cheryl currie: refocusing our efforts to promote responsible gambling: the importance of a public...
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Cheryl Currie: Refocusing our Efforts to Promote Responsible Gambling: The Importance of a Public Health Lens Session 4B Presented at the New Horizons in Responsible Gambling Conference in Vancouver, January 27-29, 2014TRANSCRIPT
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Cheryl Currie, PhD
Alberta Translational Health Chair & Assistant
Professor of Public Health, University of Lethbridge
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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?
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Science of prevention
To fulfill society’s interest
in assuring conditions in
which people can be
healthy.
What is Public Health?
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A Public Health Lens
Describe gambling in populations
Determinants of PG
Action
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Descriptive Epidemiology
Person
Place Time
Describe gambling
behaviour by:
Population-focused
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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
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1. Biologic – Genetics, epigenetics
2. Environmental – Gambling environment
3. Individual – Choices, psychological mechanisms
4. Social – Poverty, unemployment,
discrimination, childhood trauma
Determinants of PG
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Levels of Prevention
1. Primary Prevention – Prevent PG
2. Secondary Prevention – Catch
preclinical PG symptoms early
3. Tertiary Prevention – PG treatment
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Levels of Prevention
Symptomatic
Clinical phase of
disease (PG)
Pre-Symptomatic
Early PG symptoms
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The Problem with an
Educational Focus
Educational approaches to health
promotion have proved disappointingly
ineffective.
(Gilliam et al. 2012)
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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
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“...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)
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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?
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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?
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A shift in focus to reducing incidence not
prevalence
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Link to
article
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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?
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Income Inequality & Mental Health
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Gambling redistributes $$ randomly among
participants.
How could gambling revenues $$ be used to
redistribute wealth in society?
Big Picture Thinking
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How can we structure the
gambling environment
To make individual’s
default decisions about
gambling responsible?
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Link to
article
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Gambling Profits
Social Responsibility
Finding the Right Balance
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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.
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High-Risk Focus
Target: High-risk gamblers
based on behaviour
Most
responsible
Least
responsible
Average gambling
behaviour
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Where do the High-Risk come from?
Most
responsible
Least
responsible
Average gambling
behaviour
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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.
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Comparing Populations
Average Blood Pressure
Link to full
reference
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Comparing Populations
Causes of Cases
Similar in Alberta
& Quebec
Causes of Incidence?
0%
2%
4%
6%
8%
Alberta Quebec
PG Prevalence
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Why do some individuals have PG
Why do some populations have more PG?
What is Our Question?
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Whole Population Target
Edited from Frohlich and Potvin (2008)
Most
responsible
Least
responsible
Average gambling
behaviour
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In reality, this is what often happens
The Problem!
Frohlich and Potvin (2008): Link to article
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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
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Determinants of PG
Adverse Childhood Experiences
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Link to
article
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1. High-risk population
2. Whole population
3. Vulnerable populations
Framing Prevention Targets
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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
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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?
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Gambling Profits
Social Responsibility
Finding the Right Balance
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Refocusing Our Efforts to Promote
Responsible Gambling
Cheryl Currie, PhD
AIHS Translational Health Chair &
Assistant Professor of Public Health, University of
Lethbridge, [email protected]