Gambling: a neglected public health issue
Authors: None The Lancet Public Health
Journal: The Lancet Public Health (2021)

Today, in The Lancet Public Health, Heather Wardle (University of Glasgow, Glasgow, UK), Louisa Degenhardt (University of New South Wales, Sydney, Australia), and Shekhar Saxena (Harvard University, Cambridge, USA) announce the launch of the journal's inaugural Commission on Gambling—a scientific inquiry and response to an urgent, neglected, understudied, and worsening public health predicament. Gambling involves placing something of value at risk in the hopes of gaining something of greater value, and includes casino gambling, lotteries, and internet gambling. Gambling is not an ordinary activity: it is a health-harming addictive behaviour, recently recognised in the International Classification of Diseases 11th Revision (ICD-11) and Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5). Gambling disorders often remain undiagnosed and untreated. According to WHO, the prevalence of gambling disorders among adults varies between 0·1% and 5·8%. Gambling is a source of potentially serious and wide-ranging harms, affecting an individual's health, wealth, and relationships. It affects whole families and communities, and can become a lifelong struggle to avoid relapse. There is an urgent need to assess and understand the barriers and facilitators to preventing gambling-related health harms. The rapid and geographically broad increase in use of internet and smartphones has completely altered the gambling landscape. Today, the possible adverse effects of the COVID-19 pandemic on addictive behaviours and disorders are yet to be fully understood. The COVID-19 pandemic response, bringing lockdowns and unprecedented restrictions in people's lives, could act as a catalyst, intensifying gambling behaviours by increasing time spent at home and time spent online. Preliminary data from a survey of 6000 respondents in China suggest that coping behaviours during the COVID-19 crisis increased the risk for substance use disorders and internet addiction. An awareness of this growing public health issue could provide an opportunity to ensure public support to tackle gambling-related harms and protect the most vulnerable. In this issue of The Lancet Public Health, Heather Wardle and Sally McManus report results from a survey in young adults aged 16-24 years showing an association between gambling behaviour and suicidality (suicidal thoughts and suicide attempts). As Charles Livinsgtone and Angela Rintoul note in an accompanying Comment, ”In view of these data, it is crucial to improve screening and support services for people with gambling problems, either within primary care or in addiction treatment settings”. Unfortunately, gambling has been neglected and understudied as a public health issue. In their review of interventions to reduce the burden of gambling-related harms, Lindsay Blank and colleagues conclude that the evidence is sparse and weak. But they also caution that it is imperative to ensure that a scarcity of evidence is not used as a justification for inaction. They warn that the complexity of the relation between gambling and its associated harms, together with the paucity of robust evidence, could be used as a rationale to oppose or delay policy interventions. They argue that, “The gambling industry will strongly resist and argue against proposals to introduce interventions that might regulate or restrict their commercial activities.” Gambling is a highly profitable industry, but policy makers should not ignore the substantial threats to health and wellbeing that exist. The normalisation of gambling in many countries, its widespread and easy accessibility, and governments' addiction to revenues from gambling could be a threat to reaching the sustainable development goals. The growth of commercial gambling across sub-Saharan Africa and the so-called gamblification of sports over recent years deserves closer scrutiny, not least because gambling can deepen poverty. Gambling-related harms reveal multiple intersections between the social, commercial, and political determinants of health. It is against this backdrop of complexity that the The Lancet Public Health Commission on Gambling will apply a public health lens. Conscious of the challenges ahead—nationally and globally, in high-income and low-income settings, today and post-COVID-19—the Commission will be science-led, international, multidisciplinary, and will aim for transformational change in policy and political action. Gambling and its related health harms have been ignored and hidden from public health scrutiny for too long—our Commission intends to correct this aberration. The Lancet Public Health Commission on gamblingGambling is pervasive in society and is provided by increasingly powerful supra-national corporations, whose reach transcends national boundaries. The development of commercial gambling practices is deeply tied to technological development, and leaps in communication technologies have resulted in the expansion of commercial gambling.1 This pattern is also evident with online infrastructure, where the development of smart phone technology and increased accessibility and speed of access to the internet has generated new gambling products that were previously unavailable (eg, in-play betting). Full-Text PDF Open AccessGambling-related suicidality: stigma, shame, and neglectThe relationship between gambling and suicidality is now more apparent than ever. In The Lancet Public Health, Heather Wardle and Sally McManus1 provide an important addition to a growing body of literature on this important and greatly worrying issue. The factors that might lead many people to gamble are also likely to have been exacerbated this year by the COVID-19 pandemic and consequent economic recession, with further possible consequences for public health. Full-Text PDF Open AccessSuicidality and gambling among young adults in Great Britain: results from a cross-sectional online surveyProblem gambling appears to be associated with suicide attempts in both young men and young women. This association persisted after adjusting for anxiety, impulsivity, life satisfaction, and other factors, which suggests that other mechanisms, such as the severity and multiplicity of harms experienced, or gambling to cope with life stressors, might underpin this relationship. Young people with problem-gambling behaviours should be considered at risk for suicidality. Full-Text PDF Open AccessInterventions to reduce the public health burden of gambling-related harms: a mapping reviewRecognition is growing that gambling, although highly profitable for corporations and governments, is a source of serious and unevenly distributed harm. This recognition has led to demands for public health strategies at the local, national, and international levels. We aimed to identify review-level evidence for interventions to address or prevent gambling-related harms and explore policy implications, using stakeholder consultation to assess the evidence base, identify gaps, and suggest key research questions. Full-Text PDF Open Access