Launch of the Lancet Public Health Commission on Gambling

Heather Wardle (University of Glasgow, Glasgow, UK), Louisa Degenhardt (University of New South Wales, Sydney, Australia), and Shekhar Saxena (Harvard University, Cambridge, USA) have announced in The Lancet Public Health, the launch of the journal’s inaugural Commission on Gambling.
The Commission on Gambling is described by them as “a scientific inquiry and response to an urgent, neglected, understudied, and worsening public health predicament”.
The announcement goes on to state:
Gambling involves placing something of value at risk in the hopes of gaining something of greater value, and includes casino gambling, lotteries, and internet gambling. Gambling is not an ordinary activity: it is a health-harming addictive behaviour, recently recognised in the International Classification of Diseases 11th Revision (ICD-11) and Diagnostic and Statistical Manual of Mental Disorders 5th Edition (DSM-5). Gambling disorders often remain undiagnosed and untreated. According to WHO, the prevalence of gambling disorders among adults varies between 0·1% and 5·8%. Gambling is a source of potentially serious and wide-ranging harms, affecting an individual’s health, wealth, and relationships. It affects whole families and communities, and can become a lifelong struggle to avoid relapse. There is an urgent need to assess and understand the barriers and facilitators to preventing gambling-related health harms.
The rapid and geographically broad increase in use of internet and smartphones has completely altered the gambling landscape. Today, the possible adverse effects of the COVID-19 pandemic on addictive behaviours and disorders are yet to be fully understood. The COVID-19 pandemic response, bringing lockdowns and unprecedented restrictions in people’s lives, could act as a catalyst, intensifying gambling behaviours by increasing time spent at home and time spent online. Preliminary data from a survey of 6000 respondents in China suggest that coping behaviours during the COVID-19 crisis increased the risk for substance use disorders and internet addiction.
An awareness of this growing public health issue could provide an opportunity to ensure public support to tackle gambling-related harms and protect the most vulnerable. In this issue of The Lancet Public Health, Heather Wardle and Sally McManus report results from a survey in young adults aged 16-24 years showing an association between gambling behaviour and suicidality (suicidal thoughts and suicide attempts). As Charles Livinsgtone and Angela Rintoul note in an accompanying Comment, “In view of these data, it is crucial to improve screening and support services for people with gambling problems, either within primary care or in addiction treatment settings”.
Unfortunately, gambling has been neglected and understudied as a public health issue. In their review of interventions to reduce the burden of gambling-related harms, Lindsay Blank and colleagues conclude that the evidence is sparse and weak. But they also caution that it is imperative to ensure that a scarcity of evidence is not used as a justification for inaction. They warn that the complexity of the relation between gambling and its associated harms, together with the paucity of robust evidence, could be used as a rationale to oppose or delay policy interventions. They argue that, “The gambling industry will strongly resist and argue against proposals to introduce interventions that might regulate or restrict their commercial activities.” Gambling is a highly profitable industry, but policy makers should not ignore the substantial threats to health and wellbeing that exist.
The normalisation of gambling in many countries, its widespread and easy accessibility, and governments’ addiction to revenues from gambling could be a threat to reaching the sustainable development goals. The growth of commercial gambling across sub-Saharan Africa and the so-called gamblification of sports over recent years deserves closer scrutiny, not least because gambling can deepen poverty.
Gambling-related harms reveal multiple intersections between the social, commercial, and political determinants of health. It is against this backdrop of complexity that the The Lancet Public Health Commission on Gambling will apply a public health lens. Conscious of the challenges ahead—nationally and globally, in high-income and low-income settings, today and post-COVID-19—the Commission will be science-led, international, multidisciplinary, and will aim for transformational change in policy and political action. Gambling and its related health harms have been ignored and hidden from public health scrutiny for too long—our Commission intends to correct this aberration.
You can download below the Comment article mentioned above, that contains more information about this new Commission on Gambling.