Gambling in Suburban Australia

Research Report – March 2019

1. Introduction

1.1 Purpose of this report

Gambling is recognised as a significant public health and policy issue in Australia. Australians lose approximately $22 billion on legal forms of gambling each year, representing the largest per capita gambling losses in the world (Queensland Government Statistician's Office, Queensland Treasury, 2016; The Economist online, 2014). The largest proportion of gambling expenditure is on land-based EGMs, which account for 62% of all gambling losses (Queensland Government Statistician's Office, Queensland Treasury, 2016). While state governments regulate gambling across their jurisdiction, EGM availability, activity and harm can vary widely at the local level. For instance, studies have demonstrated a social gradient in gambling losses, with areas of higher socio-economic disadvantage losing more than areas of lower disadvantage (Rintoul, Livingstone, Mellor, & Jolley, 2013). This suggests that gambling may be entrenching inequality in already disadvantaged areas.

To date there has been relatively limited research into gambling at the local level. While there have been desktop analyses of locally available administrative data and modelling of predicted and observed EGM catchments (Doran & Young, 2010; Marshall & Baker, 2001; Marshall & Baker, 2002; Rintoul et al., 2013), there have been relatively few qualitative studies that capture the experiences of local residents, and their own explanations of and attitudes towards local gambling opportunities. Reith and Dobbie (2011, 2013) explored the role of the environment and social networks in the development of gambling in Scotland. They argue that qualitative accounts of the social, environmental and political context in which gambling takes place have been lacking. Reith (2012) also argues that the policy and regulatory context in which gambling takes place can have a determinant effect on the prevalence and nature of gambling problems.

Australia provides a unique environment for the study of community-based, high-intensity gambling opportunities. In all but one Australian jurisdiction (Western Australia), EGMs are widely available in local community hotel and club venues. Around 30% of the Australian population use EGMs at least once a year (Queensland Government Statistician's Office, Queensland Treasury, 2016). EGMs are associated with the most gambling-related harm of any form of gambling: around 85% of people who experience gambling harms report EGMs as their main problem (Productivity Commission, 2010).

Using a burden of disease model,1 a recent study revealed that the burden of harm associated with gambling problems is about 60% of that associated with alcohol use and dependence (Browne et al., 2016). In 2010, it was estimated that the social costs of problem gambling in Australia ranged from $4.7 billion to $8.6 billion annually (Productivity Commission, 2010). However, a more recent estimate, which included the costs associated with people who gamble at low- and moderate-risk levels, estimated the social costs to be about $7 billion in Victoria alone (Browne et al., 2017).

This current report contributes to building a framework of understanding of the key determinants of EGM gambling, many of which are yet to be properly investigated. By understanding the key determinants of gambling consumption and harm, solutions to address these harms can be developed in a more coordinated way. It is hoped this study's findings will assist in developing a systematic response to gambling harm in line with, for instance, the responses developed for road transport injury prevention and tobacco control.

1.2 Place and health

This study hypothesises that EGM gambling consumption is influenced by the built environment in which one lives.

There is a growing body of public health research that reveals how the built environment and social and commercial factors influence health outcomes (Commission on Social Determinants of Health, 2008; Kickbusch, Allen, & Franz, 2016; Malambo, Kengne, De Villiers, Lambert, & Puoane, 2016; Marmot & Wilkinson, 2005; Townshend, 2017). This research describes how unhealthy retail stores and services affect health, and argues that health promotion and illness prevention efforts should take in to account the neighbourhood attributes of communities.

The social determinants of health2 describe, in part, how inequalities in outcomes differ across the population. Often these inequalities appear to be avoidable and are the result of structural (or socio-economic) inequity. Increasingly, a tendency of some research to focus on individual choices and lifestyle factors, in the context of addictive consumption such as of tobacco, alcohol and gambling, has been criticised for failing to account for significant commercial, social and economic influences on population consumption patterns (Kickbusch et al., 2016; Livingstone et al., 2017).

To date, little gambling research has reflected the social determinants of health approach. The gambling accessibility literature has gone some way to explaining local EGM venue expenditure patterns by predicting the catchment areas of venues using EGM density, losses, venue size, socio-economic disadvantage and local population to show ecological associations3 of likely levels of harm. However, to date, the research has not progressed beyond evidence of an association between increased EGM density and rates of family violence incidents and assaults (Markham, Doran, & Young, 2016).

Further, little research has progressed beyond abstract statistical description to explain high expenditure clusters in areas of socio-economic disadvantage. Therefore, the authors of this study sought to qualitatively explore factors underpinning the link between socio-economic disadvantage and gambling consumption. Understanding this phenomenon, and its effects on people who gamble, and their families and communities, will assist in the development of improved public policy designed to prevent and reduce gambling-related harm.

Gambling affects a wide range of domains, including household functioning and relationships, health and wellbeing, productivity and employment and, in more extreme cases, can lead to contact with the criminal justice system, family violence, suicidal ideation and suicide (Black et al., 2015; Blaszczynski & Farrell, 1998; Dowling et al., 2016; Productivity Commission, 2010; Wong, Kwok, Tang, Blaszczynski, & Tse, 2014). Harms attributable to high-risk gambling at a population level are similar to major alcohol-use disorder, and moderate-risk gambling has a higher burden of harm than moderate alcohol-use disorder (Browne et al., 2016). It is estimated that for every person who gambles at high-risk levels, on average at least six others are directly affected. For people who gamble at low- and moderate-risk levels, around one and three others, respectively, are affected. Immediate family members such as partners and children are most likely to be affected (Goodwin, Browne, Rockloff, & Rose, 2017).

There are also likely economic effects on local communities via the diversion of money to gambling businesses. For example, subsidised food and other social activities drawing on profits generated through EGM operation may disadvantage non-gambling enterprises offering the same services.

There is some debate about the reasons for high levels of gambling accessibility, and high per capita losses in disadvantaged areas. Typically, EGM operators argue that they are meeting demand for their product. An alternative explanation, explored in this study, is that exposure; that is, supply of gambling products, is a key factor for uptake.

Further, it is possible, and likely, that people living in disadvantaged areas experience higher levels of stress (Boardman, Finch, Ellison, Williams, & Jackson, 2001) and may find temporary relief from this stress through the use of EGMs. Recent studies in neuroscience have demonstrated that use of an EGM can stimulate the striatal dopamine system (Yücel, Carter, Harrigan, van Holst, & Livingstone, 2018). Such stimulation is likely to lead to a temporary sense of relief and reduced anxiety, but clearly can also lead to and entrench excessive gambling.

1.3 Rationale

This study explores the interaction between EGM supply and demand through the experiences and attitudes of local residents, in particular by concentrating on the experiences of people who gambled, and their significant others, in two selected neighbourhoods. While acknowledging that gambling consumption is a function of individual characteristics, neighbourhood context and macro-level influences, the theoretical basis upon which this study was developed is that populations living in more disadvantaged areas:

  • have less social and economic resources, leading to higher levels of stress (Boardman et al., 2001)
  • experience higher levels of accessibility and exposure to high-intensity EGM products, and are more likely to be exposed to the promotions of these venues and the products that they offer
  • have reduced community amenities.

In combination, these factors were hypothesised to contribute to increasing the attractiveness of EGM venues and their promotions. Our aim was to use qualitative data to explore the validity of this hypothesis.

1.4 Aims and research questions

This study is grounded in an approach drawing on the social determinants of health. It is focused on two spatially defined communities in Melbourne, selected for their differing EGM gambling availability and consumption and socio-economic characteristics. This study seeks to understand the effects of these differences in the distribution of gambling opportunities between these areas. This comparison allows us to interpret findings in relation to the distribution of advantages and burdens at a population level (Gostin & Powers, 2006).

The primary aims of the study are to:

  • explore and document local environmental factors that influence gambling consumption patterns in selected local areas or suburb clusters. This involves exploring the features and characteristics of gambling venues, as well as the local community context in which gambling occurs
  • document the nature and consequences of gambling-related harm among people who gamble, their families and local communities.

The key research questions are:

  • How do different environmental factors contribute to gambling consumption in each local area? How does this differ between the two selected local areas?
  • How do the characteristics of the local community interact with gambling opportunities to influence gambling consumption?
  • What are the nature, consequences and effects of gambling on people who gamble and 'significant others' in this local area?

The study explores factors that determine the ways in which people live, work and socialise in each site. It explores how the characteristics of this local environment (e.g. venue operations, social, economic, geographic and regulatory factors) influence gambling consumption. The study seeks to understand how exposure to gambling and the social capital (community resources and available opportunities), combined with the relative availability of alternative non-gambling recreational facilities, may influence engagement with local gambling opportunities.

The report provides:

  • an overview of the methodology (chapter 2, details provided in appendices A and B)
  • results that describe:
    • factors influencing EGM gambling activity and consumption, including amenity and recreational facilities, and venue accessibility and promotional strategies (chapter 3 and chapter 4)
    • life stressors experienced by local residents, including social, financial and structural stressors (chapter 5)
    • gambling-related harms, including financial and crisis harms (chapter 6), physical and mental health harms (chapter 7), and relationship harms, including conflict and violence within personal relationships and intergenerational harms (chapter 8)
    • community benefits of gambling (chapter 9)
  • recommendations and conclusions for preventing and reducing gambling-related harm, particularly harm related to EGM consumption (chapter 10).

1 Burden of disease measures the impact of living with illness and injury and dying prematurely. The summary measure 'disability-adjusted life years' (or DALY) measures the years of healthy life lost from death and illness (Australian Institute of Health and Welfare [AIHW], 2018).

2 The social determinants of health are the conditions in which people are born, grow, live, work and age. These circumstances are shaped by the distribution of money, power and resources at global, national and local levels. The social determinants of health are mostly responsible for health inequities - the unfair and avoidable differences in health status seen within and between countries (World Health Organization [WHO], 2018; see www.who.int/social_determinants/sdh_definition/en/). The commercial determinants are a subset of this field and describe 'strategies and approaches used by the private sector to promote products and choices that are detrimental to health' (Kickbusch et al., 2016).

3 Ecological associations describe the frequency with which an outcome of interest occurs in the same geographic area. These studies are useful for generating hypothesis but cannot be used to infer causal conclusions (Jekel, Katz, Elmore, & Wild, 2007).