Time for policies on gambling to benefit health ‐ not the gambling industry

It has been more than a decade since the last HPJA editorial calling for action on gambling.1 Since then, the industry has exponentially expanded its reach into new markets and media. With this increased focus comes an opportunity for action to mitigate the health and social impacts of the industry's tactics and harmful products. The current Australian federal parliamentary inquiry into online gambling and its impact for those experiencing gambling harm,2 can provide a pathway to transformational reform of the Australian commercial gambling industry. Recent Royal Commissions and Inquiries into casinos in Australia,3-5 and a New South Wales (NSW) Crime Commission report into money laundering through poker machines in community clubs and pubs,6 have also sparked national debate about the gambling industry's adverse behaviour. They have also demonstrated how “harmful industries and complacent and complicit governments can create doubt and frame the public debate with devastating consequences” for community health and wellbeing.7 In this editorial, we argue that it is time for comprehensive governmental action to protect the Australian community from being harmed by the commercial gambling industry and its products. Gambling products—ranging from lotteries and instant scratch tickets to casino games and poker machines, and more recently online wagering—have become increasingly normalised and none are harm-free. Many gambling products are linked to issues of major community concern including family violence, homelessness, energy poverty, mental health problems and suicide (see8). These harms impact not only on the individual gambler, but also on their social network members.9 Prolific and omnipresent gambling marketing has also led to the normalisation of gambling for children and young people, who are now exposed to gambling products and promotions in everyday community settings, and consider gambling a normal or common part of sport.10 Unhealthy commodities exacerbate pre-existing health and social inequities,11 and gambling is a powerful example of how industries can amplify these harms when governments do little to regulate them appropriately. With the exception of Western Australia (which does not allow poker machines outside the casino), community gambling venues are overwhelmingly concentrated in areas of deprivation and disadvantage,12 with losses from poker machines in some municipalities reaching over $440,000 every day.13 The advent of modern technologies has also meant that no community is immune from incentives and opportunities to gamble. Those who should play a key role in promoting and protecting community health and wellbeing have become integral to the normalisation, legitimisation and promotion of the gambling industry and its products. While sporting peak bodies claim that sports deliver “long term social, health, community and economic benefits”,14 sporting organisations and athletes have been willing to accept money from industry for promotions, have endorsed gambling through marketing and sponsorship relationships, and own gambling venues.15, 16 Researchers and professional organisations have accepted funding and sponsorship from the gambling industry, becoming part of the industry's corporate social responsibility strategies.17 Regulators participate in gambling industry events, giving the industry credibility and providing scope for direct or indirect lobbying. Politicians also present messages that encourage and normalise gambling and frame the “problem” as associated with a small minority of individuals—“We all have a role to play in supporting Queenslanders to gamble safely”18; “There is no problem if people have the occasional punt on the Melbourne Cup, the problem is a group of people who will become problem gamblers”19; “Most people can gamble without experiencing any harm but for a small minority it can become a huge problem impacting multiple areas of their lives”.20 Political parties and members of parliament have accepted donations and other gifts from the gambling industry,21 and own gambling venues.22 Governments and political parties have been reluctant to implement reforms based on compelling independent evidence. An example is the policy response to the NSW Crime Commission's investigation into criminal gambling activity into clubs and pubs, which recommended the introduction of a cashless gambling system to minimise money laundering associated with poker machines in clubs and pubs.6 While this measure has been supported by peak charities, unions, and health organisations, and parties across the political spectrum, the newly elected NSW Labor government has only committed to a tokenistic trial of this system in 500 out of the state's 86,000 machines.23 It is our observation that governments do not appear willing to accept that the gambling industry merits similar robust policy responses to those that have been applied to other harmful industries, or to utilise the considerable expertise that now exists in responding to addressing their activities. Gambling is mostly dealt with through agencies with a regulatory focus and little if any expertise in prevention, or through statutory bodies which may see the industry as an important partner.25 As noted elsewhere,26 there is rarely a comprehensive, whole-of-government approach to important health issues. This is compounded in relation to gambling by minimal political will to invest in prevention strategies, or to include health departments and related groups with relevant expertise, not least from the health promotion sector, which has so much to contribute in terms of developing evidence-based policies and programs.27 Both inside and outside government, organisations and researchers remain largely focused on downstream, individualised behavioural solutions rather than broader population approaches. These personal responsibility approaches encourage individuals to “gamble more safely”,28 get their gambling “under control”,29 “become more aware” of their gambling,30 or “take charge” of their gambling.31 While support for those affected by gambling harms is important, this should not occur in isolation, or with the implication that it somehow also serves to play a significant role in risk prevention.32 There is seemingly limited interest in funding transformative, upstream prevention approaches, or addressing the commercial and political determinants of harm, approaches that have been shown to be so valuable in addressing the impacts of other harmful industries. Governments (and other organisations) have tried to placate widespread criticisms of “responsible gambling”, by developing new approaches such as “safer gambling”, or media campaigns about “gambling harm” which are simply repackaged personal responsibility approaches. These existing programs have been shown to be ineffective in preventing gambling harm.33 While public perceptions of government interventions on health-related behaviours can initially depend on the perceived levels of intrusiveness in people's lives, this can be addressed through effective education and consultation, recognising that the least intrusive measures are also the least effective.34 So how do we move forward? Shifting to a comprehensive public health approach provides an opportunity for governments to significantly reduce the threats to the health and wellbeing of our communities posed by the gambling industry. In our recent testimony to the federal parliamentary inquiry into online gambling, we recommended several areas for action in preventing gambling harm (Figure 1).24, 35, 36 Integral to these recommendations is ensuring mechanisms are in place requiring that consumers, those with lived experience, and young people are suitably engaged in reshaping gambling policy reforms urgently needed to stem gambling related harm across our communities. Harms caused by the gambling industry and its products highlight the complex interplay of the social, political, commercial, and economic determinants of health and the sophisticated tactics used by industry to undermine action that would reduce these harms. Industry and those with vested interests will resist strong government intervention, but community support for evidence-based action on gambling is clear. The Ottawa Charter for Health Promotion and successive charters and declarations have galvanised health promotion in its raison d’être to influence macro forces which can reshape the distribution of wealth, power, and resources towards positive health and social outcomes. We encourage those working across health promotion practice, policy, and research to support advocacy efforts to minimise the influence of the gambling industry on policies which impact on health and social outcomes. It is time for a whole-of-government approach with a strong focus on prevention and the expertise that resides in health departments and organisations. Preventing the harms caused by gambling is too important to be left to regulatory processes, inexpert government agencies and policies that favour industry rather than the health and wellbeing of the community. Samantha L. Thomas has received funding for gambling research from the Australian Research Council Discovery Grant Scheme, the Victorian Responsible Gambling Foundation, Healthway and the New South Wales Office of Responsible Gambling. She is currently a member of the Gambling Harm Prevention Advisory Group for LotteryWest, and is a board member for the International Conversation of Alcohol, Tobacco and other Drug Research Associations (ICARA). She is currently Editor in Chief of Health Promotion International. Gemma Crawford: In the last 5 years Dr. Gemma Crawford has been involved in research projects funded by the Aboriginal Health Council of Western Australia, Australian Health Promotion Association, Curtin University, Department of Health (Western Australia), Hepatitis WA, Injury Matters, Living Proud, Royal Life Saving Society of Western Australia, Sexual Health Research Fund (QLD), South Australian Health and Medical Research Institute, WAAC and the Western Australian Health Promotion Foundation (Healthway). She is the National President and Board Chair of the Australian Health Promotion Association which receives funding from the Commonwealth Government. Mike Daube has received funding for gambling research from the Australian Research Council Discovery Grant Scheme, the Victorian Responsible Gambling Foundation Grants Scheme, and Healthway. Hannah Pitt has received funding for gambling research from the Australian Research Council Discovery Grant Scheme, the Victorian Responsible Gambling Foundation, the New South Wales Office of Responsible Gambling, VicHealth and Deakin University. Jonathan Hallett: In the last 5 years, Dr. Hallett has been involved in research projects funded by Healthway, the Department of Health (Western Australia), Curtin University, Living Proud and Hepatitis WA. He is currently a Regional Associate Editor of Health Promotion Journal of Australia. Simone McCarthy has worked on projects related to gambling which have been funded by the Victorian Responsible Gambling Foundation, the Australian Research Council Discovery Grant Scheme and Deakin University. Louise Francis has received funding from the Royal Society of Public Health (UK), The Anglican Church of Southern Queensland; Foundation for Alcohol Research and Education (FARE); The Municipal Association of Victoria; Fairfield City Council; The Australia and New Zealand School of Government (ANZOG). Melinda Edmunds is a Board Director and Vice President of the Australian Health Promotion Association which receives funding from the Commonwealth Government and Western Australian Health Promotion Foundation (Healthway).

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