Gambling: an unaddressed public health challenge, especially for children

There is an increasing understanding that gambling is a public health issue, yet insufficient mainstream effort is being used to address gambling related harms. While many people gamble and experience no adverse consequences, many others experience harms from their gambling.

Gambling is not illegal. It generates considerable tax revenue for UK governments, provides employment, creates innovation within business communities, provides benefits to other leisure sectors, and gives pleasure and enjoyment to some participants. However, there are also considerable societal costs, often unseen and unacknowledged, arising from the harms associated with it, particularly in vulnerable and deprived communities. Importantly many children are exposed to gambling as part of everyday lives, not least on via social media.

In Britain, there are more than 340,000 adult problem gamblers and a further 1.7 million experiencing some harms. But the harms that arise from gambling are far broader than medical-based criteria for problem gambling. Partners, families, and communities also suffer the serious consequences.

The good news is that policy makers, regulators, and the broader public health community are increasingly recognising that gambling-related harms need to be better understood and measured.

For example, the Department of Health and Social Care (DHSC), working with Public Health England (PHE), is supporting an evidence-based review of the impacts of gambling-related harms on health and wellbeing. In Wales the Chief Medical Officer majored on gambling in his annual report and in Scotland there is growing concern about the lack of appropriate provision to prevent gambling-related harms. The National Institute for Health and Care Excellence (NICE) is discussing development of treatment guidance and the Gambling Commission is consulting on the next iteration of its strategy, putting a public health approach at its core.

And there have been some significant signals of the general acceptance that more needs to be done to reduce gambling related harm. When the responsible minister, Tracey Crouch, resigned it precipitated a climb-down by the Treasury on the pace of introducing the £2 limit for Fixed Odds Betting Terminals. Parliamentarians in both Houses raised their concerns about the more general issues of the growth of online gambling and increasing numbers of children involved in gaming and gambling.

The proliferation of advertising around sporting events, particularly on television and especially before the 9pm watershed, is increasingly being seen as leading to normalization of betting behaviors and has led to a proposal for a voluntary ban around televised football matches by the Remote Gambling Association (RGA), which includes a deal to stop adverts during live sports broadcasts.

Children and young people are growing up in a vastly different world from their parents. Their world is dominated by technology and being almost constantly connected to the world via the internet. It cannot be right that 1 in 8 11 to 16 year olds are following gambling companies on social media. There are those who say that this amounts to grooming children, and that the constant stream of gambling-related promotion activity represents abuse.

The recent report by the Gambling Commission describes this changing world, one in which social media and online gambling are on the increase, yet poorly understood. The comorbidity with mental health problems and the impact of debt increase the importance for better understanding of betting, gambling, and how to prevent its incipient harms, not least the higher rates of suicide amongst problem gamblers. At the same time there is a lack of educationfor parents, policy makers, and providers of health services. And there is a significant treatment gap. Currently the NHS only commissions one specialised clinic and the others that exist are funded through the charity GambleAware, which although independent is funded by the industry.

GambleAware is the primary commissioner of specialised problem gambling treatment services in Britain. Last year around 8,700 people were treated in those services, less than 3% of the estimated population of problem gamblers—a gap that the state needs to help bridge with both funding and leadership. Part of the problem is that gambling falls under the remit of the department for culture, media, and sport, not the health department. It is only recently that NHSE and PHE have engaged in discussion about problem gambling and a brief, but important, reference is made to gambling in the new NHS 10 Year Plan. So a good start is being made. But there is much more to do.

Sian Griffiths, Emeritus Professor, Chinese University of Hong Kong. Visiting Professor, Institute of Global Health Innovation, Imperial College London.

Declaration of interest: Associate Board member, Public Health England. Trustee, GambleAware. Trustee, Royal Society of Public Health.

Marc W. Etches is Chief Executive of GambleAware.

Declaration of interest: GambleAware is wholly independent of the gambling industry but does receive funding from gambling businesses via an arrangement prescribed by the regulator, the Gambling Commission. It is a condition of holding a gambling licence in Britain that an annual financial donation must be made to one or more organisations for the purposes of research, education, and treatment in relation to reducing gambling-related harms. Full details are available via