Insights Nigel Fairbrass

Doctored: how the public health community weaponised a tobacco ‘playbook’ against UK gambling  

A regulatory clampdown on the UK gambling sector echoes the war waged by the public health community against cigarettes. But these parallels are not accidental and reveal how clinicians use the long shadow cast by the tobacco industry to effect regulatory change across the consumer landscape.  

Last month, a dozen public health experts published an editorial in Health Promotion International, accusing the gambling sector of replicating the tactics of big tobacco in stifling regulation. Central to the complaint was that gambling companies are funding their own one-sided research into gambling harm. Evoking evidence presented by tobacco companies in the 1970s and ‘80s, which claimed cigarettes were not addictive. 

By coincidence, last week also saw the news that a gambling ‘levy’, proposed in a UK government white paper on regulation, might raise £100m from gambling operators to fund treatment and research related to gambling harm.  This levy, like the punitive damages famously awarded against big tobacco, revolves around much the same narrative: that the gambling industry damages society and tries to conceal the evidence.  

The comparison between gambling and tobacco is not new but the conflation of the two reveals more about the accuser than the accused. Because the ‘big tobacco’ script is the public health community’s template for social change, rather than a useful guide to the behaviour of companies they attach it to. 

Perfected against cigarettes and deployed at scale against alcohol, soft drinks, and junk food, the public health community’s ‘tobacco playbook’ follows a proven formula for social change: generate moral panic around a product category; demonise and disempower the industry in question; establish a new evidence base; and propose sweeping new restrictions on the price, availability and promotion of products.  

The strategy is deliberately adversarial. Executives are cast as tobacco-style villains, and if their companies challenge the consensus they are dismissed as sinister propagandists.  Scientists who work with the industry, or even benefit from its funding indirectly, are denounced as corporate shills by colleagues and barred from other work. And legislators who have meetings with the industry are accused by health campaigners of being in executives’ pockets – if not of outright corruption. 

The ultimate goal of the tobacco playbook is to inexorably medicalise a product category, putting the state in control to save citizens from themselves.   

In this scenario, everyone becomes a potential victim.  Passive-smoking is reimagined as passive-drinking, contributing to family breakdown.  Gambling disorders will be linked to rising rates of crime and deteriorating mental health, and junk food translates into a terrifying array of associated co-morbidities that threaten the very healthcare system itself.  

Into this febrile mix, clinicians will moonlight as behavioural economists, or tax specialists, advocating for warning labels on products, for major restrictions on advertising, for new pricing structures and complex duty changes.  Hypothecated taxes will be demanded to fund the establishment of vast new industries to diagnose, treat and rehabilitate those citizens who may be, as yet, blissfully unaware of the danger they have been exposed to.  

It is precisely these circumstances that have engulfed the gambling sector in recent years, punctuated last week by the closure of a consultation on so-called ‘affordability checks’. This will likely result in gambling companies having to demand access to punters’ financial records to ensure they aren’t laying bets they can’t afford.   

This extraordinary extension of state and corporate control would be astounding in any other recreational context.  Imagine, for instance, if affordability checks were applied to season ticket holders for premier league clubs?  But successful deployment of the tobacco playbook means that gambling is progressively positioned as a chronic health condition that needs to be treated rather than enjoyed.  To illustrate the point, doctors are now advised to ask about your gambling alongside alcohol consumption and exercise at routine check-ups. 

Some will point to the levels of profitability enjoyed by the tobacco sector, where regulatory crackdowns simply created high-margin monopolies, and suggest that price controls and advertising restrictions are not the end of the world.  But £100m from a levy on gambling operators will be just the beginning.  There will be no incentive for researchers to declare gambling safe.  So every pound spent on research into gambling harm will be in search of the next pound, predicated on revealing an ever-greater burden on society. 

The tragedy for the rest of us, who may not gamble away the mortgage money, drink to excess or stuff our faces with junk food, is that the legacy of the tobacco playbook is a more divided society, where the public health community is complicit in perpetuating a trust deficit in private enterprise.    

The notion that every company in the alcohol, confectionary, fast-food or gambling space is disinterested in reform is palpably false.  Most companies will be acutely aware that sustainable profits over the long term are dependent on a fair compact with society and their customers.   

But the public health community’s preferred template of social reform weaponises a narrative that polarises society. And that doesn’t feel good for our health either.