Decisions about building casinos in the UK have not given enough weight to the potential health effects, argue two doctors in this week's BMJ.
In March 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. This decision reflects polarised views about the costs and benefits of liberalised gambling in the UK, but the health dimension of the debate has been lacking, write John Middleton and Farid Latif.
They call on the government to assess the health effects of any new proposals and urge 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.