Conceptualising the commercial determinants of gambling-related harm, self-harm and suicide

The commercial determinants of health can influence everything from individual behaviour, to the design of the built environment, to systems of global finance and trade. Beneficiaries of commercial gambling i.e. the commercial gambling ecosystem (i.e. operators, manufacturers, media, banks, IT and telecommunications, software developers) are powerful actors that can produce widespread harms. Harms associated with gambling include criminal activity, loss of assets, family violence, separation and divorce, cardiovascular disease, mental illness, self-harm, suicidal ideation and suicide. Gambling is now recognised as a risk factor for suicide in England's Suicide Prevention Strategy. Informed by our recent research that showed an at least 4.2% of suicides in Victoria, Australia were gambling-related, as well as interviews with those who have been bereaved by or experienced gambling-related suicidality, we outline a model of the commercial determinants of gambling-related harm, self-harm and suicide. 
At the system level this includes state-level taxation arrangements that create dependencies on gambling revenues, including support services directly funded by gambling revenue, often described by those who use them as ineffective.At the political level  lobbying, donations, and the ‘revolving door’ between parliamentarians and gambling operators facilitiates an advantage for industry operators.At the scientific level funding research, that often emphasises complexity and downplays the role of gambling in harm has been shown to delay action.Marketing and corporate social responsibility activities serve as legitimation tools, and build a social license for their operations.Gambling products are increasingly supercharged enabling substantial losses. They also appear in video games and are available around the clock via the internet and smartphone applications.These systems are underpinned by the discourse of ‘responsible gambling’ that frames gambling as harmless fun and those harmed by their products as the source of the problem. This carefully manages the reputation of the industry to prevent the adoption of meaningful reforms that will reduce harm. It generates stigma and shame, preventing people from seeking help. It may be useful for the suicide prevention sector to consider the systemic and structural forces that contribute to self-harm, suicidality and death from gambling. Observing gambling-related harm as part of the broader commercial determinants of health may provide greater insights into preventing harm. Disrupting the conditions under which gambling is offered can prevent suicide.