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Artillery Row

“Public health” doubles down

Prohibitionists are never satisfied

Hysteria is the oxygen of the “public health” industry. If people believed that a problem was trivial or getting better or was simply none of their business, activist-academics would have to do something useful with their lives. One way of keeping the public in a permanent state of fear is to move the goalposts. If people are drinking less alcohol, you lower the drinking guidelines and create a million “hazardous drinkers” overnight. If kids are eating less sugar, you halve the guidelines and complain that they are consuming twice as much sugar as they should. You can create a childhood obesity epidemic out of thin air by dropping the threshold of obesity.

Official statistics show that the rate of problem gambling in England is 0.3 per cent. This is low by both historical and international standards and so the Gambling Commission has decided to hike it up. New, experimental statistics released last week report a problem gambling rate of 2.5 per cent. As the Guardian eagerly reported, this means that “UK problem gambling rates may be eight times higher than thought”.

The government first started systematically measuring the rate of problem gambling in 1999. It has been consistently below one per cent in every survey, usually hovering around 0.6 per cent and falling somewhat in the last few years. The gambling minister, Stuart Andrew, claimed that the new survey “presents a higher quality picture of gambling participation and harm than has existed previously.” So have we been mismeasuring the rate of problem gambling all this time?

Almost certainly not. The best figures come from the “gold standard” Health Survey for England which typically involves face-to-face interviews with around 10,000 people selected at random. The findings of this survey are supported by a quarterly telephone survey of 4,000 people conducted by the Gambling Commission which consistently arrives at a similar estimate. 

The new, experimental survey also involves 4,000 people — although the aim is to increase this to 20,000 eventually — but it is conducted mostly online, with the rest conducted by snail mail. It is not “higher quality”. It is just cheaper. Not that the Gambling Commission is short of cash. It gets to keep the revenue from the multi-million pound fines it dishes out to operators. The government intends to put a levy on the gambling industry which could rake in as much as £100 million a year. With all this money sloshing around, conducting a proper survey using recognised best practice doesn’t seem too much to ask. But since Andrew Rhodes became its CEO in 2021, the Gambling Commission has taken a more activist stance and is now more or less openly hostile towards the activities it was set up to regulate. If problem gambling is perceived to be more widespread than previously thought, it makes the case for more anti-gambling regulation stronger.

There are several reasons why the new survey inflates the statistics, but the main issue is selection bias. All surveys try to get a representative sample of the population, but you can’t force someone to participate. If there are systematic biases behind people’s reasons for participating or not participating, the data will be skewed.

And indeed there are. Firstly, online surveys appeal to people who are very online — and that includes a lot of problem gamblers. Older people, who are less likely to be problem gamblers, are under-represented. The Gambling Commission has acknowledged that an “online methodology means that the sample responding to the survey are more likely to be engaged online, thus skewing the data”. 

Secondly, people who gamble a lot are attracted to surveys about gambling

Secondly, people who gamble a lot are attracted to surveys about gambling. The Health Survey for England asks about a range of health issues, but the new Gambling Survey for Great Britain is just about gambling. The clue is right there in the name and a study published in 2009 found that “gamblers and problem gamblers are intrinsically more interested in “gambling” surveys and therefore participate at a much higher rate than nongamblers”. If a disproportionate number of problem gamblers take the survey, the survey will naturally identify a disproportionately high number of problem gamblers.

The Health Survey for England has a response rate of more than 50 per cent, but the response rate for the Gambling Survey for Great Britain is only around 20 per cent. Four out of five people simply refuse to take the new survey, leaving a relatively small group of self-selecting individuals who differ from the general population in various ways, not least in being more likely to have gambling problems.

The bottom line, as the authors of a 2021 study concluded, is that “online surveys over-estimate gambling harm” because of this selection bias. This is well known among gambling researchers and the Gambling Commission is fully aware of it. Nevertheless, the Commission says that it intends to make the results of its online survey the “official statistics” and that it will “replace previous sources such as the Health Surveys and our quarterly telephone survey”. The fix is in. You will hear the claim that one in forty people are gambling addicts a lot in the years ahead.

One perverse consequence of this gerrymandering is that it will make gambling responsible for an implausibly large number of suicides. Anti-gambling groups already claim that there are 409 gambling-related suicides in the UK every year, a factoid from the dying days of Public Health England that has no basis in fact. Public Health England took a study involving 21 suicides in Swedish hospitals and inappropriately extrapolated it across the population of England, assuming a problem gambling rate of 0.4 per cent. But if the problem gambling rate is 2.5 per cent, as the Gambling Survey for Great Britain claims, then there are 2,556 gambling-related suicides a year. This will make gambling responsible for around half of all suicides. The “public health” lobby gets away with a lot of bogus statistics, but this will surely be too much for anyone to swallow, although the Bishop of St Albans recently told the House of Lords that there are 400,000 gambling-related suicides a year and no one batted an eye-lid, so perhaps people are more credulous than I thought.

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