SCWRU Researcher, Caroline Norrie, reports on a NatCen-hosted debate about whether gambling should be treated as a public health issue. (1,335 words)

Researchers, industry and government representatives, LA staff and gambling-support organisation workers gathered to debate whether gambling is a legitimate entertainment activity or an escalating public health danger on 7 March 2018 at the NatCen (National Centre for Social Research) offices in London.

Opportunities to gamble have burgeoned in England since the introduction of the Gambling Act 2005 (implemented in 2007). Industry de-regulation combined with technological advances have triggered an explosion of new online and offline gambling products which has been accompanied by widespread cross-media advertising.

Whether gambling should be classified as a public health matter and regulated in line with drugs, alcohol, has therefore become a hot topic. The government are currently holding a consultation on proposed changes to gaming machines (FOBTS – fixed odds betting machines, where large sums of money can be gambled in a matter of minutes) and social responsibility measures. Meanwhile the gambling industry maintains that gambling is an enjoyable leisure pastime enjoyed safely by most people and the status quo is acceptable in terms of regulation and advertising.

Under the current model, gambling is regulated by the Department for Digital, Culture, Media & Sport (DCMS); those in favour of a public health approach advocate moving gambling under the remit of the Department of Health & Social Care (DHSC), arguing this is more appropriate given the associated health implications for some people.

Anne Conolly, Research Director, Health Survey for England, NatCen, summarised quantitative data about gambling participation. She presented findings from the NatCen British Gambling Prevalence Surveys as well as more recent NHS datasets which include a gambling question. Key findings were identified: for example, the majority of adults reported some form of gambling behaviour in the last 12 months (63%). In general, similar gambling participation rates have been found across Great Britain and levels of problem gambling, defined as ‘gambling to a degree that compromises, disrupts or damages family, personal or recreational pursuits’ have remained relatively stable. 0.8% of adults are problem gamblers, equating to approximately 430,000 people, and 3.9% or approximately 1.89 million adults are at risk of problems. The audience was reminded, however, that these are self-reported surveys and there are many reasons respondents might not admit to problem gambling.

Certain groups were reported as being particularly susceptible to problem gambling including men, younger people, single people, those who have never married, ethnic minorities, people of lower socio-economic status, and tenants. Problem gambling rates were also higher among current smokers, people with a General Health Questionnaire 12 score above 4 and people with a low level of mental wellbeing.

Heather Wardle, Assistant Professor, London School of Hygiene and Tropical Medicine took a more sociological stance and declared herself in favour of using a public health approach, but noted challenges to the popularisation of these strategies. She noted how public health approaches can include broad-brush, whole-population methods, but can also be targeted interventions focusing on individuals. Take for instance anti-smoking strategies; many different levers have been used to try to reduce smoking, including changes to advertising as well as specific cessation initiatives. Heather questioned how these approaches would work if applied to gambling with its spider web of different harms?

Heather argued that there are tensions in the Care Act itself between people’s liberty to gamble and protection against exploitation especially for vulnerable adults and children.   This chimes with our own research about safeguarding, adults at risk and gambling-related harm (Bramley, Norrie, Manthorpe, 2017). There has been no public debate in England about this and whether public health approaches would be viewed as appropriate.

Heather highlighted that biomedical approaches focusing on health outcomes do not encompass the financial harm, ruined relationships, loss of time and mental health problems experienced by problem gamblers. The harm-minimisation initiatives that have been introduced so far in England (such as self-exclusion measures, where a problem-gambler can ban themselves from certain gambling environments, e.g. local betting shops) are aimed at individuals. These have not been impactful because problem-gamblers can easily find alternative opportunities to gamble if banned from one medium.

Gambling participation is highly varied across the population as was described earlier, but Heather stated a more nuanced picture is required, so for example, people from deprived areas and minority groups are less likely to gamble, but once they start, they are more likely to experience problems. So, levers would have to be evidence-based and skilfully applied.

Heather concluded by calling for a change in the discourse and a move away from discussion of prevalence rates to a focus on people who are unwell and need support. She highlighted the need for gambling-related harms to be defined so improved measuring and monitoring could take place, including longitudinal approaches so better understanding of gambling throughout the life-course could be ascertained.

Dan Waugh, Regulus Partners represented the point of view of the industry and responded to points raised by Heather. Dan started by expressing shared concerns about various aspects of gambling. He noted that in casinos, half of all customers visit once a year only, and there is high expenditure by a relatively small group of people. The industry hoped-for democratisation of gambling which would attract a cross-section of new players has not happened over the past ten years; rather those who do participate have increased their expenditure. It was also noted that only 34% of gamblers stated they were involved to have fun, while 46% were in it to win money – so could this be described as a ‘fun’ leisure activity, and how does this compare to the number of people who ‘enjoy’ drinking or smoking? Dan stated that despite this, it was not easy to find the harms created by gambling. Instead, it could be possible that public health issues are not severe and greater public awareness was raising fears about gambling-related harm rather actual increases in problem cases.

Dan noted how gambling venues such as bingo halls also provide jobs and opportunities for enjoyable activities, for example for older people; foot fall is decreasing to these venues and their closure would be a loss to local communities.

Dan agreed there was a need, however, to focus on public health rather than individuals and stated it had taken the industry a long time to wake up to this. He stated recent cost- benefit research (e.g. costs of prison, GP appointments, etc) was progress and moved the debate away from prevalence surveys, which did not address the complexity of gambling-harms.

Dan also stated that the ‘responsible gambling’ message was also possibly not helpful and different messages were needed for specific groups of problem gamblers. He expressed the view that people with gambling issues are made to feel to blame for their problem in a way that those with an alcohol addiction might not be.

Audience members raised interesting issues. Sarah Ramanauskas from gambling support charity, Betknowmore, for example asked about the role of the product from a public health perspective/consumer perspective. She felt emphasis should be placed on acknowledging some products are riskier than others. Other attendees raised points about the need for cross-platform research as higher-risk customers gamble in a variety of environments.

Toby Spouce from NatCen returned the discussion to how gambling is similar or different to other public health issues such as drugs, alcohol or obesity and noted gambling has more parallels with alcohol than tobacco, as the harms manifest themselves as affecting friends and communities, rather than health directly.

Finally, concerns were raised about risks to younger people from gambling participation, gambling incorporated into online gaming, and targeted social media gambling advertising.  One participant commented that young men are particularly vulnerable and having an addiction at an early age could impact on their life chances.

The debate will continue………meanwhile we await with anticipation the Government’s decision on the reduction of stake size permitted on FOBTs, which is likely to be announced very soon.

Caroline Norrie is a Research Fellow at the Social Care Workforce Research Unit, King’s College London. Project page. This blog post was written on 20 March 2018.

Reference

Bramley, S., Norrie, C. & Manthorpe, J. (2017) ‘The nature of gambling-related harms for adults at risk: a review‘, London: Social Care Workforce Research Unit, Policy Institute at King’s College London.