Would a public health approach help tackle problem gambling?

What is a public health approach?

Public health is the ‘science and art of preventing disease, prolonging life and promoting health through the organised efforts of society’. It recognises the effect of systems on individuals, and how our health is partly determined by our social surroundings and environment.

Public health often uses a multi-pronged approach, focusing on the three levels of prevention: primary (investing in infrastructure to stop problems occurring in the first place); secondary (a focus on early detection, to implement harm-reduction interventions); and tertiary (minimising the negative consequences of a problem). While it has commonly been used to address large issues – including epidemics, smoking and obesity – public health is also recognised as a school of thought that can be applied to issues outside of clinical healthcare.

In 2005, Strathclyde Police in Scotland set up the Violence Reduction Unit (VRU) in response to a World Health Organization report calling Glasgow the ‘murder capital of Europe’. The initiative recognised that punitive and justice-based interventions had not been effective at reducing violence and crime, and that a public health approach was needed to address its causes holistically. The unit utilises the three levels of public health prevention, with a focus on tackling the societal conditions that allow violence to develop.

In 2006, the VRU was expanded to cover all of Scotland, and the country has seen a dramatic reduction in violent crime. And following on from the unit’s success, a number of VRUs have been set up across the UK. The success of the VRU demonstrates that taking a public health approach to ‘non-health-related’ issues can have a huge positive impact.

What does a public health approach to problem gambling look like?

Using a public health framework to deal with problem gambling requires a multi-pronged approach that utilises the different levels of prevention. In Aotearoa New Zealand, a public health approach to problem gambling has been in place since 2003. Health NZ offers a range of interventions, including promoting public health policy; developing personal skills and promoting responsible gambling behaviour; increasing community awareness around problem gambling; creating environments where at-risk populations receive targeted support; and monitoring and updating interventions to reorient services to meet the needs of the public.

Evaluations of some of the interventions have shown a long-term positive impact on problem gambling behaviours. Monash, Australia, has implemented a number of interventions that take a public health approach to gambling, including a campaign to reduce the number of gaming machines in the city; support groups for at-risk communities, to prevent and reduce gambling harm; and policy guidelines for future interventions.

Some proposed evidence-based interventions to reduce problem gambling include:

• collecting comprehensive data to show the prevalence and distribution of problem gambling in the UK, which will facilitate the design of targeted interventions
• using in-community workers to facilitate communication and cooperation among different stakeholder groups
• removing gambling advertising in all forms, including sports team sponsorships
• levying mandatory taxes on gambling companies to help fund research, education and treatment around gambling harms
• providing specialised counselling services for those dealing with problem gambling, with robust referral processes to other sectors if needed
• launching large-scale public awareness campaigns, including in-school lessons, about the harms of gambling and the signs of problem gambling.

The status of a public health approach to problem gambling in the UK

Despite the fact that problem gambling has long been recognised as a public health issue by the UK’s Gambling Commission, the Labour Party and Peers for Gambling Reform (a bipartisan group that aims to implement legislation to reduce gambling harm), few policies have been implemented that approach it through a public health lens. A 2023 UK White Paper on possible reforms of the 2005 Gambling Act received mixed reactions from gambling control advocates, charities and researchers. There were positive reactions to the recognition of problem gambling as a public health issue, and to the proposal to tax the gambling industry to raise revenue for research, education and treatment. But a lack of regulation around gambling advertising was identified as a missed opportunity for primary prevention. The White Paper’s proposed timelines were also criticised for being too long; immediate action is needed to reduce the impact of problem gambling.

The shortfall in policy recommendations has been attributed to factors including political influence from gambling companies; revenue earned by taxing the gambling industry; a desire not to affect people who engage in recreational gambling; and a belief among the public that problem gambling is a self-inflicted issue that doesn’t require system change.

More needs to be done to tackle problem gambling

While politicians in many countries recognise problem gambling as a global public health issue, future legislation should consider the lessons learnt from countries where a holistic approach has been taken. Efforts to tackle the problem should promote prevention strategies, which might include: banning advertising of gambling (or, at least, minimising young people’s exposure to it); providing screening and support services to people at risk; and levying taxes on the gambling industry to help fund research, and to educate and treat those affected by problem gambling.

The opinions expressed in this blog are those of the author and do not necessarily represent the views of The Health Policy Partnership.