Gambling is not the business of “public health professionals”

Gambling is not a public health issue. Never has been, never will be. Problem gambling is a mental health problem but not a public health problem. It is no more of a public health issue than depression, anxiety or standing on a piece of Lego in your bare feet. There may be things that the government could do to alleviate these problems, but that does not make them public health issues. For the term “public health” to be useful, it has to mean something more than the aggregated health conditions of a society. Pollution, contagious diseases and sewage are public health issues because they present risks that individuals cannot easily avoid through their own actions. The same cannot be said of putting a tenner on the 2.30 at Chepstow.

Obesity and smoking are routinely described as public health issues when they are nothing of the kind. The legal professor Richard E. Epstein pointed out twenty years ago that this misleading terminology is “designed to signal that state coercion is appropriate when it is not.” As I wrote last month, gospel temperance groups have reinvented themselves as ‘public health’ groups because that’s where the action is if you want something banned these days.

It is not a matter of semantics. Resources for genuine public health problems are limited and infectious diseases may flourish if money is diverted towards clamping down on the leisure pursuits of affluent westerners (yes, I’m looking at you, World Health Organisation). In any case, saying that something is a public health problem doesn’t make it any easier to solve. Indeed, it makes it more difficult to solve because it opens the door to a legion of clueless “public health professionals” and single-issue campaigners who bumble in waving their hammer and looking for another nail.

We are seeing this happen in real time with gambling and it will go into overdrive once “public health” quackademics get their hands on millions of pounds from the new gambling levy. Gambling disorder has been treated and studied for decades by unassuming clinicians and researchers who understand that it is complicated. They will soon be eclipsed by dogmatic barkers pushing “solutions” that are clear, simple and wrong.

Two such individuals wrote about gambling for the British Medical Journal recently. Kevin Fenton, a journeyman “public health professional” who once worked at Public Health England and Will Prochaska, a former management consultant now running the Coalition to End Gambling Ads. Under the headline “Ending gambling adverts could prevent harm to millions of adults and children in the UK”, they repeat some dubious factoids and demand an evidence-free intervention from the government. It is a taste of things to come.

Official figures released in 2024 showed that 2.5% of the adult population has a gambling problem.

No, they showed that 2.5 per cent of adults who responded to an invitation to take part in an online survey about gambling for a £10 reward had a gambling problem. Of all the people invited, 81 per cent declined. This left a rump of people who either like doing surveys or like gambling. It was not a representative survey, as the Gambling Commission is well aware. For example, people who completed the survey were seven times more likely to play the football pools than average. The Health Survey for England gets a much better response rate and is less likely to attract people who gamble a lot. Over many years, it has found that the problem gambling rate has remained at around 0.4 per cent.

The Department of Health and Social Care estimates that each year, in England, 117-496 people die by suicide that is related to gambling.

We simply have no idea how many suicides are related to problem gambling (notice how Fenton and Prochaska omit the word “problem”). On average, problem gambling is mentioned on one coroner’s report per year. In the absence of evidence, the Office for Health Improvement and Disparities (OHID) took a study of Swedish hospital patients who had a large number of physical and mental health problems and extrapolated their suicide rate across the population of England. It was execrable junk science, but modern “public health” is not a truth-seeking exercise. It is fundamentally political and what counts in politics is persuasion, not facts.

One of the authors of the Swedish study has since said that her research “could not determine whether GD [gambling disorder] is an independent risk factor for suicide”. The online survey that produced the “2.5% of adults are problem gamblers” factoid found that the gamblers who responded were no more likely to think about suicide than the non-gamblers. Moreover, OHID extrapolated from the Swedish study using the Health Survey for England’s problem gambling estimate of 0.4 per cent. If it used the 2.5 per cent estimate that Fenton and Prochaska reckon is the “real” figure, then there would be more than 2,500 gambling-related suicides every year. In other words, half of all the suicides in England would be linked to gambling. Doesn’t pass the smell test, does it?

As for their proposed ban on gambling advertising, Fenton and Prochaska do not explain how “phasing out” gambling advertising will address “the harms of gambling”. Rates of problem gambling were no lower before gambling ads were legalised in 2007 and there is no reason to think they will be lower if they are banned again. They do not discuss the damage that will be done to culture, media and sport if £1.5 billion of marketing spend is withdrawn. They don’t care if a ban on advertising and sponsorship makes it more difficult for punters to distinguish legitimate gambling websites from unregulated ones. They don’t know, they’re not interested and it’s not their problem.  Knowing a bit about the activity you’re trying to regulate and understanding the problem you’re trying to solve is optional in “public health”. Their job is to keep barking.