Oct 24 2012

Report: Potential Health Impacts of a Casino

file Tatiana Lin, Kansas Health Institute

The health upside to a new casino can be the increased quality of life and life expectancy associated with new jobs. But, it can bring health downsides too, including the fallout associated with gambling addiction. Those are some of the key findings in a new health impact assessment (HIA) from the Kansas Health Institute (KHI), released this week. The HIA was funded by a grant from the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and the Pew Charitable Trusts, and conducted by KHI together with the University of Kansas School of Medicine-Wichita.

“Our first HIA intended to inform the discussion of potential casino development…” says Robert F. St. Peter, MD, who is KHI’s chief executive officer. “In many cases,” says St. Peter, issues like these may not seem to have direct connections to health, making them a good fit for [a] health impact assessment.”

The results of the new HIA suggest that there may be positive impacts of casino development related to new jobs; the negative impacts would be related to increases in pathological gambling, which is also associated with nicotine dependence, substance abuse, depression, insomnia, and domestic violence. The HIA offered recommendations including:

  • Train physicians to screen for problem gambling behaviors
  • Eliminate smoking within and around casino buildings
  • Strengthen local services to treat and prevent gambling addictions and related conditions
  • Operate a “safe ride” program for patrons and residents
  • Use a “loss limit” strategy to prevent substantial financial losses among casino visitors

Read a recent NewPublicHealth interview with Tatiana Lin, KIH senior analyst and strategy team leader, who was the director of the Casino HIA. 

NewPublicHealth: How did you come to the idea of doing an HIA on casino development?

Tatiana Lin: We screened different topics and looked at which ones might benefit from the assessment. We selected this one in part because we found there were quite a few opportunities to inform the development process since there are three bills pending right now in the state House and Senate. We knew we could look at both the positive and negative impacts, and that there was a great deal of community interest in the project.

NPH: Construction of a casino isn't something people think of as impacting the public's health. Why is an HIA important for this project?

Tatiana Lin: The casino can have multiple health implications and the HIA can bring health into the conversation and illustrate how the presence of a casino in the community can impact multiple determinants of health. And the topics will be discussed around an issue where health might not always be a part of the conversation.

NPH: What are some of the health considerations you're expecting to look at?

Tatiana Lin: We’ll be looking at a wide spectrum of issues. Casinos are usually seen as a viable economic tool, so we are looking at the impact of the casino on state and local revenues, employment and creation of jobs. Other potential impacts include traffic and traffic accidents, driving under the influence, increased access to gambling, potential personal bankruptcies, second-hand smoke and recreation, which can help to relieve stress.

NPH: What do you expect to achieve with this HIA?

Tatiana Lin: We have several goals—to bring the concept of HIAs to the state of Kansas, and show how it can inform the decision-making process, and to expand our capacity for doing HIAs going forward. We hope policymakers will be able to utilize findings from this HIA.

NPH: This is a novel application of HIA to an important policy topic. How will this help to make sure both sides of the debate are being looked at methodically and scientifically?

Tatiana Lin: We have put in place a number of safeguards, including a team that includes health and economics experts and external reviewers, including staff from the University of Kansas School of Medicine-Wichita to review our work. We’re engaged with the stakeholders from day one, and they have input from day one. We have regular emails updating our work to all the stakeholders, and we have qualitative and quantitative analysis of a two year old casino in Dodge City to rely on, as well as a literature review.

NPH: Even though your HIA is about a casino construction, how might the process and outcome inform other communities about the types of projects that might benefit from an HIA?

Tatiana Lin: This can produce a roadmap for other communities on how to engage communities, conduct data analysis, and screen for HIA topics. We think communities will be able to adapt what we've done, including a review of topics to find the HIAs that best suit their needs.

NPH: What partnerships and alliances are you creating now to be able to address possible project changes that the HIA might suggest when it is completed?

Tatiana Lin: We have engaged a broad group of stakeholders, including local and state organizations, individuals and agencies; and they are involved in all stages, including the recommendations we’ll be making at the end.

>>Read the new HIA report.

>>Read more on the context for the HIA report, and how it has impacted the field of health impact assessments.

Tags: Built Environment and Health, Community Health, Health Impact Assessment, Prevention, Q&A, Smart Growth