Gambling has become a talking point in the UK Conservative Party leadership election after the health secretary Matt Hancock called for a £100m-plus annual levy on betting companies. If chosen as the next prime minister, Hancock said he intends to impose a 1% tax on these companies’ profits to pay for treatment and research into this area.

Labour have also called for this policy and a radical overhaul of the UK Gambling Act. The party has described gambling as a “hidden epidemic”, and deputy leader Tom Watson has promised that it would introduce a mandatory levy on the industry if elected to government.

It is certainly good to see this issue being addressed by frontline politicians. But imposing a levy is one thing, spending it wisely another – for the swathes of people affected by gambling harms, it is vital that we get this right.

The ripple effect

There are around 340,000 problem gamblers in the UK, and over half a million more people at moderate risk of harm from an expanding commercial landscape of products, particularly electronic gaming machines and games on online platforms.

The impacts from problem gambling spread out to families, communities and society as a whole. As well as financial problems, they include relationships breaking down, the abuse or neglect of partners and children and, in extreme cases, suicide – with all the corresponding burdens on social and health services that this involves.

Eyes down. Jordan Bauer, CC BY

For every one person with problems, it is estimated that five to ten other people end up being affected. Cost estimates to the UK alone range from £200m to £1.2 billion per year. The Faculty of Public Health has called this a “serious and worsening public health issue”.

In Australia, where the evidence base is more fully developed, the burden of harms on health and well-being is estimated to be comparable to alcohol misuse. From an economic perspective, it actually costs societies more if they ignore these harms than if they address them.

Several years ago in Australia’s state of Victoria, for example, total tax revenue from gambling was AU$1.6 billion (£874m) while estimated social costs were AU$7 billion, a net deficit of AU$5.4 billion.

The funding gap

In the UK, the current system of funding for research, education and treatment of gambling harms relies on voluntary industry donations to a charitable organisation, GambleAware. Too often, GambleAware struggles to meet its target contributions of just 0.1% of the money that industry retains once bets have been paid out – known as the gross gambling yield. That’s about £10m in donations for an industry whose gross gambling yield exceeds £14 billion. In this context, a £100m annual levy could clearly make an enormous difference.

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Yet while Hancock’s promises to fund treatment and research are welcome, he makes no mention of prevention. This is disappointing, since any attempt to reduce gambling harms must address causes and not simply consequences. That prevention is better than cure is well recognised across other areas of public health. It is also a matter of social justice, since those who suffer from gambling are disproportionately likely to be poorer people from the poorest areas.

In the UK in 2017-18, the total spending via GambleAware on prevention was less than £1.5m, which amounts to approximately 2p per capita. Compare this to a jurisdiction that treats gambling as a public health issue – in New Zealand, for instance, where harm reduction is a legislative requirement, the annual budget for prevention is more than NZ$18m (£9.3m) for a population of 4.7 million. That’s 99 times more per capita than the UK.

Prevention would involve using legislation to curtail advertising, particularly the personalised marketing that we see all over social media. We should be stricter about promotions and inducements, such as special offers and “free” bets, and stop the use of online credit.

We need tougher regulations on the design and placement of gambling products: this was done recently with high-stakes machines, but betting companies are already finding ways around these rules with different machines.

Prevention also means targeting people who are at risk. This sort of approach is under developed in gambling, so we need to invest in research to understand what works, for whom and under what circumstances. This also needs to be supported by public health campaigns to increase awareness.

Optimising the system

There are several other critical considerations. The first is that funds from a levy need to be ringfenced. Experience from other jurisdictions such as Ontario, Canada shows that if funding is not ringfenced, monies can become swallowed by national healthcare budgets. There are precedents for doing this in the UK: all monies from the sugar tax go to school sports, for instance, while from next year the majority of the Highways England budget will be ringfenced funds from vehicle road duty.

Machine learning. Igor_Koptilin

Prevention, education and treatment all need to be grounded in robust and trusted evidence. One option involves channelling funding through the infrastructure and expertise of independent academic research councils such as the Economic and Social Research Council and the Medical Research Council.

Another would be to adopt the Department of Health and Social Care’s highly successful model of policy research units. This could help to produce timely evidence that keeps up with the speed at which gambling technologies are changing.

Finally, we need to overhaul the system in which commercial gambling is regulated. This would involve a new gambling act that is focused on protecting public health rather than promoting gambling as a leisure activity. This new approach is long overdue.

When the 2005 Gambling Act was drafted the world was very different. Twitter, Facebook and YouTube didn’t exist. Gambling was often seen as a shady activity typically conducted in smoky high-street betting shops. You certainly couldn’t use a smartphone to gamble 24/7 with a couple of clicks.

Aware of these changes, in 2019 the UK government announced a review to ensure that the Gambling Act was “fit for the digital age”. The government recently called the review a priority but has not announced a new date for its publication after announcing a delay in July 2022.

As the government contemplates how to regulate this industry, new rules are needed to cover, not just sports betting, but the rise of online casinos, poker matches and virtual slot machines in the internet age.

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In particular, reform of gambling advertising is sorely needed. It has morphed out of all recognition in the last 18 years. Gambling logos can be seen 700 times during major football matches on TV, while the social media accounts of big betting companies post over 28,000 ads per year.

Research shows that gambling ads on Twitter are particularly appealing to children and young people. So it is perhaps no surprise that as many as 30,000 young people aged 11 to 16 may suffer from harmful gambling habits. Gambling harms include financial, emotional and social difficulties.

Another recent study indicated a link between exposure to gambling ads and suffering from such harms for all age groups. This is particularly worrying since there are already 400 gambling-related suicides every year in the UK.

But the UK is actually at the global forefront of gambling advertising deregulation, while other European countries have been tightening these rules. From changes announced in Italy four years ago to more recent reforms in Germany, Spain, Belgium, and the Netherlands over the last few months, the UK could learn a lot from these regulatory approaches.

Italy: a complete ban on all gambling advertising
At the start of 2019, Italy banned almost all gambling marketing. The Decreto Dignità (Dignity Decree) prohibited all TV, radio, press and internet gambling marketing. This blanket ban was brought in shortly after a study highlighted that 3% of the Italian population was suffering from gambling harms.

The gambling industry said such a ban would be ineffective at addressing betting in settings such as shops or casinos. And that it would encourage customers to use illegal gambling sites such as unregulated online casinos.

It also complained that industry revenue dropped from €19 billion in 2018 to €15 billion in 2021. But since gambling revenue remained consistent until February 2020, it is generally accepted that this drop resulted from the COVID lockdowns, when sports events came to an almost total halt.

Different approaches to gambling regulation

Produced by the authors.
Belgium, the Netherlands and Germany: one step at a time
Other EU countries have taken a more piecemeal approach to recent reforms than Italy.

In 2018 Belgium banned the broadcasting of gambling adverts 15 minutes before or after children’s programming, public posters for gambling, and direct advertising to named individuals in any form. Even these moves were deemed inadequate, with the Belgian Justice Minister arguing last year: “Gambling advertising is fired at us from all sides every day and encourages these addictions, including among young people.”

Subsequently, the Belgian government approved new legislation in December 2022 to ban gambling advertising almost entirely as of July 2023.

The Netherlands has focused on restricting mass marketing on television, radio, internet search engines and public spaces. This approach aims to prevent a “bombardment” of gambling ads, particularly to children and young people.

Germany’s June 2021 State Treaty on Gambling is the least restrictive measure of the four EU countries that have made the most recent changes to gambling regulations.

It includes a ban on advertising to minors or at-risk groups (such as people likely to suffer from certain mental health conditions, or who previously suffered from a gambling addiction). But most interesting is Germany’s “watershed” approach to licensed online casinos, poker and virtual slot operators. Gambling adverts for these providers are prohibited on radio, TV and the internet between 6am and 9pm.

While the UK also has a watershed approach, this only applies to TV adverts during live sporting events. In the digital era, this seems insufficient.

Man using online sports betting services on phone and laptop
There have also been calls for online sports betting restrictions. Kaspars Grinvalds/Shutterstock
A senior commissioner in Germany’s ministry for health championed this measure and also wants to expand it to sports betting.

Italy, the Netherlands, Belgium and Germany all have restrictions around sports betting given the close relationship between sport (particularly football) and gambling. In Germany, advertising with active athletes and officials is prohibited. Belgium, the Netherlands and Italy have strong restrictions on most sports betting marketing including betting ads during football matches and full sponsorship bans.

A number of UK campaigners have called for a similar approach, including the Big Step initiative, whose supporters include former England football star Peter Shilton.

Reviewing the UK Gambling Act
These four EU countries’ recent gambling reforms have been quite different, but they all have one thing in common: substantial legislative reforms.

For the UK, our research shows that the safest option, particularly for children and people at risk, is a full advertising and sponsorship ban such as Italy and Belgium have executed.

The UK gambling industry and its lobbying group, the Betting and Gaming Council, has argued that such measures would drive people into black market gambling. But we can find no credible evidence for such claims. It has also argued that there is no evidence to link gambling advertising to gambling harms. But research has shown this link.

The UK government has emphasised that the current gambling act review needs to “get the balance right” while “following the evidence”. So now is the time to listen, not only to public opinion, but also to mounting evidence about the links between gambling advertising and gambling harms and tighten the regulation.

The prior literature has suggested that gaming venue employees might be an at-risk group for developing gambling problems. A variety of occupational stressors and workplace factors were uncovered for causing the elevated risk. However, little theory-driven research has been conducted to investigate Asian gaming venue employees’ experience of work stress and gambling behavior. Adopting the transactional theories of stress and coping, this exploratory study examined perceived job satisfaction, work stressors, stress strains, coping responses and gambling behavior among Chinese casino employees in Macau. Semi-structured interviews with fifteen casino employees (9 men and 6 women) were conducted. Many interviewees described working at casino as very stressful. Seven types of workplace stressors were identified. Most were aware of the harmful effects of work stress on their health. They experienced physical and psychological strains despite various coping strategies were employed to alleviate job stress. Many gambled after work to ‘unwind’. Using the DSM-IV criteria, one male employee could be categorized as a pathological gambler, and five men exhibited symptoms of problem gambling. In addition to job stress and male gender, other risk factors for problem gambling were also found. The study results have implication for workplace stress prevention and responsible gambling practices.