Charting a path towards a public health approach for gambling harm prevention

This scholarly review utilizes nearly 140 research articles to consider how a public health model can be operationalized to address gambling harms and using a growing evidence base, develop policies to address gambling-related harm at a population health level.

Quantitative Data Highlights

• 50% to 66% of people in the high-risk gambling category were identified as problem gamblers.

Co-ocurring Disorders

• • 94% of people with gambling problems will have at least one cooccurring mental health or addiction disorder (including alcohol and nicotine dependence, depression, anxiety, and obsessive-compulsive disorder).

Identified Risk Factors

Population Level

• Gender.
• Age.
• Ethnicity
• Employment status
• Having a family history of gambling.
• Participating regularly in continuous forms of gambling.

Protective Factors

• Gambling research towards population impacts.

Qualitative Data Highlights

• As problem gambling gained more acceptance as a significant public health problem, governments and health professionals have been under pressure to develop effective responses to gambling expansion.
• As of this research (2021), New Zealand is the only country with a public health approach (even though public health principles to approaching gambling were advanced almost two decades ago in other countries).

Co-Occurring Disorders

• Gambling problems stem from complex and diverse social and economic factors, which may be complicated by the high rate of comorbid health conditions.

Gambling Policies

• The governance structure of legal gambling industries typically do not include the department of health (This will continue until the public views gambling harm as a public crisis that requires public health input).

Gambling Harms

• The impact of gambling harms affects not only the gambler, but also radiates with negative implications for family, friends, workplaces, and communities
• Gambling harms can take the form of financial insecurity, employment disruption, suicide, substance abuse, psychological disorders, and more.
• Although the health, economic, social, and personal harms of gambling are most severe among problem gamblers, they can extend across the risk spectrum.
• Low-risk and moderate-risk gamblers are responsible for more harm at the population level than those identified as struggling with problem gambling. Thoug, many times experiencing less severe gambling harms, there are many more of them experiencing these harms, which affect their communities.

Identified Assessment Tools

Treatment

• The Problem Gambling Severity Index (PGSI) is useful for determining risk categories (though, missing data measuring harm as an outcome).
• The Problem and Pathological Gambling Measure (PPGM) is an instrument used by some researchers to identify the incidence of specific gambling harms concurrently with an assessment of problem (though it fails to capture the extent of harm being experienced by close relations).

Identified Challenges

• Making the case that gambling harm is a public health issue and developing data to articulate the issue due to lack of data, and cross-jurisdictional data.

Identified Conclusions

Research

• Public health interventions for gambling should rely on the best available evidence and must be plausible.
• Population-level longitudinal studies serve the needs of evidence-informed policy and program development.
• Identifying significant impacts on health across the full spectrum of gambling behavior is necessary to advance the public health agenda.
• There has been a movement towards not accepting research funding from industry to study gambling and related harms, consistent with research funding practices for other health issues such as tobacco and alcohol abuse.

Treatment

• There is an opportunity for health professionals to screen for gambling problems when people present with mental health and substance use disorders.
• It may be that by treating the gambling problem, there will be a positive impact on comorbid conditions, or vice versa.

Identified Recommendations

Research

• More gambling-related harm data is needed to develop integrated systems for gambling policy, treatment and counselling interactions.
• Encourage public health system involvement to leverage expertise and resources for preventive interventions, health promotional information, and data development and analysis for the field’s advancement.
• To help advance knowledge and fill the research gap, cross-jurisdictional support can expand longitudinal research and present an opportunity to share data widely among the gambling and public health research communities.
• Collect data of gambling harms experienced by gamblers and significant others through helpline calls to financial institutions to monitor gambling transactions, as well as other sectors such as intimate partner violence services (where gambling is listed as a cause), bankruptcy courts, and coroners’ reports where gambling is indicated as a cause of suicide.

Policy

• Develop network of stakeholders to access and assess gambling related data to work towards a common public health goal to identify gambling problems at earlier stages and respond in a concerted manner to reduce or prevent harm from occurring disorders.
• Form a basis to address population gambling-related health problems by developing integrated approaches to where gambling harm intersects with other public health issues such as substance abuse, mental illness, poverty, etc.