Profit Before People: The commercial determinants of health and lessons from the tobacco epidemic (2023)

Gambling

Gambling involves staking or risking something of value on an event with an uncertain or chance outcome. It's defined as gaming, betting, or participating in a lottery⁶².

There is increasing concern in the UK about the harms associated with gambling, where the gambling market is one of the largest and most accessible in the world⁶³.

Statistics report there were almost 2500 gambling operators in the market in 2022⁶⁴, with earnings of £14.1bn in the year to March 202264. An estimated 60% of online gambling industry profits come from roughly 5% of gamblers who are classified as experiencing "problem gambling" or as "at risk"⁶⁵

Over the last few years, there has been an increase in the availability of gambling, both in-person and online. Whilst there are some regulations of gambling advertisements, children are regularly exposed to gambling advertisements which can normalise and predict future gambling. Opportunities to gamble exist on most high streets and, with the spread of the internet, in virtually every home. Based on existing evidence, it is reasonable to say that the commercial gambling industry has become one of the most innovative health harming industries of recent times⁶⁶.

It is no surprise to learn that the commercial gambling industry operates from a similar playbook to other health-harming industries, such as tobacco. This involves delaying and circumventing regulation, developing innovative products and promotions, appealing to new markets, co-opting the production of research and knowledge and capturing 'public health' responses through corporate political activities⁶⁷.

There is ample evidence to show the significant negative health and social consequences of gambling not only for individuals who gamble, but also for families and communities^66. The harm from gambling is a public health issue because it is associated with harms to individuals, their families, close associates and wider society and can both create and exacerbate inequities⁶³.

It can be argued that the Gambling Act 2005 was harmful from its inception as it was designed to make the UK the centre of the online gambling industry, and defined people, not products, as the problem, while requiring regulators and local authorities to "aim to permit" gambling⁶⁸. To date, Britain has taken the approach of working alongside industry, encouraging them to adopt 'responsible' corporate practice, rather than introducing legislation to regulate them.

It's important to remember though that gambling is sustained and promoted by a powerful global industry in ways that not only make it more widespread but also shape how we think about appropriate policy responses to the health effects of its products. The approach above allows the gambling industry to be seen as a legitimate policy actor, with the regulator legally obliged to consult the industry when planning the governance of its practices and products.⁶⁸

By defining people as the problem, the Gambling Act 2005 shifted blame and implied that the problem could be addressed through public education and treatment for those who cannot or who will not gamble responsibly. This provided space for the gambling industry to step into and it did this readily by becoming the main funder of research, education, and treatment, and yet after over 40 years of industry research funding there is little high-quality research on a public health approach to prevent gambling harms. The current system preserves the status quo, leads to a tolerance of harm, and presents the industry as part of the solution⁶⁸.

The political will of governments to enact policies and legislation to address harmful industries can have a transformational impact on population health and wellbeing⁶⁶. We see this in the approach to tackling tobacco which demonstrates that public health approaches can seek to and succeed in protecting current and future generations from a predatory industry.

In England, the North-East has the highest number of gamblers who are at-risk of developing harms from gambling (4.9%). These harms represent a disorder, rather than a disease that directly causes ill health or death, but evidence shows that it can lead to significant adverse health and wellbeing outcomes.

Harmful gambling is also associated with an increase in criminality. Despite this, current policy responsibility for gambling is held by the Department for Digital, Culture, Media, and Sport rather than the Department of Health and Social Care, confirming that gambling is not considered a public health issue in the current legislative framework.

Other impacts include⁶³:

Suicide

The leading causes of death associated with gambling harm are suicide and domestic homicide/filicide. Gambling severity, increasing losses and unmanageable debt are predictive of a greater tendency to suicide.

Financial harm

Often severe and affects both the gambler and those closest to them, especially partners. Gambling has been associated with poor concentration at work and tardiness, eventually leading to resignations, demotions, or termination of employment. Bankruptcy, housing problems and homelessness are also associated with gambling. Financial harm also negatively impacts relationships, mental health, and criminal behaviour.

Relationships

Gambling harm is associated with a reduction in both social support and family functioning. Gambling is associated with arguments, relationship strain and domestic abuse. Relationships with those closest as well as wider friendship networks are negatively affected.

Mental Health

People experiencing gambling harm described experiencing shame, guilt, loneliness, sleep difficulties and low self-esteem. Close associates similarly reported negative emotions and poor sleep.

Affected others

Around 7% of Great Britain have been negatively affected by someone else's gambling. Affected others are most commonly women. Of those affected, partners/spouses accounted for 48% of those affected, followed by a parent gambler (41%) and a child gambler (38%).

Vulnerable groups

Groups vulnerable to gambling harm include those who misuse alcohol and drugs, have mental health difficulties, and offender populations. There is also a higher prevalence of harm in people who are unemployed and live in deprived areas. The most socio-economically deprived and disadvantaged groups in England have the lowest gambling participation rates, but the highest levels of susceptibility and harm from gambling. Therefore, gambling is related to and exacerbates health inequalities. Young people are a vulnerable, higher prevalence group and being young and male is a strong predictor of developing problems with gambling. Young men of lower socio-economic status are particularly vulnerable. Gambling in children and young people is associated with poorer mental health, particularly anxiety and depression. Framing gambling as an individual choice, a classic tactic adopted by the TI, causes victim blaming and stigma and is at-odds with the service user experience. Gambling harms can be experienced across the spectrum of gambling involvement/participation. Therefore, population level interventions that focus on the gambling environment, gambling products and the wider determinants of gambling-related harm are needed.