The global health impact of commercial gambling is worse than previously understood and stronger regulatory controls are needed, a Lancet Public Health Commission on gambling has found.

The commission involved leading international experts in gambling studies, public health, global health policy, risk control and regulatory policy, including Monash University’s Associate Professor Charles Livingstone, and those with lived experience of gambling harms.

“Gambling poses a threat to public health, the control of which requires a substantial expansion and tightening of gambling industry regulation,” the commissioners concluded after reviewing available literature and figures generated from a systematic review and meta-analysis.

The global call to action comes as the Australian Government continues to delay its decision on a raft of recommendations of the all-party Parliamentary inquiry into online gambling, chaired by the late Peta Murphy. The 31 unanimously supported recommendations include banning all gambling advertising, and establishing a National regulator for online gambling.

The commission called for effective gambling regulation in all countries, regardless of gambling’s legal status. This should include reduced population exposure and gambling availability, through prohibitions or restrictions on access, promotion, marketing and sponsorship.

It also recommended affordable, universal support and treatment for gambling harms alongside well-resourced social marketing and awareness campaigns to raise awareness of harms.

Professor Livingstone, from Monash University’s School of Public Health and Preventive Medicine, is a Commission member and gambling research specialist, and was a major contributor to the review, which was chaired by researchers at the University of Glasgow, UNSW Sydney and Harvard University and published in The Lancet Public Health.

“Australians spend the most per head on gambling worldwide, $AUD 1,555 per adult per year,” Associate Professor Livingstone said. “Both online betting, boosted by close connection with football and other sports, and electronic gaming machine gambling continues to grow at a rapid pace here, despite escalating concerns of ordinary people and the voice of those affected by gambling harms becoming more prominent.

“There is a desire for change and to rightly treat gambling as a serious public health issue in Australia, given the extent and nature of harm. Yet extensive evidence of dishonest and illegal behavior by casino operators requires Herculean efforts to properly regulate these entities, and the commercial gambling industry more broadly have been shown to be heavily resistant to reform efforts.”

New figures the commission generated show that harms from commercial gambling to global health and well-being are far worse than previously understood, with net consumer losses projected to reach nearly US$700 billion annually by 2028.

This is largely due to a rapid global expansion of mobile technology, and the gambling industry’s digital transformation.

A systematic review and meta-analysis conducted for the commission estimated that about 448.7 million adults worldwide experience any risk gambling, where individuals experience at least one behavioral symptom or adverse personal, social or health consequence of gambling.

Of these, an estimated 80 million adults experience gambling disorder or problematic gambling. Gambling harms included physical and mental health problems, relationship breakdown, heightened risk of suicide and domestic violence, increased rates of crime, loss of employment, and financial losses.

The new analysis also estimated that gambling disorder could affect 15.8% of the adults and 26.4% of the adolescents who gamble using online casino or slot products, and 8.9% of adults and 16.3% of adolescents who gamble using sports betting products.

The report noted that this impact was not spread evenly through populations. Specific groups faced an elevated risk of harm, including children and adolescents routinely exposed to gambling advertising in ways unprecedented before the digital revolution, particularly those in deprived socioeconomic groups. Gambling is also often embedded into video games.

The commission stressed that global leadership is needed to ensure gambling is prioritized as a global public health issue. It wants UN entities and intergovernmental organizations to incorporate a focus on gambling harms into their strategies and work plans for improving health and well-being.

The commission also calls for a World Health Assembly resolution on the public health dimensions of gambling, and a new international alliance to advocate to reduce gambling harms and provide leadership, made up of people with lived experience of gambling harm, professional organizations and researchers.

Commission Co-Chair Professor Heather Wardle, from the University of Glasgow, explained the changing nature of gambling: “Most people think of a traditional Las Vegas casino or buying a lottery ticket when they think of gambling,” Professor Wardle said.

“They don’t think of large technology companies deploying a variety of techniques to get more people to engage more frequently with a commodity that can pose substantial risks to health, but this is the reality of gambling today.

“Anyone with a mobile phone now has access to what is essentially a casino in their pocket, 24 hours a day. Highly sophisticated marketing and technology make it easier to start, and harder to stop gambling, and many products now use design mechanics to encourage repeated and longer engagement.

“The global growth trajectory of this industry is phenomenal; collectively we need to wake up and take action. If we delay, gambling and gambling harms will become even more widely embedded as a global phenomenon and much harder to tackle.”