key: cord-254904-4eduslpb
authors: Griffiths, S.; Reith, G.; Wardle, H.; Mackie, P.
title: Pandemics and epidemics: public health and gambling harms
date: 2020-07-22
journal: Public Health
DOI: 10.1016/j.puhe.2020.06.022
sha: 
doc_id: 254904
cord_uid: 4eduslpb

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When we started the process of creating this special issue of Public Health, we were seeking to respond to an increasing call to recognise gambling harms as a public health problem and to address concerns about a potential growing epidemic of harms that threatened the health and well-being of populations across the globe. That this is increasingly being accepted as a public health issue, albeit among a relatively small field of gambling researchers and practitioners, is not in question. However, the question that faced us was what such a response, for this Journal, at this point in time, should look like.

We began to realise that what was needed was a kind of 'next step'. An evolution of discussion that goes beyond the simple repetition that 'gambling is a public health problem' brings the issue to a wider audience of academics, public health and healthcare professionals. And for this to include what public health policy and practice might be in the future.

To facilitate mature debate, we needed to help public health, primary care and healthcare professionals see that gambling is not necessarily a harmless pastime, and to understand that gambling harms contribute to many of the social and economic inequalities that are determinants of health and well-being for individuals, their families and the communities in which they live. In short, we needed to bring what was known from the evidence base to the readers of this Journal. As with any issue of Public Health, we wanted to do that in a way which helped readers see both the reason for the concerns relating to gambling harms across the globe and the potential for translating such evidence into public health action. This issue is the result of those discussions.

What we did not discuss was how you present a special issue of Public Health on what some are coming to see as an epidemic of gambling-related harms, when the world is experiencing a global pandemic. At the time of writing, COVID-19 is still an emerging disease. Whilst we await population surveillance based on antibody testing, containment measures will continue to focus on the isolation of symptomatic cases and social lockdowns. Across the world, public health attention has, naturally, been directed towards the pandemic response, whether locally or as advisors for national and local politicians.

Yet, even in the midst of this pandemic, we need to be aware that gambling harms are still occurring. The pandemic has not interrupted gambling, merely changed how it is happening. We can but speculate on how keeping people in their own homes, many without their usual occupations, activities and social networks, might impact their use of online gambling platforms. Obviously, sporting events have been cancelled and land-based venues closed during lockdowns, vastly reducing the availability of gambling, but other options online have sprung up. As competitive sports and horse racing restart, albeit behind 'closed doors', and social distancing continues to affect the footfall in gambling venues, in the US at least, one company has created 'drive-thru' gambling centres. 1 Debate has already started about the impact the COVID-19 pandemic has had on gambling behaviour. Industry commentators point to lost revenues, which are likely to be significant. The industry will regroup and a critical business consideration for them will be how to future-proof itself against such shocks of this nature. A greater push to online gambling seems inevitable. It may also be tempting for governments to use gambling expansion and its subsequent revenues to recover resources which will be a priority with the inevitable economic depression looming. However, from a public health perspective, we need to focus on people, not purses. We need to consider the impact on individuals and communities and to assess how gambling harms are changing in the context of our vastly altered posteCOVID-19 world.

In Britain, as elsewhere, one of the aims of gambling legislation is stated to be the protection of the vulnerable. Importantly, vulnerability is not a static state but something that may vary for individuals based on their life experiences and conditions. In the context of great economic and social uncertainty, it is vital to understand who are the new 'vulnerable' and what measures should be put in place to protect them. This may mean taking and maintaining a more precautionary approach to gambling regulation whilst the knowledge about impact is generated. COVID-19 is likely to create many more vulnerable people and to exacerbate existing inequalities: inequalities that are already expressed in the distribution of gambling harms. It is vital that politicians, regulators and public health officials are sighted of these changes and able to respond rapidly.

What this collection of special articles shows is how varied and diverse the experience of gambling harms can be, how far reaching for individuals, families and communities, and how global the potential impact could be. Vulnerability to harms is manifest through socio-economic or cultural status, through the areas in which people live and through the practices engaged in by the industry. These things are not simply the preserve of the individual but of individuals embedded within their broader social and environmental contexts.

It is particularly heartening to see the local actions being undertaken that are sensitive to these contexts. At the same time, COVID-19 aptly reminds us of the global reach of gambling and the need to embed local responses within global strategies to reduce harm. That the World Health Organization (WHO) is starting to take interest in championing strategy in this area is positive. Yet, there is much still to do. Research and policy nearly always plays catchup to industry developments. The industry, especially the online industry, is sophisticated in its use of data and technology to promote, protect and expand its services. Increasingly, researchers interested

Public Health jo u rn a l h o m e p a g e : w w w . e l s e v i e r . c o m / l o c a t e / p u h e in gambling will have to also be interested in data science and technological infrastructure if they are to truly understand the nature of gambling products, the industries responsible for generating them and their impacts.

We agree a new framing is necessary: we need to acknowledge that the context of people's lives, broader social, economic and environmental circumstances and the actions of politicians, regulators and corporations, along with individual characteristics, can all influence behaviours. This is a public health framing, one where responsibility lies with multiple actors and agencies for preventing gambling harms. In Britain, as politicians begin the process of reviewing the 2005 Gambling Act and updating it for the digital world, there is the potential for such change to occur. But it requires bold thinking and e crucially e action to overcome challenges in how to deliver such a joined-up, global and systems-based approach to reducing gambling harms. The articles in this special issue offer hope that with sustained effort and action, this may be possible.

We all recognise that the world into which we will return will be very different, and within that new world, we will have an opportunity to do things differently. Once the immediate pandemic is past its peak and lockdown is slowly released, the public health community will refocus on what recovery will be needed and begin planning for the new normal. With this pandemic, we are already seeing questions being asked about how we can 'reset' rather than 'recover'.

Paine 2 (1737e1809), the British-born American political theorist and revolutionary, wrote: 'We have it in our power to begin the world over again'. As we reset from the COVID-19 pandemic, should we not see this as a real opportunity to rebuild the world in a way that also addresses and reduces gambling harms? If we are to have the sort of mature discussion around building the public health response to gambling harms, this is an important time to start.

Competing interests P.M. reports serving as an advisor to the Scottish Chief Medical Officer and the Scottish Government on the public health response to gambling harms. P.M. reports being invited to speak at the launch of the Gambling Commission's National Strategy to Reduce Gambling Harms in Scotland. He reports not being remunerated for this. He reports receiving funding from the Gambling Commission to undertake a project developing a public health strategy to prevent gambling harms in Glasgow for his employing agency, Public Health Scotland. This funding was provided as part of a regulatory settlement to the Gambling Commission.

Between May 2015 and March 2020, H.W. reports serving as the Deputy Chair of the Advisory Board for Safer Gambling, an independent group that provides advice on gambling policy and research to the Gambling Commission and was remunerated by them. She reports working on one project funded by GambleAware on gambling and suicidality in the last three years. H.W. reports running a research consultancy, Heather Wardle Research Ltd. She reports not providing consultancy or any other services for the industry. She reports providing evidence at the House of Lords Select Committee enquiry into the social and economic impact of gambling as an unpaid expert witness in summer 2019. She reports serving as a member of WHO panel on gambling.

S.G. reports serving as an Emeritus Professor at the Chinese University of Hong Kong which has institutionally received charitable and research support from the Hong Kong Jockey Club. She reports being the Deputy Chair and Trustee of GambleAware, which is unremunerated, Chair of the Safer Gambling Board which is responsible for the BetRegret Campaign. In addition, S.G. reports being an Associate Non-Executive Board Member of the Public Health England Board Global Health Committee.

G.R. reports currently being a member of the World Health Organization's panel on gambling and the Howard League's Commission on Problem Gambling and Crime. Neither position is remunerated. She reports receiving research funds from the National Institute for Health Research, the Economic and Social Research Council, the Medical Research Council and the British Academy in the past three years. Between 2009 and 2014, she reports being a remunerated member of the Responsible Gambling Strategy Board (now the Advisory Board for Safer Gambling): an independent body that advised the Gambling Commission on research and strategy.

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Common sense: (Appendix)