The objective of this summation is to review and structure the content and emerging themes of the conference placing them in an international context for policy, treatment and prevention of the harmful impacts of gambling.
First there is a need to acknowledge the significant role played by the moderators throughout this conference, attending every session and then, most importantly, reviewing papers at the final session of each day. The good attendance at these sessions confirmed that the value added by the moderators and their work made this present summation possible.
Second I must give my apologies for missing the last session, the panel discussion, as I took time to try and put my thoughts together and digest the wonderfully iconoclastic presentation from Peter Collins, the third keynote speaker. Probably, like you I shall not ever again be able to buy a lottery ticket without smiling to myself as I recall Peter’s explanation of what we are really
doing!
In summarising this conference it is inevitable that one starts with the name, Ralph Nader, and my hope is that we have not heard the last of his contributions to gambling policy.
Ralph Nader commented that "gambling does not rank high amongst socially redeeming behaviours". He questioned the trends in community values he associated with contemporary increases in the availability of all forms of gambling and the determination of cultural activities by global industries rather than by the community. In other presentations value judgements of gambling products and activities, particularly VLTs, have been made explicitly or implicitly. Last night Maude Barlow spoke about the need for, and the steps required to change government policy in Canada and elsewhere in order to reject a dependence on gambling.
In my own data, by going outside the safety of conventional sources of information on the harmful impacts of gambling, I reported ethical implications too obvious for even a dweller in an ivory tower to ignore.
None-the-less having spent 20 years or more removing and challenging value judgments I read in research theses under my supervision, it took me at least three years to digest and formulate the response I gave during my address yesterday. At the risk of being repetitive, the data we collected showed the virtual impossibility of regular VLT or EGM players gambling responsibly: that this failure to control expenditure and time had nothing to do with pathology but was an integral part of the pleasure of gambling on a continuous form and a purely human response to the method whereby the EGM supplies games in an automated and endless sequence.
Perhaps with the energy of a pedant I have tried to focus the negative ethical judgment, rather than on gambling or on gaming machines, but quite specifically on the process of selling gambling epitomised by the transaction between player and the EGM:
• the sequence is fast, unending and emotionally engaging/distracting,
• the total per annum purchases are very significant.
The process is unethical because it is contrary to existing consumer protection principles of informed consent.
I also said that I thought EGMs, "the pokies", as we know them in Australia, are wonderfully researched and developed and represent a very successful and popular form of entertainment.
The whole question of whether the values of a community are reflected in its acceptance or increased participation in gambling is a topic area fraught with difficulties. I could not possibly personally endorse within a summary of an international scholarly conference on gambling the views and recommendations expressed by Maude Barlow last night at the conference dinner. I respect absolutely her right to express the views she did but they clearly go beyond the "essential elements of gambling-related ethical social policy", to quote the first question that this conference set out to address.
More importantly I do not have community membership here in Nova Scotia and do not fully appreciate local issues and community values. It would be the same for many of you were I to ask you to endorse a community action plan for introducing an additional 50,000 EGMs into Australia because I believed them to have such beneficial positive associations and impacts on the community. A community boasting the best chamber orchestra in the world, the Opera House, the best rugby league in the world, and directly providing in the clubs themselves since the 1960s, a safe and secure public space for women to eat, drink, socialise and to gamble.
Conferences such as this cannot become politicised for or against gambling: the debate as an open evaluation of information and ideas and the creation of new and valuable concepts, policies and strategies is a sensitive process that requires an openness to all points of view. At any hint of battle lines for or against gambling per se many academics run for cover. I, a notable and famous coward, the first to take in a reef, to leap from snakes both real and imaginary, reacted foolishly when mud was first thrown at me during a conference in Australia. I became angry and insulted not just a whole nation but friends as well.
Embedded in the insult thrown at me that day was a real question concerning the criteria whereby services for problem gamblers were funded in different jurisdictions but in the heat of the moment I was incapable of identifying this issue and responding in a more appropriate manner.
The point is, that the combination of personal values and emotions for or against gambling or particular approaches to issues AND the scholarly presentation of ideas and empirical findings is not compatible with open debate engaging all parties and points of view. I am not saying that strong emotions cannot lead to creativity and new ideas, clearly they can and do in many spheres, but they require a different arena and format to the lecture podium. In this conference the debate has remained open but at times, only just: successful creative debate has survived and I will try to summarise some of the broad themes that emerged.
CONSUMER PROTECTION
Prior to attending this conference if someone other than Ralph Nader had suggested that we had something to learn from the early consumer protection work concerning automobiles I would have been sceptical. In reviewing aspects of this history Ralph Nader noted that a key measure of the success of the work on cars was the shift in the responsibility for accidents away from the driver to the manufacturer: how could drivers be proactive about the impact of accidents if no seat belts were fitted? This immediately resonated with my own views about the contemporary and increasing concern with "responsible gambling", a state of considered, planned purchasing of gambling products to be achieved by the individual entirely by education, pamphlets and community education campaigns.
Ralph Nader recommended that the first priority in gambling policy should be to shift the emphasis to pre-crash strategies, specifically the use of technological interventions, (they are less unreliable than human interventions such as the standard and training of venue staff) that protect the consumer of gambling. Such consumer protection technology already exists and is currently being marketed throughout the world. It enables/requires gamblers to preset binding limits to expenditure of time and money prior to entering the gaming venue floor. This type of consumer protection was endorsed by all the keynote speakers and by several other presenters too.
I made the point that such consumer protection steps were needed now: they did not require some empirical evaluation that they reduced harm.
Consumer rights were being violated now and they should be reinstated now on principle; a key component in ethical public policy on gambling.
If such consumer protection also eliminates under-age gambling, ensures self-exclusion and has other broad beneficial harm reduction impacts, then these are potential bonuses that can be evaluated after the consumer has been given back what Australians call a "fair go".
PUBLIC HEALTH MODEL APPLIED TO GAMBLING IMPACTS
Good conferences produce challenges to conventional thinking and this was true over the past two days. The established, perhaps even conventional frame of reference for policy dealing with the harmful impacts of gambling is that of public health and was represented here by the very latest thinking on the topic, two approaches that plan to influence future problem gambling policy, the New Zealand Think Tank (Stephenson & Clifford) and the Reno Model, (as critiqued by Schellinck).
The lenses of the public health ‘glasses’ are certainly valuable in providing a coherent overview of the wide range of strategies to manage the harmful impacts that can arise from gambling and to make important links with other health issues. None-the-less consumer protection is not included within this frame of reference. Both of the above models specifically excluded consumer protection. The New Zealand Think Tank process had the consumer protection arguments presented both in writing from me and also argued by a participant from Nova Scotia. It was rejected. The authors of the Reno Model also rejected the kind of consumer protection by technological safety nets emphasised at this conference apparently because the authors believed such technology undermined rather than protected the individual’s choice!
The failure of both the New Zealand Think Tank and the Reno Model to include pre-crash consumer protection is a serious omission from problem gambling policy.
The reason why the public health model has gone unchallenged until this conference can be understood in terms of the traditional sources of information, clinical groups and prevalence studies, tending to ignore studies of regular consumers of gambling, and, as pointed out by Peter Collins, the coalition who have agreed on the politically acceptable way of representing and managing problem gambling: governments, industry, researchers and therapists, a powerful group creating a strong head wind to new ideas that may threaten the established order, the
funding of research and treatment.
If consumer protection is to become a key component of gambling policy it needs the involvement of existing consumer groups, some of which, as in Australia, have deliberately excluded gambling and gamblers from their mandates, perhaps on the basis of the mistaken impression that everything possible is already being done to prevent the harmful impacts of gambling on some consumers.
If consumer protection is to become an integrated component of gambling policy we need to know a great deal more not just about problem gamblers but about all consumers of gambling: we have to know in great detail just what ordinary gamblers do. Several presentations at this conference have made contributions to this important data base:
• the rational thinking of gamblers,
• the characteristics of the regular consumers of VLT gaming,
• the interaction of alcohol consumption during the process of gambling not just as an ‘end point’ of co- addiction.
The work on women gamblers is an excellent example of the need to know how women gamble, how they perceive their gambling. How can the issue of equity of access to helping agencies be addressed if over a third of women gamblers don’t even know about service availability?
There were also other more technical and creative themes dealing with the consumer context:
• the development of a method of classifying and measuring the availability of different
gambling products within a jurisdiction and
• the linking of levels of risk of harmful impacts amongst consumers according to type of gambling product, its availability and its uptake by consumers.
There has to be a whole shift of emphasis to studying the consumer of gambling as a crucial data base for informing policy development. Ethical social policy has to be inclusive. Consumer protection is about all players/gamblers not just those experiencing harm. Consumer protection can be essentially proactive in ways that make the public health policy of harm minimization seem reactive to harm that is already occurring.
The Reno Model was well savaged by Tony Schellinck’s presentation but I hesitate to endorse the "Halifax Model" as I dislike orthodoxy where none is needed. We need good science and that means a range of methods. Good social and behavioural science has always endorsed rigorous use of multi-methods, qualitative, quantitative, experimental, survey and single cases: a range is essential in order to establish the validity of any particular conceptual model.
The Reno Model emphasises the principle of individual choice:
• to gamble
• to make informed choices.
The former is used to dispute and apparently reject the use of pre-commitment systems on the grounds that the use of technology somehow undermines the independence of the decision, (systems we have identified at this conference as providing the most effective and available "pre-crash" consumer safeguards) and the latter is supported within the model by education of the player. The author’s themselves admit that this may not be effective.
Coming as I do from Australian jurisdictions, ‘swimming’ in information, pamphlets and media campaigns, players pressing their $100 bills into note acceptors on which are stuck problem gambling warnings, I can confirm that despite the value of such information to raise public awareness of the availability of services, even high levels of information seems to give little help to the gambler in their attempts to stay within their preferred limits of expenditure of time and money. All our data sets on regular players have been collected in this information ‘overload’ context; 10-15% of such players report no difficulties of control.
Although in this summation I have dwelt on prevention, the conference included significant presentations on the treatment of problem gamblers. In particular several presentations described aspects of the role of help-lines in the provision of services. A comparison of the procedures (e.g. whether the service promised anonymity or identified clients and used that identification to ensure continuity of help and evaluation of efficacy) enabled delegates to gain an understanding of the possible advantages of both approaches. Overall it is apparent that such help-lines are often the first port of call for potential client problem gamblers and their families and provided that such services are integrated with other types of help available in the community they play a very important role in managing the harmful impacts of gambling.
It was of particular interest that another approach to helping problem gamblers, self-exclusion, emphasised integration with other approaches to treatment and also the use of technological approaches that reduce the dependence on the ability and training of venue staff in the identification of self-excluded players trying to re-enter a gambling venue. If the choice to self-exclude is an option taken up by only a small proportion of problem gamblers then it is essential that such procedures work across all venues and that as a "treatment" self-exclusion is integrated with other types of help.
These cross-linkages emphasize the critical importance of collaboration between all stakeholders both here in the conference and on the ground.
The weakest areas of coverage of topics in this conference have been those typically the hardest to study and research, the impacts of gambling on aboriginal and culturally diverse groups. The published literature on these areas is growing slowly but numerically the researchers remain but a few.
CONCLUSION
The conference theme "Myths, Reality and Ethical Public policy" had a sub-plot to address a number of questions listed in the conference program and a consideration of these is a method of evaluating what we have achieved over the past few days:
What are the essential elements of gambling-related ethical social policy, consumer protection and responsible gambling?
