A casino in your pocket: Gambling industry is a growing worldwide health threat, experts say

The rapid pace of commercial gambling in a complex digital world—where users can play virtually anywhere, anytime— has outpaced monitoring, policy, and regulatory controls. (Photo credit: Daviles)

Fueled by digital technology, the gambling industry drives rapidly expanding and highly profitable products that are more harmful to public health than previously known—and should be tightly regulated, according to a recently released report by The Lancet Public Health Commission on gambling. 

The report says that more than 400 million adults worldwide are at risk of harmful physical or mental health consequences, such as disability and depression, due to the gambling industry. So are children and young people, experts say.

Gambling disorder (ongoing betting that causes multiple problems) could affect nearly 16% of adults and 26% of adolescents who gamble using online casino or slot products. It could also harm roughly 9% of adults and 16% of adolescents who gamble using sports betting products, based on a systematic review and meta-analysis of the gambling industry worldwide. 

“These findings underscore the potential harmfulness of products…that are now driving the global expansion of the gambling industry,” says the Lancet’s multidisciplinary group of experts, co-chaired by Prof. Heather Wardle of the University of Glasgow in Scotland. “This Commission stresses that gambling is a public health issue.”

The gambling industry can cause a wide range of harms, from monetary losses and financial ruin to loss of employment, broken relationships, crime-related impacts, stress, and other serious health issues, the researchers say. Gambling products also have been shown to heighten the risk of suicide and domestic violence.

The risk of harm is higher for certain populations, including children, young people, minority ethnic groups, and those who are most socially or economically disadvantaged, according to the report, published Oct. 24 in the Lancet Public Health journal.

That is similar to patterns in other potentially harmful product industries (commercial determinants of health, or CDoH), such as alcohol, tobacco, and ultra-processed food.

“As with other harmful commodities, adverse effects are often felt not just by the person gambling, but also by significant others, families, and friends, and can result in both tangible and intangible costs to communities and societies,” says the Commission, which also includes contributors with firsthand experience of gambling industry impacts. “Although some harms might be short-lived, others are long lasting and can affect subsequent generations.”

A casino in your pocket

For decades, gambling industry experts have alerted the public health community to the threat of the industry’s expansion. But the rapid pace of commercial gambling in a complex digital world—where users can play virtually anywhere, anytime—has outpaced monitoring, policy, and regulatory controls, the report shows.

As Wardle says, “Anyone with a mobile phone now has access to what is essentially a casino in their pocket, 24 hours a day.”

Gambling in various forms is legally permitted in more than 80% of countries worldwide, with net losses by consumers projected to reach nearly US$700 billion by 2028. In the U.S., 38 states legalized gambling since the U.S. Supreme Court overturned a ban on sports betting in New Jersey in 2018.

The industry’s growth is fueled by the rise of online gambling, mobile phone options, and increased legalization, the Lancet Commission says. Commercial gambling is also being introduced to new areas, particularly in low- and middle-income countries with weak regulatory infrastructure. 

Researchers note that the industry’s influence over consumers has grown, via:

• Blurring of the boundary between gaming and gambling, with gambling embedded into video games that appeal to children and adolescents 
• Capacity to target consumers with surveillance and data about their preferences and practices, and the profitability of certain products
• Emphasizing community benefits (funding social causes or paying taxes)
• Faster cycles that immerse users “in the zone,” and continuous access through smartphone apps for products such as lotteries and bingo
• Introduction of in-game betting during live sports matches
• Network of software, information technology infrastructure, and financial technology services
• Sponsorships and partnerships with professional sports organizations, media, and social media

The industry also targets consumers, especially children and young people, through social media advertising, influencer marketing, and the use of cartoons and celebrities.

One U.K. study found that Twitter gambling industry accounts in 2021 had more than 41,000 followers who were minors. It also found that two-thirds of gambling industry advertising tweets failed to fully comply with regulations. 

“Most people think of a traditional Las Vegas casino or buying a lottery ticket when they think of gambling,” Wardle says. “They don’t think of large technology companies deploying a variety of techniques to get more people to engage more frequently with a commodity that can pose substantial risks to health, but this is the reality of gambling today.”

Following the “Big Three” playbook for betting

In addition, given its fiscal resources and corporate political activities, the gambling industry exerts “considerable influence” over policy-making processes and academic research into gambling and gambling harms, the report shows. This has allowed it to follow alcohol, junk food, and tobacco industry strategies, which feature framing industry messaging in a positive light and focusing policy and regulatory attention elsewhere, researchers say.

“The commercial gambling sector promotes its products and protects its interests by adopting corporate practices designed not only to influence consumer behavior, but also the narrative and political processes around regulation—with a tendency to focus on individual responsibility rather than broader policy changes,” reads a Lancet editorial accompanying the Commission report.

“Such practices are not new and have been used by other harmful industries, but in today’s digitalized, interconnected, and borderless world they pose increasing threats to public health.”

The gambling industry’s design of its products plays an important role, too, researchers note. Studies have found gambling activates a reward system in the brain in the same ways substance addictions do, though symptoms may be less noticeable.

Highly sophisticated marketing and technology make it easier to start and harder to stop gambling, and many products now use design mechanics to encourage repeated and longer engagement. There’s typically no time limit or fixed price. Often industry does not disclose basic information, such as the cost of a gambling session, the report shows.

The title of a panel discussion at a gambling industry show, according to The New York Times? “Build a Better Mousetrap.”  

Calls for more population-level, public health interventions

In 1999, the National Gambling Impact Study Commission recommended that the U.S. Congress pause the expansion of the gambling industry to consider its impacts.

“Without such a pause and reflection, the future does look worrisome,” that study group advised. “A likely scenario would be for gambling to continue to become more and more common, ultimately omnipresent in citizens’ lives and those of their children, with consequences no one can now know.”

Today, controlling this growing problem requires “a substantial expansion and tightening” of gambling industry policy controls and regulation, free of industry or other competing influences, says the Lancet Commission. 

Enhanced protections would bring the regulation of gambling more closely in line with controls on other potentially addictive and harmful products, the experts say.

“Our recommendations provide most people who never gamble, or do so only very occasionally, with protection against corporate practices designed to coerce them into activities in which they would otherwise have little interest,” they say. “By restricting advertising and marketing practices, governments can provide protections for those who need it most, such as children and young people.”

The Commission proposes enacting effective gambling industry legislation in all countries, including bans or substantial restrictions on gambling availability and access, promotion, marketing, and sponsorship. It should also include measures to support at-risk individuals and those experiencing or recovering from gambling industry harms, the researchers say.

The Commission also calls for:

• Enforced minimum age requirements, backed by mandatory identification, to protect children and adolescents from the gambling industry
• Gambling industry restrictions, such as enforceable deposit and bet limits, and universal pre-commitment systems (voluntary limits)
• Rapid transitioning away from industry-funded research and treatment, coupled with increased investment from independent sources
• Well-resourced, independent, and adequately empowered regulators to protect health and well-being in all jurisdictions that permit gambling
• World Health Assembly resolution on the public health impacts of gambling

“The industry will claim that their products are enjoyed by millions of people, the overwhelming majority of whom do not suffer adverse consequences, and that such recommendations are unfairly encroaching on the freedom of individuals,” the Lancet editorial states. 

“This Commission exposes these assertions as deeply misleading. Governments have a duty to protect their citizens from harmful and addictive products and to adopt a public health response to gambling.”

References

Wardle, H, et al. “The Lancet Public Health Commission on gambling.” October 24, 2024. The Lancet Public Health. Published October 24, 2024

The Lancet Public Health. “Time for a public health response to gambling.” The Lancet Public Health. Published October 24, 2024. doi: 10.1016/S2468-2667(24)00248-2

Related

• Bhuptani S, et al. A comparative study of industry responses to government consultations about alcohol and gambling in the UK. Eur J Public Health. 2023;33(2):305-311. doi:10.1093/eurpub/ckad018
• Derevensky, J. L., et al. The migration between gaming and gambling: Our current knowledge. Pediatr Res Child Health. Volume 5(1): 2021
• Hing N, et al. Adolescents Who Play and Spend Money in Simulated Gambling Games Are at Heightened Risk of Gambling Problems. International Journal of Environmental Research and Public Health. 2022; 19(17):10652. https://doi.org/10.3390/ijerph191710652
• How Do Industry-Funded Alcohol and Gambling Conferences Frame the Issues? An Analysis of Conference Agendas. J Stud Alcohol Drugs. 2023 Mar;84(2):309-317. doi: 10.15288/jsad.22-00045.
• Newsweek. “These Are the Real Dangers of the Sports Betting Boom for Young Men.” March 22, 2023.
• Baker, R, et al., Gambling Away Stability: Sports Betting’s Impact on Vulnerable Households (June 30, 2024). http://dx.doi.org/10.2139/ssrn.4881086            
• Thomas SL, et al.. Gambling advocacy: lessons from tobacco, alcohol and junk food. Aust N Z J Public Health. 2016 Jun;40(3):211-7. doi: 10.1111/1753-6405.12410. Epub
• U.S. Department of Justice. “National Gambling Impact Study Commission Final Report.” Published June 1999.
• van Schalkwyk, M. C. I., Cassidy, R., McKee, M. & Petticrew, M. Gambling control: in support of a public health response to gambling. The Lancet 393, 1680–1681 (2019).