Gambling: A developing global disaster for public health

Australia has a dreadful reputation as the world’s leading country for per capita gambling losses. Pokies, sports betting, racing, lotteries, casinos and all the other gambling products took A$32 billion in 2022-23. That’s an average of $1555 from every adult, and it’s growing every year.

Increasingly, we’re aware of effects of these losses: Family breakdown and separation, domestic violence, loss of assets, neglect of children, crime and imprisonment, loss of employment or educational opportunities, mental and physical health issues, lifetime regret and shame, and in some cases suicide.

But we’re not alone. A newly released report from a commission established by The Lancet Public Health reveals for the first time the global scale of this problem, with gambling, and its consequences, growing rapidly across the world.

The harms of gambling are much more extensive than previously thought, with about 80 million people worldwide suffering from gambling disorder, and 450 million affected to some degree by gambling harms.

To this can be added many more people – children, partners, and other family members and loved ones of those with gambling disorder – who experience major harm because of gambling.

The new analysis by the The Lancet Public Health Commission on Gambling reveals that gambling disorder affects about 15.8% of adults and 26.4% of adolescents who gamble using online casinos or slot products. About 9% of adults and 16.3% of adolescents who gamble on sports betting products experience gambling disorder.

Importantly, for Australia’s current policy debate regarding gambling ads, the commission found that some groups face heightened risks.

This includes children and adolescents who are now routinely exposed to gambling promotions and advertising at a scale and in ways unimaginable even 10 years ago.

Gambling has become digitised and readily available via mobile technology. Accessibility is unprecedented, and heavily promoted by saturation marketing and sponsorship deals with sporting leagues and players.

The commission’s report highlights that early exposure to gambling promotions and to gambling increase the risks of developing gambling problems later in life. Children and adolescents are particularly at risk, attracted by the allure of “easy money”, the game-like aspects of many online gambling products, and carefully cultivated associations with sport.

Additionally, gambling disproportionately affects disadvantaged groups, and makes a huge slice of its revenue from those who suffer from gambling disorder.

The report highlights the rapid expansion of the gambling ecosystem globally, with high, middle and low-income countries now all in the sights of global gambling giants.

Mobile gambling, and the rapid uptake of mobile communications, means anyone, anywhere, can have a casino in their pocket for 24 hours a day. The global growth trajectory of this is now phenomenal, with gambling revenue (that is, losses by gamblers) estimated to hit US$1 trillion by 2030, up from about US$500 million currently.

As multiple casino inquiries in Australia have demonstrated, effective regulation of gambling is a Herculean task, made even harder by the many strategies the gambling ecosystem uses to influence political decisions and policy settings.

This is identified by the commission, but in Australia, we can easily see the principal actors in this ecosystem – those who derive revenue from its operations – singing from the same song sheet.

The AFL, NRL, broadcast networks, as well as the gambling operators, have all been vocal in defending their slice of the action. In doing this, they use a “corporate playbook” of government influence, originally developed by the tobacco industry, and expanded to other harmful commodity businesses.

All members of the ecosystem have extensive resources and well-developed networks to oppose reform. As Australia’s leaders ponder how to address gambling advertising, it’s clear that those with vested interests in the gambling ecosystem have the ear of leading politicians – up to and including the Prime Minister – and have distorted the debate in their interests.

The gambling ecosystem also distorts the debate by funding research that promotes individual responsibility – the so-called “responsible gambling” approach – labelling individuals as “problem gamblers”, and directing attention away from highly addictive, expensive, and intense gambling products, such as poker machines, and online wagering platforms incorporating sophisticated features that promote deep immersion and loss of control.

These have been carefully developed to maximise the amount of time and money lost. Meaningless messages calling for self-control have little impact in the face of such technologies.

Among its recommendations, the commission calls for international agreements to regulate online gambling, the establishment of effective regulation in all countries, with support for those with limited experience of gambling operators. UN agencies such as the World Health Organisation are urged to provide that assistance.

Overall, the commission calls for urgent action in all countries to reduce gambling harm using a public health approach. This means that protection of the health and wellbeing of the population must be given priority over commercial interests. This is especially so when children and young people are concerned.

It calls for proper regulation and effective enforcement systems for commercial gambling, restriction of promotion and marketing, including advertising, and effective de-normalisation of gambling – which was a key element in the fight against smoking.

Importantly, the report recommends a focus on harm prevention, including using available technologies such as pre-commitment and cardless gaming, as introduced in Australian casinos in the wake of the Crown and Star scandals, and now also slated for club and pub pokies by the Victorian and Tasmanian governments.

The scale of commercial gambling has reached a tipping point. At this time, there is the possibility that effective action can stem the growth of avoidable harm from commercial gambling. However, as this business and its ecosystem expands – and in Australia, for example, wagering grew by 55% between 2018-19 and 2022-23, driven by online betting – it will become much more difficult to control.

That’s why we must work towards an international agreement to regulate the borderless business of internet gambling.

The global call to action comes as the Australian government continues to delay its decision on a raft of recommendations of the all-party parliamentary inquiry into online gambling, chaired by the late Peta Murphy. The 31 unanimously-supported recommendations include banning all gambling advertising, and establishing a national regulator for online gambling.

The commission’s report – arrived at by a much different and independent process, and adopting an international perspective – completely validates the conclusions and recommendations of Murphy’s committee, and in large part echoes them.

Implementation of the recommendations of these reports would go a long way towards preventing and reducing the harm that unprecedented promotion and accessibility to gambling provides.

We have the chance to put the interests of our children above those of corporate bookies, and their hangers-on, and demonstrate world-leading policy in regulation of gambling. It would be tragic to miss this opportunity, not just in Australia, but globally.

The Lancet Public Health is a high-ranking journal published by The Lancet group. The Lancet Public Health Commission on Gambling includes 22 international experts on gambling policy and harms, epidemiologists, public health experts, policy experts, and clinicians from the UK, Finland, Australia, the US, Malawi, Hong Kong, Indonesia, Canada, Germany, India, and Ghana. Some research staff were employed by grants from the Australian government and the UK Wellcome Trust. Commissioners received no remuneration or funding for their work on the commission other than that provided by their institutions.

Charles Livingstone is a commissioner of the Lancet Public Health Commission on Gambling.