Gambling-harm: Public Health Approach?

Updated: Apr 15

From 2016, the Gambling Commission and the Advisory Board for Safer Gambling (RGSB) have consistently reiterated the need for a public health approach to gambling-harm through the "National Responsible Gambling Strategy" and the "National Strategy to Reduce Gambling Harms."


What is the public health approach?

A public health approach aims to achieve the best health outcomes for the whole population. It does not just focus on those who are most severely affected and instead aims to reduce the disease's overall burden.


The first step of a public health approach is to define the problem:

  • Who is affected?

  • How big is the problem? (burden of disease)

  • What contributes to the problem?

  • When and where is the problem most likely to occur?

In the last 30 years, Disability-Adjusted Life Years have been used widely to measure disease burden on a population level. Globally, there have only been two published attempts to measure the gambling-harm burden of disease (Australia 2016 & New Zealand 2017).


What is burden of disease?

World Health Organisation - WHO:

"Burden of disease is a concept that was developed in the 1990s by the Harvard School of Public Health, the World Bank, and the World Health Organization (WHO) to describe death and loss of health due to diseases, injuries, and risk factors for all regions of the world.


The burden of a particular disease or condition is estimated by adding together:

  • the number of years of life a person loses as a consequence of dying early because of the disease (called YLL, or Years of Life Lost); and

  • the number of years of life a person lives with a disability caused by the disease (called YLD or Years of Life lived with Disability).

Adding together the Years of Life Lost and Years of Life lived with Disability gives a single-figure estimate of disease burden, called the Disability-Adjusted Life Year (or DALY). One DALY represents the loss of one year of life lived in full health."


Why is it important to measure the burden of disease?

  • Prioritising actions in health and the environment

  • Planning for preventive action

  • Assessing performance of healthcare systems

  • Comparing action and health gain

  • Identifying high-risk populations

  • Planning for future needs

  • Setting priorities in health research

What is the gambling-related burden of harm?

New Zealand, 2017 (Adult population = 3.6m)

Years of disability due to gambling-harm = 0.16m

  • 67, 199 years due to harms from own gambling in adults (prevalence: 7.3%)

  • 94, 730 years due to harms from someone else's gambling in adults (prevalence: 13.6%)

  • Alcohol - Hazardous drinking (>8 AUDIT): 87, 620 years (prevalence: 22.3%)

  • Anxiety and depressive disorders: 106, 280 years (prevalence: 17.4%)

  • Drug use disorders: 22, 396 years (prevalence: 1.9%)

Other DALYs in New Zealand for context

Total number of DALYs in New Zealand 2013 (gambling-harm omitted) = 1.10m (0.57m (52%) due to YLD + 0.53m (48%) due to YLL)

Victoria, Australia 2016 (Adult population, 4.4m)

Years of disability due to gambling-harm = 0.12m

  • 101, 675 years due to harms from own gambling in adults (prevalence: 12.5%)

  • 16, 320 years due to harms from someone else's gambling in adults (prevalence: 2.8%)

  • Alcohol use and dependence: 142, 262 years (prevalence: 25.0%)

  • Major depressive disorder: 142, 451 years (prevalence: 6.6%)

  • Cannabis dependence: 16, 906 years (prevalence: 0.4%)

Other DALYs in Victoria Australia for context

Total number of DALYs in Victoria Australia 2015 (gambling-harm omitted) = 1.2m years

Great Britain, 2020 (Adult population = 53.6m)

Years of disability due to gambling-harm = 2.04m (using Disability Weights estimates from New Zealand and Australia populations)

Years of life lost due to gambling-harm = 0.05m+ (using standardised mortality ratios from a longitudinal study in Sweden)

  • 1.10m years due to harms from own gambling in adults (prevalence: 8.5%)

  • 0.94m years due to harms from someone else's gambling in adults (prevalence: 6%)

  • 0.05m years due to mortality in individuals with gambling disorder aged 20-50

Other DALYs in England for context

Total number of DALYs in England 2013 = 13.7m (gambling-harm omitted, Adult population = 43.7m)

  • Gambling-harm in adults: 1.71m (12.5%)

  • Dietary risks: 1.47m (10.8%)

  • Tobacco smoke: 1.46m (10.7%)

  • Gambling-harm in adult gamblers: 0.94m (6.9%)

  • Gambling-harm in adult affected others: 0.77m (5.6%)

  • Alcohol use: 0.55m (4.0%) including Alcohol use disorders: 0.09m (0.7%)

  • Drug use: 0.27m (2.0%)

What's missing?

Conclusion

  • Early evidence illustrates that gambling harm is attributable to more harm to health than any other risk factor in New Zealand and Great Britain.

  • The results from Victoria Australia provide a less clear picture, as estimates of harm from alcohol use vary by study design; however, gambling harm in adults would still be one of the leading risk factors for overall health harm.

  • Gambling-harm is expected to be an even more significant factor when evaluating harm to health in individuals aged <50 years old and especially when evaluating harm to health via disability separately (quality of life)

  • Research, Education, and Treatment (RET) in the UK should define gambling-harm in the public health context through measurements of the burden of disease, and these measurements should look to consider harms in under 16-year-olds, legacy harms, and loss of life due to mortality.

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