A question of balance: prioritizing public health responses to harm from gambling.

AIM To provide an overview on the nature and importance of public health approaches to the global expansion of commercial gambling. METHOD Three key areas of public health activity are examined: harm minimization, health promotion and the political determinants for change. FINDINGS The rapid proliferation of gambling experienced in many countries is driven by the commercial development of new products orientated around continuous and rapid mass consumption. This is particularly the case with ongoing refinements to electronic gambling machines and the development of new gambling technologies using the internet and mobile telephones. So far responses to negative impacts have, on the whole, focused upon individualized treatment interventions. A public health approach to gambling offers a broad range of strategies to tackle the wider implications of gambling expansion: harm reduction provides evidence-based strategies for managing identifiable harm; health promotion focuses upon communities building their capacity, knowledge and resilience with regard to the attractions of gambling, and action on the political determinants sets out to increase the accountability and reduce the conflicts of interest that influence government resolve in managing their gambling environments. CONCLUSION In this new environment of mass consumption, efforts in developing treatment responses to problem gambling need to be balanced with, at least, equal efforts in developing public health responses. With the expansion of commercial gambling occurring globally, international agencies could play a critical role in supporting public health initiatives.