Learning lessons from tobacco control

At the start of February, we submitted evidence together with the Faculty of Public Health and Royal Society for Public Health to the Digital Culture Media and Sport (DCMS) Committee’s Inquiry into gambling regulation. Then, last week, there was a flurry of speculation in the press about the long-awaited white paper on gambling harm. When it will be published remains to be seen, but, today, on the eve of No Smoking Day, it feels timely to look at lessons already learned from tobacco control and set out our stall once more on the harm that is caused by gambling, and what can be done to help.

Every year, over 400 lives are lost to gambling in England alone, with many more people’s health and finances hugely affected. The gambling industry often quote the arguably more palatable figure that only 0.3% of people suffer from so called ‘gambling harm’. Some even say that the solution is to focus on that 0.3%, and not the remaining 99.7%. In other words – treat the individual, not the cause.

However, what is crucial to remember is that gambling harm is entirely preventable – there are no underlying physical predispositions at play, no uncontrollable external factors and ultimately, no need for any harm to come to anyone. Yet, in addition to financial and medical harm, a gambling addiction has far reaching impacts on individual relationships, families and communities, with people not able to pay bills, work or provide food for their family.

Like it or not, gambling – like tobacco and alcohol – is a public health issue.

Over 60 years ago, there were calls on the Government to impose greater restrictions on the sale and marketing of cigarettes after a report highlighted the link between smoking and lung cancer. Over the next 40 years, more links were made, attitudes gradually changed and regulative laws were introduced to curtail the tobacco industry’s actions. The result? A significant improvement to everyone’s health.

These changes in the law were, in no small measure, attributable to the work of public health teams, who looked at the evidence and worked with a range of partners to find local solutions to eliminate regional and socio-economic variations in smoking rates.

In other words, one of the reasons smoking rates are now at the lowest since records began, is because a wider approach to tackling smoking was taken – one that looked beyond the individual and instead, at who was being harmed and where, and advocating strongly for a change to the environment around them to ensure the risk of harm was reduced.

With alcohol too, harms are not confined to those with alcohol dependence but are experienced by a wider group including people’s families and communities. Like with tobacco, the public health profession has long argued that in order to reduce alcohol related harm, a range of prevention measures are needed in addition to supporting the small minority of people who are dependent on alcohol – including policies to address affordability, availability and marketing.

However, even though the parallels are obvious, we now find ourselves having the very same discussions about gambling, despite the fact that what shifted the dial for smoking cessation and, to an extent alcohol consumption, has been looking beyond the individual and tackling industry tactics with regulation and legislation.

The gambling industry, like the tobacco an alcohol industries before it, necessarily wants and needs people to buy their products in order to make a profit. As a result, they work hard to make gambling attractive and as easy as possible to access.

Of course, accessible and effective support for the 0.3% is needed but it is nowhere near sufficient and, by perpetuating the narrative that the answer lies in finding and helping that tiny minority and ignoring the majority, we are contributing to net harm overall.

Put simply, everyone should be protected from preventable harm, regardless of their ability to protect themselves.

Furthermore, while addiction and treatment services are clearly needed, helpful and transformative for some, sadly, by the time an individual realises they need support, it might well be too late. NHS clinics report that people often only get to the point of treatment after they have been gambling for an average of 18 years – 18 years of harm and missed opportunities.

With no established screening system and ineffective, industry created algorithms to identify ‘problem gamblers’ it is vital that the Government learns from the public health journeys of tobacco and alcohol and implements a similar, regulatory approach to gambling.

We need to put the numbers to one side and think about who is being harmed, where and how they are being harmed and who is benefiting which is why, in our response to the DCMS Committee, we argue for a shift away from blaming individuals and instead, call for a significant increase in the regulation of the exposure of the public to advertising, marketing and sponsorship.

We also suggest that the roles and responsibility of the industry regulator should be strengthened to increase the public heath expertise within the regulatory body and ensure that it is jointly accountable to both the DCMS and the Department of Health and Social Care (DHSC).

Local government must also be given much stronger powers and responsibilities, along with sufficient resourcing to help protect people from harmful gambling products.

So, while we wait for the white paper with baited breath, the message from Directors of Public Health is clear: we want the Government to focus on prevention, equity and social justice and ensure that policy is based on evidence (with research processes that are free from conflicts of interest and industry funding) so that we can begin to address the causes of gambling harm.

Then – and only then – will we truly be able to protect both individuals and society.