Gambling as a public health issue?

Gambling Is Not a Public Health Issue

When campaigners call gambling a public health issue, they are not making a loose rhetorical point. They are invoking a specific piece of theory, and it matters that people understand what it is and what it commits them to.

The theory is the Total Consumption Model, imported from alcohol research. It holds that harm in a population rises and falls with total consumption. Under this model, you do not need to identify who is being harmed or show that a policy helps them. You only need to reduce the overall amount of the activity. Less gambling in aggregate is treated as less harm by definition.

Read Gambling with Lives’ own evidence to Parliament this year. They state openly that the policy question is not whether advertising causes addiction. The question is whether it increases participation. Participation itself has become the target. That is the model working exactly as designed. Once it is accepted, every measure that shrinks the market counts as a success, whether or not a single person suffering from gambling disorder is helped.

This is why important racing figures like Martin Cruddace need to revise his view that for political reasons we need to accept the gambling as a public health issue. Because it is false. Were we to accept this premise we could argue driving as a public heath issue similarly.

Road safety policy however differs from the ‘gambling public health argument’ in that it targets the harmful behaviour and leaves the rest of the population alone. Drink driving laws restrict drunk drivers. Speed enforcement restricts speeders. Nobody proposes cutting road deaths by reducing the total volume of driving, rationing mileage, or requiring ordinary motorists to prove they can afford their petrol. That is precisely what advocates seek from gambling reform. It attacks everyone, not just the vulnerable. Changing my old mucker’s mind on anything is like trying to shift the Titanic. He is, however of enormous influence, so we must try. I am not suggesting the boss of Arena Leisure as an anti gambler. Far from it

The participation in argument matters because the model makes a testable prediction, and in gambling the prediction fails. Total consumption rose enormously over two decades. This is a key point. Online betting grew from nothing into the largest part of the market. Advertising spend ran into billions. Smartphones put a betting account in every pocket. If harm tracked total consumption, problem gambling prevalence should have climbed with it. It did not. On the health survey series it stayed at around half of one percent of adults throughout. Exposure went up. The rate of disorder did not. The foundation of the entire framework does not hold for this activity.

Now look at what the model has delivered in practice. Affordability checks applied the total consumption logic directly: restrict the whole betting public in order to reach the few. Customers refused intrusive document demands and left the regulated market. Racing’s funding contracted. The Gambling Commission has produced no evidence that problem gambling fell as a result. Under any normal test that is failure. Under the total consumption test it is success, because the market got smaller. That is the sleight the public health framing performs. It changes the definition of success from harm reduced to gambling reduced, and nobody voted for that change. Gamblers neither want to reduce, nor does it shift the bar on problem gambling one iota (that is if you don’t move the bar, as the gambling commission has with its absurd gambling survey of Great Britain!)

The same logic now underpins demands for tax rises designed to shrink the sector and for the denormalisation of betting called for by the chair of the Lancet Commission, and fanatical anti gamblers like Heather Wardle on gambling. The stated aim in each case is less gambling, not less harm.

Gambling disorder is real and can be devastating. It affects a small minority who need identification, treatment and support. Those are targeted clinical tasks. A framework that measures success by the contraction of a lawful market, while producing no evidence of reduced harm, is not protecting anyone. It is pursuing a different goal under a borrowed name.