Cheryl Currie: Refocusing our Efforts to Promote Responsible Gambling: The Importance of a Public Health Lens Session 4B Presented at the New Horizons in Responsible Gambling Conference in Vancouver, January 27-29, 2014

1. Cheryl Currie, PhD
Alberta Translational Health Chair & Assistant
Professor of Public Health, University of Lethbridge

2. What is done to resolve a
particular societal matter depends
on how it is framed
(Korn, 2002)

• All Canadian provinces provide funds to
promote responsible gambling
• But are we framing the matter in ways that
guide effective action?

3. What is Public Health?

 Science of prevention
 To fulfill society’s interest
in assuring conditions in
which people can be
healthy.

4. A Public Health Lens
Describe
gambling in
populations
Action
Determinants
of PG

5. Descriptive Epidemiology

Describe gambling
behaviour by:
Population-focused
Person
Time
Place

6. Population Health Focus
Individual Focus
 Chasing losses
 Cravings to gamble
 Health problems
 Financial problems
 Population Focus
 844,000 PGs in Canada
(2.4%)
 Higher in males
 Prevalence lowest in
Quebec, east coast
 Low treatment seeking

7. Determinants of PG

1. Biologic – Genetics, epigenetics
2. Environmental – Gambling environment
3. Individual – Choices, psychological mechanisms
4. Social – Poverty, unemployment,
discrimination, childhood trauma

9. Levels of Prevention

1. Primary Prevention – Prevent PG
2. Secondary Prevention – Catch
preclinical PG symptoms early
3. Tertiary Prevention – PG treatment

10. Levels of Prevention
Symptomatic
Clinical phase of
disease (PG)
Pre-Symptomatic
Early PG symptoms

12. The Problem with an
Educational Focus

Educational approaches to health
promotion have proved disappointingly
ineffective.
(Gilliam et al. 2012)

13. Example – Montana Meth Project

 45 000 TV ads, 35 000 radio ads, 10 000
print impressions, 1000 billboards
 Education campaign portrays the
consequences of meth use.

14. 

15. Findings – Anderson (2010)

 “...the effects on meth use are statistically
indistinguishable from zero.”
 Campaign did not contribute to a decrease in meth
use among youth.
 To better guide the allocation of resources this study
calls for a focus on the determinants of meth use.

16. What are the problems with
educating people?

1. Educating people on ‘how to behave better’
is often not that effective in eliciting
lasting behaviour change.
2. Some education-based behaviour change
theories are popular, but not necessarily
evidence-based.

17. 
Link to article

18. What are the problems with
educating people?

3. New people continue to enter the
population at an unaffected rate - who then
have to be
educated on “how
to behave better”
(Syme, 2008)

19. A shift in focus to reducing incidence not
prevalence

20. Link to
article

21. Wealth Distribution
Divide the 34 million people in Canada into 5 groups
each with 6.8 million people
 Wealthiest 20%
 Upper middle
 Middle
 Lower middle
 Bottom 20%
Question: What % of wealth is owned by each quintile?

22. Income Inequality & Mental Health


23. Big Picture Thinking

 Gambling redistributes $$ randomly among
participants.
 How could gambling revenues $$ be used to
redistribute wealth in society?

24. How can we structure the
gambling environment

To make individual’s
default decisions about
gambling responsible?

25. Link to
article

26. Finding the Right Balance

Gambling
Profits
Social
Responsibility

27. Rose - Preventative Medicine

 Personal lifestyle is socially conditioned.
 It makes little sense to expect individuals
to behave differently than their peers.
 It is more appropriate to seek a general
change in the circumstances which
facilitate behavioural adoption.

29. High-Risk Focus
Target:
High-risk gamblers
based on behaviour
Most
responsible
Average gambling
behaviour
Least
responsible

30. Where do the High-Risk come from?
Most
responsible
Average gambling
behaviour
Least
responsible

31. What Determines the Population Average?
The more
widespread a
cause, the less it
explains the
distribution of
cases.
Most
responsible
The hardest
causes to identify
are those
universally
present.
Average gambling
behaviour
Least
responsible

32. Comparing Populations
Average Blood Pressure
Link to full
reference

33. Comparing Populations

Causes of Cases
Similar in Alberta
& Quebec
8%
PG Prevalence
6%
4%
Causes of Incidence?
2%
0%
Alberta
Quebec

35. What is Our Question?
Why do some individuals have PG
Why do some populations have more PG?

36. Whole Population Target
Most
responsible
Average gambling
behaviour
Least
responsible
Edited from Frohlich and Potvin (2008)

37. The Problem!
In reality, this is what often happens
Frohlich and Potvin (2008): Link to article

38. The Problem
Increased PG Inequalities

 Those with higher SES derive more benefit
from whole population approaches
 Not addressed – underlying mechanisms in
society that lead to mental health inequalities
in various groups.

40. 

41. Determinants of PG

 Adverse Childhood Experiences

42. Link to
article

43. Framing Prevention Targets

1. High-risk population
2. Whole population
3. Vulnerable populations

44. Developing a Framework for
Responsible Gambling

1. Focus: Primary, secondary, tertiary prevention?
2. Strategies: Based on scientific theory & evidence?
3. Targets: Causes of cases or incidence?

45. Responsible Gambling
Where are We Now?

1. PG prevention programs not generally informed by
research evidence.
2. Most widely employed strategies are the least
effective (education, responsible gambling features,
self-exclusion)
3. No magic bullet strategy in PG literature.
Williams, Simpson & West (2012): Report Link

46. Finding the Right Balance

Gambling
Profits
Social
Responsibility

47. Refocusing Our Efforts to Promote
Responsible Gambling

Cheryl Currie, PhD
AIHS Translational Health Chair &
Assistant Professor of Public Health, University of
Lethbridge, cheryl.currie@uleth.ca