The Lancet Public Health Commission on Gambling

By Heather Wardle, Louisa Degenhardt, Virve Marionneau, Gerda Reith, Charles Livingstone, Malcolm Sparrow

The global gambling industry The global gambling industry is rapidly expanding, with net losses by consumers projected to reach nearly US$700 billion by 2028. Industry growth is fuelled by the rise of online gambling, widespread accessibility of gambling opportunities through mobile phones, increased legalization, and the introduction of commercial gambling to new areas. Recent expansion is most notable in low-income and middle-income countries, where regulatory infrastructure is often weak. Gambling, in some form at least, is now legally permitted in more than 80% of countries worldwide. Online gambling, given its borderless accessibility, is available everywhere via the internet. Digitalization has transformed the production and operation of commercial gambling, but the consequences of this shift and its effects on consumers have not yet been fully recognized. The production of online gambling is interconnected with an ecosystem of software, information technology infrastructure, and financial technology services. The commercial gambling industry has also developed strong partnerships in media and social media. Sponsoring and partnering with professional sports organizations provides gambling operators with marketing opportunities with huge new audiences. This far-reaching and interdependent corporate ecosystem collectively wields substantial influence over policy and has multiple points of contact through which to leverage the behavior of consumers. Online gambling products are designed to be rapid and intensive, characteristics that are associated with a higher risk of harm for consumers. The introduction of in-game betting during live matches has made online sports betting instantaneous and increased both its frequency and prevalence. Traditional gambling products, such as lotteries and bingo, now have faster cycles and are continuously accessible through smartphone apps. The boundaries between digital gaming and gambling are becoming blurred, with gaming increasingly acting as a conduit to gambling. Leveraging online digital infrastructures and surveillance data, gambling companies now have unparalleled capabilities to target consumers, including through the use of social media and influencers to engage individuals and online user data to tailor marketing to individuals, cross-sell products, and prolong user engagement. To safeguard their interests, stakeholders in the commercial gambling ecosystem deploy a range of strategies, many of which are similar to those used by other industries selling potentially addictive or health-harming products. To shape public and policy perceptions, and as they lobby policymakers directly to further their commercial interests, the industry portrays gambling as harmless entertainment and stresses the economic benefits (including tax revenues) and employment opportunities that the industry provides. The gambling industry particularly stresses the social benefits that accrue when some portion of gambling profits are used to fund education, health services, or other worthwhile social causes. According to industry narratives, responsibility for gambling harm is attributed to individuals, particularly those deemed as engaging in problematic gambling, which deflects attention from corporate conduct. The gambling industry also exerts considerable influence over research into gambling and gambling harms, which helps it retain control of the framing and messaging surrounding these issues. Industry messaging has substantially influenced gambling policy and regulation. Most policy solutions to gambling harms rest on the notion of individual responsibility. Providing support services, treatments, and protections for at-risk individuals is, of course, important. Improving these remedies further and making protective supports broadly available remains a priority. However, framing the problem in this way and narrowly focusing policy attention on a small subset of the people who gamble draws attention away from industry practices and Key messages • Commercial gambling is a rapidly growing global industry and is becoming increasingly digital. • The harms to health and wellbeing that result from gambling are more substantial than previously understood, extending beyond gambling disorder to include a wide range of gambling harms, which affect many people in addition to individuals who gamble. • The evolution of the gambling industry is at a crucial juncture; decisive action now can prevent or mitigate widespread harm to population health and wellbeing in the future. Thus far, globally, governments have paid too little attention to gambling harms and have not done enough to prevent or mitigate them. • Stronger policy and regulatory controls focused on harm prevention and the protection of public health and wellbeing, independent of industry or other competing influences, are now needed. Given the increasingly global and boundary-spanning nature of the industry, international coordination on regulatory approaches will be necessary for corporate behavior. We must also seriously examine the structures and systems that govern the design, provision, and promotion of gambling products. 

Lancet Public Health, Oct. 2024.