A group representing 1.7 million doctors in 36 European countries has called for gambling to be treated as a significant, growing, and urgent public health issue that requires immediate action.

The Standing Committee of European Doctors (CPME), which represents national medical associations to EU policymakers, wants a total ban on gambling advertising, promotion, and sponsorship (including online, especially related to sports and cultural activities); a harmonization of national gambling regulations in European countries; a review of the health and social impacts and addictive qualities of gambling and gaming; and more strictly enforced protections for minors, among other measures.

Mounting evidence about the harms associated with gambling addiction and gambling disorders has prompted the statement, Ray Walley, MB BcH, professor of general practice at University College Dublin, Dublin, Ireland, and treasurer of the CPME, told Medscape News Europe. “People are coming into the general practice waiting rooms with mental health issues because they are in so much debt and find it difficult to control the urge,” he said. Many of them have suicidal tendencies, he added.

A Swedish study found that patients with a gambling disorder were 15 times more likely to die by suicide than the general population. Problem gambling among adolescents, particularly girls, is rising. Among adults, 5.5% of women and 11.9% of men experience any risk gambling (defined as occasional experience of at least one behavioral symptom or adverse consequence from gambling), according to The Lancet Public Health Commission on gambling. Patients who progress to a gambling disorder (80 million people worldwide) often have comorbid addictions to drugs and alcohol. European states and the EU have a responsibility to protect the public against gambling just as they protect against other addictions, Walley added.

Regulatory Consistency

The CPME wants more controls on the methods that entice people to gamble in the first place, including promotional deals by influencers, addictive gambling platform designs and algorithms, gambling product advertising, and industry messaging and sponsorship. Almost 300 top-flight football clubs across Europe have deals with betting firms, for example.

The CPME also wants doctors to better recognize patients with gambling disorders. When asking patients about smoking, alcohol consumption, or the use of other substances (as part of a routine health check or of registering with a general practitioner), doctors should also ask about gambling, they said. This proposal is in line with the UK’s National Institute for Health and Care Excellence guidelines encouraging doctors to ask about gambling when patients present with thoughts about self-harm or suicide, depression, anxiety, psychosis, bipolar disorder, posttraumatic stress disorder, personality disorder, or attention deficit hyperactivity disorder. Patients who take medicines that may affect impulse control (including dopamine agonists for Parkinson’s disease and aripiprazole for psychosis) should also be monitored, according to the guidelines.

While it is not calling for an outright ban on gambling, the CPME wants more consistency in how gambling is regulated. Today, European countries take notably different approaches. Norway runs a monopoly gambling provider: a single company is allowed to provide online casino games and betting. The UK has a licensing system with several thousand operators. Cyprus has prohibited slot machines, online casinos, and betting exchanges, and Belgium has restricted the sum that players can lose to €200 per week (which can be increased after customer safety checks). Ireland has proposed harsh prison sentences for those who allow children to gamble.

Self-regulation, which is a core component of current regulations, has not worked, said Walley. He cited a recent proposal to remove gambling logos from the front of English Premier League football shirts, which he claimed would only remove 7% of all gambling logos from an average Premier League football match. The French Évin Law, which restricts alcohol and tobacco advertising and sponsorship, would be a better alternative, he said. The CPME, therefore, has proposed EU-wide regulation, perhaps based on existing instruments such as the Digital Services Act or the Anti-Money Laundering Directive, alongside an EU-wide surveillance system.

Costs and Benefits

It is significant that so many doctors have agreed that gambling is a public health problem because it signals a shift to structural rather than individual solutions to gambling disorders, Heather Wardle, professor of gambling research and policy at the University of Glasgow, Glasgow, Scotland, and lead author of The Lancet Public Health Commission on gambling, told Medscape News Europe. “The gambling industry is a multinational, global corporation. Online gambling is boundaryless, so you need intergovernmental, cross-boundary action to address some of the harms that the industry is creating,” she said.

Wardle and colleagues at the University of Glasgow have produced a scorecard comparing international gambling systems; approaches to advertising, marketing, and mandatory limits; and monitoring and surveillance. The scorecard reveals how fragmented European systems are today.

The CPME’s emphasis on preventing minors from gambling is particularly significant, said Wardle, whose research found that 10.3% of adolescents had gambled online despite a prohibition against it. Children have repeated exposure to gambling advertising at football matches on TV, to their favorite celebrities in gambling adverts online, and to gambling mechanisms embedded within video games. This exposure tells young people that the progression from gaming or interest in sports to gambling is natural, said Wardle. “That next 10-year period is incredibly risky. The incidence of problem gambling among patients just reaching adulthood is incredibly high,” she said. For minors, the goals should be to “denormalize” the gambling environment and to ensure that they don’t access gambling, she added.

Pushback from industry is certain. The global gambling industry is rapidly expanding, with net losses by consumers projected to reach nearly USD $700 billion by 2028, according to the Commission. Many gambling companies have successfully lobbied governments for less punitive regulation, often arguing that their profits increase states’ tax revenues, provide employment, and therefore benefit economies. Accumulating more evidence of the true cost to patients with gambling disorders and their families and the cost to healthcare systems to treat them, will therefore be crucial, Wardle said.

Walley has called on the World Health Organization to hold an annual gambling awareness day. The gambling industry currently sponsors a European safer gambling awareness week. Walley also wants more transparency on the behind-the-scenes industry lobbying that often delays or waters down legislation. “Just like with alcohol and tobacco, there may be profits to be had, but the significant cost burden is on the state. And if you do health technology analysis on these things, you will find that the cost greatly outweighs the benefits to countries,” he said. “Gambling addiction is no different than any other addiction, and the industry is no different.”

Walley and Wardle reported having no relevant financial relationships.