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?
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, [email protected]