Gambling is an emerging public health concern. Not all gambling exposes everyone to the same degree of harm (Atherton and Beynon, 2019); it can, however, have a negative impact on individuals, families and communities. It merits population-level interventions and the creation of programmes to tackle the health risk by addressing underlying social, economic and environmental conditions. New trends and technologies are affecting gambling behaviour across a range of populations. Worldwide, legislation appears to have failed to constrain gambling, particularly in young people. Technology such as online gaming apps (mobile gambling) and online gambling venues has substantially fuelled exposure to the risks of problem gambling.
The World Health Organization (2018) includes gambling disorder as an addictive behaviour in ICD-11, characterised by a pattern of persistent or recurrent gambling behaviour, which may be online or offline. The addictive behaviour results in impaired control over gambling, its onset, frequency, intensity, duration, termination, context, and increasing priority given to gambling such that it takes priority over other life interests and daily activities and continuation or escalation of gambling despite the presence of negative consequences. It can be continuous or episodic and recurrent, it results in significant distress or in significant damage to personal, family, social, educational, occupational or other important spheres of functioning.
In 2018 the Chief Medical Officer for Wales highlighted gambling as a public health issue (Atherton, 2018). In the UK, gambling is a common and socially acceptable pastime enjoyed by many, and can provide people with social spaces to meet. There are employment and leisure opportunities along with other social and economic benefits and the gambling industry also provides tax revenues. Yet there are gambling-related harms that must also be given consideration. At its worst, gambling can lead to loss of life. The harms reflect social and health inequalities: the negative consequences disproportionately impact economically and socially disadvantaged groups, often they are associated with a variety of mental and physical health comorbidities. The economic benefits of gambling must be considered against the social and health harms. There is a need for improved understanding of the burden of, and the responses to, problems related to gambling. Clinicians should endeavour to establish dialogue with people with lived experiences, experts in the field of gambling and gaming, social workers, users of technology and family. A fine balance is needed so everyday behaviours are not seen as psychological abnormalities and risky behaviours are identified early in order to prevent the development of problematic behaviours.
Currently, we have limited data and evidence on gambling-related harms, particularly compared with our understanding of other public health threats. Raybould et al (2021) noted that a robust understanding of harms distribution related to gambling can better equip health and care workers to identify people who are at risk, or those showing signs of a gambling disorder. Targeting and prevention, sign-posting and developing pathways to accredited agencies for gambling support services and offering interventions are key in assisting those who may have issues with gambling or are seeking support for issues they are facing. A comprehensive, whole-system public health response is needed to reduce gambling-related harm.