The Lancet Public Health Commission on gambling in a recent report has pointed out the prevalence of commercial gambling in over 80% of countries globally, with lower- and middle-income countries witnessing a particularly rapid growth in the activity. The gambling, the Commission warns, seriously undermines progress towards UN Sustainable Development Goals, with a “heavy burden of harm,” falling on individuals who are already socially disadvantaged. 

In an exclusive interview with First Check, the Commission said that gambling is an activity that can be health-harming, and called for “social marketing and public awareness campaigns to denormalise gambling.” 

The responses to our questions were prepared by Shekhar Saxena, Professor of the Practice of Global Mental Health at the Department of Global Health and Population at the Harvard T. H. Chan School of Public Health, Manoj Sharma, professor at the National Institute of Mental Health Neurosciences, India), and Heather Wardle, professor at the University of Glasgow. 

Excerpts from the interview: 

How does the rise of commercial gambling in lower- and middle-income countries specifically impact their economic stability and public health?

Economic costs of gambling are disproportionally borne by the poor. This increases economic inequality- which is already high in low and middle income countries. The impact on economic stability can be substantial and is likely to increase. In our Commission, we highlight this possibility and note a range of ways in which commercial gambling might undermine progress towards the UN Sustainable Development Goals, particularly with respect to reducing poverty.

As the Commission clearly demonstrates, the public health impact of gambling is large and increasing. The harms to health and wellbeing that result from gambling are more substantial than previously understood, extending beyond gambling disorder to include a wide range of gambling harms, which affect many people in addition to individuals who gamble. These public health harms are likely to increase faster in low and middle income countries since commercial gambling is being targeted in these countries as a growth sector by the industry.

What factors make lower- and middle-income countries more vulnerable to gambling-related harms compared to advanced countries?

While the commercial gambling industry is targeting low and middle income countries for rapid growth, these countries often have weaker policies and regulations on gambling. Even if regulations exist, their actual implementation is limited. This makes these countries more vulnerable to gambling related harms. In addition, existence of higher poverty makes the economic and related harms more widespread and substantial. For this reason, we highlight the central importance of strong, well-resourced and enforced regulation.

In what ways are advanced countries less susceptible to the negative impacts of gambling, if at all they are, and what lessons can developing countries learn from them?

Some high income countries (we would not call them advanced) have developed strong policies and regulations that make them less susceptible to gambling related harms. This has included prohibitions on advertising and marketing, limiting how much money people can lose in a week, a month or year, for example.

However, other high income countries and most low and middle income countries lack adequate policies and regulations, making them more susceptible especially since the industry is targeting these countries with increasing access and stronger marketing efforts. The key lesson to learn is to develop stronger and independent public health based policies and regulations and to implement them vigorously to limit gambling related harms to the population.

What kind of educational initiatives should be implemented to raise awareness about gambling disorders, particularly in countries like India where mobile phone access is widespread and poverty is also widespread? A new UN report describes India among five countries with the largest number of poor people living in poverty?

The commercial gambling industry is very adept at presenting their products as part of normal and ordinary leisure. But gambling is not an ordinary leisure activity, it’s an activity that can be health-harming. In our recommendations, we argue for social marketing and public awareness campaigns to denormalise gambling.

This could use a variety of offline and online platforms, such as print media articles, FM radio programs on gambling (given that India has a large number of FM radio listeners),  enabling health and mental health professionals to screen and advise/psychoeducation. In addition, mime acts, Nukkad natak, or street play, involving local influential people to talk about these issues like chai pe charcha program along with social media, AI supported chatbot to address queries can all be used in educational initiatives to raise awareness about the signs and solutions of gambling disorders.

What really happens when someone suffers from gambling disorder, how the rich suffer and cope with it and how the poor suffer and deal with it?

Regardless of rich and poor, people tend to only seek treatment once they reach crisis point – often when they have extinguished all resources to gamble. They experience significant guilt about their loss and/or what happens to them when they gamble and the impact it has on others. Treatment and support for those harmed by gambling is vital to enable people, including significant others, to recover and recovery is possible – but this support needs to be widely available and to be affordable. This is why we recommend that a regulatory infrastructure for gambling needs to include provision of affordable, universal support for treatment for gambling harms. Gambling harms can affect anyone, and there needs to be equitable support available for all people. 

Also read: Rising human cost of gambling: 449 million affected, 80 million with disorders - First Check

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