Four Types of Killjoy: #4 Anti-gambling

The anti-gambling coalition: strange bedfellows

In this series of posts, the IEA’s Christopher Snowdon explains the background and beliefs of the anti-smoking, anti-alcohol, anti-obesity and anti-gambling movements in the UK.

This is part 4 on anti-gambling.

Read part 3 on anti-obesity here, part 2 on anti-alcohol here, and part 1 on anti-smoking here.

In contrast to tobacco, alcohol and high-calorie food, gambling has a long history of being banned in Britain. Casinos and off-course bookmakers were not legalised until the Betting and Gaming Act of 1960. Liberalisation led to something of a free-for-all which was addressed by the 1968 Gaming Act, limiting casino numbers and establishing the Gaming Board. The National Lottery was introduced in 1994 and the Gambling Act (2005) came into force in 2007, legalising gambling advertising and removing a number of rules that were considered archaic, such as the prohibition on entering a casino within 24 hours of becoming a member. It also replaced the Gaming Board with the Gambling Commission.

The 2005 Act introduced less liberalisation than the government originally intended. Plans to build ‘super-casinos’ were scaled down in the final legislation and were abandoned altogether once Gordon Brown became Prime Minister in 2007. When the economist Alan Budd carried out a review for the government in 2001, he argued that gambling regulation since 1960 reflected ‘grudging toleration’ of behaviour that could not be suppressed by criminal law. The Blair government believed that attitudes had changed, but the backlash from the media and many backbench MPs suggested that the public was only prepared to tolerate gambling so long as they did not have to think about it too often.

Although a majority of British adults consistently report having gambled in the last month, they seem to draw a distinction between ‘soft’ gambling, such as playing the lottery or bingo, and ‘hard’ gambling such as casino games. In 2007, British attitudes towards gambling were more negative than positive, with most believing that there were too many opportunities to gamble and that gambling should be legal but discouraged. A Gambling Commission survey in 2022 found that 62% believed that ‘people should have the right to gamble whenever they want’ and yet 79% agreed that there are ‘too many opportunities for gambling nowadays’. A non-trivial 28% said that gambling ‘should be banned altogether’.

In recent years, gambling has been repositioned as a ‘public health’ issue for reasons explained by Wardle et al. (2019):

‘Harms related to gambling reflect social and health inequalities, with negative effects unequally distributed among economically and socially disadvantaged groups and are commonly associated with a range of mental and physical health comorbidities. At its most severe, gambling can contribute to loss of life.

.. Harms affect a much larger proportion of the population than just those who might be defined as problem gamblers: for every one person with problems, an estimated five to 10 people are adversely affected.

.. Harms from gambling affect health and wellbeing and, even at low risk levels, contribute to a loss of quality of life similar to the long term consequences of a moderate stroke, moderate alcohol use disorder, and urinary incontinence.’

Put simply, the public health approach to gambling focuses on discouraging gambling across the whole population whereas the harm reduction approach seeks to identify risk factors for problem gambling and find interventions that will target them. Harm reduction does not preclude regulation or a degree of coercion (it might limit stakes or ban the use of cash machines in casinos, for example), but it puts more focus on giving individuals the tools to self-regulate. Although some have argued that Geoffrey Rose’s prevention paradox, which claims that targeting a large number of people at low risk is more effective than targeting a small number of people at high risk, does not apply to gambling, advocates of the public health approach implicitly follow the whole population approach that has become dominant in the alcohol field and they explicitly seek to copy policies that have been used to tackle the consumption of tobacco, alcohol and sugary drinks, even when that would be completely impractical.

In essence, they believe the way to tackle problem gambling is to make everyone gamble less, and preferably not at all. The public health approach takes a dim view of the concept of personal responsibility and is sees gambling disorder less an issue for individuals than as an issue for the whole of society - one which can only be addressed by changing societal norms. As Atherton and Beynon (2018) put it:

‘Public health action to reduce harm from gambling should not focus solely on individuals but should include a wide range of population based measures including advocacy, information, regulation and appropriate prohibition in a co-ordinated way’.

Gambling’s transition from being seen as an individual issue to a ‘public health’ issue is not yet complete. Calls for gambling to be regulated by the Department of Health and Social Care rather than the Department for Digital, Culture, Media and Sport have so far fallen on deaf ears (there are echoes here of the complaints about alcohol policy still being controlled by the Home Office). Gambling’s status as a health issue, let alone a public health issue, is more tenuous than that of smoking, excessive drinking or excessive calorie consumption, all of which can lead directly to specific diseases and death. The pathway from gambling to ill health is more convoluted, requiring a degree of ‘addiction’ accompanied by a chronic shortage of money and followed by stress and depression. Spending more money than you can afford can certainly ‘affect health and wellbeing’ and ‘contribute to a loss of quality of life’, as Wardle et al. argue, but gambling is far from the only way in which individuals can get into debt. One might as well claim that investing in the stock market or setting up a business is a public health issue.

In the absence of obvious health consequences caused directly by gambling, public health academics have focused on suicides. Activists cite figures from a 2023 report from the Office for Health Improvement and Disparities (OHID) claiming that there are ‘between 117 and 496 suicides associated with problem gambling’ in England, but it is very unusual for problem gambling to be mentioned in coroner’s reports and OHID’s estimates rely on some absurd extrapolations.

Gambling disorder is a bona fide mental health condition but, as with the food/obesity issue, problem gambling does not lend itself to easy policy solutions at the population level. Problem gambling is much less common than alcoholism, nicotine addiction and obesity. In Britain, the disorder affects less than one per cent of adults at any one time (although the Gambling Commission has recently made attempts to inflate this figure). It is far from clear that the number of problem gamblers can be controlled by regulation, although it may be possible to limit the ‘harm’ (i.e. losses). Sin taxes are not a viable option because the amount spent is at the player’s discretion. Instead, some campaigners have focused on limiting how much players can spend in any given transaction or session. Advertising is a target and there have been concerns about availability, particularly with regards to bookmakers and online gambling.

The academic literature on gambling is not insubstantial but it is smaller than that which covers tobacco, alcohol and food. Much of it looks at the issue of problem gambling and is conducted by psychologists who are not driven by activism. These researchers occasionally suggest harm minimisation policies, but tend to be nuanced in their analysis and acknowledge unintended consequences and trade-offs (e.g. Parke et al. 2016). This has started to change in recent years as ‘public health’ academics who have no specialist knowledge about gambling have taken an interest in the topic and this is likely to accelerate with the new gambling levy that will unlock millions of pounds in research grants for academics. ‘Public health’ researchers tend to portray gambling, rather than gambling disorder, as the problem and promote policies borrowed from tobacco control as the solution.

The ‘anti-gambling’ movement has seen three phases of activity in the past 25 years:

(1) resisting the Gambling Act and ‘super-casinos’ (2001-2008)

(2) campaigning against fixed odds betting terminals (FOBTs) (2011-2018)

(3) lobbying against gambling advertising and online gambling (2018-present).

I use the term ‘anti-gambling’ to describe the groups involved in these campaigns for the sake of brevity and in the very broadest sense since it includes organisations that are implacably opposed to all forms of gambling as well as those which have specific, limited concerns and those who are themselves part of the gambling industry.

A similar coalition of sometimes unlikely allies has coalesced in all three phases, made up of religious groups (such as the Salvation Army, Quaker Action on Alcohol and Drugs, the Methodist Church and the Evangelical Alliance), think tanks at both ends of the political spectrum (Respublica, the IPPR and the Centre for Social Justice), problem gambling charities (such as GamCare), several newspapers (notably the Times and the Guardian), and elements of the rival arcade, casino and pub industries. Other organisations involved in anti-gambling campaigns include the Local Government Association and the Royal British Legion. This is a broad church indeed, with motivations ranging from concerns about the ‘clustering’ of betting shops to religious objections and commercial self-interest.

Health groups have not traditionally had a strong or consistent line on gambling regulation. Certain individuals have spoken out against specific gambling issues, such as when the National Lottery was introduced, but public health organisations have tended not to have a corporate view and have not actively campaigned in the way they have for anti-smoking policies. That began to change in 2019, after the campaign against fixed odds betting terminals had been won, when the Royal Society for Public Health formed the Gambling Health Alliance.

Since 2012, the most significant figure in the anti-gambling coalition has been the former professional poker player and casino game inventor Derek Webb who set up two campaign groups - the Campaign for Fairer Gambling and Stop the FOBTs - after finding three card poker, which he had invented, on an FOBT in 2007. He considered legal action but, as he said in 2013, ‘rather than sue I backed a campaign to make my point’. Over the next four years he spent £3 million on this campaign before setting up the Coalition to End Gambling Ads and Clean Up Gambling and taking the Campaign for Fairer Gambling to the USA where it lobbies against sports betting.

As with the other interest groups discussed above, the anti-gambling interest group was instrumental in setting up an All-Party Parliamentary Group. Formed in 2016, it was initially called the APPG on Fixed Odds Betting Terminals but changed its name to the APPG on Gambling-Related Harm when the FOBT battle was won and has since become the Gambling Reform APPG. Derek Webb has funded all three iterations of the APPG.

In contrast to the other three interest groups discussed in this series, the anti-gambling movement succeeded in the 2010s despite lacking leadership from public health organisations and having virtually no peer-reviewed studies to cite in its favour. The campaign against FOBTs relied instead on research produced by think tanks, economic analysts and other sources, including the All-Party Parliamentary Group. Anti-gambling groups such as Gambling With Lives embrace the ‘public health’ approach because it justifies the kind of incremental prohibitions that they support. As with the other issues discussed in this series, there is no meaningful difference between the policies and outcomes desired by policy entrepreneurs from ‘public health’ and the policies and outcomes desired by those who have a moral or religious aversion to the activity in question.