We need to start treating gambling harm as a public health issue – here's why

If £2 billion of public health costs were the result of a contaminated consumer product, urgent national action would follow.

Official estimates place the cost of gambling harm at £1.77 billion, although the full impact is hard to quantify. Yet because gambling harms are often obscured and framed as matters of individual behaviour, they remain under-addressed.

Gambling is seen as part of our cultural landscape. Betting shops proliferate on our high streets, sports teams advertise gambling companies and our digital world offers unlimited access to gambling platforms. It is so embedded in everyday life that it has become normalised. Only when we look at the health cost of this pervasive and addictive product do we begin to appreciate the extent of what we are allowing to happen in our society.

Gambling harm is not a marginal concern. As both a public health doctor and a member of parliament, I believe we need to reframe our national approach from one focused on individual responsibility to one that recognises gambling as a public health issue shaped by systems, environments and commercial practices.

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A changing industry, a new set of risks

The gambling sector has evolved dramatically over the last two decades, while regulation has struggled to keep pace. Today’s products are fast-paced, easily digitally accessible and data-driven. Operators use real-time data to personalise incentives and encourage continued play. The concept of “responsible gambling” sounds reasonable, but in practice it diverts attention from an industry where profit is often closely linked to harm.

The scope of gambling-related harm

Official figures show that 2.5% of the population – around 1.3 million people – are at high risk of gambling-related harm. These harms include financial strain, psychological distress, relationship breakdown, housing insecurity and crime. Gambling is recognised as a risk factor in the National Suicide Prevention Strategy, with the government estimating between 117 and 496 gambling-related suicides in England each year.

International evidence suggests that the burden gambling places on health and wellbeing is comparable to major depressive disorder or alcohol misuse. And the impact extends well beyond the individual. Research indicates that for every person experiencing serious harm from gambling, six others – partners, children, friends or colleagues – may also be affected, facing joint debts, eviction threats and the heavy burden of stigma and stress.

Going beyond treatment to prevention

Well-funded treatment services and public information are essential. But if we are to reduce harm meaningfully, we must also change the environment in which it occurs.

As with tobacco and alcohol, upstream interventions are necessary including product regulation, advertising restrictions, and better controls on availability. Gambling is not simply the outcome of individual choices; it is shaped by commercial systems and risk-promoting design.

The idea that only a “vulnerable few” are affected is misleading. Life events such as bereavement, job loss or mental ill health can make anyone more susceptible and regulation must reflect that reality.

Key recommendations for reform

In a recent pamphlet for the Fabian Society, I set out how a public health approach would combine regulation, transparency and evidence-based prevention to protect the population from the most harmful products and practices. This would start with overall policy responsibility being moved from the Department for Culture, Media and Sport to the Department of Health and Social Care.

Other measures should include overhauling gambling advertising and sponsorship, especially in sport and in media accessed by children and young people; reviewing the outdated 2005 Gambling Act to ensure our laws reflects the reality of smartphone-based gambling and digital risk; and giving local authorities the ability to limit the concentration of gambling premises, including removing the current legal duty to permit licences in almost all cases.

The government should also mandate industry data sharing to allow researchers and regulators to identify patterns of harm and intervene more effectively and prohibit the gambling products associated with the highest levels of harm.

These proposals do seek to prohibit gambling. Rather, they seek to regulate it in line with other consumer industries where harm is possible.

Not the first time

We have addressed comparable challenges before. The UK’s approach to tobacco control, for example, used a combination of product regulation, advertising bans and public education to reduce smoking rates. At its peak, smoking was promoted in glamorous terms and woven into daily life. Tireless public health advocacy led to change.

We have the evidence on gambling harm. The only question now is whether we want toshield harmful industries or act to protect the public.

Dr Beccy Cooper is a public health doctor and MP for Worthing West. She is a member of the Health and Social Care Select Committee and the author of Gambling – Where’s the Harm?, published as a Fabian Ideas pamphlet by the Fabian Society.

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