Embracing public health approaches to gambling? A review of global legislative and regulatory trends

BACKGROUND/ISSUE: The public health community has increasingly called for governments to recognise the health harms associated with gambling, and for prevention policies to include population-based approaches. Whether and to what extent these calls have translated into actual policy-making globally has not been investigated. Our paper fills this gap. METHODS: Using Vixio Gambling Compliance database, we mapped the global availability of legal forms of gambling, changes in its provision, and the prevalence of gambling harm prevention policies. Using global case studies of 33 jurisdictions from across Europe, Asia, Africa, and Americas that introduced major changes to their gambling legislation in 2018-2021, we further analysed the extent to which protection of health and wellbeing is a priority within a changing gambling legislation and explored the extent to which individual- and population-based approaches to gambling-related harms are being integrated into policy. RESULTS: We find that over 80% of countries globally now permit gambling. Among the jurisdictions changing their gambling policies, protection of health and wellbeing is often secondary to revenue growth. Most prevention policies focus on individual responsibility and few jurisdictions aim to address the political, economic, or commercial determinants of gambling harms. CONCLUSIONS/LESSONS: Addressing gambling as a public health issue, thus, is not yet translating into comprehensive policy action across jurisdictions. This is a concern, given that legislative frameworks set the agenda for the regulation of gambling and the actions implemented. By providing new systematic comparative data on responses to gambling-related harms globally this paper will be useful both for public health researchers, and for health policy-makers and advocates around the globe looking to understand how other countries/jurisdictions are responding to this public health challenge. KEY MESSAGES: • While over 80% of countries globally now permit gambling, addressing gambling as a public health issue is not yet translating into comprehensive policy action across jurisdictions. • Most newly introduced prevention policies focus on individual responsibility and few jurisdictions aim to address the political, economic, or commercial determinants of gambling harms.