[Comment] Offline: Gambling—“We are everywhere, we see everything”

The annual office Grand National sweepstake is a harmless ritual for many. What’s wrong with an occasional flutter? In the UK, what’s wrong is that 430 000 adults are living with a serious gambling problem. More shockingly still, 55 000 children aged 11–14 years are addicted to gambling. Such is the growing awareness of this emerging public health threat that gambling has now been classified as a behavioural addiction. In DSM-5, gambling is defined as a persistent, recurrent pattern of behaviour that is associated with substantial distress or impairment. A similar reclassification took place in ICD-11. There is a wide understanding of the epidemiology, pathophysiology, genetics, neurobiology, diagnosis, screening, prevention, and management of gambling. But there are also vast gaps in our knowledge. The result is that millions of people are undiagnosed and untreated. Worse, the landscape of gambling behaviour is not static. The advent of internet gambling has accelerated physical and mental harms. And the links between gaming and gambling are only now being teased apart. So, a question: is gambling a legitimate part of the entertainment industry or is it a dangerous and unregulated predator on the young and the vulnerable? Answers were sought during last week’s Global Health Lab, held at the London School of Hygiene & Tropical Medicine and chaired by Martin McKee.

Heather Wardle is a specialist in gambling behaviour and policy. She argued for a more capacious definition of gambling-related harms. Those harms include adverse effects on resources (work and employment, money and debt), relationships (partners, families, and friends), and health (physical and mental health, psychological distress). Gambling is no ordinary commodity. It is not a simple leisure pursuit. Gambling is related to social inequalities. And it is an industry driven by technology. Politicians commonly argue that gambling is purely an issue of freedom. When defending the UK’s Gambling Act 2005, the late Tessa Jowell said that, “In the future, well-informed adults will have greater freedom and choice to spend their leisure money on gambling if they want to. The law will, for the first time, treat them like grown ups.” This argument is dangerously naive. The global gambling industry has used unprecedented quantities of individuals’ data, together with techniques of precise electronic personalisation, to ensure that gambling begets more gambling, drawing people ever deeper into a hellish vortex of addiction. The expansion of gambling has disturbing neocolonial dimensions too. In Africa, the combination of widespread smartphone use and a love of sport is creating fertile opportunities for new gambling markets to flourish. Free markets are generating sharp global risks.

The shadow of gambling is large. May van Schalkwyk studies gambling policy and the commercial determinants of health. She described how for every problem gambler, 17 others are affected deleteriously. Gambling will limit progress to reach the Sustainable Development Goals, not least because gambling deepens poverty. But curbing the globalisation of gambling will not be easy. Liberalising trends towards more open markets, deregulation, and consumer freedom do not help. Governments earn vast tax revenues from gambling and so have little incentive to step in and strengthen protections. If we truly want to tackle gambling, we will have to rethink fundamental assumptions about the way our societies and their economies are structured. Darragh McGee specialises in ethnographic studies of the social, economic, and political determinants of health. He framed gambling as an important dimension of the predicament of being young. Africa, for example, is facing a child betting epidemic. With 3 billion people having access to smartphones, multinational gambling corporations have the democratic means to expand their commercial gambling operations quickly. They can do so because of non-existent or outdated regulatory and legislative regimes. And the urge for identity formation among young people adds a further incentive to join what is quite literally “casino capitalism”. All three speakers at last week’s Global Health Lab conveyed the utter evil of an industry that does indeed prey on those facing social peril and financial precarity. Gambling is not taken seriously enough by the global health community. It is a world we don’t see and still less understand. But as the gambling industry itself says: “We are everywhere, we see everything.” It’s time we shed our ignorance.

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Published: 21 December 2019

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DOI: https://doi.org/10.1016/S0140-6736(19)33152-6

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© 2019 Elsevier Ltd. All rights reserved.

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