Abstract

There is a growing call to approach gambling from a public health perspective in the UK(1) as has been undertaken in some other countries(2). Gambling is a heavily marketed and commonly participated in activity; the Gambling Commission telephone survey estimates over 40% of people aged at least 16 years in the UK have gambled in the last four weeks(3). In their 2021 evidence review, Public Health England reported that half of the UK population participate in gambling, with 0.5% of the population experiencing a high level of harm(4). Gambling related harm disproportionately affects disadvantaged and marginalised groups, exacerbates existing health and social inequalities(5), and intersects with challenges including suicide prevention, alcohol, smoking, interpersonal violence, criminality, and homelessness(6). Disordered gambling impacts physical and mental health in a range of ways and has significant community and societal costs. Recent estimates in the UK suggest the economic burden of harmful gambling is approximately £1.27 billion, including £342.2 million in mental and physical health harms and £79.5 million in employment and education harms(7).

Disordered gambling is associated with greater proximity to and density of in-person gambling facilities(8,9), and a person with disordered gambling is more likely to live in a deprived area(10), be unemployed(11), smoke, consume alcohol excessively, and have mental ill health(7). Each person with a gambling disorder has on average 6-10 affected others who may experience relationship strain, stress, and financial loss, with interrelated health impacts(7).

Geospatial mapping is a technique used to display and describe the distribution and variation of information within a specified geography. Modern mapping technologies are increasingly used to assist in developing public health initiatives(12), and visualise social determinants of health in association with rates of health conditions and behaviours, for example in studying the prevalence of non-communicable chronic disease(13), and links between alcohol outlet density and violent crime(14). Mapping has been used to explore gambling at local levels, including in the UK(15,16), however, previous studies have focused on urban and city locations, and mapping has been at a broad geographical level.

In recent years, local public health teams have shown increasing interest and ambition in gambling harm prevention, yet there are few shared examples of gambling harm mapping being used to inform local public health practice.

Lincolnshire is a large county in England host to urban, rural, and coastal communities. Levels of wealth, deprivation, and infrastructure vary significantly across the county, and coastal areas experience significant health challenges(17). The local prevalence of gambling related harms was not known. Geospatial mapping techniques were employed as part of a local health needs assessment, to inform and develop a local public health approach to gambling harm.

Aim
To map gambling related harm in Lincolnshire using routine data and geospatial mapping to predict 'hotspots' of harm, and to compare findings between urban, rural, and coastal areas.