In a stark assessment of gambling’s growing impact on public health, The Lancet public health commission has unveiled a report warning of an urgent, global crisis that demands immediate intervention. The Guardian’s health editor, Andrew Gregory, emphasises the commission’s findings draw from extensive research and consultations with experts in mental health, public health policy, and addiction studies. This highlights the interconnected negative effects associated with gambling, which the report argues are now comparable to those posed by tobacco and alcohol.
The timing of this report coincides with a global surge in online and mobile gambling platforms driven by technology, creating a market worth billions but one that poses substantial public health risks. The report estimates that approximately 450 million people globally have encountered at least one harmful outcome from gambling, whether personal, social, or health-related. Within this population, estimates suggest that around 80 million people have a gambling disorder, defined by a compulsive, repetitive gambling pattern that persists despite significant negative impacts on daily life and wellbeing.
These figures represent conservative estimates, according to the commission, suggesting that the real burden of harm may be even higher because of under reporting and limitations in tracking across different regions and populations
The global scope of gambling harms
The commission’s research presents gambling as a multifaceted crisis affecting individuals, families, communities, and society at large. One of the report’s key concerns is the pervasive nature of gambling-related harms, which are widespread across various socio-economic backgrounds. Vulnerable populations, particularly young people and those with mental health challenges, are especially at risk.
Gambling-related harms cover a spectrum of issues, including mental health effects like elevated rates of depression, anxiety, potential suicide, and domestic violence. Additionally, the report highlights severe financial difficulties, often leading to cycles of debt and personal loss, impact not just individuals but also family members and dependents. The cascading effects create a public health challenge, underscoring a need for unified action from governments, industry players, and health institutions.
Dr Heather Wardle, a public health expert and contributor to the report, notes, “Most people think of a traditional Las Vegas casino or buying a lottery ticket when they think of gambling. They don’t think of large technology companies deploying a variety of techniques to get more people to engage more frequently with a commodity that can pose substantial risks to health, but this is the reality of gambling today.
“Anyone with a mobile phone now has access to what is essentially a casino in their pocket, 24 hours a day. Highly sophisticated marketing and technology make it easier to start, and harder to stop gambling, and many products now use design mechanics to encourage repeated and longer engagement.”
Wardle adds, “We need to wake up and take action. If we delay, gambling and gambling harms will become even more widely embedded as a global phenomenon and much harder to tackle.” Her statement serves as a call to policymakers who have often downplayed gambling’s effects as personal or moral failings rather than as a systemic health crisis.
Young people and vulnerable populations in focus
The report underscores the heightened susceptibility of young people, particularly given the wide availability of online betting. According to the findings, gambling disorder affects 15.8 percent of adults and 26.4 percent of adolescents who use online casino or slot products, and 8.9 percent of adults and 16.3 percent of adolescents who engage in sports betting. Digital gambling platforms use highly targeted advertising that creates a culture where gambling is normalised among younger demographics. They often employ sports stars, influencers, and integrated social media promotions to reach younger audiences who may not fully grasp the risks.
The report calls for stringent age-verification protocols on digital platforms, alongside public health messaging similar to anti-tobacco campaigns. Dr Kristiana Siste, one of the report’s experts, echoes this, warning, “We need to take action to protect children from the harms of gambling. We know that early exposure to gambling increases the risk of developing gambling disorders later in life, and children and adolescents are particularly vulnerable to the allure of easy money and the game-like designs of online gambling.”
A critical aspect of the report is its focus on technology’s role in amplifying gambling’s reach and harms. Technological advancements enable 24/7 access to online casinos, sports betting, and other digital products, allowing global reach. The commission compares these techniques to those used by social media to drive habitual engagement, stating that digital gambling mechanisms can be highly addictive. Such tactics blur the lines between gaming and gambling, drawing users deeper into gambling ecosystems.
Need for stronger regulation and corporate accountability
One of the report’s most pressing calls to action is for tighter regulations, particularly for digital gambling platforms, where advertising remains largely unchecked in many regions. This has allowed companies to reach vulnerable populations, including minors, with relative ease. The report recommends restricting gambling advertising in ways similar to tobacco and alcohol, specifically targeting vulnerable groups.
Further, it advocates for robust regulatory frameworks to enhance transparency and accountability within the industry, especially for digital platforms. Standardised protocols and regular audits could protect vulnerable communities and emphasise public welfare over corporate profits.
Reframing gambling as a public health issue
The report’s main point is gambling should be seen as a public health issue, rather than being considered solely as an individual choice or vice. Integrating gambling harm into national health agendas would require a strong emphasis on prevention, education, and intervention strategies. It encourages public health campaigns aimed at raising awareness and reducing the stigma associated with gambling addiction, especially among high-risk groups.
The report highlights that self-regulation interventions, such as voluntary limit setting, self-exclusion policies, and providing information about sources of help, are based on the idea of informed choice. However, it argues that placing the responsibility solely on individuals can perpetuate shame and stigma associated with gambling harms. This, in turn, negatively affects the rates at which people seek help, even if help is readily accessible.
The way forward
The commission urges public health bodies to collaborate with research institutions and industry experts to develop more effective prevention and treatment strategies. Given that gambling is a relatively new public health concern, extensive research into effective treatments is necessary, with resources directed toward understanding the behavioural aspects of gambling addiction.
For those exploring further, the report recommends insights from organisations actively involved in gambling research, such as the World Health Organisation and the UK Gambling Commission. To develop a more comprehensive understanding of gambling harms and craft evidence-based policies, the report deems collaborative research as essential.
A united stand against a growing threat
The Lancet commission’s report is a wake-up call for policymakers, public health officials, and the industry. Gambling-related harms represent a systemic health crisis, extending beyond personal choice. The report underscores that without immediate action and comprehensive regulation, gambling will continue to pose a significant threat to public health.
The responsibility for addressing gambling-related harm does not rest solely on gaming companies; it requires a balanced approach involving both industry accountability and comprehensive, well-designed regulatory oversight. Big state intervention can act as a necessary counterbalance to corporate interests. However, many industry experts advocate for a collaborative relationship with regulators, fostering a consistent approach that allows for industry growth while prioritising protections for vulnerable gamblers.
The time for action is now. Many industry leaders advocate for stronger, cohesive and coherent partnerships with regulators, recognising that effective safeguards support both sustainable growth and innovation and the wellbeing of communities globally.
You can read The Guardian article and access The Lancet Public Health Commission report .
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