Gambling is a highly lucrative business, which the gambling industry in the UK making a gross gambling yield of £14.5bn between October 2017 and September 2019.3 As a consequence, gambling is a global corporate industry with the ability to rapidly evolve its products and services. The move to gambling online means that traditional harm reduction strategies are less likely to be effective at a population level and require more creative approaches. We currently have limited data and evidence on gambling- related harms, especially when compared with our knowledge of other public health threats. Yet this is beginning to change, with the recent classification of gambling as an addictive behavior and increasing recognition of harms stimulating interest in this field. Some countries are already leading the way in terms of reframing gambling as a public health issue, with Canada and Australia, and Wales, standing out as notable examples. Gambling-related harms are diverse, ranging from risks to housing and homelessness, domestic violence, debt, family break- down, depression and suicide. Certain groups are more vulnerable to harmful gambling e including men, young people, certain ethnic minority groups, homeless people and people with mental health and substance misuse issues. What is less evident is the impact beyond the individual gambler. A survey in UK suggests that, on average, for every person harmed by gambling between six and ten additional people are affected, from family, friends and colleagues, to the local community and society. There is also evidence of a social gradient in gambling behaviors and harm with deprived areas and groups most adversely affected. This is particularly evident in the North of England. Gambling among young people is a particular concern. More were gambling than participating in other risk-taking behaviors in accordance with a Gambling Commission survey which found that 2% of 11 to 15-year-olds self-reported as high risk gamblers. What sets gambling apart, especially for this group as a unique public health issue, is the rapidly changing impact of technology on behavior. The internet and smart phones have increased access and availability to gambling, and the lines are blurring between on-line gaming and gambling.
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