Digital Health: Gambling

If you were recovering from drinking alcohol too much, it wouldn’t be a good idea to carry a bottle of booze around with you. These days, even carrying a mobile phone would be risky as in most cities you can order drink to be delivered 24/7 – for a lot of cash true, but when you’ve ‘got a habit’ any financial sense is the last thing that will protect you.

With gambling the problem is much worse. Unless you get rid of your phone and every other digital device you constantly have a casino in your pocket or near at hand on your other devices, 24/7 – in bed, at work, driving, on the bus or train, watching sports on television. And you’ll be assailed by precisely designed marketing to ‘enjoy’ playing ‘games’ precisely and scientifically designed to be potential instruments of addiction. Or instruments of torture.

You have choices with alcohol. Pour it down the sink. Avoid socialising with drinkers, at least early on in your recovery. Don’t carry it with you. Obviously.

But with gambling, unless you completely cut yourself off from the digital world, the supply is there by default. It follows you wherever you go. Younger people are ‘digital natives’. To them gambling is a completely normal and fun activity, especially associate with sport and sporting heroes. Loot boxes and other ‘games’ blur the boundary between childhood behaviour and adult ‘fun’. Every kid wants to grow up and act like the adults. Immersed in constant usage of digital devices – for good or ill – the ease of quick-thrill access to gambling, pornography and drugs (the latter just a text message away for quick delivery) puts many – not all – young people in harm’s way. What age checks may officially exist are easily circumnavigated. In the digital world you are not a thirteen-year-old you are a bundle of data. Very profitable data.

On our main site, The Machine Zone, we have begun to examine the huge area of what is known as Digital Health. This phrase is riding like a juggernaut through health services including the NHS and is already a multi-trillion dollar corporate industry. It is heavily promoted as A.Very.Good.Thing. In many ways it is and will be: there can be no doubt about that. But we’ll be looking at some more precautionary views. While data sharing can speed up and enhance healthcare, for instance, there are concerns about privacy. There’s also the question of whether a consultation with a human doctor may be more beneficial than diagnosis and treatment via remote apps and algorithms.

Well, it’s also the case that digital health should, in the interests of prevention, consider the digital causes of illness and ill-being. There are, in the case of gambling, many apps which prevent digital bank transactions – and credit card transactions are now illegal. One may ask, and be certain to be fiercely argued against, whether a truly effective preventive method may see the complete banning of all digital online gambling and hence marketing. Such a radical move, even the proposal, is enmeshed in the fundamental political questions around business and personal freedom, business and personal responsibility, loss in tax revenue, and – of course – the deprivation for millions who enjoy a little flutter responsibly and safely. Even tobacco regulation hasn’t gone nearly so far, and surely tobacco causes far more illness and death than gambling. All true.

It is hard to see where treatment for people with gambling-related distress may develop. ‘Addiction services’ in the UK have been decimated since the government transferred responsibility to local councils reeling under budget cuts. Stigmatising attitudes in all mental health care are institutionalised. Medical professionals, through no fault, do not have the knowledge and experience to help. Stigma prevents many people admitting to problems and seeking what help there may be. That help is there in some geographical regions (although in Scotland there are no dedicated gambling services). Anti-stigma projects around mental health are proving of some success: people generally are willing to identify their own issues, such as depression, and seek help. Perhaps one way forward to destigmatising gambling issues is to launch an ongoing social media campaign – the very social media that have proved their weight in gold to businesses of every shade. Funding for such a campaign is unlikely; less so a willingness to see the need for such a campaign.

The weight of prevention of gambling harms has been given over to schools and social enterprises funded ultimately by voluntary donations from the gambling industry. There is much good work being done – along with some not so good work. The big problem is that educational initiatives have behind them a paucity of evidence, research and effectiveness evaluation. Whether by design or not, the weight given to education repeats the dominant ideology of modern capitalism: individuals are responsible for their choices and behaviour; individuals identified as ‘pathological’ or ‘failing’ should be given support but ultimately everything is down to them. The responsibility of industry is thereby de-emphasised – in the case of gambling, the industry’s social responsibility to ensure harm minimisation by discontinuing harmful products, marketing and willingness to reduce profits in the name of rigorous procedures to monitor and prevent individual disasters. Not everybody will agree with this; some will vigorously disagree. That’s life, that’s politics, and no one anywhere can press a magic button to produce a win-win. The savage legal restrictions faced by the tobacco industry, the negative social perception of tobacco, emerged after more than 50 years of furious debate. While it’s true that the comparison between gambling and tobacco is often too heavily simplified and overstated, from a health perspective there remains a good deal to learn good lessons.

One of the dangers around ‘digital health’ is that it is embedded in wider ideological worship of data and algorithms. Buzz-words are efficiency, cost-saving, productivity. Unsurprisingly, the same words are almost holy icons in business. It can tend to work at a population level, seeking to insert a living human individual into a categorised ‘box’. It was the philosopher Kierkegaard who said, ‘To label me is to dehumanise me’. Sadly, in our ordinary lives we do tend to label people: ‘waster’, ‘junkies’, ‘alkies’. Big Data takes labelling into the realms of a high art, an ethereal cloud of digital bits totally disunited from the hearts and souls of a whole, living individual with all that means. The word ‘whole’ is where we get the word ‘health’ from. In seeking and recognising the unique wholeness of a person we have to go beyond statistics, data and ‘evidence’. That’s why it’s greatly to be welcomed that far below the data clouds the voices of individuals are being heard more and more. In health generally, perhaps most visibly, ‘Experts by Experience’ are coming to the fore. In what relatively little gambling research there is, there is a turn away from quantitative data-crunching towards qualitative research focused on individual human experiences, the voices of whole individuals. Such approaches may, of course, be appropriated by powerful stake-holders, including the researchers themselves, to ultimately hide those voices. Yet it cannot be denied that the gathered voices of ordinary people have been successful in so many ways in ‘bottom-up’ challenges to policy making so often driven drom the ‘top-down’.

We live in a digital world, breathe it, an air as invisible and taken-for-granted as the sea is by the fish that swim there. But we aren’t bits of cork bobbing about and carried this way and that by environments over which we have no control. We are not bits of data, we are human beings rich with the powers of solidarity and more power than we sometimes realise to make a better world just by being who we are.

 

The Problem with “Problem Gamblers”

In the bad old days,  among the cruel behaviours of teachers was to make a child sit facing a corner and wear a hat with ‘Dunce’ written on it. If that didn’t make  them learn and behave properly, a child could expect a thrashing for their irresponsible waywardness.

More progressive education renamed ‘dunces’ as ‘problem children’.

Now, of course, in more enlightened times we speak of ‘problem schools’ as the main reason for between a quarter and a fifth of school leavers being functionally illiterate after eleven years of education. It has been a great leap forward for  society to recognise that the ‘problems’ may have something to do with the education system itself.

This month (July 2020) has seen the UK government launch a ‘war on obesity’. Proposals include advertising bans, stopping two for one incentives on junk foods, public health campaigns, taxes on industry, education, more help from primary health care and so on. There are critics of all this. They say that people should be able to eat whatever they want to, they are free to make their own choices and shouldn’t have that freedom removed by the nanny state. Parents, they say, have the right to feed their children whatever they like. The fact that unhealthy, fattening food is cheap should not stop poor responsible people making sensible meals with basic nutritious items such as turnips: if they can afford widescreen televisions and smartphones , they can afford to eat well. But such is the devastating impact on health and the economy, the state is now proposing to get tough, go beyond voluntary industry actions and the good sense of consumers.

After decades of denial the tobacco industry accepted that their product was both addictive and highly detrimental to health. Stringent government action has seen a huge fall in the number of people smoking.  A total ban on advertising and marketing, removal of branding on cigarette packs along with reference to tar and nicotine content which some took to allow for a choice of ‘safer smoking’, severe annual rises in duty, a ban on smoking in public places, and the hiding from sight of tobacco products in shops. Alongside this, smoking cessation programmes are free to everybody. Individuals remain free to use tobacco if they so wish.

These days, at the tobacco counter in a shop, the tobacco products are screened from sight. (It’s worth noting that alcohol is still freely on display, but that’s a different story for now). At the front of the counter, inches from the customer are advertisements for the National Lottery and a range of scratchcards priced from £1 to £5 each. Like sweets placed at a supermarket till they make impulse purchases more likely. They’re also an indicator of how normalised respectable gambling has become. A website called casinoplay.com warns the public that ‘it can actually be quite hard to win one of the top prizes.’ It advises that to increase your chances you should buy scratchcards in bulk.

The Myth of the ‘Responsible’ v ‘Problem Gambler’

Unlike smoking and obesity, the risks associated with gambling aren’t associated with physical health (except in the many tragic cases of suicide). Gambling risks include financial ruin, turning to crime, family and relationships breakdown, mental illness. Many sources of information refer to the incidence of gamblers running into such conditions is ‘only’ 0.5% of the adult population (the same way as ‘only’ 0.5% of the the population are schizophrenic). There are other figures for children and young people, and for adults ‘at risk’ of being in the 0.5%. Data is never simple. It isn’t always available. It’s a snapshot of a previous period in time. It requires interpretation – and these interpretations differ. But if the 0.5% figure is taken as it is, given the personal suffering indicated above, plus the damage to immediate others such as family, plus societal costs is not that alone reason to give gambling damage the same weighting as a serious mental disorder such as schizophrenia? And unlike schizophrenia which, although it can be managed and treated well, in many cases very difficult to treat and manage, are not problems associated with gambling more easily attenuated using the approaches we have seen with tobacco, and beginning with junk food?

Yet it’s sometimes implied that if there are only 300,000 or so people in deep trouble because of gambling, that’s all right. They didn’t stop when the fun stopped. No one made them spend much more than they could afford: they were irresponsible. It was down to their having that much-cherished freedom to chose, but making the wrong choices. Many millions more enjoy the fun of a flutter. The appeal to the ‘millions who safely (and responsibly) enjoy a flutter’ is something of an industry catchphrase, and it needs unpicking.

Having placed the ‘problem gamblers’ into a sort of pathological ghetto, the logic goes that everybody else is a ‘responsible gambler’, enjoying a harmless flutter. This isn’t so.

In all our lives fortune rises and falls, and this is more nearly literal in the case of the regular happy flutterer. A regular bettor or gambler will win some, lose some, and for the great majority, over time will lose more than they win. Winning £25 on a £5 scratchcard won’t compensate for the many weeks of getting into debt with rent or power or council tax after buying four such cards each week. The strain on marriages and families will increase as essential money leaks into slots or online gambling. The wage packet won’t be spent on days out with the kids or new school clothes. Things will be pawned, payday loans become essential as credit is refused elsewhere and credit cards are maxed out. Loans from friends and family go unpaid. There may be catastrophic times, perhaps a threat of eviction or repossession, survived only by a hair’s width and that survival with ongoing negative financial consequences. (Sometimes, such a catastrophe can be the impetus to stop gambling). Anxiety, depression, arguments may go with the territory. The danger of becoming one of the statistics in that ‘problem gambler’ ghetto may increase. As it is, there are many whose quality of life is negatively affected by gambling, and they don’t show up in the statistics.

Now obviously, this is painting a bleak picture. Not everybody who enjoys a doughnut or two will incur an obesity-related illness. Most people do spend money responsibly and can enjoy a harmless flutter. There is, of course, even for them a risk of going beyond the harmless flutter. Even somebody new to betting and gambling can (not will) spiral down to dangerous levels.

What’s needed is research into the ‘twilight zone’ of gambling-induced harms. This is an area which has to involve personal testimonies of experience over time. It’s especially important in relation to young people who have been nurtured in a normalised gambling environment. It may lead to a more nuanced understanding of the scale and nature of gambling harms than that offered by dominant narratives of ‘problem gamblers’ versus the rest of us.

 

Children Learning to Gamble

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In the digital environment – where some toddlers learn to use a digital device before they can talk – bright and cheerful interactive apps and games are the norm for children.

Go to an online gambling site for adults and you see the same sort of bright and cheerful apps and ‘games’. Roulette? You can play for free using virtual credits. Just a click of a button and you can play for real money. Children are no different from adults in enjoying risk, winning and losing chances, and are likely to be drawn to these games of chance.

In addition, the format of children’s games and gambling screens is blurred. A child who learns to love screen games is already primed to love online adult ‘games’.

The Australian Gambling Research Centre has published a worrying report:

According to the report, the fact that gambling and gaming have been mixed together means that gambling has been normalised for children. 

Young people are effectively being taught the basics of gambling at a younger age than ever before. 

But from making one click on your Facebook page, to one simple swipe on your smartphone, simulated gambling games are everywhere and they can be difficult to avoid.

Since television and online advertising for gambling is on the increase, and children today grow up in a world where televised football, for example, equals televised gambling, there is cause for concern.

Image Lee Davy