips etc). In addition to this, it’s usually pretty easy to find things marked GF on menus in cafes and restaurants (not fast food places!) and most staff having an awareness of what that means. Having said that though, because I do not have coeliac disease, I don’t have to be vigilant with cross contamination. How well these places do with that I don’t know. I would say that that as far as the general population, most people would have heard of or know someone that is GF or has coeliac disease.
I was in the UK this year and found, mainly in London, that it very easy to eat safely as a person with celiac disease. Everywhere we dined the restaurant staff were knowledgeable and confident in talking about eating gluten-free and meeting my needs. I had a much more positive experience traveling in the UK for 7 days than I do here at home in the US.
I am British, have lived in both Canada and the US and visited my sister in Australia … plus I have coeliac disease, so I’m probably in a good position to comment.
Australia definitely leads the field regarding coeliac awareness – I remember stopping at a motorway service station far from any cities and finding a selection of pre-packed, gluten-free food readily available including sandwiches and muffins. I can’t say I found them very tasty, but then what service station food is?!
In Britain and Canada I’ve found that there are lots of gluten-free products available in supermarkets, but I fared less well in terms of eating out at restaurants (London being a notable exception). In Britain I’ve had people trying to tell me that food is gluten-free that patently isn’t – there is a lot of ignorance about what gluten-free really means.
In the US I’ve been surprised with the level of awareness where I live in the Mid-West. I have a good selection of restaurants that understand and cater safely to those with coeliac disease and I am enjoying eating out again for the first time since I was diagnosed ten years ago. It is a different story when I’m on the road – outside the cities I find awareness to be very low and I’ve learned to be prepared. I can easily find gluten-free food in my local supermarkets, but this isn’t the case when I go on road trips.
I was actually diagnosed while living in Germany – a country whose medical profession seems to be far more switched on to coeliac disease than in Britain (where I lived with it for 20+ years undiagnosed) – however general awareness of the disease amongst the public is very low and their supermarkets are only slowly beginning to stock gluten-free products. Don’t even bother trying to have a conversation with a waiter about it (even in German) – they won’t have a clue!
What an awesome study. I am not surprised at all that Canada and Australia are ahead in celiac awareness. When I was diagnosed with Celiac in the 1980s, my Canadian grandmother joined the Canadian Celiac Association. They were way ahead in any information than the US groups and were a wonderful resource to my family in my early years of being gluten-free. My grandmother would often buy me gluten-free food and save it for my visits.
I am an avid traveler and have always felt that many countries outside of the United States, especially in Europe, are way ahead of us in terms of labeling and general awareness. I also feel that being gluten-free isn’t seen as a trend, but a medical necessity in other countries.
I would love to share this with my readers!
Erin Smith