Cheryl Currie, PhD

Alberta Translational Health Chair & Assistant

Professor of Public Health, University of Lethbridge

What is done to resolve a

particular societal matter depends

on how it is framed (Korn, 2002)

• All Canadian provinces provide funds to

promote responsible gambling

• But are we framing the matter in ways that

guide effective action?

Science of prevention

To fulfill society’s interest

in assuring conditions in

which people can be

healthy.

What is Public Health?

A Public Health Lens

Describe gambling in populations

Determinants of PG

Action

Descriptive Epidemiology

Person

Place Time

Describe gambling

behaviour by:

Population-focused

Population Health Focus

Individual Focus

Chasing losses

Cravings to gamble

Health problems

Financial problems

844,000 PGs in Canada (2.4%)

Higher in males

Prevalence lowest in Quebec, east coast

Low treatment seeking

Population Focus

1. Biologic – Genetics, epigenetics

2. Environmental – Gambling environment

3. Individual – Choices, psychological mechanisms

4. Social – Poverty, unemployment,

discrimination, childhood trauma

Determinants of PG

Levels of Prevention

1. Primary Prevention – Prevent PG

2. Secondary Prevention – Catch

preclinical PG symptoms early

3. Tertiary Prevention – PG treatment

Levels of Prevention

Symptomatic

Clinical phase of

disease (PG)

Pre-Symptomatic

Early PG symptoms

The Problem with an

Educational Focus

Educational approaches to health

promotion have proved disappointingly

ineffective.

(Gilliam et al. 2012)

45 000 TV ads, 35 000 radio ads, 10 000

print impressions, 1000 billboards

Education campaign portrays the

consequences of meth use.

Example – Montana Meth Project

“...the effects on meth use are statistically

indistinguishable from zero.”

Campaign did not contribute to a decrease in meth

use among youth.

To better guide the allocation of resources this study

calls for a focus on the determinants of meth use.

Findings – Anderson (2010)

1. Educating people on ‘how to behave better’

is often not that effective in eliciting

lasting behaviour change.

2. Some education-based behaviour change

theories are popular, but not necessarily

evidence-based.

What are the problems with

educating people?

Link to article

3. New people continue to enter the

population at an unaffected rate - who then

have to be

educated on “how

to behave better”

(Syme, 2008)

What are the problems with

educating people?

A shift in focus to reducing incidence not

prevalence

Link to

article

Wealth Distribution

Divide the 34 million people in Canada into 5 groups each with 6.8 million people

Wealthiest 20% Upper middle Middle Lower middle Bottom 20%

Question: What % of wealth is owned by each quintile?

Income Inequality & Mental Health

Gambling redistributes $$ randomly among

participants.

How could gambling revenues $$ be used to

redistribute wealth in society?

Big Picture Thinking

How can we structure the

gambling environment

To make individual’s

default decisions about

gambling responsible?

Link to

article

Gambling Profits

Social Responsibility

Finding the Right Balance

Rose - Preventative Medicine

Personal lifestyle is socially conditioned.

It makes little sense to expect individuals

to behave differently than their peers.

It is more appropriate to seek a general

change in the circumstances which

facilitate behavioural adoption.

High-Risk Focus

Target: High-risk gamblers

based on behaviour

Most

responsible

Least

responsible

Average gambling

behaviour

Where do the High-Risk come from?

Most

responsible

Least

responsible

Average gambling

behaviour

What Determines the Population Average?

Most

responsible

Least

responsible

Average gambling

behaviour

The more

widespread a

cause, the less it

explains the

distribution of

cases.

The hardest

causes to identify

are those

universally

present.

Comparing Populations

Average Blood Pressure

Link to full

reference

Comparing Populations

Causes of Cases

Similar in Alberta

& Quebec

Causes of Incidence?

0%

2%

4%

6%

8%

Alberta Quebec

PG Prevalence

Why do some individuals have PG

Why do some populations have more PG?

What is Our Question?

Whole Population Target

Edited from Frohlich and Potvin (2008)

Most

responsible

Least

responsible

Average gambling

behaviour

In reality, this is what often happens

The Problem!

Frohlich and Potvin (2008): Link to article

Those with higher SES derive more benefit from whole population approaches

Not addressed – underlying mechanisms in society that lead to mental health inequalities in various groups.

The Problem

Increased PG Inequalities

Determinants of PG

Adverse Childhood Experiences

Link to

article

1. High-risk population

2. Whole population

3. Vulnerable populations

Framing Prevention Targets

1. Focus: Primary, secondary, tertiary prevention?

2. Strategies: Based on scientific theory & evidence?

3. Targets: Causes of cases or incidence?

Developing a Framework for

Responsible Gambling

1. PG prevention programs not generally informed by

research evidence.

2. Most widely employed strategies are the least

effective (education, responsible gambling features,

self-exclusion)

3. No magic bullet strategy in PG literature.

Williams, Simpson & West (2012): Report Link

Responsible Gambling

Where are We Now?

Gambling Profits

Social Responsibility

Finding the Right Balance

Refocusing Our Efforts to Promote

Responsible Gambling

Cheryl Currie, PhD

AIHS Translational Health Chair &

Assistant Professor of Public Health, University of

Lethbridge, cheryl.currie@uleth.ca