Has Public Health Already Lost the Battle Against Gambling?

“Anyone with a mobile phone now has access to what is essentially a casino in their pocket, 24 hours a day… collectively we need to wake up and take action. If we delay, gambling and gambling harms will become even more widely embedded as a global phenomenon and much harder to tackle.”

Professor Heather Wardle

Co-Chair, Lancet Commission on Gambling, 

Professor, University of Glasgow

INTRODUCTION

Gambling is not a new phenomenon or vice, but current gambling trends pose an emerging threat to public health. The digitalization of betting, together with regulations becoming more permissive of gambling, has caused a rapid expansion of the gambling industry.  Regulations are struggling to keep up with the new gambling landscape. This is, in part, due to the dialogue promoted by the gambling industry that the harmful impacts of gambling are an individual’s responsibility to mitigate. Viewing gambling harms through a public health lens highlights the need to shift the focus onto prevention at a population level. Urgent industry regulation, paired with rigorous research into the consequences of near-constant access to gambling, will be critical in tackling this growing battle.

In this article, we will explore the changing landscape of gambling:

• Gambling – old problem, new threat
• Why do Gambling Harms Matter in Public Health?
• Shifting the Odds: a Public Health Approach to Reducing Gambling Harms

Gambling – Old problem, new threat

Gambling is not new. In fact, it is considered one of humanity’s oldest activities, with references to betting and gambling found in ancient texts and drawn on our oldest human artifacts (Chances, Probabilities, and Odds, 2025). Despite gambling’s presence throughout our history, the nature of betting and gambling has undergone a tremendous shift in the past decade. With digital gambling now almost universally available, coupled with the global trend towards deregulation and normalization of gambling activities, accessibility to gambling has expanded beyond regulatory control, posing a new threat to public health.

The Lancet Public Health Commission on gambling report published in October 2024 summarized the Commission’s findings on the new gambling landscape:

• 46.2% of adults and 17.9% of adolescents were estimated to have engaged in some form of gambling in the preceding year. This is likely a conservative figure given that research heavily relies on self-reporting, which tends to underestimate statistics.
• 80 million adults globally are estimated to be experiencing gambling disorder or problematic gambling (see below). This is also likely an underestimation due to self-reporting, as those with disordered gambling tendencies do not always recognize these attributes in themselves.
• Gamblers are expected to lose up to $700 billion USD by 2028 globally
• 80% of countries globally now allow some form of gambling. However, considering the borderless nature of VPNs and cryptocurrency facilitated gambling, it is accessible practically everywhere (Wardle et al., 2024).

Dr. Malcolm Sparrow, Professor of Public Management at Harvard Kennedy School and member of the Lancet Commission on Gambling, attributes the aggressive growth in gambling to three major factors:

1. Trends towards legalization across the world. Notably, the U.S. Supreme Court lifted federal bans on sports betting in 2018, opening the door for individual states to legalize betting on sports.
2. The digitalization of gambling has unlocked access to 24-hour, 7-day-a-week gambling. This shortens the time between bets and allows bets to be placed on a wider range of outcomes.
3. The aggressive and deliberate expansion of the gambling market into low- and middle-income countries (LMICs), where regulation often lags or is insufficient to control gambling (Ranalli, 2024).

The entire global population is now a potential market where gambling is increasingly normalized as everyday behaviour. Adolescent exposure to gambling and pressure to gamble is particularly alarming. As outlined above, nearly 1 in 5 adolescents surveyed engage in gambling (Wardle et al., 2024), despite it being widely accepted that people who are underage should not engage in gambling activities (Ranalli, 2024). As venues for gambling increasingly move online, age verification becomes particularly difficult. While it is easy to question people who look too young to be gambling in physical spaces, such as entering racetracks and casinos or when buying lottery tickets,  it is laughably easy to circumvent age verification online.  

Why do Gambling Harms Matter in Public Health?

Gambling has been recognized as a mental and behavioural condition in the International Classification of Diseases (ICD) since the 1970s. Hazardous gambling, according to the ICD-11, refers to gambling that increases the risk of harmful physical or mental health consequences and that may require intervention or monitoring. Hazardous gambling is a recognized addiction disorder which does not reach the threshold of a gambling disorder. The ICD-11 and DSM-5 describe people with gambling disorder as exhibiting behaviours that create multiple problems in their lives. The gambling individual has impaired control over their gambling behaviour and gives increased priority to gambling, which negatively impacts other aspects of their life (Wardle et al., 2024).  

Some harms associated with gambling are: 

• Increased risk of suicide and self-harm
• Increased domestic violence
• Loss of employment 
• Financial instability and ruin
• Breakdown of relationships (Wardle et al., 2024)

These harms are not limited to just the individual gambler. It is predicted that gambling impacts six people around the gambler as well (Wardle et al., 2024).

Importantly, there is little understanding around the long-term harms of today’s near ubiquitous access to gambling and the relentless bombardment of gambling advertising, particularly for young people (Wardle et al., 2024). Children and adolescents now have unprecedented exposure to flashy gambling and betting promotions, often flaunted by their sports heroes (Ranalli, 2024). How will the constant barrage of betting ads shape the next generation’s view on gambling? Urgent research is needed to uncover the true, long-term public health impact of gambling.

Shifting the odds: A public health approach to reducing gambling harms

Traditional interventions for gambling largely place the responsibility of modifying behaviour on the individual. Unfortunately, a “gamble responsibly” label on advertising and gambling products does little to modify problematic gambling behaviour. Public health experts are urgently calling for policy solutions at both the population level as well as the individual level, targeted at people exhibiting problematic gambling behaviour. 

Individual-level interventions that have shown efficacy include:

• Tracking gambling behaviour,
• Personalized feedback on gambling activities and losses
• Cognitive behavioural therapy (Ranalli, 2024; Wardle et al., 2024)

While these and other individual-level interventions can be effective, these interventions rely on affected people recognizing their own problematic behaviour and seeking help. These strategies are also often implemented late, after a person has experienced harm such as serious financial hardship or loss of a relationship. 

Applying universal, population-level measures across the gambling ecosystem can alleviate the burden of gambling. The goal is to prevent and reduce harm, ideally before serious harm occurs. Population-level interventions that have shown to be effective include:

• Rigorous age restrictions
• Restricting bet size
• Reducing the speed and intensity of gambling products (particularly in digital products)
• Limiting access to money borrowing for gambling/removing ATMs from gambling venues (Ranalli, 2024; Wardle et al., 2024)

While the above interventions demonstrate efficacy, a significant barrier to effective gambling harm reduction is the lack of rigorous academic research. Research into appropriate interventions is hindered by the entwinement of the gambling industry in research and regulation. Gambling lobbyists are active politically and shape policy. The narrative is twisted to laud the positive impact of gambling on the economy, with the industry visibly supporting sports, media networks, health facilities, and education initiatives while also creating new jobs. At the same time, public health resources are spread thin, making it difficult to give the threat of gambling due attention (Ranalli, 2024). 

Should scarce public funds be diverted to combating gambling harms at the expense of other critical social protections such as vaccination, non-communicable disease prevention, and maternal and child health? Can public health truly tackle this threat, given the deep influence and resources of the gambling industry? Or has public health, indeed, already lost the battle against gambling?

Conclusion

“Our conclusion is clear: gambling poses a threat to public health, the control of which requires a substantial expansion and tightening of gambling industry regula­tion (Wardle et al., 2024, p. e952).” 

The conclusions of The Lancet Public Health Commission on Gambling report cannot be any more direct: gambling IS a public health threat and, if not properly mitigated, WILL continue to cause harm, particularly in vulnerable populations. Whether public health has already lost this battle depends on how urgently we act now. 

Written by: Malissa Underwood, BSN, MPH