Gambling goes back millennia, but today’s proliferation of mobile phones has transformed it into a nearly ubiquitous global commercial enterprise, with looming public health implications. “You’ve got your casino in your pocket 24-7,” observes Harvard Kennedy School professor of the practice of public management Malcolm Sparrow, who specializes in the regulation of public harms. Gone are “all of the normal impediments and obstacles to gambling, such as place restrictions.” Sparrow is co-author of a recent Lancet report which estimates that worldwide, 46 percent of adults (approximately 2.3 billion people) and nearly 18 percent of adolescents (159.6 million youths between 10 and 19 years old) have gambled in the past year. Gambling is not like other leisure activities. It’s a “health-harming addictive behavior” that affects not only an individual’s well-being, points out an accompanying editorial, “but also their wealth and relationships, families and communities….”
Although only a small proportion of individuals engage in problem gambling—an addiction that affects an estimated 1.4 percent of gamblers, or 80 million adults globally—the researchers recommend that policymakers treat gambling as a public health issue rather than as a medical problem. That’s because, as Sparrow points out, one gambler’s problem behavior typically affects six to eight additional people, including family, co-workers, friends, and employers.
Rachel Volberg, a co-author and expert on gambling at the University of Massachusetts Amherst, says that the gambling industry has effectively portrayed gambling’s harms as the faults of individuals rather than as “an issue of consumer protection.” Jürgen Rehm, professor of public health at the University of Toronto and another co-author of the report, compares the problem to the tip of an iceberg. “You have the minority, who would qualify for a gambling disorder. That’s about 1 percent. And then you have all of those who…do not necessarily qualify for the disorder but have some serious consequences, like losing a family or losing even payments for a car. So, you get into trouble because of gambling even if you do not qualify for a diagnosis.” These are the estimated 5.5 percent of women (140 million) and 11.9 percent of men (308.7 million) whom the report identifies as at some risk from gambling.
During three-and-a-half years of studying the problem, the Lancet-convened researchers—including experts in public health, gambling studies, global health policy, risk control, and regulation—found that the epidemiological landscape is changing. Of particular concern is the rise of gambling among adolescents, 10 percent of whom have gambled online in the past year, despite age restrictions. Of those, an estimated 26 percent are at risk for disorders, a far higher proportion than among adults. “These findings,” they write, “underscore the potential harmfulness of products (e.g., online casino or slot games and sports betting) that are now driving the global expansion of the gambling industry.”
Although four-fifths of countries worldwide permit gambling, that number understates the global nature of the industry’s influence, since digital technology transcends borders. And the online environment has “enhanced the ability of gambling operators to capture detailed data about the performance of their products and the behavior of their customers,” the researchers write. “Online gambling companies precisely target consumers using predictive algorithms, personalization, and persuasive technologies, and train sophisticated algorithms to enhance an individual’s user experience,” they continue. “Targeted forms of marketing include capitalizing on sports fandom” while “Data on consumers are shared widely across the gambling ecosystem and are used to profile customer behaviors.”
In the United States, legalized gambling has spread swiftly since 2018, when the Supreme Court overturned a law banning online sports betting. Thirty-seven states and the District of Columbia have now authorized this form of online gambling. The industry markets its services through social media, aided by well-remunerated celebrities, athletes, and sports organizations. In 2024, U.S. bettors wagered $150 billion on sports, not just on the outcomes of sporting events but through minute-by-minute bets on a dizzying array of statistical ephemera: whether a particular player, for example, will score more than a certain number of points by halftime even as his or her team is defeated. Globally, consumers are wagering far more—and by 2028, the Lancet report found, are expected to lose a staggering $700 billion. Young people are particularly vulnerable to developing addictions to sports and video betting, which are driving the surge in gambling. The executive director of the National Council on Problem Gambling, Keith Whyte, said in late 2023 that sports betting in particular has caused “the largest and fastest expansion of gambling in our nation’s history.”
Worldwide, the Lancet report finds, lawmakers seeking fresh tax revenue sources have loosened restrictions on online betting without sufficiently weighing the public health risks or social costs, which are regularly measured in billions of dollars. Numerous studies cited by the Lancet researchers link gambling to job loss as well as “suicide, suicidality, mental health [problems], anxiety, depression, family ruin, [and] domestic violence-related crimes,” says Sparrow. One study found that 37 percent of people experiencing a gambling problem have perpetrated intimate partner violence. A 2021 analysis of banking transactions found that a 10 percent increase in spending on gambling increased the likelihood of missing a mortgage payment by 97.5 percent. Said an American woman quoted in the report, the financial harm “is probably going to impact me for the next two or three, four years…the system here is pretty brutal when you mess up.”
Governments can mitigate such harms through regulation: by requiring the establishment of accounts to limit an individual’s annual losses, prohibiting the use of credit, and setting restrictions on advertising, marketing, and game features and designs. The report further recommends establishing a “firewall” between research into gambling’s effects and the industry itself.
The widespread availability of mobile and online gambling arrived in North America later than in Europe, which “has been at this legalized online gambling a lot longer” says Sparrow, “and therefore seen more misery.” The data from Europe, where many countries legalized online betting before 2010, is robust and clear about the public health problems, including increased rates of depression and anxiety among those who gamble. While such research is still only emerging in the United States, Sparrow and his coauthors hope that as gambling’s dangers here become clear, policymakers in the United States and Canada will follow their European counterparts by adopting belated regulatory measures. “We urge people to get there sooner,” he says, “than they might otherwise.”
