Gambling-related harms evidence review: summary

1. Introduction

In the 2005 Gambling Act, gambling is defined as gaming, betting and participating in a lottery.

In recent years, concern about the harms associated with gambling has been increasing in the UK and in March 2018, the Public Health England remit letter confirming  priorities for 2018 to 2019 included the request for PHE to ‘inform and support action on gambling-related harm as part of the follow up to the Department for Digital, Culture, Media and Sport-led  review of gaming machines and social responsibility’.

In May 2018,  published its response to a consultation on proposals for changes to gaming machines and social responsibility measures. In it they announced that will conduct an evidence review of the health aspects of gambling-related harm to inform action on prevention and treatment’.

The UK has one of the biggest gambling markets in the world, generating a profit of £14.2 billion in 2020. Previous research has shown that harms associated with gambling are wide-ranging. These include not only harms to the individual gambler but their families, close associates and wider society There have been growing calls by the public health community, people with lived experience and parliamentarians that a population-level approach is needed to tackle this public health issue . However, there was a need to fully understand the extent to which gambling is a public health issue, for whom it is a problem and the extent of the possible harms.

Our evidence review and analysis examined the following questions:

  1. What is the prevalence of gambling and gambling-related harm in England by socio-demographic characteristics, geographical distribution and year?
  2. What are the determinants (risk factors) of gambling and harmful gambling?
  3. What are the harms to individuals, families, communities, and wider societal harms associated with harmful gambling?
  4. What is the social and economic burden of gambling-related harms?
  5. What are stakeholder views on gambling-related harms in England?
  6. To what extent has coronavirus (COVID-19) affected gambling participation and behaviour?

You can find the full technical reports on the gambling-related harms evidence review page

2. Approach and methods

We used a mixed methods approach for this review, including quantitative, qualitative and rapid review methodologies. We developed 6 studies to answer each of the 6 questions.

To answer question 1, we conducted a quantitative analysis to examine the prevalence of gambling and related harms in England using data from the annual Health Survey for England (HSE) and a number of other gambling data sources.

To answer question 2, we conducted an umbrella review (a systematic review of systematic reviews) to identify and examine evidence on potential risk factors associated with gambling and harmful gambling.

To answer question 3, we conducted an abbreviated systematic review to identify and examine the potential harms associated with gambling.

To answer question 4, we conducted an analysis to estimate direct, indirect, and intangible excess costs of gambling-related harms based on the best available evidence.

To answer question 5, we conducted a qualitative investigation of stakeholder perspectives on gambling using data from a Gambling Commission consultation and an anonymous sample of gambling-related tweets from Twitter.

To answer question 6, we conducted a rapid review of studies to examine the impact of COVID-19 on gambling behaviour and associated harms.

The evidence review was underpinned by an adaptation of an existing framework which classifies gambling-related harms by type and temporality.

The types of harms are:

  • financial
  • relationship disruption, conflict or breakdown
  • mental and physical health
  • cultural
  • employment and education (referred to as reduced performance at work or study)
  • criminal activity

Temporality includes general, crisis and legacy and is based on the idea that a harm might occur at the first single engagement with gambling and continue even after a person stops gambling.

3. Results

The gambling population in England

Overall prevalence of gambling

In 2018, 24.5 million people in England gambled (54% of the adult population, or 40% when you exclude the National Lottery). The National Lottery is the most common type of gambling across all age groups, except among younger people where scratch cards are more common. Football pools and electronic gaming machines are more common among people under 35 years of age compared with older age groups. Men are more likely to gamble than women, and this difference is most obvious for online gambling where 15% of men participate, compared to 4% of women.

Our analysis revealed that overall gambling prevalence has fluctuated between 2012 and 2018. Participation in the National Lottery reduced by 10%, participation in other gambling activities has stayed at 40% despite an increase to 45% in 2015, and online gambling (excluding the National Lottery) has increased from 6% in 2012 to 9% in 2018.

Prevalence of at-risk and problem gambling

Based on 2018 data, we estimated that 0.5% of the population reached the threshold to be considered problem gamblers, and this proportion has remained relatively consistent since 2012. We also estimated that 3.8% of the population are classified as at-risk gamblers. These people are typically low- or moderate-risk gamblers, meaning they may experience some level of negative consequences due to their gambling.

The highest rates of gambling participation are among people who have higher academic qualifications, people who are employed, and among relatively less deprived groups. People who are classified as at-risk and problem gamblers are more typically male and in younger age groups. The socio-demographic profile of gamblers appears to change as gambling risk increases, with harmful gambling associated with people who are unemployed and among people living in more deprived areas. This suggests harmful gambling is related to health inequalities.

Gambling and the risk of gambling-related harm are also associated with psychological and physical health. The highest levels of gambling participation are reported by people who have better general psychological health and higher life satisfaction. And people who have poorer psychological health are less likely to report gambling participation. However, it is the opposite for at-risk and problem gambling, where there is a higher prevalence among people with poor health, low life satisfaction and wellbeing. This is particularly true where there is an indication of psychological health problems.

Body mass index (a measure of overweight or obesity) and cigarette smoking were not found to be associated with gambling, but there was a clear association between gambling at all levels of harm and increased alcohol consumption. This association is evident for overall gambling participation but is greater for at-risk and problem gambling.

Harmful gambling has a different activity profile to general gambling. It includes low National Lottery participation and high participation in online gambling (including online slots), casino and bingo games, electronic gambling machines in bookmakers, sports and other event betting, betting exchanges and dog racing. Harmful gamblers are far more likely to participate in 7 or more gambling activities. Overall participation in online gambling for at-risk gamblers (23.4%) was more than double that of the general population (9.4%) in 2018.

Demographic factors, particularly being male, appear more significant in predicting at-risk gambling behaviour than economic factors such as income, employment, and relative deprivation. Poor mental health is a stronger predictor of at-risk gambling than both poor physical health and negative health behaviours, with the notable exception of alcohol.

Regional variations

The North West (4.4%) and North East (4.9%) had the highest prevalence of at-risk gamblers, while the South West (3.0%) had the lowest prevalence. Due to small numbers, it was not possible to determine the levels of problem gambling for each region in England with any statistical significance.

Gambling among children and young people

The proportion of children and young people who reported participating in any gambling in the last 7 days has reduced from 23% in 2011 to 11% in 2019. The proportion reporting any gambling in the last 12 months reduced from 39% in 2018 to 36% in 2019.

The extent of gambling among children and young people is lower than drinking alcohol but higher than using e-cigarettes, smoking tobacco cigarettes, or taking illegal drugs. There may also be a relationship between these other harmful activities and gambling. Compared with children who have not gambled, those who have spent their own money on gambling are more likely to have consumed alcohol, taken drugs, or smoked either a tobacco cigarette or an e-cigarette.

Nearly double the number of boys (13%) reported participating in any gambling activity in the past 7 days than girls (7%), and participation was higher in children aged 14 to 16 years (12%) compared to those aged 11 to 13 years (9%). Electronic gaming (fruit and slot) machines were often identified as the first experiences of gambling among children and young people although National Lottery, scratch cards, and placing private bets with friends were the most common forms of gambling reported. As young people got older there was a significant increase in online gambling among boys.

Other people affected by gambling

Around 7% of the population of Great Britain (adults and children) were found to be negatively affected by someone else’s gambling according to the best available evidence from YouGov.

Affected others are more likely to be women. The most severe impacts of problem gambling were felt most by immediate family members. Almost half (48%) of people who were affected by a spouse or partner’s gambling reported a severe negative impact. This was followed by people affected by the gambling of a parent (41%) and the gambling of a child (38%).