The global gambling industry is rapidly expanding, with net losses by consumers projected to reach nearly US$700 billion by 2028. Industry growth is fuelled by the rise of online gambling, widespread accessibility of gambling opportunities through mobile phones, increased legalisation, and the introduction of commercial gambling to new areas. Recent expansion is most notable in low-income and middle-income countries, where regulatory infrastructure is often weak. Gambling, in some form at least, is now legally permitted in more than 80% of countries worldwide. Online gambling, given its borderless accessibility, is available everywhere via the internet.

This Commission conducted a systematic review and meta-analysis of the global prevalence of gambling participation, including any risk gambling (defined as occasional experience of at least one behavioural symptom or adverse consequence from gambling), gambling disorder, and problematic gambling in adults and adolescents.

Key findings

• The harms to health and wellbeing that result from gambling are more substantial than previously understood, extending beyond gambling disorder to include a wide range of gambling harms, which affect many people in addition to individuals who gamble.  
• Evolution of the gambling industry is at a crucial juncture; decisive action now can prevent or mitigate widespread harm to population health and wellbeing in the future. 
• Stronger policy and regulatory controls focused on harm prevention and the protection of public health and wellbeing, and independent of industry or other competing influences, are now needed.