The expansion of gambling across the Americas poses risks to mental health and wellbeing.

The Americas are facing a significant burden of mental health conditions. The Pan American Health Organisation's regional Strategy for Improving Mental Health and Suicide Prevention is an important milestone in tackling this challenge. However, absence of any focus on gambling as a potential risk to the health and wellbeing represents a serious omission in the Strategy. In this viewpoint, we review existing scholarship demonstrating unequivocal links between gambling and a variety of mental health conditions and related harms. This is followed by an empirically-grounded discussion of how commercial gambling has recently rapidly expanded across the region and how the risks of this expansion have not been sufficiently considered at the policy level. We then present emerging regional evidence of the negative mental health impacts of gambling expansion. The review concludes by proposing possible policy actions to improve control over the gambling industry and reduce ensuing harms on mental health and wellbeing in the region, with a focus on PAHO's remit.

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© 2024 The Author(s).

Déclaration de conflit d'intérêts

DU has been funded as a member of staff at the University of Glasgow to work on this project by Wellcome Trust through a Humanities and Social Sciences Fellowship and by the University of Glasgow through the Lord Kelvin Adam Smith Readership Fellowship to HW. VM has been funded for gambling studies by the Finnish Ministry of Social Affairs and Health (section 52 of the Finnish Lotteries Act), the Academy of Finland (Project 349589 CODEG; Project 31834 POLEG), the Finnish Foundation for Alcohol Studies, French Observatory on Drugs and Addictions, and the Finnish Ministry of Justice. VM declares consulting fees from the Gambling harms evaluation group under the Finnish Ministry of Social Affairs and Health. VM has received support for travel from the Finnish Foundation for Alcohol Studies, University of Bergen, and the Council of Europe, Pompidou Group. VM has been paid for delivering a webinar by Bochum University, and for peer reviewing by Routledge. She regularly provides expert advice and consultations to third sector and public sector across in Finland. RV has been funded for gambling studies by the Massachusetts Gaming Commissions, the University of MA Donahue Institute, Connecticut Department of Mental Health & Addictions Services, and Evergreen Council on Problem Gambling. RV declares consulting fees from Karolinska Institute, NatCen, and Greo. RV declares travel costs paid by International Gaming Conference 2023 and Alberta Gambling Research Institute. In the past 5 years, HW has been funded for gambling studies by the Economic and Social Research Council, National Institute for Health Research, Wellcome Trust, the Gambling Commission (including their regulatory settlement fund), Office of Health Disparities and Improvements/Public Health England; Greater London Authority; Greater Manchester Combined Authority; Blackburn with Darwen Local Authority and the Department of Digital Culture Media and Sport. In 2018/19, HW has received funding from GambleAware for a project on gambling and suicide. HW declares consulting fees from the Institute of Public Health, Ireland and the National Institute for Economic and Social Research. HW declares payment for delivery of seminars from McGill University and from John Hopkins University. HW has been paid as an expert witness by Lambeth and Middlesborough Borough Councils; HW declares travel costs paid by Gambling Regulators European Forum, the Turkish Green Crescent Society, Alberta Gambling Research Institute and the REITOX Academy (administered through the Austrian National Public Health Institute). She served as Deputy Chair of the Advisory Board for Safer Gambling between 2015 and 2020, remunerated by the Gambling Commission; is a Member of the WHO panel on gambling (ongoing) and provided unpaid advice on research to GamCare for their Safer Gambling standard (until 2021). She runs a research consultancy for public and third-sector bodies only. She has not, and does not, provide consultancy services to the gambling industry.