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A recent report from The Lancet Public Health Commission recommends sweeping reforms to the global gambling industry, treating problem gambling as an urgent public health issue. Some of the recommendations would require significant political capital to implement, like removing gaming companies’ influence from research into gambling addiction.
Achieving the sort of change Lancet would like to see requires a paradigm shift in how the problem is perceived by government and the public. PlayUSA spoke with one of the report’s authors and another expert about their proposals and what it means to view gambling through the lens of public health.
While many of the recommendations fall upon governmental agencies and officials to consider, like increasing funding for education about and treatment of problem gambling, the reforms are more comprehensive than simply throwing more money at intervention and prevention. It focuses on a comprehensive shift in the approach to gambling.
One of the report’s authors, Dr. Rachel Volberg, stresses that there are actions that gaming licensees can take immediately to assist with prioritizing public health in their businesses. Dr. Sanam Hafeez also emphasizes that a regulatory system that prioritizes public health is possible if all stakeholders commit to the principle.
The Lancet Public Health Commission shares findings
The 45-page report from The Lancet Public Health Commission is an expansive overview of the gambling industry across the world and a top-level overview of regulation. The report’s summary encapsulates the report into four observations.
- Commercial gambling, especially online, is growing rapidly
- Harms related to gaming are underestimated
- Governments haven’t taken enough action to properly mitigate those harms but have an opportunity to do so now
- Such reforms must prioritize public health and divorce themselves from industry influence
The report’s authors haven’t drawn these conclusions without also creating a path to address those concerns. The recommendations begin with stakeholders accepting that gambling is already a public health concern.
The map to a safer gambling landscape
The report’s recommendations for improving outcomes related to gambling begin with the understanding that gambling affects the whole of society, not just the people who work in the industry or play. From that perspective, the first recommendation from the Commission is “protecting health and wellbeing over competing economic motivations.”
Other recommendations in the report include:
- Prohibitions against advertising and sponsorships
- Investment in awareness campaigns
- Universal player registration systems
- Regulating gaming products proportionate to their risk of harm
- Caps on player bets and deposits
- Transitioning away from industry-funded research and treatment
Some of those recommendations, like restrictions on marketing, fall to legislators and regulators in the United States. Other recommendations, such as universal registration, would need participation from casino operators.
Volberg elaborated on these recommendations for PlayUSA and highlighted more ways that both operators and government officials could reform practices and standards to prioritize public health.
Volberg’s points highlight weaknesses in US regulatory structures
As the report mentions, economic ambitions in the gambling industry can compete with public health concerns. Volberg stresses that the measures that the report identifies have been implemented in at least one jurisdiction without affecting the viability of the regulated gaming industry in those places.
As an example, Volberg discussed funding harm intervention related to gambling.
Regarding distribution of tax revenues, it would be desirable to fund problem gambling prevention, treatment and recovery services with a portion of revenues raised from gambling (called a hypothecated tax). However, this funding should be maintained at a predictable level and supplemented using General Fund revenues.
Dr. Rachel Volberg
On that point, commitments from governments across the United States have fluctuated from one jurisdiction to the next and over time. As just one example, Washington, D.C. Mayor Muriel Bowser proposed eliminating funding for problem gambling services amid a failure of her administration to release the earmarked funds for three consecutive years in 2023.
Volberg’s points of emphasis are more comprehensive than just ensuring adequate funding for interventions, however. She gave suggestions of actions that lawmakers and regulators could take to shift toward valuing public health.
Those included requiring operators to send automated alerts to players when their activity escalates and requiring licensees to submit annual reports on their efforts to mitigate harm. For licensees themselves, Volberg suggested that they could make it easier for customers to close their accounts and institute a universal pre-commitment to limits on deposits, losses, time, and wagers.
Some US jurisdictions have already employed some of Volberg’s recommendations. As examples, Connecticut and New York have deposit limits for people who gamble online of $2,500.
However, those are per-licensee limits, not universal, and such restrictions are far from universal across the US. Some of the adjustments would require substantial reforms compared to the current landscape of legal online gambling in the US.
Reforming existing systems could be heavy lift
Taking just one of the report’s recommendations, a universal registration system, would be easier in some US jurisdictions than others. In Rhode Island, where Bally’s is essentially the lone licensee, such a system is partially already in place. It’s important to note that Bally’s, not the state of Rhode Island, runs that system.
In more competitive markets like New Jersey, where nearly licensed 30 online casino apps from several different companies are available, creating one registration system would be a bigger task.
It would require all licensees to integrate that system into their consumer-facing platforms. Additionally, it would require regulatory bodies to expand their budgets and staff to maintain the system.
The additional costs and work are bearable, if not essential, when public health is the first priority for gambling regulation.
Shift in mindset creates new priorities
A section of the report highlights a problem with existing ideology around gambling.
“Most policy solutions to gambling harms rest on the notion of individual responsibility. … However, framing the problem in this way and narrowly focusing policy attention on a small subset of the people who gamble draws attention away from industry practices and corporate behaviour.”
Hafeez, speaking with PlayUSA, shared that a shift in attitudes toward gambling could be the start of a healthier society.
If problem gambling was treated as a public health problem, we could greatly enhance the lives of those suffering from it.
Dr. Sanam Hafeez
Hafeez also added, “Psychologically, this would make it possible to create a more holistic, helpful and preventative model of how problem gambling is managed, mentally, emotionally and socially. Presenting gambling as a public health concern would eliminate the stigma surrounding it. People who struggle with problem gambling will be less inclined to seek help if they’re ashamed or perceived as ‘weak’ or ‘irresponsible.’
“If we make it a medical issue, it’s more accessible for people to seek treatment without fear of judgment. Public health interventions may target prevention by ensuring people understand the risks of gambling and learn to manage temptations and triggers. This training may be particularly valuable for populations that are younger and potentially more susceptible to developing gambling addictions.”
In the absence of such interventions or until they materialize, professionals can take a similar approach on an individual level according to Hafeez.
“Mental health professionals can support patients with disordered gaming by utilizing research-based treatments such as CBT (Cognitive Behavioral Therapy) to recognize and interrupt harmful thinking related to gaming,” Hafeez explained. “They can also show clients healthier ways to manage stress and emotions, then provide alternative outlets to develop a more balanced lifestyle. When coping with mental illness, integrative treatment is imperative. Additionally, professionals can help clients set appropriate objectives, impose boundaries and remediate gaming-affected relationships. Follow-ups or peer support are additional ways of preventing relapse and aiding recovery.”
While policies and practices could change substantially as a result, advocates are primarily pushing for a shift from framing gambling as entertainment or gambling as revenue provider to framing gambling as a public health concern. With such a shift, many of the specific reforms would naturally emanate.
