Intended for healthcare professionals


Harm built in—why the gambling industry needs a Silent Spring moment

BMJ 2023; 380 doi: (Published 26 January 2023) Cite this as: BMJ 2023;380:p203
  1. May CI van Schalkwyk, NIHR doctoral fellow1,
  2. Rebecca Cassidy, professor of anthropology2,
  3. Mark Petticrew, professor of public health3,
  4. Martin McKee, professor of European public health3
  1. 1Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine
  2. 2Department of Anthropology, Goldsmiths University, London
  3. 3Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine

A watershed moment is needed to expose the inherent harms of gambling and protect vulnerable people, write May van Schalkwyk and colleagues

There are times when we begin to see things in a completely different way. In 1962, Rachel Carson’s Silent Spring led to a shift in how people viewed the pesticide DDT by portraying the silence of a world without birds.1 This publication was a watershed moment.2 Until then, DDT had been seen as a vital input to US food production. Henceforth it would be regarded widely as poison that hangs around for ever.3 In the few months before she died, Carson was feted by many scientists but vilified by the chemical industry. Policy change proceeded slowly, but within a decade DDT was banned and the Environmental Protection Agency established. The consequences went beyond one chemical. Silent Spring undermined the trust that many Americans placed in manufacturers. But other industries have expected us to mindlessly trust that they are doing good, even when evidence suggests otherwise.

One is the gambling industry. As we struggle with a cost-of-living crisis, we must ask why we seem unable to act against a powerful industry that, in effect, acts as a mechanism for transferring money from the poor and vulnerable to the wealthy and privileged. When will the gambling industry have its Silent Spring moment?

Could publication of the long awaited UK White Paper be this moment? It should be, but it seems unlikely. Explicitly framed as an exercise in balancing “consumer freedoms and choice on the one hand, and prevention of harm to vulnerable groups and wider communities on the other,”4 it is likely to propose incremental changes,5 leaving intact the statutory aim “to permit” gambling.6

At first glance one might see grounds for optimism. Recent guidance by the UK’s Gambling Commission served to fill the void created by a delay in the White Paper’s publication.7 With some elements already in force and the rest planned for early 2023,8 the guidance emphasises the obligations of online operators. First, to “enable a customer to gamble safely,” operators must use player tracking technologies to “identify” indicators of harm, “act,” and “evaluate” to ensure their actions are effective.7 Interventions must be timely and “reflect the seriousness of the indicators of harm, including refusing service and ending the business relationship where necessary.” Second, they must identify and protect those who may be most vulnerable to harm.7

Vulnerability is fluid, and a vulnerable person is defined as “somebody who, due to their personal circumstances, is especially susceptible to harm, particularly when a firm is not acting with appropriate levels of care.”7 Those personal circumstances include recent job loss or bereavement. However, the Commission cites that 46% of the adult population display some form of vulnerability—hardly a small minority. Unsurprisingly, the industry has resisted some of these measures, including the “requirement to take timely action where indicators of vulnerability are identified” and “to prevent marketing and the take-up of new bonus offers where there are strong indicators of harm.”7 The guidance expects everyone’s online gambling activity to be “monitored” by computer algorithms and staff members 365 days a year, 24 hours a day, to ensure some of these products are being used “safely,” although how effective this would be is unclear. Nonetheless, the government portrays the guidance and other measures as evidence that action is being taken to prevent harm and make gambling “safer.”9

At this point, someone new to gambling regulation might reasonably ask, “Why are we devising regulations that enable consumers to use dangerous products, rather than preventing their release onto the market?” We don’t usually allow people to use hazardous or dangerous products as long as the manufacturers monitor how they are used. Rather, we replace them with safer alternatives.

From a practical and public health perspective, the guidance is illogical. Designed to prevent harm, it involves retrospective interventions triggered when certain “indicators of harm” are identified. Similar guidance has been issued for land based venues.10 The commercial operators face an obvious problem. Their owners expect them to maximise income but now they are being asked to deter their best customers. In other sectors, consumer products are required to be safe by design and undergo mandatory safety testing, and defective products are recalled. Where no alternative exists, dangerous products are tightly regulated and explicit warnings and safeguards are applied to protect those at risk, to safeguard the user and those around them to counter the “profit at any cost” incentive. So why is gambling different?

We need to ask whether gambling products and services are inevitably and unnecessarily harmful. Could they be made safer by design before being released onto the market? And if so, who should decide what level of risk is acceptable and on what grounds?

We are concerned that the White Paper will continue enabling the flawed gambling policies of the past two decades, when gambling was viewed as a leisure product that brought enjoyment to many. The official narrative emphasises “balance” between the right to profit from dangerous products and the harm that they inflict. The guidelines appear radical, but in reality they reflect an exceptionalism that the gambling industry currently benefits from. This leads us to ask of gambling policy, “why do we assume that society should permit an industry that is intrinsically harmful, assuming that the NHS, social services, and other sectors will be there to pick up the pieces?”

Gambling still awaits a Silent Spring moment, when people gasp with incredulity at a system we have created and perpetuated, that acts against the interests of most people. It makes no sense for regulation to struggle to manage the damage caused by dangerous products. From a public health perspective, regulation should prioritise the prevention of harm to those who choose to gamble and those around them.11 As the minister for gambling recently stated, “if gambling is to be a pastime that people can enjoy, it must not be dangerous or exploitative.”9 The purpose of the gambling industry is to make profit, but it does not have the right to do this at any cost, using any product, under the veneer of providing fun.


  • Funding: MvS is funded by the National Institute for Health Research (NIHR) Doctoral Fellowship (NIHR3000156) and her research is also partially supported by the NIHR Applied Research Collaboration North Thames.

  • The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

  • MP is a co-investigator in the Spectrum consortium, which is funded by the UK Prevention Research Partnership (UKPRP), a consortium of UK funders (UK Research and Innovation research councils: Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, and Natural Environment Research Council; charities: British Heart Foundation, Cancer Research UK, Wellcome, and The Health Foundation; Government: Scottish Government Chief Scientist Office, Health and Care Research Wales, National Institute of Health Research and Public Health Agency). MP (principal investigator) has grant funding from the NIHR “Three Schools” Mental Health Programme. RC reports no funding associated with the production of this article.

  • Competing interests: none declared.

  • Provenance and peer review: not commissioned; not externally peer reviewed.