Dr Michelle Gillies Consultant Public Health Scottish Public Health Network

1. Gambling harms: a public health issue Dr Michelle Gillies Consultant Public Health Scottish Public Health Network https://www.scotphn.net/ Michelle.Gillies1@nhs.net

2. What is public health? ‘the science and art of promoting and protecting health and well-being, preventing ill-health and prolonging life through the organised efforts of society’ Acheson; WHO; 1988

3. What is public health? ‘the science and art of promoting and protecting health and well-being, preventing ill-health and prolonging life through the organised efforts of society’ Acheson; WHO; 1988 ‘what we as a society do collectively to assure the conditions in which people can be healthy’ Institute of Medicine; 1988

4. What is public health? ‘the science and art of promoting and protecting health and well-being, preventing ill-health and prolonging life through the organised efforts of society’ Acheson; WHO; 1988 ‘what we as a society do collectively to assure the conditions in which people can be healthy’ Institute of Medicine; 1988 Public…or population health?

5. Dahlgren and Whitehead (1993), cited in The King’s Fund (2013)

7. Our public health priorities

8. UnderpinningPrinciples https://www.gov.scot/publications/scotlands-public-health-priorities/pages/12/

10. the vicious curse of disadvantage consumes and defines my being the roar of the Bengal tigress is suppressed to a whimper. it will be echoed through my sister and my daughter and those that follow. Through no fault of your own, you will have to be twice as good for half the reward. Mabfara Ahmed

11. Human rights principles

12. Whole system approach to place & community

13. Phases of a whole system approach https://publichealthreform.scot/media/1570/whole-system-approach-for-the-public-health-priorities.pdf

14. What makes a public health problem?

15. A populationhealth approach • Whole population, not just ‘high risk’ people • Proportionate universalism • Whole system • Focus on prevention & early intervention • Recognise complexity & address the wider determinants of health • Achieve equality of outcome • Adopt a life course approach • Effective policy at Government level • Collective action with meaningful participation at local level • Evidence based, informed & generating • Valued judgement & precautionary principles where evidence is lacking • Creative, innovative & brave!

16. Gambling in Scotland: Key Facts References in notes

17. Is gambling a public health problem? • Popular, legal leisure activity • Most people gamble without harm • A small but significant number experience harm • For every gambler that experiences harm, around six other people in their life, most often close family members including children, are negatively affected1 1Goodwin BC et al. Int Gamb Stud. 2017

18. Gambling harms are defined as the “adverse impacts from gambling on the health and wellbeing of individuals, families, communities and society”1. 1Wardle H et al. Gamb Comm. 2018

19. Gambling harms can be temporary or act cumulatively across the life course, persisting long after the person that gambled has stopped.They can be intergenerational, for example adverse childhood events (ACEs) experienced as a result of parental gambling. Children and young people experience gambling harms differently from adults; gambling harms influence their present and future potential.1 1Blake M et al. Gamb Comm. 2019

20. Screening tools to identify people experiencing harm are at best crude; societal & economic costs of gambling harm are vastly underestimated.At population level those experiencing the greatest level of harm, problem gamblers, account for a very small proportion of the total burden of harm. People at low to moderate risk of gambling harm, or those affected by the gambling of others’ experience fourtimes as much harm as problem gamblers.People at low risk of harm lose almost 20% of their quality of life through gambling; problem gamblers around half of their quality of life, comparable to that lost by a person with severe alcohol problems.1 Langham E et al. BMC Public Health. 2016

21. Gambling harms reflect a complex interplay between individual, environmental and social factors1 1Wardle H et al. Gamb Comm. 2018

22. Some people, groups and communities are more vulnerable to gambling harms than others1 1Rogers RD et al. Bangor Uni.. 2019

23. Gambling participation, risks and harms are socially patterned reflecting, and exacerbating, existing inequalities. Universal and targeted actions to address the wider determinants of health are needed.

24. Are there evidence based prevention, early intervention or treatment interventions?

25. Are prevention, early intervention or treatment interventions in place?

26. Is gambling a public health problem?

27. Context & challenges

28. Opportunities • Transferable learning • Other unhealthy commodities such as tobacco, alcohol, drugs, fast food • Other areas such as violence reduction • Other countries that have adopted a public health approach to gambling • New ways of working • Health and social care integration • Public Health Scotland • New legislation, strategy and policy • Better use of existing policy, strategy and legislation • Changing public opinions • Strengthening of the position of the regulator • Brexit? Independence?

29. Phases of a whole system approach

30. Making it work in the Glasgow context

31. People have the knowledge, capacity and agency to make informed choices to prevent and reduce gambling harms • Communities are informed, resilient and empowered to effectively participate in decision making about preventing and reducing gambling harms • People affected by gambling harms have equitable access to effective help and support that meets family needs • Local communities and the organisations that service them work in partnership to effectively advocate for actions to prevent and reduce gambling harms • Legislation and public policy at local, Scottish and UK level prevents and reduces gambling harms