A recent report from The Lancet’s Public Health Commission on Gambling argues the gambling industry understates the social harm of gambling by emphasizing the low rate of clinically disordered gambling and ignoring other forms of harm. The esteemed medical journal’s new report suggests our focus on individual responsibility in response to ‘problem gambling’ likewise minimizes industry practices that increase risk.
As a remedy, the Commission urges governments and regulators to take a public health approach to gambling policy to better address the full scope of gambling-related harms.
From the report:
This Commission stresses that gambling is a public health issue. A public health approach to regulating the gambling industry and preventing and responding to related harms should underpin policy design, implementation, and review.
The Commission also raised the alarm over the industry’s “considerable influence” on gambling research. This influence, it argues, helps the industry “retain control of the framing and messaging” around gambling and calls for a shift away from industry-funded research.
Industry messaging has substantially influenced gambling policy and regulation. Most policy solutions to gambling harms rest on the notion of individual responsibility. Providing support services, treatments, and protections for at-risk individuals is, of course, important. Improving these remedies further and making protective supports broadly available remains a priority. However, framing the problem in this way and narrowly focusing policy attention on a small subset of the people who gamble draws attention away from industry practices and corporate behaviour. We must also seriously examine the structures and systems that govern the design, provision, and promotion of gambling products.
Public Health Approach Requires Long Term Effort
To reach its conclusions, the Commission relied on diverse expertise and analysis of existing research, including 299 previously released prevalence studies. The resulting findings, it says, should “mark the beginning of a serious and sustained effort” to apply public health logic to the “rapidly increasing threat of gambling harms.”
We acknowledge that implementing these recommendations might take time, will not be easy, and will require sustained effort and cooperation from multiple international actors. We hope to establish a clear direction for future action that will lead to effective policy design and implementation.
Gambling Harms Not Defined Solely by Disorder
One of the report’s key messages is that beyond gambling disorder, related “harms to health and wellbeing” are more substantial than previously understood.
Gambling can inflict substantial harm on individuals, families, and communities. Beyond the obvious danger of financial losses and financial ruin, these harms can include loss of employment, broken relationships, health effects, and crime-related impacts.
However, the Commission argues that a “substantial proportion of harm” is suffered by those who fall below the threshold for gambling disorders. For this reason, the authors say that “examining the effect of gambling across the entire spectrum of consumption is crucial.”
Following its advice, the Commission conducted a systematic review and meta-analysis of the global prevalence of gambling participation. In its findings, it introduces “any risk gambling,” which it defines as the occasional experience of at least one gambling-related behavioral symptom or “adverse consequence.”
As with other harmful commodities, adverse effects are often felt not just by the person gambling, but also by significant others, families, and friends, and can result in both tangible and intangible costs to communities and societies. Although some harms might be short-lived, others are long-lasting and can affect subsequent generations.
Based on the review, the Commission estimates that 46.2% of adults and 17.9% of adolescents (globally) gambled in the previous year. Within that, 10.3% of adolescents gambled online, which the researchers said is noteworthy since legal sites should prohibit underage participation.
Further, the review found approximately 5.5% of women and 11.9% of men experience any risk gambling. Extrapolating globally, the researchers say this suggests close to 450 million adults could experience similar risk. Compared to the approximate 80 million adults who experience gambling disorders, this indicates that focusing only on diagnosable behavior could abandon many who need help.
Industry-Influenced Policy Out, Regulatory Cooperation In
Since commercial gambling is becoming increasingly digital and rapidly increasing globally, the Commission argues that now is the time to shift priorities.
Evolution of the gambling industry is at a crucial juncture; decisive action now can prevent or mitigate widespread harm to population health and wellbeing in the future. Thus far, globally, governments have paid too little attention to gambling harms…
Stronger policy and regulatory controls focused on harm prevention and the protection of public health and wellbeing, and independent of industry or other competing influences, are now needed. Given the increasingly global and boundary-spanning nature of the industry, international coordination on regulatory approaches will be necessary.
Commission Tables Seven Priorities
Culminating its deep dive into problem gambling, the Commission tabled seven recommendations for moving forward.
First and foremost, the group asserts that gambling is a public health issue and must be prioritized as such, regardless of competing economic motivations.
Additionally, the authors recommend that:
- All countries—whether gambling is legal or not—institute effective gambling regulation
- Legal gambling jurisdictions employ a well-resourced, independent, and adequately empowered regulator focused on the protection of public health and wellbeing
- Gambling-related policy, regulation, treatment, and research must be free from the distortionary effects of commercial influence and encourage a rapid transition away from industry-funded study and treatment, coupled with and enabled by increased levels of investment from independent sources
- UN entities and intergovernmental organizations at the international level should incorporate a focus on gambling harms into their strategies and work plans for broadly improving health and wellbeing
- Development of an international alliance—including civil society, people with lived experience of harms related to gambling, researchers, and professional organizations—to provide thought leadership and advocacy
- Beginning the process of adopting a World Health Assembly resolution on the public health dimensions of gambling
In closing, the Commission urges governments to recommit to the sustained protection of public health.
In the long term, success would mean more jurisdictions adopting policies known to be effective in preventing harms. As a community, we need to foster strong relationships with civil society and those with lived experience of harms and support the integration of their perspectives and contributions within the gambling policy cycle. Success would also mean having more civil society organizations adopt issues of gambling harms and include them within their portfolios.
We urge governments at all levels to adopt our recommendations and to commit themselves to substantial improvements in the protection of public health and welfare from harms associated with gambling.
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