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In this article, we illustrate two issues with the funding for efforts to prevent, research, and treat gambling harm. 1) Chronic underfunding of RET 2) Issues with the distribution of RET funding Gambling operator director remunerations vs RET funding From 2016 to 2020, the total director remunerations across ten top gambling companies were £2.19 billion. Bet365 makes up a considerable amount of this, with £1.91 billion in key management personnel remunerations. In comparison, totalled, all other companies’ remunerations were £278 million. In contrast, total funding for gambling harm research, education, and treatment received £77.19 million between 2016 and 2020. Total funding for gambling harm RET equates to 3.5% of the spending on director remunerations for ten top gambling companies. Focusing solely on 2020 alone, total remunerations across the ten companies were £654 million. Again, Bet365 makes up a significant amount with £607 million in key management personnel remunerations with all other companies’ remunerations together standing at £46.4 million. In contrast, funding given to gambling harm research, education, and treatment totalled £27.3 million in 2020 (4.2% compared to the remunerations). Figure 1. A comparison of remunerations of gambling operators and RET funding between 2016 and 2020. Note: Our figures reflect on ten of the top leading gambling companies: Bet365, Camelot Group, Entain (Coral, Ladbrokes), Flutter Entertainment (Paddy Power, Betfair), Gamesys, Kindred Group (Unibet, 32Red), Rank Group, Playtech, William Hill and 888. Remunerations include the base salary and all other forms of financial compensation (e.g., bonuses) paid to directors or key management personnel. Statistics were calculated from Companies House (1), the Gambling Commission (4, 5) and the Charity Commission (6). Funding for charities can be received in two different ways: Gambling operators must donate an annual financial contribution (RET contribution) to a charity that focuses on research, education and treatment of gambling harm, as a condition of holding a Gambling Commission Licence. No amount is specified in the Licence Conditions and Codes of Practice (2). Funding from regulatory settlements. A payment to a charity that addresses gambling-related harm can be made as part of a settlement with the Gambling Commission when regulatory action is taken against a gambling operator. The gambling operator cannot receive positive publicity, and the money needs to be separate from RET contributions and should be given for socially responsible purposes (3). Distribution of funding In 2020, charities received £27.26 million, with £17.57 million in RET contributions from industry and £9.68 million in regulatory settlements. In 2021, charities received £60.46 million, with £37.05 million in RET contributions from industry and £23.41 million in regulatory settlements. Funding for charities has increased, comparing 2020 to 2021. However, the distribution is uneven across organisations. In 2020, GambleAware’s income was £16.88 million, with £15.59 million in donations from industry and £1.29 million in regulatory settlements. In comparison, the total from other RET organisations was £10.38 million, with £1.99 million in RET donations from industry and £8.39 million in regulatory settlements. Funding has started to be given over a broader range of charities during 2021. However, GambleAware still receives the majority of the income with £33.63 million; of which £24.83 million is from voluntary donations from the gambling industry and £8.8 million in regulatory settlements. In comparison, in 2021, £26.83 million was given towards all other RET efforts with £12.22 million in voluntary donations from the gambling industry and £14.61 million in regulatory settlements. Figure 2. Voluntary RET Donations between 2016 to 2021. Note: RET contributions shown of organisations which have been published by the Gambling Commission with additional analysis conducted for GambleAware, GamCare, YGAM, and Gambling with Lives using the Charity Commission service. Organisations shown include Action Against Gambling Harms, ARA, Betblocker, Bet Know More, EPIC Risk Management, Gambling with Lives, GambleAware, GamCare, Gordon Moody Association, Leon House Health and Wellbeing, Red Card Gambling, Sport in Mind and YGAM. Statistics were calculated from the Gambling Commission (4) and annual returns from the Charity Commission (6). May include public donations for YGAM and GamCare as it was not possible to separate. Figure 3. Regulatory settlements between 2018 to 2021. Note: Regulatory settlements, including part-funded projects. Statistics were calculated from the Gambling Commission (5) and annual returns from the Charity Commission (6). Figure 4. Overall Income (Voluntary RET donations and Regulatory Settlements) between 2016 and 2021. Conclusion The comparison between remunerations and RET funding reflects a chronic issue of insufficient funding and illustrates industry priorities towards profits over meaningful harm reduction. The voluntary system does not help organisations develop effective long-term strategic planning to reduce harms created by gambling, due to the uncertainty and lack of consistency over funding (7). “Increases in funding first promised by five of the largest gambling operators nearly one year ago have yet to materialise, and industry has now demonstrated its ability and willingness to change the direction of funding at short notice” - Wardle et al., 2020 (7). This demonstrates the unstable environment and is further shown by the gambling commission review into RET arrangements in 2018, where the industry had “consistently failed to meet GambleAware’s modest funding aspiration (0.1% of GGY), by a significant margin” (8) and that “there is a strong case for implementing a statutory levy if the industry cannot provide what is needed voluntarily” (8). Another issue caused by the voluntary RET contributions is the uneven funding distribution. Most donations go to GambleAware, rather than across a range of charities, and focus on treatment rather than prevention (7). “The task was hopeless, as the industry worked to undermine all the evidence and deny their responsibility, blocking use of their funding for education and research into how gambling causes addiction” - Robin Burgess, Former CEO of the Responsibility in Gambling Trust, 2021 (9). Researchers have reflected that unilateral decision-making in funding allocations is one way the industry exerts influence (7). To counteract this, researchers are calling for the primary aim of the new government white paper to focus on the prevention of harm (10). The gambling commission stated in 2018 that there should be “Demonstrable independence and rigour of the research process” (8); this has not been achieved due to the industry's influence in the voluntary system. Researchers and health experts have stressed their concerns to decision-makers and highlighted the need for a levy that funds prevention and treatment free from real or perceived industry influence. (7, 10, 11). New Zealand has a statutory levy (12). Independent funding for research and treatment should be under the Department of Health and Social Care and the NHS (10) or by an organisation such as UK Research and Innovation (7). This would follow the NHS, which has announced they are cutting ties with voluntary funding from the Gambling Industry via GambleAware (13, 14). Overall, with the approaching gambling act review, the government should recognise gambling harm as a significant public health issue, like smoking, and that it needs similar funding (9). Public health experts are calling for three criteria that need to be met by the government, 1) The scale of gambling harm to be recognised with due attention given to affected others. 2) The gambling industry should not be involved in how to prevent gambling harm, as it is a conflict of interest. 3) The legislation should assume a precautionary principle; lack of definitive evidence cannot be a licence for inaction(11). References 1) Companies House. Available from: https://find-and-update.company-information.service.gov.uk 2) LCCP 3.1.1 Combating problem gambling. Available from: https://www.gamblingcommission.gov.uk/licensees-and-businesses/lccp/condition/3-1-1-combating-problem-gambling 3) Payments in lieu of financial penalties 2.14. Available from: https://www.gamblingcommission.gov.uk/policy/statement-of-principles-for-determining-financial-penalties/statement-of-principles-for-determining-financial-penalties-applicable 4) LCCP RET contributions data – January 2020 to March 2021. Available from: https://www.gamblingcommission.gov.uk/licensees-and-businesses/guide/list-of-organisations-for-operator-contributions#lccp-ret-contributions-data-january-2020-to-march-2021 5) Information about destinations of regulatory settlements to be applied for socially responsible purposes. Available from: https://www.gamblingcommission.gov.uk/licensees-and-businesses/page/regulatory-settlements-applied-for-socially-responsible-purposes 6) Charity Commission Register. Available from: https://register-of-charities.charitycommission.gov.uk 7) Wardle H, Banks J, Bebbington P, Blank L, Bowden Jones OBE H, Bramley S et al. Open letter from UK based academic scientists to the secretaries of state for digital, culture, media and sport and for health and social care regarding the need for independent funding for the prevention and treatment of gambling harms. BMJ 2020; 370:m2613. Available from: DOI: https://doi.org/10.1136/bmj.m2613 8) Gambling Commission. Reviewing the research, education and treatment (RET) arrangements. 2018. Available from: https://consult.gamblingcommission.gov.uk/author/copy-of-national-strategy-to-reduce-gambling-harms/user_uploads/review-of-ret-arrangements-february-2018.pdf 9) R Burgess. Gambling firms will never take responsibility for addiction. The Guardian. 13 April 2021. Available from: https://www.theguardian.com/society/2021/apr/13/gambling-firms-will-never-take-responsibility-for-addiction 10) M Gaskell. Gambling addiction treatment should be led by health experts. The Times. 2 February 2022. Available from: https://www.thetimes.co.uk/article/gambling-addiction-treatment-should-be-led-by-health-experts-nnvpqfzxq 11) van Schalkwyk, M C I, Blythe, J, McKee, M, Petticrew, M. Gambling Act Review. BMJ 2022; 376:o248. Available from: DOI: https://doi.org/10.1136/bmj.o248 12) Gambling (Problem Gambling Levy) Regulations 2019. Available from: https://www.legislation.govt.nz/regulation/public/2019/0134/10.0/whole.html 13) E Dugan. NHS cuts ties to gambling cash. The Times. 30 January 2022. Available from: https://www.thetimes.co.uk/article/nhs-cuts-ties-to-gambling-cash-3kskx6b6n 14) T Menmuir. GambleAware faces RET rethink as NHS cuts gambling funding ties. SBC News. 31 January 2022. Available from: https://www.sbcnews.co.uk/social-responsibility/2022/01/31/gambleaware-faces-ret-rethink-as-nhs-cuts-gambling-funding-ties/

On Thursday 9th December 2021, the 'Preventing Gambling Harm in Diverse Communities' initiative took a further step in helping twenty-eight more students grasp an awareness and understanding of gambling harms as we delivered our second workshop to Newham Sixth Form College (NewVic). A truly remarkable workshop, challenging questions, engaging responses, and a brilliant reaction to our new short film; Do It For Her. It still rings true that Newham Sixth Form College is a school we believe can gain a lot from our workshops. Research shows that in 2015 one street in Newham, High Street North, ranked first in the nine worst-hit streets for gambling losses in London, with punters losing £3 million pounds (see this article for further reading: Revealed: London's worst-hit streets for gambling on fixed odds betting machines | London Evening Standard | Evening Standard) Thank you, Newham Sixth Form College (NewVIc), for recognising the significance of gambling harm on young people and for allowing us to come in to deliver our free specialist workshops to the students. We look forward to our working relationship in the future.

Newham Sixth Form College houses three of our specialist workshops this week and hopefully many more in the future. You can sense the students were engaged throughout the entire workshop, responding with insightful answers, challenging questions and extremely positive feedback made on the short film ‘Do It For Her’. This is exactly what we want to hear and gain from our workshops and why we love what we do. I was greeted with a fantastic reception for a small class. Each student introduced themselves, touching on what subject they are studying and what they plan to do with the education they are receiving. The initial welcome was solidified with immediate help from students when technical difficulties arose. For this I must truly thank each and every student at the session. The Preventing Gambling Harm in Diverse Communities took another step today in helping 24 more students grasp an understanding of what Gambling is and raising awareness on Gambling Harms as we delivered our workshop to Newham Sixth Form College. This is something I believe is more important for Newham Sixth Form College than may meet the eye. Not only was my walk from the train station to the college met with 3 separate betting shops, but Newham is also a borough that has been heavily affected by Gambling and financial issues. In 2017 Newham was dubbed the ‘Debt Capital of the UK’ (see this article for further information: researchforaction.uk). In 2013, Newham contained 82 different betting shops and one road alone, High Street North, held 18 different stores. This is what we want to challenge, change and have an impact on.

I was invited by Alcohol Change UK to share my lived experience of gambling harm and alcohol dependence. In addition to gambling and alcohol addiction and recovery I shared my experience of being recently diagnosed with ADHD. Please do take 20 minutes out of your day to watch.

Gambling Harm UK: We're pleased to share ‘Do It For Her’ a first-of-its-kind short drama reflecting on gambling harms in diverse communities experienced by a student and loved ones The short film involved a lived experience inspired and an evidence-based approach specifically throughGambling Harm UK’s research report that was also the first of its type to raise awareness on the disproportionate harms in ethnic minority communities. 'Do It For Her' was produced by Fully Focussed/Million Youth Media, directed by Shehroze Khan, written by Mohammedally Shushtari, and featured Fady Elsayed as the lead actor! The film was co-commissioned as part of the novel ‘Preventing Gambling Harms in Diverse Communities’ alongside YGAM and Red Card Gambling Support Project. The whole team at Gambling Harm UK are extremely proud to have helped bring about a hard-hitting and impactful short film bringing to a life a story that is prevalent but rarely seen or heard about. Kishan Patel (Chair of the Board of Trustees at Gambling Harm UK) first reached out to Fully Focussed on the 13th of February 2021, and following a competitive tender process and some 299 days later, 'Do It For Her' premiered in full for the world to see for free on YouTube on the 9th of December 2021. How did the short film incorporate an evidence-based and lived-experience led approach? A diverse range of topic experts and individuals with lived experience helped guide the film-making process and as a result the film intelligently and creatively reflects a wide range of important discussion points. For example: Factors towards gambling: Industry inducements: Free bets and game design: electronic gaming machines and online casino products have structural characteristics that affect human decision-making and behaviours, and therefore addiction potential, such as free bet offers, high event frequencies, random ratio reinforcement schedules, near misses, losses appearing as wins, multiline betting, and exaggerated audible and visual reinforcements Advertising: the industry spends an estimated £1.6bn on advertising in Great Britain with 80% of that or £1.2bn spent on online advertising, advertising is particularly effective at getting younger individuals to gamble when they otherwise were not going to, 61% of 18-24 year olds spent money on gambling after seeing a gambling ad or marketing when they were otherwise not planning to Association and exposure through sports: Boxing has been estimated to have the highest frequency of gambling sponsorship references in sports per broadcast minute at 4.70 gambling sponsorship references per minute Risk factors: Students/young people (the prevalence of gambling harm is expected to be highest among 16-24 year olds and according to the last gambling prevalence study, BGPS 2010, 17.5% of (or almost 1 in 5) 16-24 year olds suffered significant gambling harm from their gambling in the past year Ethnic minority backgrounds: individuals from ethnic minority backgrounds are less likely to gamble, more likely to live in areas disproportionately concentrated with betting venues, and between 3-5x more likely to suffer gambling disorder than individuals from white ethnic backgrounds Low mental well-being status: individuals with a low Warwick-Edinburgh Mental Wellbeing score have been estimated to be 7.65x more likely to suffer gambling disorder harm Types of gambling harm shown in 'Do It For Her': The film demonstrates the development and escalation of harms across all the known domains of gambling harm (taxonomy of harms) for the individual who gambles and the loved ones around that individual including: financial relationship crime health/psychological education and work cultural The potential for recovery by breaking stigmas and through conversation: 'Do It For Her' also aims to empower young people to talk about their experiences of gambling harm to someone they can trust, whether that be a professional or a trusted loved one. Additionally, the film demonstrates how someone may effectively help someone else if their behaviour worries them. We are extremely grateful to have worked with such a talented and dedicated team - thank you to all those involved! With an extra special thanks to all cast and crew involved and individuals with lived experience who helped guide the creative process.

In December 2020, the Government announced a major and wide-ranging review of the Gambling Act 2005 to ensure they are fit for the digital age. The underlying assumption in this statement is that gambling harm has emerged as a legislative issue worth tackling due to the changes in how the population interact with online gambling products. In this article, we summarise existing evidence to provide commentary on whether gambling harm was an issue prior to the digital age. Therefore, we hope to assess whether the Gambling Act Review should be brought about with a focus around a) the significance of the digital age or b) the significance of gambling harm on the population. In 2019, the remote gross gambling yield exceeded the non-remote gross gambling yield for the first time in Great Britain (Table 1). Table 1 Gross gambling yields statistics stratified by non-remote gambling and remote gambling (excludes lotteries) Despite gambling harm being consistently common in the adult population (Figure 1), at the time of writing there have been no meaningful efforts to understand the significance of gambling harm on the Great British population. Figure 1 Prevalence of gambling harm in the adult population (%) in Great Britain as stratified by low-risk harm, moderate-risk harm, and gambling disorder-harm from 2007 to 2020 To conclude, we find evidence that reflects that gambling harm had been a neglected major public health issue prior to the digital age. We suggest that a public health approach to gambling harm would recognise that the digital age is likely to exacerbate gambling harm issues. However, it is imperative that the review of the gambling act be focussed on reducing and preventing gambling harm, due to gambling harm being a major and neglected public health issue, rather than just due to issues relating to the digital age.

Woodbridge High School, what can I say? A truly amazing experience from start to finish. From the first point of call to the end of the day, Woodbridge High School welcomed us with open arms, which set the scene perfectly for us to deliver our Preventing Gambling Harm in Diverse Communities project. We were given centre stage (quite literally, as the venue was changed to the drama hall). Each sixth form student truly did themselves proud in engaging, listening and soaking in all discussions held today. I would like to thank Mr Graham Samuels and every other member of staff throughout the day who helped us to get our programme to run as smoothly as possible.

We took another step today on our mission to eradicate Gambling Harm and reach as many young people as possible and I would like to send a big thank you to Mr Robert Potterton and the Year 10’s and 11’s at Royal Docks Academy as they welcomed us in with open arms and listened attentively throughout.

Prevalence of gambling harm in Adults Significance of gambling harm in Adults (Quality of Life Impacts and Mortality related to gambling harm) Significance of gambling harm on society Miscellaneous

Prevalence of gambling in Young People (11-16 year olds) Prevalence of gambling harm in Young People (11-16 year olds) Miscellaneous

Gary and Ant are two great guys who like me love football. They love it so much they decided to talk about it a lot and started their podcast What A Ball Ache. It's a podcast I have enjoyed listening to regularly. So when Ant got in touch and asked me to come on and talk about gambling harm and it's relationship with sport, particularly football, amongst other things I was really excited. What I didn't realise was that Ant was going to use the podcast to share his own experiences of gambling harm. I feel incredibly privileged to have been part of this recording. Well done Ant, top man! https://open.spotify.com/episode/5tvu77BMxqnHtAwzpCCNCn?si=1OMblgYpRSewCv7wmQEB-g

Young People and Gambling 2020 The findings are taken from the data tables of the annual Young People and Gambling Survey, conducted in 2020 by Ipsos Mori on behalf of the Gambling Commission. These statistics seemed significantly noteworthy to us but have been omitted from discussion within the overall report. In 11-16 year old school students in England and Scotland: Lost sleep at night because of worrying about a family member’s gambling rarely or sometimes or often or all the time: 4.9% often or all the time: 1.3% Not had enough food (food at home or money on school canteen card/account) rarely or sometimes or often or all the time: 1.8% often or all the time: 1.1% Stopped you from belonging to clubs or doing activities you like doing rarely or sometimes or often or all the time: 1.3% often or all the time: 1.0% Stopped you from going on trips (e.g. family holidays or school outings) rarely or sometimes or often or all the time: 1.8% often or all the time: 0.9% Parent’s or guardians have less time to spend with you rarely or sometimes or often or all the time: 1.6% often or all the time: 1.0% More arguments or tension at home rarely or sometimes or often or all the time: 2.1% often or all the time: 1.2% Has made you feel sad rarely or sometimes or often or all the time: 2.4% often or all the time: 0.6% Has made you feel worried rarely or sometimes or often or all the time: 2.9% often or all the time: 0.7%