Sugar(House) is Bad for Our Health

Sunday marks an anniversary – 13 months – of the SugarHouse Casino opening. And that seems a fitting time to discuss gambling since, from a public health perspective, we’re pretty unlucky to have an urban casino in our backyard.


Pathological gambling is a bona fide disorder, according to the DSM-IV, the Diagnostic and Statistical Manual of Mental Disorders that psychiatrists rely on to classify conditions. It also is also linked to public health problems like suicide, intimate partner violence, and child neglect (things like leaving young kids unattended in cars while parents gamble at the Parx Casino — it happened at least twice last summer).

Research also shows that the closer you live to a casino, the higher your risk of being a pathological gambler. One study found that living within 10 miles of a casino doubled pathological/problem gambling risk, while another study found the same association for those living within 50 miles.

Given the geography of Philadelphia, this means that there are likely to be a lot of new addicted gamblers in our region in the coming years, with significant public health consequences.

Seems kind of dismal, huh? But there are things that can be done to prevent, or at least mitigate, the adverse health effects that are likely to accompany casino gambling in the region.

A sizeable portion of the fees and taxes assessed on casinos, for example, could be invested in public awareness campaigns, initiatives to prevent pathological gambling, and the recruitment and training of counselors with experience in treating gambling disorders. Philadelphia’s Department of Behavioral Health is taking action in these areas.

It’s also critical that these initiatives be culturally competent and language appropriate for those at highest risk. Some studies have identified Asian American communities as having significantly higher rates of gambling disorders than other racial and ethnic groups. It has been theorized that the cultural significance of “luck” in some Asian communities, combined with the predatory marketing tactics of casinos, have helped to shape this pattern.

Looking forward, the city should consider conducting a full health impact assessment before deciding the fate of the city’s second casino license. Health impact assessment -- commonplace in Europe, mandated by law in Thailand, but just starting to gain traction here in the U.S. — is a systematic process, somewhat like the environmental impact statements that have been routine for years, to estimate the potential health impacts of a policy or project that would typically be considered beyond the purview of health officials.

This time last year, I conducted a rapid health impact assessment to get a sense of whether a full version would be warranted and the processes through which the casino could impact our health.

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