[Not] everyone is a winner: gambling participation and problem gambling in rural communities

Many people enjoy placing an occasional bet, even if it means they lose money. But for some people this activity can disrupt or compromise their life. Gambling problems can happen to anyone. Whether from sports, scratch cards, roulette, poker, slots – in a casino, at the track, in a betting shop or online – for some betting can become a problem, placing a strain on their personal relationships, interfering with their work, sometimes leading to financial ruin and suicide. It is estimated that one-third of a million people in the UK are problem gamblers. How much of an issue is problem or compulsive gambling in rural areas and what can be done to reduce gambling-related harm? Jessica Sellick investigates.

What is gambling – and who gambles? 

Within the Gambling Act 2005 gambling is defined as ‘betting, gaming or participating in a lottery.’ The definition distinguishes between activities which need to be licensed and other activities which do not. The Gambling Commission categorises different gambling activities into what they call ‘sectors.’ The sectors include arcades (those for adults and those for families), betting (online, at an event or in a high street bookmakers), bingo (online or in a bingo hall), casino (online or in a casino), lotteries (raffles, tombola’s, sweepstakes) and gaming machines (fruit machines, fixed odds betting terminals).  

The Gambling Commission publishes a regular tracker of gambling participation. The tracker provides an annual snapshot of consumer gambling behaviour in Great Britain. It includes data on participation in gambling activities, online gambling behaviour, consumer awareness of gambling management tools, and perceptions and attitudes towards gambling. The information is based upon quarterly telephone and online surveys. 

The tracker for gambling participation in 2019 (published in February 2020) shows that, overall, gambling participation has remained stable since 2018, with 47% of respondents aged 16+ years having participated in at least one form of gambling in the past four weeks of 2019 (compared to 46% in 2018). By age, the highest level of gambling participation was found in people aged 45-54 years (53%). A larger proportion of men (51%) have participated in gambling compared to women (43%). The National Lottery draw is the most popular gambling activity (30%), followed by other lotteries (13%) and scratch cards (10%). Until 2017 there had been a decline in participation in National Lottery draws – thought to have been caused by the increase in the ticket price from £1.00 to £2.00 – but participation levels are now showing signs of recovery. Over half of gamblers (51%) gamble at least once a week. When the National Lottery draw participation data is omitted from the analysis, those aged 25-34 years had the highest participation level (41%). Football is the most popular betting activity (5.8%), followed by horse racing (4%) and other sports (2.7%). 

21% of respondents had gambled online in the past four weeks of 2019, a significant increase since 2018. Mobile phones remained the most popular method of gambling online (at 50% – an increase of 6% since 2018), whilst laptop use declined (to 38%, a 6% decrease since 2018). Those who gamble on mobile phones are in the younger age groups – 76% of 18-24 year olds, 72% of 25-34 year olds and 66% of 35-44 year olds. Online gamblers predominantly play at home (95%), however there has been an increase in the proportion of people gambling in the workplace (at 15%, a 3% increase since 2018). 

On average people in Great Britain spend £2.60 per week gambling, totalling some £135.20 per year. Those in the highest income percentile spend the most on gambling (£4.20 per week) and those in the lowest percentile spend the least (£1.50 per week). 

A survey of 2,943 school children aged 11-16 years conducted by Ipsos MORI on behalf of the Gambling Commission found 22% had spent their own money on a gambling activity in the 7 days prior to taking part. Participation in gambling remains higher among boys (13%), compared with girls (7%) and older children (12% of 14-16 year olds, compared with 9% of 11-13 year olds). The most common gambling activities that young people have spent their money on in the past 7 days are placing a private bet for money (5%) and fruit/slot machines (4%). Overall, the pattern of young people’s participation is consistent with previous years in terms of the activities they choose, who they are with (typically their parents/ guardians) and where it takes place (usually fruit machines in a family arcade or private bets with friends). However, there is a small but significant increase in online gambling since 2018 (from 1% of 11-16 year olds, to 3% in 2019). 

Gross Gambling Yield (GGY) is the total amount of stakes plus total amounts that accrue to the licensee minus the amount paid out in prizes or winnings. Between April 2019 and March 2020, the total GGY for the industry was £14.2 billion. Remote (or online) gambling is the largest combined sector by GGY – at £5.7 billion GGY, it comprises 39.9% of the overall market. National Lottery ticket sales increased by £696.4 million to £7.9 billion. This supported a GGY equivalent increase of £319.9 million (10.4%), to £3.4 billion, making the National Lottery the second largest sector by GGY. Non-remote betting GGY was the third largest sector by GGY with £2.4 billion. 

Data and information are being collected to better understand how COVID-19 has impacted on gambling behaviour. This aims to show how gambling behaviours have evolved as the country responded, and continues to respond, to varying levels of restrictions and lockdowns. For example, on 20 March 2020 all retail gambling venues closed. This meant that activities which normally generate 50% of the overall market [excluding lotteries] stopped. However, data collected in May 2020 shows the decrease in the availability of retail outlets did not lead to a high incidence of switching from land-based to online gambling. Only 1.6% of past-four-week gamblers surveyed by YouGov in mid-May 2020 said that during that period they had gambled online on some activities that they used to take part in on premises or in person. Further, only 2% of recent gamblers said they had signed up to one or more gambling websites during this period. However, the first lockdown period did see changes in repertoire for some – with YouGov research finding that around three in ten (31%) of the past-four-week gamblers saying they have tried one or more gambling activities for the first time during lockdown. This figure rises to almost half (48%) of engaged gamblers, with this group being most likely to try online bingo (13%), betting on virtual races or sports (12%), National Lottery online instant wins (11%) and online slots (11%). Overall, the data shows that fewer consumers were gambling during the first lockdown, but some people who were gambling already tried new products. Data from March to September 2020 found the online gambling market grew – with a month-on-month increase of 3% in gross gambling yield (GGY) and a 7% increase in active accounts: the main driver here was real event betting and is likely to have been boosted by the return of premier league football. 

In 2020 the Department for Digital, Culture, Media & Sport (DCMS) ran a consultation to understand if and how loot boxes may cause harm. When the BBC interviewed young people about loot boxes they found welfare problems had been exacerbated by people having more time on their hands during COVID-19: “Over the years me, my brother and dad have spent thousands. I normally put money on Fifa on a Saturday night. Before you know it, you have put £50 or £60 on. I find it incredibly addictive because I always want the best players. I would not say it is a problem. I guess when you’re spending a lot of money on it, it could become a problem.”  The Universities of Wolverhampton and Plymouth are carrying out research to investigate the interface between gaming and gambling, and the psychological profiles of young people and adults who buy loot boxes. From 1 October 2021 the Government will be raising the minimum age of sale for all National Lottery products to 18 years of age.

A partnership of universities, led by Stirling and Glasgow, are currently undertaking research to consider the effect of pandemic restrictions on young adults and sports bettors. Academics are seeking to investigate (1) how COVID-19 has changed gambling practices and the risk factors for and experience of gambling harms; (2) the effect of COVID-19 on gambling marketing; and (3) how COVID-19 has changed high risk groups’ gambling experiences and practices. 

What are gambling harms – who are the ‘at risk’ and ‘problem’ gamblers? 

Problem gambling is defined as ‘gambling to a degree that compromises, disrupts or damages family, personal or recreational pursuits.’ The Gambling Commission measures this using a number of tools, including the Problem Gambling Severity Index (PGSI). Within the PGSI, problem gamblers are defined as ‘gamblers who gamble with negative consequences and a possible loss of control’; moderate risk gamblers as ‘gamblers who experience a moderate level of problems leading to some negative consequences; and ‘low risk gamblers’ as gamblers who experience a low level of problems with few or no identified negative consequences. Other tools include the DSM-IV which was developed by the American Psychiatric Association and uses a four point scale (ranging from ‘never’ to ‘very often’) across ten diagnostic criteria resulting in a total score of between nought and ten.  

The Health Survey for England (HSE) looks at health-related behaviours over time. The HSE uses a score of 8 or more for PGSI and a score of 3 or more for DSM-IV as indicative of problem gambling. Using PGSI scores, the HSE found 0.4% of adults were identified as problem gamblers (i.e., they score 8+) and 3.6% of adults were identified as problem or at-risk gamblers (scoring 1+). Using the DSM-IV scores, 0.5% of adults were identified as problems gamblers (i.e., they scored 3+). Using PGSI scores, the proportion of men identified as problem or at-risk gamblers is substantially higher than women – with 6% of men and 2% of women identified. The proportion of problem or at-risk gamblers also decreases with age – affecting 5-7% of those aged 16-44 years and just 1% of those aged 75+ years.  

It is important to remember that no screening tool is perfect; it does not tell us who may progress up the scale from low risk to become a problem gambler for example. 

Although there is no explicit definition for gambling-related harm, the Gambling Commission defines the term as covering ‘adverse impacts from gambling on the health and wellbeing of individuals, families, communities and society.’ These impacts can be related to (but are not limited to): relationships, debt, health, employment and/or crime. 

Harmful gambling is defined as ‘any type of repetitive gambling that disrupts or damages personal, family or recreational pursuits. Harms can be experienced by gamblers, their families, friends and social networks, employers, communities and society as a whole. There is increasing awareness about the impact on families and local communities, as well as the individuals directly harmed by it. 

Problem gambling is ‘any gambling behaviour that disrupts your life’ – if you are spending more and more time and money on it leading to significant consequences for your life. Compulsive gambling, often called gambling disorder, is the uncontrollable urge to keep gambling despite the toll it takes on your life. Gambling means that you are willing to risk something you value in the hope of getting something of even greater value.

A report on measuring gambling-related harms published by the Advisory Board for Safer Gambling (ABSG), Gambling Commission and GambleAware noted that without a clear definition it was difficult to quantify the harm. Nevertheless, 50 different metrics of gambling-related harms were identified under the themes of resources, relationships and health. The report recommended that the following areas be used in a foundation model to begin to estimate some of the social costs associated with gambling-related harms: loss of employment, experience of bankruptcy or debt, loss of housing/homelessness, crime associated with gambling, relationship breakdown/problems, health-related problems, and suicide and suicidality. The report acknowledges that many of the harms identified do not easily lend themselves to being converted into a social costs – and that this does not make them any less important and all gambling-related harms need increased visibility.  

NHS data released in December 2019 revealed how the number of gambling related hospital admissions had doubled over a six-year period – from 150 to 321. Of those, 171 patients were admitted for ‘pathological gambling’, where a patient’s addiction to gambling is so severe that it can lead them to crime. The NHS estimates that over 400,000 people in England have an addiction to gambling and two million people are at risk of developing the condition. There has also been an increase in the number of young people that are affected by gambling related harm. 46 people under the age of 25 years attended a hospital as a result of their addiction last year, with one person as young as 15 years of age receiving treatment, compared to 37 people under 25 years receiving treatment the year before – an increase of a quarter.

Common traits displayed by problem gamblers include reporting a preoccupation with gambling beforehand – similar to cravings felt by alcoholics or drug users before they drink or get their fix – a fear they are going to miss an opportunity to win and therefore they may feel irritation or anger if they are unable to place a bet, and their behaviour may oscillate from elation / confidence to remorse or guilt. Academic studies of gambling risk factors have focused on individual or environmental factors. These variables include being male, having psychiatric disorders (anxiety, depression and attention deficit/hyperactivity disorder (ADHD)), and being of extreme old or young age. Environmental factors such as level of income, socioeconomic integration or social support also have an influence. Research has also found people from minority communities and deprived areas as well as homeless people adults with mental health issues, offenders/ex-offenders and migrants bear disproportionate burdens of harms associated with gambling. 

While we do not know exactly how many deaths are related to gambling each year, research indicates that there may be between 250 and 650 gambling related suicides annually – a minimum of one death every working day.  

A report from the National Audit Office (NAO) in February 2020 focused on the role of the Gambling Commission and the wider regulatory framework it operates within. The report described the Gambling Commission as a small regulator in a challenging and dynamic industry. To reduce harms, the report acknowledges how the Gambling Commission has increased its regulatory action (such as penalties on operators that break rules) and its collaboration with others in the field. However, the report concludes that there is more it needs to do to identify where problems are occurring and ensure gambling operators raise their standards. The way people gamble is changing, with new risks emerging in online and mobile gambling and other technological developments.  

How is (and should) gambling be regulated? 

The Gambling Act 2005 became law on 7 April 2005 and was fully implemented in 2007. The Act covers two main areas: providing facilities for gambling and using premises for gambling. The Act covers arcades, betting, bingo, casinos, gaming machines, society lotteries, and remote gambling (including online gambling). It also created and set the functions and objectives of the Gambling Commission as the principal regulator. In 2014, it was amended to cover all online gambling companies who offer gambling to customers in Great Britain, wherever they are based. Gambling is reserved across Great Britain but devolved in Northern Ireland. The Gambling Commission regulates all commercial gambling in Britain except spread betting (regulated by the Financial Services Authority). 

The Department for Digital, Culture, Media & Sport (DCMS) is responsible for ensuring a proportionate gambling framework that balances economic growth against protecting the vulnerable. In December 2020 the Government launched a call for evidence to review the Act and ensure it is fit for the digital age. 

Local Authorities are responsible for issuing premises licenses for gambling venues and for issuing gambling operators with permits. The advice contained within the Act is that Local Authorities should ‘aim to permit’ licenses so long as applications are reasonably consistent with three licensing objectives: (i) preventing gambling from being a source of crime or disorder; (ii) ensuring that gambling is conducted in a fair and open way; and (iii) protecting children and other vulnerable persons from being harmed or exploited by gambling. Since the Act was implemented the introduction of local risk assessments into the Licensing Conditions and Codes of Practice (LCCP) encourages Local Authorities, the regulatory and industry to work in partnership to address any local issues or concerns.   

The Advisory Board for Safer Gambling (ABSG) provides independent advice to the Gambling Commission. In 2019 the Gambling Commission, with support from the ABSG, published a National Strategy to Reduce Gambling Harms. The Strategy is intended to make faster and better progress in reducing gambling harms, and to achieve substantial and lasting progress over a three-year period. The Strategy is divided into two parts: prevention and education, and treatment and support. Actions are being undertaken around regulation and oversight, seeking out collaboration opportunities between businesses and sectors, collating evidence and evaluation, and independent research on harms. The ABSG published a progress report in June 2020 highlight the work being done on prevention and treatment but calling for a greater focus on gambling related suicide, the establishment of a safer gambling league table, involving people with lived experience in the delivery of the Strategy, and calling on the NHS to work with the third sector to create a national treatment strategy.  

GambleAware is a charity that commissions and funds research, education and treatment services to help reduce gambling-related harms. Its work is guided by the National Responsible Gambling Strategy (2016-2021) and a delivery plan. GambleAware asks those who profit from the gambling industry to donate a minimum of 0.1% of their annual gross gambling yield. 

The Betting and Gaming Council was founded on 18th September 2019 to bring together and replace the Remote Gambling Association, the Association of British Bookmakers and the National Casino Forum. The BGC seeks to raise awareness of responsible gambling and supports initiatives that improve player safety and ensures people have control of their betting and gaming.  

In 2018-2019 the DCMS Select Committee conducted an inquiry into Immersive and Addictive Technologies. The Inquiry considered the potential psychosocial and financial harms associated with the use of immersive technologies. The Government published its response to the inquiry’s recommendations in June 2020. This included a commitment to setting a framework for a programme of research into video games and a wider review of the Gambling Act (including a focus on loot boxes). 

In June 2020, the Public Accounts Committee published its report into gambling regulation. At the same time, the All-Party Parliamentary Group (APPG) on Gambling Related Harm issued its report into online gambling harm. Both reports highlighted the failure to adequately protect consumers and called for the whole system of regulation to be overhauled.      

In July 2020, the Select Committee on the Social and Economic Impact of the Gambling Industry released its report into Gambling Harm. This highlighted how successive Governments and regulators have failed to keep up with the evolution of the UK gambling sector and have been wholly reactive towards regulation since gambling was liberalised. The Committee made over fifty recommendations to address the misery that a gambling addiction can bring. The Government published its response to the report in December 2020. The Government highlighted The Gambling Commission, as the industry regulator, has broad powers to keep gambling fair, open, and crime free, while ensuring that there are protections in place for children and vulnerable people. However, as the Committee’s report highlights, gambling – like many other sectors of the economy – has undergone rapid change. The Review of the Gambling Act that is currently underway will consider whether changes are needed to the regulatory system including to the powers and resources that the Gambling Commission has to regulate the licensed market and tackle unlicensed operators.  

The Committee’s report, alongside those of the NAO, Public Accounts Committee, and APPG and together with a thorough assessment of the impact of COVID-19, are now shaping the Gambling Commission’s work

Harmful gambling is increasingly being seen as a public health issue, requiring a broader response than policy or regulation. The Local Government Association (LGA) and Public Health England (PHE) jointly developed a document to provide an overview of problem gambling, and how Councils can begin to try to help local residents who are impacted by it. Given the rise in hospital admissions, the NHS has committed to expanding specialist face-to-face treatment for gambling addiction, currently only available in London, to open up to 14 new clinics by 2023-2024.  

Some examples of other initiatives include ‘bet regret’ a whistle-to-whistle sport advertising ban; Barclays helping customers to turn off card payments to gambling websites and betting shops; lesson plans for teachers; and an e-learning course aimed at professionals who do not specialise in the treatment of gambling problems such as social workers, probation officers and employment advisors.          

Gambling behaviours, participation and harms are going up the policy agenda. While lots of people gamble safely and enjoy gambling, reviews are underway to look at how the industry is regulated (particularly online), education, treatment and engagement (particularly from a public health / health services perspective), and ways of addressing problems and harms.  

How much of an issue is problem or compulsive gambling in rural areas? 

Back in 2015 an article was published in the American Psychological Association’s journal bringing together literature describing the prevalence and types of gambling taking place in rural areas. The review found, overall, that while participation in gambling was generally higher in rural areas – compared to urban areas – this did not tend to translate into more problem or pathological gamblers. Protective factors in rural areas, including wider community cohesion whereby people look out for one another, were seen to reduce the risks of problematic gambling. In some countries indigenous residents showed higher prevalence rates for problem gambling compared to non-indigenous residents living in the same area. In common with urban areas, young people and men were found to be at greater risk of problem gambling but in a rural context women were more vulnerable than their urban counterparts which was attributed to isolation. The article concluded that further research to identify the protective factors was needed to ensure rural communities could become more active in tackling gambling related harm.  

Also, in 2015, a study in Great Britain looked at machine gambling characteristics by location. Using the Rural-Urban Classification, this found players tended to live in urban neighbourhoods in large urban centres; with players in rural and remote locations generally travelling further to betting shops situated in larger urban areas, either in, or out-of-town.    

More recently, studies in Australia have looked at what sets rural gamblers apart from urban gamblers. These factors included limitations in leisure choices in rural areas; the problem of social familiarity in relation to anonymous help-seeking; and the dearth of specialised services. However, when rural residents do seek treatment for problem gambling, while overall treatment outcomes are much the same as for urban residents, patients in rural areas appear to respond more rapidly and see sustained improvements over time. The normalisation of gambling among young people – and the availability and accessibility of gambling products in rural areas has also been highlighted. 

In Great Britain data on gambling participation is broken down by region. We do know that there is there is considerable geographical variation in problem gambling. It is higher in Scotland (0.9%) and in Wales (0.8%) than in England (0.7%). Within England, the rate is highest in the North East and in the West Midlands (both 1.1%); in London it is 0.9%, but only 0.3% in the South East and 0.2% in the South West. In Scotland, the Reducing Gambling Harm Programme is setting up a lived experience forum to put the voice of people affected by gambling harms at the heart of action to reduce those harms.

While some studies have looked at geographical distributions (e.g., participation, outlets, connectivity, harms), there is still relatively little known about the impacts of gambling on rural communities in England. For me, increasing our understanding of rural gambling involves four themes:  

  1. Building the rural evidence base – to better understand who participates in gambling, how, the harms being caused. This involves developing a baseline and then looking at trends over time.  This may also help us to identify at risk and non-problem gamblers so as to prevent progression into problem behaviour. 
  2. Raising awareness of gambling amongst rural residents – to better understand the social and financial benefits and risks in communities. For example, certain gambling activities such as horse racing are seen as providing strong social cohesion in rural communities. Mutual aid and support amongst rural residents are regarded as offering protection from problematic gambling. How can we better understand and build protective support in rural communities?  
  3. Understanding the different support and clinical services and tailored treatments related to gambling – and rural proofing these to ensure they are accessible to rural residents. 
  4. Collaborative working (e.g., industry, Local Authorities, regulators, community groups, health) to look at how to make gambling safe and reduce harm in rural areas. This needs to focus on prevention, and early-intervention, treatment and rehabilitation for problem gamblers. 

With Government focused on a wide-ranging review of gambling laws, and research under way to find out if the harms caused by gambling have been exacerbated by COVID-19, how can we give those that gamble safely in rural areas the freedom to do so and provide extra protections for those at risk of harm? Watch this space.

Jessica is a researcher/project manager at Rose Regeneration and a senior research fellow at The National Centre for Rural Health and Care (NCRHC). Her current work includes supporting health commissioners and providers to measure their response to COVID-19 and with future planning; and evaluating two employability programmes helping people furthest from the labour market. Jessica also sits on the board of a Housing Association that supports older and vulnerable people. 

She can be contacted by email jessica.sellick@roseregeneration.co.uk, Website -  http://roseregeneration.co.uk / https://www.ncrhc.org/, Blog - http://ruralwords.co.uk, Twitter - @RoseRegen


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