UK health experts have begun to sound serious warning notes over the promotion of gambling by the government.
In March last the House of Lords threw out government proposals to build the UK's first Las Vegas-style super casino in Manchester and build 16 other casinos around the country.
Writing in the leading health jounral, the BMJ, John Middleton and Farid Latif have called for a proper assessment of the health effects of any new proposals and urged doctors to be aware of problem gambling in just the same way they are with other potentially addictive activities like drinking alcohol and smoking.
The UK currently has a low prevalence of problem gamblers, but this seems likely to increase when the Gambling Act 2005 is implemented, they say.
Gambling affects physical, mental and social wellbeing as well as creating debt. Problem gamblers and pathological gamblers are more likely than others in the general population to have been divorced, had physical and psychological problems, lost a job, been receiving welfare benefits, been declared bankrupt, and been imprisoned.
Problem gambling is also associated with juvenile delinquency and family problems, while pathological gambling is a predictor of violence against intimate partners.
While the authors acknowledge that most casino customers will not be compulsive gamblers, they believe that the minor effects on large numbers of the population previously unexposed to casino gambling will be pervasive.
Research on lotteries shows that they tend to gather money from poor people to be spent on amusements for wealthy people. This has led Sandwell Council in the West Midlands to block any new build casinos in the area, based on risk of poverty and related health consequences.
Problem gambling is an addiction that medical professionals should be aware of, say the authors. Anything that makes the poor people in Britain even poorer, especially if they do not derive benefits in kind, will damage their health, further increasing inequality in health.
The UK government intends to bring forward new proposals for developing casinos next year. A prospective programme of properly funded assessment of health effects must be part of any new proposals, they conclude.
Following three decades during which British gambling policy was shaped by the notion of 'unstimulated demand,' the National Lottery was introduced in 1994 with a weekly draw for a large prize jackpot.
This was followed in 1995 by the introduction of instant scratch tickets, in 1997 by a second weekly draw, and in 1999 by another weekly game that offers players more chances to win smaller prizes.
Now that growth in revenues has stabilized, the next National Lottery license is likely to include a daily lottery game as well as internet based services and interactive games.
Furthermore, the introduction of the National Lottery led to strong pressures for deregulation from British casinos, betting shops, football pools, arcades, and charitable gambling industries.
This virtual explosion does not bode well for the community, doctors warn.
Another concern is the growing participation of women in gambling activities. Recent studies in Australia, New Zealand, and the United States show that women are just as likely as men to play lottery games and to gamble at casinos, and it is likely that the introduction of a lottery sanctioned by the state has led more women in the United Kingdom to gamble.
As the British Gambling Review Board considers the future of gambling in the United Kingdom, those of us who are concerned about the adverse effects of gambling would suggest that steps be taken to monitor the impacts of gambling over time.
Adequate funding of prevention and treatment programmes to minimise the harm that growing numbers of people may experience when they gamble is also of paramount importance, stresses Rachel A Volberg, president of the U.S. based Gemini Research and a leading problem gambling epidemiologist in the world.
But there are other public health experts who argue against such anti-gambling campaign.
It may well be that some people are spending their money 'unwisely' in the hope of improving their lifestyles and that some of the people who find themselves winners have problems in coping with this new state.
But most of those who participate, however, are responsible people who are knowingly taking a risk. In a society that values empowerment are we now saying that people should take only risks that are good for them? And, if so, what is the risk?
A society in which people no longer have the opportunity to take risks is not a healthy society. Public health practitioners should understand this and should focus their attention on more serious issues. For a start, how about the misery and isolation of elderly people and the hopelessness of young people who are unemployed long term?