19 Jun Waiting for the Great Leap Forward – why we should be cautious about this cultural revolution
Waiting for the Great Leap Forward – why we should be cautious about this cultural revolution
Gambling, we are told on an increasingly regular basis, is a public health issue. Translated into plain English, this means that the activity of gambling is something from which the population at large (including those of us who do not gamble) requires protection. The promulgation of this view in a growing number of developed markets represents a profound shift in regulatory philosophy and possibly an existential threat to the gambling industry as we know it; but is it justified? In this essay, we consider whether the case has yet been made for the public health lobby’s hegemony.
“We maintain this reformulation requires a shift in the dominant regulation and governance model away from gambling industry self-regulation under self-monitored codes of practice, to mandatory, externally monitored integrity standards that preferably, are internationally agreed upon, well publicised, enforced and include gambling products, practices, marketing, environments and operations within a new transparent governance frame.”
Hancock & Smith, 2017
In April 2017, a storm broke out in gambling academia over something called the ‘Reno Model’ (the school of thought which had for more than a decade held sway as the dominant western philosophy on the prevention and treatment of problem gambling). At the time, this academic spat was barely noticed outside the narrow readership of the research journal that published the piece. Subsequent events, however have cast the episode as a tipping point in global approaches to gambling regulation.
It all started when Linda Hancock (a social researcher from Deakin University in Australia) and Garry Smith (from Alberta University in Canada) co-authored an opinion piece in the International Journal of Mental Health & Addiction. The title of the essay wasCritiquing the Reno Model I-IV International Influence on Regulators and Governments (2004-2015). It constituted an iconoclastic assault on regulatory and harm prevention orthodoxy in gambling. Hancock and Smith’s essay argued that instead of attempting to balance the costs and benefits of gambling, governments should target harm reduction at a national population levelas the paramount objective of regulation. It also contended that the conception of harm reduction as a collaborative effort between the state, treatment providers and gambling operators was naïve and doomed by conflicting interests to fail.
The paper went further in dismissing the Reno Model’s assertion that the principal (but by no means sole) agent in harm prevention was the consumer himself; and raised up both the role of the state and the liability of the industry. The authors advanced their arguments under the banner of ‘public health’.
Hancock and Smith’s bombshell prompted a flurry of responses from different sides – notably from the original framers of the Reno Model, Robert Ladouceur (Laval University, Canada), Howard Shaffer (Harvard University Medical School) and Alex Blaszczynski (University of Sydney). To the outside observer, both sides to the argument made valid points – but neither was interested in compromise or accommodation. One contribution (from the University of Adelaide’s Paul Delfabbro and Daniel King) essayed a balanced appraisal of the debate. Sadly, balance and tolerance have few adherents in this Twitter age and so the battle lines were drawn between opposing camps.
Two years on, it would appear that Hancock and Smith are winning. Their beliefs are gaining in currency in regulatory debates as the so-called “public health” lobby steals a march on policy in a growing number of developed markets.
To illustrate the influence (or prescience) of Hancock and Smith’s essay, consider a number of recommendations contained therein: consumer protection and safety should be the pre-eminent principles of gambling regulation (rather than a matter to be balanced against other considerations, such as consumer choice); consumers should have a (legal) right to “redress for harm”; a “public health population” approach should be adopted, focusing on prevention of harms; communities should be given stronger powers to reject gambling operations; certain harm prevention measures should be mandated; and operators should be made responsible for ensuring effectiveness; industry data should be made accessible to researchers; research should be free of industry funding and influence.
Two years ago, this would have been considered a relatively radical agenda. Today, in a number of jurisdictions (particularly in western Europe and Australasia) it is being gradually absorbed within mainstream regulatory thinking.
Great Britain is one of the markets where the philosophy of Hancock and Smith is taking root. In 2019, the Gambling Commission published a harm reduction outline strategy stipulating that it would adopt a public health approach towards gambling; that harm prevention measures once proven should be mandated; that a central data repository should be established to facilitate data sharing with researchers; and that a levy should be exacted on the industry (replacing the existing voluntary system) in order to free research from the taint of industry funding.
At the same time, the regulator has hinted that it is prepared to act in response to societal concerns – rather than evidence of harm – suggesting that community agitation alone may provide legitimate grounds to curtail certain activities.
It seems clear that in Britain and a range of other markets – including New Zealand, Italy and Spain – the public health lobby is now dominating policy discourse and dictating the course of re-regulation. What is particularly remarkable – given its profound implications for licensed markets – is that this process is taking place without any formal examination and virtually unopposed.
The increasing dominance of public health poses – at its extreme – an existential threat to the industry. This is because it frames gambling as an inherently harmful activity that the population at large needs to be protected from (even if they are not consumers themselves). It represents a significant departure from how gaming and betting are considered by the fields of economics (which is interested in costs and benefits, trade-offs and impacts on decision-making) and psychology (which focuses on maladaptive behaviours by the individual).
It may be that a public health approach is required in gambling regulation – but who decided this and how?
Perhaps the first point that ought to be made is that there is no universally ‘right’ approach to gambling legislation. In general, we respect the rights of different cultures and different nations to adopt particular attitudes to what betting and gaming opportunities to permit and how – and we understand that laws will shift over time in response to changes in supply and societal attitudes.
In Britain, these shifts have typically been codified within Royal Commissions and similar enterprises. For example, the Rothschild Commission of 1978 to 1979 espoused a paternalistic view that gambling was an activity to be tolerated but not stimulated; while the Gambling Review Body (which produced the ‘Budd Report’ of 2001) reframed the activity as a legitimate adult pastime. In Australia, the government’s Productivity Commission reviews (which have taken place roughly once a decade) have performed a similar function.
Such assessments are of course influenced by a degree of inherent bias (e.g. through the selection of committee members). However, they do at least have the virtue of being carried out in public, subject to clear terms of reference with their findings and recommendations made public in reports that are then subjected to scrutiny by national legislatures.
What is interesting about the rise to ascendancy of public health is that it has taken place without any such process; via infiltration rather than formal review. It has also occurred against a conveniently hysterical backdrop of claims about “a problem gambling epidemic” and “a public health emergency”. It is not simply the case that very little (if any) primary empirical evidence is presented to support these contentions; but that these assertions deliberately ignore much of the evidence that is available.
The facts are that reported rates of problem gambling in Britain have barely changed over the course of the last two decades (and if anything are in decline) while participation in gambling has decreased. Globally, recorded rates of problem gambling prevalence also seem to be falling. There are of course issues with using self-report methods to arrive at rather abstract problem gambling diagnoses. We should therefore be very careful about suggesting that lower rates of problem gambling imply reduced harm; but at the same time, there ought to be a burden of proof on those making epidemiological claims (in the face of a large body of contradictory evidence) to substantiate them.
All too often, the absence of evidence is explained by the description of disordered gambling as a “hidden addiction” or a “hidden epidemic”. The idea that some harms are not easily visible seems valid – and this should prompt enquiry. Too often in the past, the pro-gambling lobby deliberately conflated absence of evidence with evidence of absence; but public health has pulled off the neat trick of interpreting absence of evidence as proof of existence.
In recent years, there have been attempts to create frameworks for measuring harm (Langham, 2015; Browne & Rockloff, 2018; Wardle et al, 2018) and the development of a new screen designed to detect harm (the Short Gambling Harm Screen). This is important work – but it is still in its infancy. At present, there are few jurisdictions in the world where gambling-related harm is being systematically recorded, analysed, measured and compared over time.
There is a number of harm-related questions contained within traditional problem gambling diagnostic screens. However, while problem gambling rates are reviewed, relatively little attention has been paid to endorsement rates for specific criteria. Our work on the six major household surveys in Great Britain between 1999 and 2016 reveals that endorsement rates for committing a crime or borrowing in order to gamble, risking an important relationship or feeling that gambling caused health problems have all declined or remained stable. It would be foolish to claim that these results prove diminished harm (these are self-report studies and there are some issues of comparability between the earlier and later surveys); but to state that harm is increasing when the available empirical studies indicate otherwise is unscientific.
It has become sufficient to allege increased harm without actually having to demonstrate it. Part of the problem here is that attempts to define harm tend to be loose, subjective and subject to wilful misidentification of correlation as causation. As a result, it is possible for those opposed to gambling to diagnose harm at pretty much any level of involvement (as any session of gambling will result in the loss of either time or money or both).
This is the point that Delfabbro and King made in their 2017, essay noting the difficulties of aggregating very low-levels of harm to create a sense of population-level emergency. They wrote: “A question…has to be raised as to whether [low-risk harms] are genuine forms of harm. If one were to spend more money on shopping, subscribing to a new television channel, or going to sporting events, would not the same sorts of harm occur? The danger here is that if one softens the deﬁnition of harm, then it becomes possible to show that harm occurs at any point at the continuum.”
This leads us to a particularly worrying aspect of the current policy debate. We seem to have lost the capacity to distinguish between forceful assertion of opinion and scientific evidence. We are also unable to discuss gambling without resort to hyperbole. Words such as “crisis” and “epidemic” are fast becoming meaningless through overuse. The public health page of the Independentnewspaper reveals a wide range of apparent “crises”, ranging from consumption of sugar, salt and alcohol; the marketing and sale of crisps, muffins, pizza, sandwiches in hospitals and even salads; ‘bad sex’ and ‘super-gonorrhoea’; scarlet fever, scurvy, rickets and gout; and of course monkeypox. We can only guess at the effects on the nation’s mental health of this incessant promulgation of anxiety.
This is problematic not simply because of the potential to distort market regulation but also because it distracts from what is important. It may well be the case that gambling harm is not taken seriously enough by governments; and almost certain that treatment services are under-resourced in most jurisdictions. It is plausible that harm may be increasing in severity (at least for some) as consumption shifts from traditional modes (analogue with long feedback loops) to digital modes (continuous gambling on video enabled devices); and that regulatory tightening is required in some areas. However, there is no empirical evidence to support the language of disaster.
The public health lobby has raised a number of valid questions about the changing nature of gambling; but there is a strong ideological tang to its arguments. Too often its claims are advanced unsubstantiated while other views (and hard evidence) are marginalised or ignored.
The left-wing think tank, the Institute of Public Policy Research (which somehow was commissioned by GambleAware to conduct a study of costs to the state relating to the gambling industry in 2016) now claims that consumer choice ought no longer to be a consideration when looking at alcohol, gambling and fast food. They argue that, where these industries are concerned, there is no choice. Instead, consumers are conditioned into pursuing unhealthy behaviours and that these are reinforced by unethical marketing practices.
This nihilist and deeply patronising philosophy – where we are all victims of circumstance – is troubling. It reflects a depressing negation of the idea of free will and reduces humanity to the level of the lab rat, haplessly responding to malign commercial stimulus. It seeks to undermine any sense of personal responsibility or individual autonomy. This is not to deny that some industries (including perhaps elements of gambling) are exploitative; but there is a rich irony when a tiny metropolitan elite bent on controlling what adults should be permitted and not permitted to do accuses others of insidious influence.
The Budd Report of 2001 (which arose from the last systemic review of gambling regulation in Britain) was not to everyone’s taste. Critically, it presented a series of views rather than fundamental truths. Its authors (drawn from a range of fields and backgrounds) claimed no monopoly on wisdom and repeatedly recommended that the effect of legislative changes be evaluated and reviewed (sound advice that was ignored by government and regulator). The report was however produced under clear terms of reference, following a lengthy period of public and expert consultation and subjected to parliamentary scrutiny.
The rise to dominance of the public health lobby has been accompanied by no such process (or indeed any Budd-like sense of humility and doubt). There has been no formal review and no presentation of evidence to justify the ideological hegemony it seeks. Instead, this has taken place incrementally – through infiltration and influence. Some licensees have abetted this process through acts of shocking negligence and greed that have fuelled the demonization of the industry at large. Nevertheless, a fundamental change in the governance of this popular pastime has taken place as a quiet putsch rather than as a considered matter of policy.
Many gambling operators seem blissfully unaware of the change that is taking place – and have set about this new campaign using tactics from the last. The fact that companies are investing significant resource in harm reduction is obviously a big step forward; but this alone is insufficient to meet the threat. There is likely to be no level of harm reduction that will appease their opponents (as demonstrated by curmudgeonly responses to pretty much anything good that operators do). It is critical therefore that operators do more to understand and articulate the benefits of gambling – and that they allow the voice of the customer to be heard.
The Budd Report recommended that the consumer benefits of gambling ought to be studied in tandem with its costs. Without this, there can be no serious attempt at cost-benefit analysis or customer-centric policy-making – and recently, the Gambling Commission has suggested that the British Government should commission such work.
A study in Australia published this year (Blackman et al., 2019) found the people who gamble have higher levels of self-reported well-being than non-gamblers; and that well-being increases with participation. The study also found that at-risk and problem gambling are associated with lower levels of well-being (substantially lower amongst problem gamblers). This research mirrors many of the findings from David Forrest’s 2013 study of self-reported happiness (and unhappiness) in Britain. While these studies demonstrate correlation rather than causation, it ought to be self-evident that any popular pastime involves benefits as well as costs.
The purpose of this essay is not to suggest that the public health approach to gambling regulation is wrong; but rather to argue that governments have a duty to ensure that any significant alteration in regulatory philosophy (likely to lead to profound changes in market supply) should be the subject of due process.
The public health lobby has had to fight to make its voice heard; but if it now seeks to drown out the voices of those with whom it disagrees, it will find that sound insight ossifies into ideology. The best interests of the public are likely to be served by a willingness to consider alternative points of view and to fuse insights and ideas rather than fall back on dogma.
For operators, it is time to stop apologising for providing a service that people want and enjoy. Work on harm prevention and cultural change must of course continue (and be stepped up) and its effectiveness must be tested. The industry should demonstrate by deeds rather than words that it can be trusted to work with others to address harm in meaningful terms (and regulators and governments should intervene where such actions are shown to be insufficient). At the same time, companies need to do more to enhance enjoyment (as distinct from maximising yield) and to champion the best interests of their customers.
At a population level, there will always be a degree of tension between being allowed to pursue well-being through free choice and the harmful consequences of some of the choices we make. Those genuinely interested in the health of the public should focus on achieving greater sympathy between these two realms.