In March the House of Lords threw out government proposals to build the UK's first Las Vegas-style super casino in Manchester and build 16 other casinos around the country.1 This decision reflects polarised views about the costs and benefits of liberalised gambling in the United Kingdom, but the health dimension of the debate has been lacking.1 The UK currently has a low prevalence of problem gamblers, estimated to be 0.6%.2 By contrast the rate in the United States is about 2.8%, although rates vary across states. In New Jersey, the home of Atlantic City, the US's second largest casino resort, the prevalence of problem gambling is 4.2%.3

However, the UK's low rates seem likely to increase when the Gambling Act 2005 is implemented. The act will give the British public more access to gambling facilities than ever before. In the year after a casino was opened in Niagara, not only did gambling rise but the percentage of residents reporting two or more gambling problems rose from 2.5% to 4.4% and those having one or more problems increased from 9.6% to 12%.4