An industry built on harm

Every year, it has been estimated, up to around 500 suicides in England are linked to gambling (doi:10.1136/bmj.p766).1 That would mean more than one person dying every day on average as a result of a preventable harm. Gambling related harms are pervasive, affecting not only people with gambling addictions but their family, friends, and wider society. More harmful, high risk gambling is associated with deprivation and unemployment, exacerbating existing health inequalities.

This month, after many delays, a white paper updating the 2005 Gambling Act is expected. But will it be far reaching enough, and will it put forward legislation to tackle this growing public health concern and to control the vested interests of the gambling industry?

Some campaigners have called for the white paper to introduce a statutory levy, but this is a divisive option. Supporters argue that a levy could raise funds for specialist treatment, clinics, and research—shifting away from reliance on industry funding (doi:10.1136/bmj.p748).2 But May van Schalkwyk and colleagues argue that “it is not clear that those funds will ultimately contribute to reducing gambling harms” (doi:10.1136/bmj-2022-075035).3 The money raised by a levy would be insignificant against the gambling industry’s profits and not enough to affect prevention policies, they write. There is insufficient evidence that a levy would persuade the industry to change its operations or its marketing. Even though a levy would not deter people from gambling, it could allow the government to be seen as acting while avoiding industry regulation. “If a levy deflects questions about how much harm should be tolerated and on what grounds, it risks doing more harm than good,” the authors conclude.

Industry funding is also influencing education material and training courses, says a new report by the not-for-profit group Tackling Gambling Stigma (doi:10.1136/bmj.p766).1 It finds that the gambling industry is funding training and education for health workers that is of “very poor quality” and that seeks to blame and stigmatise individuals for their gambling addiction rather than tackling the harms perpetuated by the industry and the sophisticated marketing it uses to promote its highly addictive products.

Emphasising the behaviour of individuals to avoid regulation is a tactic used by many other big industries. In an open letter Mélissa Mialon and colleagues criticise sponsorship of the European Congress on Obesity by PronoKal, a weight loss brand owned by Nestlé (doi:10.1136/bmj.p755 doi:10.1136/bmj.p737).45 The sponsorship of an obesity conference by a weight loss brand owned by one of the world’s largest manufacturers of ultraprocessed foods is “an especially egregious example of corporate influence on science,” they write. The sponsorship has since been removed, but Mialon and colleagues emphasise that “accepting such sponsorship from the industry promotes a market based approach to preventing and treating obesity” and call for an end to corporate influence at scientific and healthcare events.

Learning from the public health approaches taken towards other harmful products, such as tobacco, alcohol, and junk food, will be vital to the success of the gambling white paper. The policies it proposes must draw on extensive research into industry influence and the commercial determinants of health. In 2020 the UK gambling industry generated £14.2bn in profits, so gambling companies have little incentive to act. If we are serious about preventing gambling related harms we need to reframe the narrative associated with gambling: that it is not simply a fun leisure activity but an industry built on harm and is a threat to public health (doi:10.1136/bmj.o248 doi:10.1136/bmj.o1128).67