Yahoo! Exclusive: Toronto’s casino would be dependent on low-income, problem gamblers, Dr. David McKeown says

Debate over proposed Ontario casinos has health officials concerned about the risks of giving residents more opportunities to gamble away their money.

MGM Resorts is presenting its joint vision for Toronto with Cadillac Fairview at a press conference on Wednesday and the company has launched a flashy new website for the proposal. Meanwhile, the medical officers of health in Hamilton and Toronto have released reports detailing sobering facts about how problem gambling can damage health and destroy families.

Dr. David McKeown, Toronto’s medical officer of health, told Yahoo! Canada News that Ontario’s casinos have hardly taken any measures to reduce problem gambling, probably because they rely on addicts for a large proportion of their profits.

Yahoo! Canada News: How does gambling addiction affect a community as a health issue and in other ways?

Dr. David McKeown: People who are problem gamblers report poorer health, they have more mental health problems, they're more likely to have other addictions to alcohol or drugs. They're at risk of suicide. The fact that they have significant financial problems means that their families also experience difficulties. There's a higher rate of family breakdown; a higher rate of families requiring social assistance. The community as a whole is affected, really, because of the burden that's placed on social services and health services by problem gamblers. Problem gamblers are, as a result of their addiction, also more likely to drink and drive, which of course can lead to injuries and deaths outside of the gambler's family.

What proportion of those who gamble actually develop a gambling addiction and what factors influence the development of an addiction?

It is a small proportion. When we look at the prevalence of problem gambling in a population we usually measure what proportion of the population are problem gamblers today. Our research into the population of the Greater Toronto Area suggests that about 0.2 per cent, or about 11,000 people have the most severe form of problem gambling, associated with the greatest health implications. Then about three per cent are at risk of problem gambling, if you include those who are not quite as severe.

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Could an argument be made that increasing access to gambling in public may not increase addiction — given that, for example, many gamblers already have access to games online?

I've heard that argument. You might think that because anyone can gamble who has a computer in their living room or in their basement, that means that everyone has access to gambling. It doesn't work that way. There are people who access Internet gambling and there are people who become problem gamblers as a result of Internet gambling. Those aren't necessarily the same people who have problem gambling result from visiting casinos. There's something about the casino experience which is different.

In your report, you included a number of measures to mitigate the effect of a new casino if Toronto were to build one. How much could those measures counteract the public health risks?

What the gambling experts and researchers say is the most effective way to reduce the impacts of problem gambling is by the way in which the gambling itself is designed and delivered. And so the recommendations that I made about mitigating were all in that category. Things like not having casinos open 24 hours. ... They're actually forced to take a break when the casino closes as opposed to continuing until all of their money is gone.

Slot machines are essentially designed to encourage people to gamble as much as possible. That is their role, to try and make money. But for problem gamblers, the way slot machines operate can reinforce some of their unrealistic and irrational beliefs about how gambling works. For example, that they're somehow able to influence what the slot machine does. Or that some slot machines are luckier or more likely to provide a payout than others.

Those are the kinds of things that we've recommended as mitigation measures. Most of them are not in place in Ontario casinos. In fact, the casino industry has not shown a great deal of interest in implementing measures that are truly effective in preventing problem gambling. I believe one of the reasons for this is because the research shows that a significant portion of the revenues generated by casinos come from problem gamblers, perhaps as much as a third overall, perhaps two thirds when it comes to some forms of gambling, like slot machines.

If we were to implement all of your recommendations, would having a casino in Toronto be safe?

I don't think I would ever say it's completely safe. Certainly, if all the mitigation measures that have been recommended were implemented it would reduce the impact on problem gambling in the city with a casino. The research shows that when gambling is more available, such as having a casino nearby, rates of problem gambling are higher. The research varies about how much higher, some studies have shown as much as a doubling of the rate of problem gambling. So that would be, of the 11,000 people in the GTA, it might double to 22,000.

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The Canadian Gaming Association said the 10 measures in your initial report were “without basis, misguided and perhaps counter-productive.” What are your thoughts on that?

Well, those measures were drawn from the best advice of people who study problem gambling. We consulted and worked very closely with the problem gambling researchers and experts at the Centre for Addiction and Mental Health in Toronto and those recommendations have been made before. ... So we were really just reiterating the best available advice that we could find.

The health impacts of gambling are also under discussion in nearby Hamilton, which has some different conditions than Toronto. How do you assess if a casino is right for our city, as opposed to a city such as Hamilton where there is a large low-income population, or Niagara, where gambling is already a big part of their tourism industry?

In our research we did find that the impact of a new casino on problem gambling depends in part on how much gambling is already available. So opening a third casino in a city that already has two, you wouldn't expect to see a much of an impact. We also know that problem gambling is more likely in some segments of the population. People with lower income, youth, people from certain cultural groups, may be more likely to become problem gamblers. Of course, for people living at a low income, not only are they more likely, but the losses that they incur are less affordable. Lower income people who have problem gambling tend to gamble a larger proportion of their income than people who are wealthy.

We did say that as far as the location of a casino is concerned, populations that are close to the casino are more likely to be affected by access to gambling. ... There's a large population of low income people in Toronto as well. I would be concerned, particularly, about the impact of increased access to gambling on that population.

Are you planning any further research or reports on this matter?

There are no more reports planned at present but the reports that we have written will be before the city of Toronto's executive committee and city council when they make their decision about the casino. I hope that council will carefully consider the implications for the health of the population as they make this important decision.

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