The UK gambling debate: An unhealthy disregard for evidence?

Something rather strange is happening to Britain’s review of gambling legislation. In response to the law of supply and demand and the government’s insistence that the review be evidence-based, we are now witnessing the production of evidence on an industrial scale.

Much is made of the supposedly malign influence of gambling businesses on this process of evidence-gathering – based upon an unquestioning assumption that where Big Tobacco went, Big Gambling is sure to follow. The truth is far more nuanced and unsettling.

In the next few weeks, a team from the University of Sheffield will finally publish its report for the National Institute of Health Research on “the effectiveness of national and international polices and interventions to reduce gambling-related harms.”

While it is dangerous to pre-judge, we have a pretty good idea of what the Sheffield team will recommend. This is because the project team announced its conclusions at the outset of the project.

In a December 2019 article in The Lancet Public Health, the researchers wrote: “The introduction of restrictions on marketing and increasing taxation on the products associated with higher risks of harm have been used to reduce tobacco, alcohol and sugar-sweetened drink consumption. These examples should give policymakers confidence that similar policies for gambling would also be effective if successfully implemented.”

The Sheffield team had decided at the commencement of their £658,592 government-funded research project that their favoured policies for suppressing consumption of fags, booze and fizzy drinks should be applied to gambling as a point of principle.

A little over a year into the project, in January 2021, the researchers reported (again in The Lancet Public Health) that they had found little to go on – “evidence from the primary literature remains sparse and weak”; they had “struggled to make conclusive statements about the evidence they examined, in terms of clear support for any specific types of intervention or for relative superiority of particular interventions or approaches over others”.

Absence of evidence notwithstanding, the team advocated a programme of substantial legislative reform, emphasising a “need for multi-faceted and systemic interventions, including restrictions on advertising and marketing, changes to the structure of the industry and regulatory frameworks”; adding that it was “imperative to ensure that a scarcity of evidence is not used as a justification for inaction”.

Research time

The Sheffield project was conceived as a companion piece to a separate report from Public Health England (PHE), which is also scheduled to be published over the summer. The PHE team has been a little more circumspect with its views – but only a little.

For example, its project leader has written (in an article published last year) that “more research and evidence are needed to support advocacy and action” with respect to gambling reform. It is not, however the purpose of research to “support advocacy”.

The role of research should be to illuminate and enlighten rather than to bolster special interest lobbying – particularly where the research in question is government-funded. The article also recommended “developing the narrative, through campaigns…to raise awareness” of gambling’s status as a “health harm”.

Both the Sheffield and PHE teams perceive the suppression of gambling as central to a reduction in gambling harms – a view clearly informed by the tobacco precedent but with questionable validity for gambling, an activity where the vast majority of consumers experience enjoyment with no adverse health consequences.

Both projects appear to be part of the ‘research-as-advocacy’ movement espoused by public health researchers in the Australian and New Zealand Journal of Public Health in 2019. The article (David et al., 2019) is a call to arms “to systematically build advocacy movements in gambling reform”; to “establish a sense of urgency”; to “form a powerful guiding coalition”; and to “plan for and create short-term wins”. In short, how to weaponise research in order to influence government policies on gambling.

There are reasons to be wary of industry influence on public policy, but it is naïve to suggest that gambling companies are the only ones with ‘skin in the game’.

As the Australian academics Paul Delfabbro and Daniel King observed last year, “greater scrutiny should be given to the role of government and other interest groups in the determination of research agendas and greater transparency be displayed by public health advocates who are strongly opposed to gambling on moral, ethical or theoretical grounds.”

Dan Waugh is a partner at Regulus Partners and former strategy director at The Rank Group. He has written extensively on matters of gambling regulation and harm prevention.