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.