PHE’s gambling review made explicit that for gambling harm to be tackled effectively it needs to be treated as a public health issue. DDN hears from GambleAware chief executive Zoe Osmond about her organisation’s public health approach.
Public Health England’s (PHE) long awaited Gambling harms: evidence review (see news, page 4 ) stated that harmful gambling needed to be considered a public health issue as it was ‘associated with harms to individuals, their families, close associates and wider society’.
The review examined the mental and physical health harms associated with gambling in almost 50 different studies, and found that people with a gambling disorder have an ‘increased risk of dying from any cause, in a given time period, relative to the general population’. People with gambling problems were ‘at least’ twice as likely to die as a result of suicide, and there was also a ‘clear link’ between problem gambling and heavy drinking, with three quarters of people consuming more than 50 units a week also participating in gambling – more than twice the level for non-drinkers. ‘The aim of public health is to improve the health and wellbeing of the whole population,’ said a 2018 policy statement from the Faculty of Public Health – and as gambling had the potential to cause harm to both individuals and to wider society it was clearly an issue that ‘cannot be tackled by interventions aimed solely at individuals’.
Inequalities
It hardly needs stating that, as with drugs and alcohol, the people most vulnerable to gambling related harm are concentrated in areas of higher deprivation, meaning that gambling is further exacerbating already entrenched health inequalities. A recent report from the University of Bristol and the Standard Life Foundation found that gambling premises were ten times more prevalent in deprived areas, with Standard Life Foundation chief executive Mubin Haq stating that ‘those with the least resources are being targeted more’ (DDN, September, page 4). And of course none of this was helped by the liberalisation of the gambling laws in 2005, which made it far easier for gambling companies to advertise on TV.
PHE’s call for a public health approach has been welcomed by the charity GambleAware, which recently recruited two senior staff with extensive public health experience as part of a restructuring to deliver a new five-year organisational strategy – chief commissioning officer Anna Hargrave worked in NHS commissioning for 13 years, while chief communications officer Alexia Clifford led numerous public health campaigns for PHE on issues including mental health and stopping smoking.
Vision
The strategy defines the charity’s vision of a society ‘where people are safe from gambling harms’, chief executive Zoe Osmond tells DDN, underpinned by four key commissioning objectives – developing awareness and understanding of gambling harms; increasing access to services and reducing gambling harm inequalities; building capacity among health and community services to improve their response, and improving the coherence, accessibility, diversity, and effectiveness of the National Gambling Treatment Service (NGTS).
A whole-system approach is needed to achieve this, says Osmond, with GambleAware recognising the ‘many other organisations, networks and individuals that already play a key role across the gambling harms prevention system, or that have the potential to do so in the future’. Collaboration with the government, NHS, public health agencies, local authorities, and voluntary sector organisations will be key, while the new appointments will also help to expand the ‘clinical commissioning and public health expertise within GambleAware’, she says.
While gambling is a growing public health threat alongside poor diet and heavy drinking, the public does seem to be generally onside when it comes to tighter restrictions. A recent YouGov survey of almost 12,500 people found that more than three quarters of adults backed a ban on TV gambling adverts before 9pm, with the same number supporting a requirement for the industry to pay a levy to finance efforts to tackle problem gambling (DDN, July/August, page 4) – indicating that there’s far less inclination to brand restrictions ‘nanny state’ than with alcohol interventions like MUP.
‘GambleAware is concerned about gambling becoming part of everyday life for children and young people,’ says Osmond, with research commissioned by the charity in 2019 showing that exposure to advertising, including on social media, can have ‘an impact on attitudes towards the prevalence and acceptability of gambling, and in turn the likelihood that a child, young person or vulnerable adult will gamble in the future’. However, as the ‘lead commissioner working to prevent gambling harms, our job is to highlight concerns through our research and experience – it’s up to politicians to take our research and the evidence of other organisations to decide on what legislative change or policy measures are needed to address these concerns.’
Family breakdown
Of course the impact of problem gambling isn’t just restricted to the gamblers themselves. There’s also the impact on families – not just financial but higher rates of divorce, family breakdown, and associations with neglect of, or violence towards, partners and children. The GambleAware commissioned Treatment and support survey found that around 7 per cent of the population could be considered ‘affected others’ – people negatively impacted by someone else’s gambling – and who are more likely to be women, says Osmond. ‘The same report found that the vast majority of “affected others” said their relationship had been affected by the gambling of someone else. This could manifest in the form of an inability to trust the person, a breakdown in communication with them, increased arguments about their gambling, having less quality time with the person, family violence or conflict, and the taking over of decision making in the home.’
As with almost everything else, the pandemic has also had an impact. Research by the University of Bristol found that regular gamblers were more than six times more likely to gamble online compared to before COVID-19 – as betting shops were forced to close – a habit they’re unlikely give up now restrictions have lifted. How much has online gambling worsened the situation overall, with its instant, 24-hour access?
‘There is no doubt that since the introduction of the Gambling Act 2005, gambling has become far more accessible and the industry has been allowed to market itself in ways that had not previously been permitted,’ she says. ‘The advancement of technology, and the consequent growth of online gambling and gaming, has been the most significant driver, and during the pandemic there’s been widespread concern about a rise in gambling online.’ As with research into alcohol consumption during lockdowns, which has tended to find that the heaviest drinkers were drinking even more, GambleAware’s October 2020 COVID-19 research found that while there had been a 10 per cent reduction in gambling activity overall between March and May last year, those considered problem gamblers had increased their gambling during the same period.
Prevention strategy
‘Simply stating that gambling is a public health concern is not enough,’ said a 2019 BMJ article, Gambling and public health: we need policy action to prevent harm. ‘It must also be treated as one by policy makers through the development and implementation of a fully realised and sustainably funded strategy for preventing harms among the population,’ and GambleAware backs the calls for a mandatory levy on the industry to ‘guarantee the funding stream for research, education and treatment of gambling harms,’ Osmond states.
‘A levy would produce a much more consistent and sustainable flow of funding, as well as significantly improve transparency and confidence in the treatment commissioning process as a whole. We’re engaged in commissioning treatment and prevention services that are costly and have to be commissioned on a long-term basis to provide any sort of certainty for providers as well as for those seeking and accessing treatment. Despite the recent welcome financial commitment from some in the industry, ultimately only a mandatory levy will create the certainty and transparency needed.’