The Lancet Public Health Commission's report on gambling is a document that accurately summarises the state of the relationship between the marketing of gambling products and the public health risks they pose.

The report argues for a robust position based on scientific evidence that argues for greater restrictions at all stages of marketing, from the design, pricing and conditions of sale, to the marketing and promotions of gambling products.

After more than two decades of hegemony of the ‘responsible gambling’ discourse, the report is emphatic in arguing for the need to abandon it. Responsible gambling has been a widely used perspective by the gambling industry which, in a nutshell, consists of placing the responsibility/blame for irresponsible behaviour on the consumer. According to this perspective, the existence of people with gambling problems is not a social problem but an individual reality, to be treated in a personalised way by medical specialists. The report rejects this perspective and argues for a public health approach, where the very restrictive medical concept of gambling disorder is extended to the concept of ‘gambling harm’, which offers a more community and societal view of all the negative externalities that gambling entails.

As a consequence, the responsibility lies not only with the ‘irresponsible’ individual, but with the confluence of the gambling industry and its regulators, who have to ensure consumer protection and the marketing of gambling products that do not pose a risk to public health.

First of all, it should be noted that this is not a study. It is a working group in which various experts in gambling studies come together and highlight the need to address gambling from a public health perspective.

In support of this position, they present arguments from different approaches, drawing on previous research and first-hand accounts from people who have suffered from the harms associated with gambling. The social perspective they advocate at a global level is based on the increasing expansion of the gambling market thanks to digitalisation. Universal access to gambling requires a public and collective approach, in contrast to the individualistic approach that has prevailed until now. As mentioned in the text, although they do not reject individual-centred measures, they consider that those with a public approach are insufficient in some regions of the world and non-existent in others.

Therefore, they recommend a form of research and policy making that focuses on the harms caused by gambling at the level of the whole population and not exclusively on problem gamblers, overcoming the individualistic approach.

I do not know if this could be considered a limitation, but certainly achieving a global alliance represents a major challenge. Gambling, its regulation, practice and even the perception of it, depend to a large extent on the cultural context of each country. Designing universal policies and reaching homogeneous consensus can be a major challenge.