The unhealthy trifecta: tobacco, alcohol and gambling industries
While those with a concern for public health may be familiar with some similarities between the tobacco and alcohol industries, it’s time to include the gambling industry in this analysis.
That’s the suggestion from Dr Charles Livingstone, from the School of Public Health and Preventive Medicine at Monash University.
Gambling needs to be tackled as a major public health concern
Charles Livingstone writes:
Mike Daube’s article in the latest edition of the Australian and New Zealand Journal of Public Health challenges the notion that tobacco and alcohol are inherently distinct (if dangerous) commodities that should be regulated or otherwise addressed differently.
There is no safe level of consumption for tobacco, so that the public health goal is to end its use; alcohol in moderation has a role in social life, and the public health goal may therefore be to ensure its safe use. This distinction, argues Daube, is often used as a justification for differential regulatory treatment of alcohol and tobacco.
Daube argues convincingly that in fact alcohol and tobacco are much more similar than we might think, across a variety of parameters.
I want to add a third candidate to this duumvirate of dangerous commodities – the rapidly expanding gambling industry, which is fast becoming a major cause of harm in much of the world, and which shares many features with both the alcohol and tobacco businesses.
As two recent Productivity Commission inquiries (1999 and 2010) have demonstrated, gambling causes significant harm, to individuals, families and communities, and to economies, both local and national. The gambling industry has known about this since it began commercial operations.
Over the last twenty years, as we have seen in Australia, gambling has grown at a global level from a relatively small-scale, vaguely distasteful and frequently marginal activity into a heavily commercialized and highly profitable industry, with major supermarket chains and other publically listed companies, as well as state governments, reaping significant profits. In Australia, net gambling revenues are currently in the range of $20 billion a year. Most of this (55%) comes from poker machines installed in convenience venues – local pubs and clubs throughout every state and territory, bar Western Australia.
Gambling operators acknowledge that gambling is inherently risky, and can cause harm. However, they vehemently deny that this is a consequence of the technical sophistication and widespread availability of gambling opportunities, including the saturation level availability of large numbers of high impact poker machines at local social venues – particularly in socio-economically disadvantaged areas of the major cities of Australia.
They fund research on and marketing of ‘responsible gambling’ in order to shift the actual responsibility for gambling-derived harm away from their business and on to consumers, who are pathologised as flawed consumers who should be subject to individuated treatment regimes.
This emphasis on consumer responsibility, education and treatment is, as Daube has shown, also a tactic adopted in various guises by alcohol and tobacco businesses.
Like tobacco and alcohol, the promoters of gambling attempt to demonstrate that they are good corporate citizens, stressing the contribution they make to good causes. These tactics are aimed at legitimating – one might say laundering – the image of these industries specialising in profiting from commodities almost universally acknowledged as dangerous and damaging to health and wellbeing.
Gambling businesses, notably the poker machine club sector, have taken this to a new level, arguing that without their support for local sporting and charitable purposes, there would be a massive void left in community support for such activities.
Colleagues and I recently completed a study of the extent of such support. While (according to official data sources) such support does constitute a significant amount of money (about $180 million p.a. across NSW, Vic, Qld and the ACT) as a proportion of the amount people spend on poker machines (more than $9 billion a years in those jurisdictions) it is less than 2%.
The worst aspect of this is that poker machines are disproportionately located in disadvantaged communities, such as the NSW federal electorate of Blaxland, where in 2010-11 $177 million was spent on poker machines and $2.5 million (1.4%) claimed by clubs as providing a community benefit. The median individual weekly income in Blaxland is about $396 per week so, allowing for that proportion of the population who actually play poker machines (around 24% in NSW) the average pokie user in Blaxland spends more than a third of median income on that pursuit.
Thus, for those who use poker machines, there is a significant likelihood of serious harm arising not just from their preoccupation with the pastime (which itself seriously erodes social, parental and familial relationships) but also with the diversion of significant amounts towards pokie consumption away from mundane but socially beneficial purposes such as rent, mortgage repayments, food, and education. The full impacts of this include family breakdown, heightened risks of physical and mental ill-health, neglect of children, increased crime (both financial and violent), and self-harm and suicide.
This diversion of expenditure attacks the viability of local businesses, eroding local economic activity. It also appears that poker machines are a significant cause of the entrenchment and intergenerational transmission of disadvantage.
All of these effects contribute to inequity in health outcomes, in some cases to an alarming degree.
Gambling is promoted and operated by companies and organisations that also have a significant stake in tobacco and alcohol. British American Tobacco is a corporate partner of the Australian Hotels Association (AHA), along with Aristocrat Leisure (a major poker machine manufacturer) Tabcorp (a major gambling operator) and various brewers and alcohol manufacturers.
Pokies, of course, proliferate in many hotels and the AHA, along with ClubsAustralia, has been heavily engaged in lobbying against gambling reform. Woolworths and Coles, major Australian supermarket brands, both own and operate significant numbers of poker machines across Australia. Woolworths, with over 12,000 of Australia’s 198,000 poker machines, is one of Australia’s largest single poker machine operators. Like Coles, it is of course also a major alcohol retailer.
Poker machines are not the only mode of readily available commercial gambling. Amongst others, sports-betting has grown rapidly in recent years, and although it operates at a low level in comparison to poker machines, is heavily marketed and appears to be increasing its reach into vulnerable segments, particularly young males. Although sports betting leads the way, other gambling forms also sponsor, fund, or are marketed via ties to sporting codes, particularly codes popular with young people, such as NRL and AFL football, as in the past did tobacco companies and as alcohol companies still also do.
Alcohol and tobacco are rightly prominent in public health concern as industries with enormous detrimental impacts on public health and wellbeing. Gambling is exactly the same, and arguably needs to be seen in the same light. As with tobacco or alcohol, prohibition is almost certainly not politically or publicly acceptable, and because of this is unlikely to be an effective public health measure.
However, there are many important measures available to minimize the harm caused by gambling. Some of these draw from lessons learned in alcohol and tobacco control, especially around marketing. Some are relatively novel.
However, the approach public health practitioners take to addressing the harms of gambling should be the same as we take in relation to tobacco and alcohol: to ensure that public policy on such products is formed with public health considerations paramount.
The effect that good policy may have on revenue streams derived from the destruction of health and wellbeing should always be the least important consideration, not, as seems currently to be the case, the first.
• For more news about gambling and public health, follow Charles Livingstone on Twitter: @CLdeFootscray
Some metaphors for the future of healthcare: from tsumamis and trains to frogs, bikes and jigsaw puzzles