Experts Call for Public Health Approach to Gambling

Dawn O'Shea

October 08, 2021

Experts are calling for a public health approach to the prevention and treatment of harmful gambling following the publication of a report by Public Health England (PHE) which estimates that 0.5% of the English population meet the threshold for problem gambling and a further 3.8% are at-risk gamblers.

The Gambling-related harms evidence review reports that people with gambling disorder have an increased risk of dying from any cause in a given period of time compared with the general population. This risk is greatest in those aged between 20 and 49 years.

Deaths from suicide were significantly higher among people with gambling disorder or gambling problems. The evidence reviewed by PHE suggests that people with gambling problems are twice as likely to die from suicide than the general population, one study included in the review reported that people with gambling disorder have a 19 times greater risk of dying from suicide. Other studies found that some people, especially women, had already experienced suicidal events before starting to gamble, suggesting that gambling may trigger suicidal events in people already prone to suicide.

Gambling showed links with anxiety, depression and sleep problems, not just in gamblers themselves but also in family members and close associates.

Studies also reported mixed findings on the link between gambling and various measures of alcohol, smoking and drug use. In qualitative studies, gamblers reported co-occurring alcohol and drug-related problems.

Health Inequalities

Although the highest rates of gambling participation are among people with higher academic qualifications, people who are employed and among relatively less deprived groups, harmful gambling is more common is people who are unemployed and among people living in more deprived areas. This suggests harmful gambling is related to health inequalities.

The North West (4.4%) and North East (4.9%) had the highest prevalence of at-risk gamblers, whereas the South West (3.0%) had the lowest prevalence.

Commenting on the report, Faculty of Public Health President Professor Maggie Rae said: "Harmful gambling is a major public health issue which seriously impacts on health in a number of ways. As well as suicide and severe mental health problems, this report highlights harms caused by gambling including financial, employment, relationships, physical health, and criminal activity."

"Gambling organisations are preying on people’s addictions, and we see that the burden of gambling harms is born by those already facing disadvantage, serving to widen existing health inequalities," Professor Rae said. "This report is welcome as it highlights the wide range of harms caused by gambling, and calls for concerted action to tackle this major public health problem. This urgent call is especially timely as we have seen these problems exacerbated by the COVID-19 pandemic."


Data from 2018 show that 24.5 million people in England gamble. The National Lottery is the most common type of gambling across all age groups, except among younger people, where scratch cards are more common. Football pools and electronic gaming machines are more common among people under 35 years of age. Men are more likely to gamble than women, and this difference is most obvious for online gambling where 15% of men participate compared with 4% of women.

Demographic factors, particularly being male, appear more significant in predicting at-risk gambling behaviour than economic factors such as income, employment and relative deprivation. Poor mental health is a stronger predictor of at-risk gambling than both poor physical health and negative health behaviours, with the exception of alcohol.

Harmful gambling has a different activity profile to general gambling. It includes low National Lottery participation and high participation in online gambling, casino and bingo games, electronic gambling machines in bookmakers, betting on sports and other events, betting exchanges and dog racing. Harmful gamblers are far more likely to participate in seven or more gambling activities. Overall participation in online gambling for at-risk gamblers (23.4%) was more than double that of the general population (9.4%).

Economic Cost

Overall, PHE estimates that the annual economic burden of gambling is approximately £1.27 billion, however, this could be as high as £2.12 billion.

The estimated excess health care costs associated with gambling-related harms is £961.3 million, based on the direct costs of treating depression, alcohol dependence and illicit drug use, as well as the wider societal costs of suicide.

The estimated excess cost of suicide is £619.2 million, based on an estimated 409 suicides associated with problem gambling, with further cost of £335.5 million for the 212,511 people with depression and problem or at-risk gambling.

Rosanna O’Connor, Director of Alcohol, Drugs, Tobacco and Justice at PHE, stressed that there is much more at stake from gambling than just losing money, from the toll on mental health to the impact on those around the gambler.

"The evidence is clear - harmful gambling is a public health issue and needs addressing on many fronts, with an emphasis on preventing these harms from occurring as well as with help readily accessible for those directly and indirectly affected by the wide ranging and long lasting negative impacts of gambling," she said.

Stakeholders’ Views

The review also includes the findings of a qualitative analysis of stakeholder perspectives based on 302 respondents to the consultation and 929 tweets from 669 individuals. The analysis showed that commercial stakeholders believed the causes of harmful gambling are complex and could be due to co-morbidities or a tendency towards addiction. However, non-commercial stakeholders thought that harms are caused directly by gambling products and gambling environments.

Furthermore, commercial stakeholders believed that harms are experienced by a minority of gamblers only, whereas non-commercial stakeholders took a broader view that harms can be experienced by any gamblers and can also be experienced indirectly by families and society.

There were also differences in relation to the measures required to prevent and reduce gambling-related harm. Commercial stakeholders thought the focus should be on individual interventions and treatment. Non-commercial stakeholders thought that tackling gambling-related harm required a whole system, public health approach.

Jim McManus, Vice President of the Association of Directors of Public Health, agrees. "This evidence review from PHE paints a stark picture of the avoidable harms from gambling to the economy, society and the individual. Again, we see that existing regional inequalities are exacerbated by these harms with those from poorer areas at higher risk from the negative impacts."

"A public health approach, with cross-government support, properly funded, is essential to reducing harmful gambling and all the negative consequences highlighted by this research in relation to debt, relationships and jobs," he said.

Next Steps

PHE is now undertaking a Delphi study to identify public health policies and interventions that could be adapted to address the gambling-related harms identified in the review.

The Office for Health Improvement and Disparities will work in partnership with other government departments and key stakeholders to develop a workplan to address gaps in knowledge and improve data collection, as well as delivering effective and implementable responses to gambling-related harms.

This article originally appeared on Univadis, part of the Medscape Professional Network.


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