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Preventing and Minimising Gambling Harm 2010-2016: Consultation document Six-year strategic plan; three-year service plan; problem gambling needs assessment; and problem gambling levy calculations

Citation: Ministry of Health. 2009. Preventing and Minimising Gambling Harm: Consultation document. Six-year strategic plan; three-year service plan; problem

gambling needs assessment; and problem gambling levy calculations. Wellington: Ministry of Health.

Published in July 2009 by the Ministry of Health

PO Box 5013, Wellington, New Zealand

ISBN 978-0-478-31947-7 (print) ISBN 978-0-478-31948-4 (online)

HP 4796

This document is available on the Ministry of Health’s website: http://www.moh.govt.nz

Preventing and Minimising Gambling Harm: Consultation document iii

Foreword

The Gambling Act 2003 (the Act) sets out the requirements of the Ministry in developing an integrated problem gambling strategy focused on public health. This strategy must include:

The Act makes explicit the Ministry of Health’s consultation requirements for the development of the integrated problem gambling strategy, and the Ministry is now, consistent with the Act’s requirements, seeking comment on its draft six-year strategic plan, three-year service plan, needs assessment and levy calculations. The current service and strategic plans expire 30 June 2010.

measures to promote public health by preventing and minimising harm from gambling

services to treat and assist problem gamblers and their families and whānau

independent scientific research associated with gambling, including (for example) longitudinal research on the social and economic impacts of gambling, particularly the impacts on different cultural groups

evaluation.

Six-year Strategic Plan 2010–2016: The draft strategic plan (Part 1) builds on the Ministry’s previous problem gambling strategy document Preventing and Minimising Gambling Harm: Strategic plan 2004–2010. The plan provides a high-level framework to guide the structure, delivery and direction of Ministry-funded problem gambling services and activities and outlines strategic alliances with other key stakeholders and organisations with an interest in preventing and minimising gambling harm.

Three-year Service Plan 2010–2013: The draft service plan (Part 2) describes the Ministry of Health’s proposed service priorities for primary, secondary and tertiary services, including research and workforce development, to prevent and minimise harm from gambling from 1 July 2010 to 30 June 2013. This service plan focuses on achieving the high-level outcomes outlined in the strategic plan.

Problem Gambling Needs Assessment 2009: The needs assessment (Part 3) brings together a range of information to describe the impact of gambling harm in terms of population need. The needs assessment takes into account the demographic and geographic distribution of gambling harm as well as the placement of gambling opportunities. It is recommended that the needs assessment be read in conjunction with Informing the 2009 Problem Gambling Needs Assessment: Report for the Ministry of Health and A Focus on Problem Gambling: Results of the 2006/07 New Zealand Health Survey, which are available on the Ministry of Health’s website.

Problem Gambling Levy Calculations: The problem gambling levy calculations (Part 4) propose levy rates for the four gambling sectors (casinos, non-casino gaming machines, the New Zealand Racing Board and the New Zealand Lotteries Commission). The levy is calculated using the formula in the Gambling Act (s320), which provides a mechanism for recovering the cost of developing and implementing the Ministry’s integrated problem gambling strategy.

The above components are included in this document for consultation. Submissions are now invited, and the Ministry encourages you to have your say to ensure we have an inclusive and comprehensive approach to preventing and minimising gambling harm for the 2010–2016 period.

Janice Wilson (Dr) Deputy Director-General Population Health Directorate

iv Preventing and Minimising Gambling Harm: Consultation document

How to Have Your Say

Your feedback is important as it will help shape the final documents. Please take the time to make a submission. While the Ministry welcomes all feedback on the four parts of this document, the following questions may help you to focus your submissions.

1. Are there things you particularly endorse about the proposed approach in the service and strategic plans?

2. What changes do you suggest to the proposed approach in the service and strategic plans?

3. Does the service plan adequately address the areas of primary, secondary and tertiary prevention?

4. Does the service plan adequately address research and workforce development?

5. Of the three options outlined in the levy calculations, do you support the 30:70, 20:80 or the 10:90 weighting? Why?

There are two ways you can make a submission:

1. Forward your comments, with the detachable submission form at the back of this document, to:

Nathan Clark National Problem Gambling Team Ministry of Health PO Box 5013 Wellington

2. Download the submission form available at http://www.moh.govt.nz/problemgambling add your comments and email to:

[email protected] The Ministry will also be holding a series of public and special interest meetings for interested parties to discuss the documents and ask questions to inform their written submissions. Comments at the meetings will also be recorded and used in the submissions analysis. The dates, times and locations of these meetings can be found at: http://www.moh.govt.nz/problemgambling. This document can also be downloaded from http://www.moh.govt.nz/problemgambling. All submissions are due by 5 pm 21 August 2009. Your submission may be requested under the Official Information Act 1982. If this happens, the Ministry of Health will release your submission to the person who requested it. A copy of all submissions received will be forwarded to the Gambling Commission to assist their independent consultation process.

Preventing and Minimising Gambling Harm: Consultation document v

http://www.moh.govt.nz/problemgambling

Contents

Foreword iii

Six-year Strategic Plan 1 1 Introduction 1 2 Background 1 3 Ministry objectives 6

Three-year service plan 2010–2013 21 1 Introduction 21 2 2007–2010 service period 24 3 Factors for consideration 2010–2013 26 4 Three-year service plan 2010–2013 27 5 Funding 27 6 Existing and new services 29 7 Ministry of Health operating costs 36

Problem Gambling Needs Assessment 37 Background 37 Summary of service demand, 2007 and 2008 calendar years 37 Problem gambling and demographic factors 38 Problem gambling and health 39 Gambling and problem gambling in New Zealand 40 Conclusions 42

Problem Gambling Levy Calculations 45 Background 45 Process for calculating the levy 45 Levy formula and definitions 45 Levy calculations 49

Discussion of Regulatory Impact Analysis Elements 52 What is problem gambling? 52 What are the impacts of problem gambling? 52 What is the prevalence of problem gambling? 52 Deprivation 53 Low income 54 Ethnicity 54 Co-morbidities 55 Crime 56 References 61

Preventing and Minimising Gambling Harm: Consultation document vii

Submissions: Preventing and Minimising Gambling Harm 2010–2013: A Draft Document for Consultation 63

List of Tables Table 1: Problem gambling services: Ministry of Health service plan 2007–2010

(GST exclusive) 28 Table 2: Problem gambling services: Ministry of Health Spend 2010–2013 (GST exclusive) 29 Table 3: Public health expenditure on problem gambling, by service area, 2010–2013

(GST exclusive) 28 Table 4: Conference budget (GST exclusive) 32 Table 5: Intervention services expenditure on problem gambling, by service area, 2010–2013

(GST exclusive) 32 Table 6: Research budget totals 36 Table 7: Budget (GST exclusive) 36 Table 8: Gambling expenditure, 2006–2008 42 Table 9: Sector share of presentations, April 2008–March 2009 50 Table 10: Forecast expenditure by sector (GST inclusive) 51 Table 11: Problem gambling funding requirement (taking into account forecast under-recovery,

under-spend, and over-strike in the 2007–2010 levy period) 51 Table 12: Proposed problem gambling levy rates for gambling sectors – 10/90 weighting 51 Table 13: Proposed problem gambling levy rates for gambling sectors – 20/80 weighting 51 Table 14: Proposed problem gambling levy rates for gambling sectors – 30/70 weighting 51 List of Figures Figure 1: Gambling harm continuum of need and intervention 5

viii Preventing and Minimising Gambling Harm: Consultation document

Preventing and Minimising Gambling Harm: Consultation document 1

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016 Six-year Strategic Plan

1 Introduction

This document builds on the Ministry’s previous problem gambling strategy document Preventing and Minimising Gambling Harm: Strategic Plan 2004–2010 (Ministry of Health 2005). The six-year strategic plan provides a high-level framework to guide the structure, delivery and direction of Ministry-funded problem gambling services and activities, and outlines strategic alliances with other key stakeholders and organisations with an interest in preventing and minimising gambling harm. Detailed service information is set out in Preventing and Minimising Gambling Harm: Three-year service plan 2010–2013 (Ministry of Health in press). The development of this strategic plan has taken place against a backdrop of economic uncertainty on a global scale, the full impact of which is yet to be felt in the New Zealand gambling environment. Traditionally, gambling has been referred to as a ‘recession-proof industry’, but recent reports from New Zealand and across the globe suggest this is no longer the case. It remains to be seen what effect the economic downturn will have on New Zealand, and whether gambling will contract or become a preferred choice for discretionary spend. As a result, this strategic plan has been developed to be flexible and relevant in a changing environment. The Ministry’s approach has not significantly changed from its first strategic plan for problem gambling. Momentum has gathered in a number of areas, with the Ministry committed to a long-term approach. The overall goal remains the same; to:

‘Assist Government, communities and families/whānau to work together to prevent the harm caused by problem gambling and to reduce health inequalities associated with problem gambling.’

The role and requirements of the Ministry’s integrated approach to problem gambling, as set down in the Gambling Act 2003, retain the same focus across the continuum of gambling harm, from prevention to treatment and independent research.

2 Background

Gambling Act

The Ministry of Health’s responsibility for problem gambling derives from the Gambling Act 2003 and Cabinet’s decision to name the Ministry as the department responsible for the development of an integrated problem gambling strategy focused on public health. This strategy must include:

measures to promote public health by preventing and minimising the harm from gambling


2 Preventing and Minimising Gambling Harm: Consultation document

independent scientific research associated with gambling, including longitudinal research on the social and economic impacts of gambling, particularly the impacts on different cultural groups

evaluation. The Department of Internal Affairs is the primary regulator of the gambling sector and the key policy advisor to the Government on gambling regulatory issues. It administers the legislation, licenses gambling activities (except for casino gambling), ensures compliance with the legislation and provides public information and education.

The gambling environment

Gambling is a popular activity in New Zealand. Recent nationwide surveys1 indicate that between 6 and 8 out of 10 people (aged 15 years and over) gamble at some time during a year, even if this is only buying a lottery ticket. Communities also benefit from funds raised by gambling. For many people and their families, however, gambling has harmful consequences, and the effects on the community are far reaching. The social costs of gambling are out of proportion to the number of problem gamblers.2 For example, gamblers may commit crimes to finance their gambling, causing harm to their victims and their families as well as to themselves, and incur costs in the criminal justice sector (Department of Internal Affairs 2008b). One study estimated that around 10,000 New Zealanders had committed gambling-related crime in the 12-month period studied (Casswell et al 2008). The gambling environment has changed noticeably in New Zealand since the Ministry assumed responsibility for funding and co-ordinating problem gambling services in 2004, with new technologies and avenues for sales and a significant decrease in the number of non-casino gaming machines key features of the 2009 landscape. The gambling product in New Zealand is delivered by a range of agencies, including casino operators, the New Zealand Racing Board, the New Zealand Lotteries Commission (NZLC), clubs that operate gaming machines, and societies that operate gaming machines in commercial venues (typically pubs). Housie, also known as bingo, is run by societies and individuals in New Zealand but features relatively low in problem gambling data.

1 The Department of Internal Affairs 2005 Survey found that 8 out of 10 people had taken part in at least

one gambling activity in the last 12 months (Department of Internal Affairs 2008a). The 2006/07 New Zealand Health Survey found that two out of three people had gambled in the previous 12 months (Ministry of Health 2008).

2 The 2006/07 New Zealand Health Survey estimated that 0.6 percent of gamblers met the criteria for problem gambling, 2 percent were at moderate risk, and 5.4 percent were at low risk. Almost 3 percent (2.8 percent) of people had experienced problems due to someone’s gambling in the previous 12 months, and this is consistent with overseas studies that estimate that between 5 and 10 other people are affected by the behaviour of a serious problem gambler.


The NZLC and the Totalisator Agency Board (TAB) have retained their monopoly on New Zealand-run internet gambling, with NZLC introducing an online avenue for sales in 2008. The NZLC also stated in 2008 that it intends to continue its development of new games, with the aim of introducing a new short-run game to the market every year. International internet gambling (internet gambling excluding TAB and NZLC products) continues to feature low in terms of both participation and problem gambling presentation data. The number of casinos in New Zealand remains limited to the current six, located in Christchurch, Auckland, Dunedin, Hamilton and Queenstown (two). The number of non-casino gaming machines has declined from a peak of over 25,000 in 2003 to under 20,000 in 2008, located at 1537 pub and club sites nationwide. TAB venues have 659 outlets, and NZLC venues have 1005.3 Expenditure figures (gambling losses) have remained relatively steady, peaking in 2004 at $2.039 billion, with a one-off drop to $1.977 billion in 2006 and climbing again to $2.034 billion in 2008. Of this, non-casino gaming machines continue to make up the largest portion, with $938 million lost in 2007/08, followed by casinos with $477 million, NZLC $346 million and the TAB $273 million.

Participation, prevalence and presentations

Several studies have monitored gambling participation in New Zealand, including two national problem gambling prevalence studies (the 1991 national survey and the 1999 National Prevalence Survey) and a series of surveys on gambling participation. The 1999 National Prevalence Survey found that 86.2 percent of New Zealanders aged 18 years and over had gambled in the previous six months in 1999, a decrease from 90 percent found in the 1991 national survey (Abbott and Volberg 1991; 2000). In these surveys, gambling included participation in a variety of gambling activities including Lotto, gaming machines, card games and making bets with friends. Since 1985 the Department of Internal Affairs has run a survey every five years on participation in, and attitudes towards, gambling in New Zealand among people aged 15 years and over. This series of surveys has found that past-year gambling participation rates have remained relatively stable: 85 percent in 1985, 90 percent in 1990, 90 percent in 1995 and 87 percent in 2000, although with a decrease to 80 percent in 2005 (Amey 2001; Christoffel 1992; Department of Internal Affairs 2008a; Reid and Searle 1996; Wither 1987). The 2006/07 Gaming and Betting Activities Survey, carried out for the Health Sponsorship Council, found that 83 percent of people aged 15 years and over had gambled in the past 12 months (including gambling activities such as making bets with friends) (Health Sponsorship Council and National Research Bureau 2007). According to the New Zealand Health Survey 2006/07, around two in every three people aged 15 years and over had gambled in the last 12 months. Lotto was the most commonly played form of gambling, with over half of adults having played. Two in every five adults had participated in a gambling activity other than Lotto in the last 12 months.

3 2008 data.

The New Zealand Health Survey 2006/07 showed a prevalence of problem gambling in New Zealand for past-year gamblers of 0.6 percent (people 15 years and over), with an additional 2 percent of adults identified as moderate-risk gamblers. This represented 1 in 40 past-year gamblers who were either problem or moderate-risk gamblers in New Zealand. Of the total population (15 years and over), an estimated 87,000 adults had experienced problems due to someone’s gambling in the last 12 months. People aged 35–44 years were at least three times more likely than any other age group to be problem gamblers, with the lowest rates for those aged 55 plus. Māori and Pacific people were approximately four times more likely to be problem gamblers compared to the total population. The over-representation of Māori and Pacific people is reflected in problem gambling service user data.

Gambling Helpline data for 2008 showed that Māori comprised 30.9 percent of gambler callers and Pacific people 9.9 percent of gambler callers.

Face-to-face intervention service data for 2008 showed Māori comprising 43 percent and Pacific people 8 percent of total clients.

To put these figures in perspective, Census data from 2006 show that Māori comprise 14 percent and Pacific people 6.6 percent of the population. Presentation data often reflect the ‘sharper’ end of the spectrum. Research by Auckland University of Technology on barriers to help-seeking for problem gamblers found that help-seeking primarily occurs following a crisis event, with financial problems the primary motivation for seeking help.

A public health approach

The Gambling Act 2003 requires that a public health focus be taken in addressing gambling harm, in recognition of the importance of prevention and addressing the determinants of health. The Ministry of Health’s public health approach over the period of the first strategic plan has contributed to an increased recognition of the harm caused by problem gambling. During this period an overall reduction in expenditure on non-casino gaming machines has been evident, along with a number of territorial authorities introducing either caps or sinking-lid policies to limit the number of gaming machines and venues in their areas. Communities have a role in controlling gaming machine and venue numbers, in that territorial authorities are required to review their gambling venue policies every three years and these reviews require public consultation and consideration of the social impacts of gambling policies. The Ministry will continue to approach problem gambling across the continuum of harm, as illustrated in the Korn and Shaffer model (1999). This approach recognises that people are at different stages of gambling harm, and that through taking a preventive approach early in the development of a problem, considerable loss and trauma can be avoided while addressing the needs of those who have already developed a serious problem and who need specialist help (Figure 1).


Figure 1: Gambling harm continuum of need and intervention

None

Mild

Substantial

Severe

Specialised

interventions

Brief and early

intervention

Primary

prevention

Gambling-related harm

Secondary

prevention

Tertiary

prevention Source: Adapted from Korn and Shaffer 1999 The area within the triangle represents the general population. The area at the apex represents that section of the population experiencing substantial gambling harm. It is important to note that people do not simply move along this continuum, but enter and exit at various points: some may no longer require assistance from problem gambling intervention services, while others may relapse, having previously exited.

Population health

As part of its public health approach, the Ministry will continue to use a population health framework to address gambling harm across different groups within the population. A population health approach addresses the differences in health status among, and within, populations. The goal of a population health approach is to maintain and improve the health status of the entire population and to reduce inequalities in health status between groups and/or subgroups. It is a useful framework for strengthening intersectoral arrangements and examining trends. In a New Zealand context, this is particularly important for meeting the health needs of at-risk groups, particularly those reflected in prevalence and service-user data.

Whānau ora

The strategic plan for preventing and minimising gambling harm sits within and alongside a range of Ministry strategic documents, including:

He Korowai Oranga

Whakatātaka. The high-level aims of these approaches are for Māori families to be supported to achieve their maximum health and wellbeing. Whānau ora provides an overarching principle for recovery and maintaining wellness.


Although beyond the capacity and scope of problem gambling services, the whānau ora outcomes within Te Puāwaiwhero represent high-level commitments from the Government that should inform and direct all analysis and consideration of progress against problem gambling outcomes.

Health inequalities

Health inequalities can be defined as differences in health status or in the distribution of health determinants between different population groups that are avoidable or unjust. A major health challenge for New Zealand is the inequalities in health between Māori/ Pacific and non-Māori/non-Pacific peoples. It is well documented that Māori, Pacific peoples, and those with low socioeconomic status (income, education, occupation, housing), have consistently poorer health outcomes in comparison with the rest of the population. While inequalities in health are not random, the causes of health inequalities are complex and multifaceted. To address health inequalities requires a strong evidence base and a strategic approach from the health sector and other sectors to reduce health inequalities for those that are disadvantaged. The Ministry of Health is committed to reducing health inequalities between these population groups through various mechanisms, including policies; strategies; District Health Boards accountability reporting; and health targets.

3 Ministry objectives

A key part of progressing the Ministry’s goal of assisting Government, communities and families/whānau to work together to prevent the harm caused by problem gambling and to reduce health inequalities associated with problem gambling is to set realistic and measurable objectives. Considerable work was undertaken during the Ministry’s first problem gambling strategy on developing an outcomes framework that identified key objectives and the actions required to achieve them, both short/medium and long term, and indicators demonstrating the efficacy of activities and progress made. These objectives form the foundation for this strategic plan and the Ministry’s outcomes framework, providing strategic direction for the next six-year period. Following are the current objectives.

Objective 1: There is a reduction in health inequalities related to problem gambling.

Objective 2: People participate in decision-making about local activities that prevent and minimise gambling harm in their communities.

Objective 3: Healthy policy at the national, regional and local level prevents and minimises gambling harm.

Objective 4: Government, the gambling industry, communities, family/whānau and individuals understand and acknowledge the range of harms from gambling that affect individuals, families/whānau and communities.


http://www.moh.govt.nz/healthtargets


Objective 5: A skilled workforce is developed to deliver effective services to prevent and minimise gambling harm.

Objective 6: People have the life skills and the resilience to make healthy choices that prevent and minimise gambling harm.

Objective 7: Gambling environments are designed to prevent and minimise gambling harm.

Objective 8: Problem gambling services4 effectively raise awareness about the range of harms from gambling that affect individuals, families/whānau and communities for people who are directly and indirectly affected.

Objective 9: Accessible, responsive and effective interventions are developed and maintained.

Objective 10: A programme of research and evaluation establishes an evidence base, which underpins all problem gambling activities.

Objective 1: There is a reduction in health inequalities related to problem gambling

In New Zealand, ethnic identity is an important dimension of health inequalities. In particular, Māori health status is demonstrably poorer than that of other New Zealanders, and actions to improve Māori health recognise Treaty of Waitangi obligations of the Crown. Gender and geographical inequalities are other important areas for action. The Ministry will continue to focus on reducing the current disproportionate levels of gambling harm among different population groups. At-risk populations, including Māori, Pacific people and those in higher deprivation areas, will continue to be key targets of the Ministry’s population health approach, with activities tailored to relevant groups and geographical areas, and culturally relevant services made available to those seeking help. A key part of addressing the needs of these population groups will be ensuring that appropriate and effective front-line services are available and accessible. The Ministry will continue to monitor the health outcomes of, and presentations to problem gambling services by, other key groups such as new migrants and some Asian communities within New Zealand.

4 The reference to problem gambling services for this objective includes health services that treat

problem gamblers, and it excludes all primary health care services.

Objective 1: There is a reduction in health inequalities related to problem gambling

Measuring progress Reporting

Analysis of New Zealand Health Survey data (three yearly) for trends indicating inequitable gambling and problem gambling prevalence

Six-yearly

Analysis of Ministry of Health problem gambling intervention data for inequitable presentation, service utilisation and effectiveness trends

Annually

Analysis of Department of Internal Affairs electronic monitoring system data (Class 4 revenue) against the New Zealand deprivation index for trends indicating inequitable prevalence of gambling participation and opportunities in low socioeconomic communities

Annually

Analysis of the proportion of charitable trust gambling grants allocated to communities with New Zealand social deprivation scores between decile 7 and 10

Annually

Review of problem gambling provider reports for the range of low socioeconomic communities targeted by public health initiatives

Annually

Priorities for action

Short- to medium-term priorities Long-term priorities

Identify health inequalities in all communities (eg, access to initiatives to prevent and minimise gambling harm)

Identify factors that contribute to gambling-related health inequalities (eg, socioeconomic background)

Target effective and culturally appropriate initiatives to prevent and minimise gambling harm

Government agencies have a shared understanding of where health inequalities exist and a commitment to a whole-of-government approach to problem gambling

Objective 2: People participate in decision-making about local activities that prevent and minimise gambling harm in their communities

An increased awareness of and ownership by communities through public discussion and debate on gambling harm, grant distribution and related issues will continue to be a focus. A high level of interaction is expected between problem gambling service providers, their client populations, District Health Board (DHB) public and mental health services, and community groups. The local government gambling venue review process also allows communities to address their council and discuss positive and negative aspects relating to the availability and accessibility of certain types of gambling in the community. Community ownership and empowerment are important aspects of building healthy and responsive communities, and are key aspects of a public health approach.


Objective 2: People participate in decision-making about local activities that prevent and minimise gambling harm in their communities


Analysis of community awareness and concern indicators from the Ministry-funded Behaviour Change Survey

Six-yearly

Periodic review of public health provider reports to the Ministry to assess the state of local communities and progress against community readiness assessments for community action and community policy implementation

Six-yearly

Regional interest in and involvement with Ministry of Health strategic plan development, including the diversity of submissions

Six-yearly

The number and diversity of submissions received by a sample of local government bodies in relation to gambling decision-making, including assessment of the level of input from low socioeconomic communities or representatives

Six-yearly

The number of national agencies that actively screen and refer for problem gambling Annually

Review of the number and quality of opportunities for Māori, Asian and Pacific representation in the Ministry of Health, National Problem Gambling Team and Department of Internal Affairs processes for decision-making in relation to problem gambling

Annually



Develop effective community networks to identify issues relating to gambling harm and take action

Improve communities’ abilities to be involved in decision-making about the availability and accessibility of gambling opportunities

Develop community capacity and capability to take action on issues related to gambling harm

Develop effective community networks to prevent and minimise gambling harm and enforce age limits

Develop and implement effective processes for community agencies to undertake screening for problem gambling in their everyday work

Develop and implement community policies that minimise the harms arising from gambling to individuals, families/whānau and communities

Objective 3: Healthy policy at the national, regional and local level prevents and minimises gambling harm

Central to preventing and minimising gambling harm is a foundation of effective and relevant public policy. Without this, neither the Ministry nor the primary regulator of the gambling industry, the Department of Internal Affairs, can pursue activities and initiatives that are likely to have an impact on problem gambling. The Ministry will continue to comment on gambling issues based on the merits and available research and will work collaboratively with the Department of Internal Affairs, contributing where appropriate to policy development.


The Ministry will maintain an approach of minimising gambling harm through health promotion, supply control and treatment avenues. A public health approach will continue to be a central pillar of the Ministry’s work. Objective 3: Healthy policy at the national, regional and local level prevents and minimises gambling harm


The number of government departments actively participating and collaborating with the Ministry of Health and the Department of Internal Affairs to reduce gambling-related harm

Six-yearly

Analysis of government sector strategic documents (ie, annual reports and statements of intent) for commitment to addressing gambling-related harm

Six-yearly

Analysis of a six-yearly survey of the attitudes of local government councillors to awareness of problem gambling and perceptions of gambling-related harm

Six-yearly

Analysis of a Ministry-funded Behaviour Change Survey on the attitudes of participants employed in decision-making roles in relation to problem gambling and perceptions of gambling-related harm (ie, policy makers, gambling industry leaders, church leaders, school principles, kuia and kaumātua)

Six-yearly

Review of the percentage of territorial local authority gambling venue policies that reflect an active awareness of the potential harms of gambling

Six-yearly

Analysis of industry marketing expenditure and sponsorship activities Annually



Develop effective policy frameworks to guide the development and implementation of policies at the national, regional and local level that prevent and minimise gambling harm

Provide education and information to other government sectors (social services, justice, education, economic development and consumer protection) to increase understanding and acknowledgement of the need to link policies to prevent and minimise gambling harm with policy in related areas

Develop linked policies with related government sectors (social services, justice, education, economic development and consumer protection) to provide a whole-of-government approach to preventing and minimising gambling harm

Objective 4: Government, the gambling industry, communities, family/whānau and individuals understand and acknowledge the range of harms from gambling that affect individuals, families/whānau and communities

A key aspect of the Ministry’s public health activity has been raising awareness of the harms arising from gambling. The Ministry will continue to fund a media-based approach to raising awareness, de-stigmatising the issue and encouraging help-seeking for those in need. Highlighting the actions expected and required of venues through their host responsibility roles will also be a key focus, with an expectation that referrals to problem gambling services from venues will increase from current levels.


Increased buy-in from the wider government sector at a central level will be a focus of this strategy period, with key relationships formalised through memoranda of understanding to better address the wider issues associated with gambling harm. Closer collaboration with government agencies will contribute to a more expansive approach to achieving a wider recognition of the issues and efficiencies in the delivery of public health and awareness-raising activities. There is still considerable scope for wider screening of at-risk individuals and populations through working with other agencies and the populations they address on a regular basis. Objective 4: Government, the gambling industry, communities, family/whānau and individuals understand and acknowledge the range of harms from gambling that affect individuals, families/whānau and communities


Analysis of government sector annual reports and statements of intent for commitment to addressing gambling-related harm

Six-yearly

Analysis of the Department of Internal Affairs survey on community attitudes to gambling and problem gambling

Six-yearly

Analysis of Ministry-funded survey on community attitudes to gambling and problem gambling

Six-yearly

Analysis of Department of Internal Affairs annual reports of gambling industry host responsibility compliance

Annually

Analysis of the attitudes of national key decision-makers (ie, Ministry of Health and Department of Internal Affairs officials, the Gambling Commission, industry leaders, local government councillors) compared to national Ministry-funded attitudes survey responses

Six-yearly



Identify and monitor the impact of gambling opportunities on communities, including the range of harms from gambling that affect individuals, families/whānau and communities

Provide reliable information and education on the range of harms from gambling that affect individuals, families/whānau and communities

Support communities to incorporate a robust understanding of the range of harms from gambling into community social initiatives and public service delivery

Support the gambling industry to incorporate a robust understanding of the range of harms from gambling into all of its activities

Objective 5: A skilled workforce is developed to deliver effective services to prevent and minimise gambling harm

An increased emphasis on working with the alcohol and other drugs (AOD) fields will continue to be an emphasis for the Ministry, with the majority of service providers already aligned with AOD services. During the first strategy period a body of research illustrating considerable co-morbidities with these fields has shown that there are potential efficiencies to be gained from aligning gambling with other relevant services.



Continued and more effective alignment with relevant services will be pursued under this strategy, delivering more cost-effective services and a more responsive and holistic service for those in need. The development of a generic addictions sector competency framework for all services will be a significant step towards achieving this. Te Uru Kahikatea: The Public Health Workforce Development Plan 2007–2016 (Ministry of Health 2007) provides a national strategic approach to public health workforce development, including in the problem gambling area. Objective 5: A skilled workforce is developed to deliver effective services to prevent and minimise gambling harm

Measuring progress5 Reporting

Analysis of problem gambling practitioners’ (public health and intervention) employment patterns and conditions, such as duration of employment and pay ranges compared to other sectors

Six-yearly

Analysis of the number of problem gambling practitioners (public health and intervention) who have the relevant problem gambling competencies for the work they deliver

Six-yearly

Analysis of the number of problem gambling practitioners (public health and intervention) who have received relevant tertiary training

Six-yearly

Assessment of the availability of culturally specific training programmes for problem gambling practitioners

Annually

Analysis of the diversity of the problem gambling workforce, including:

ethnic diversity (Māori, Pacific and Asian), age and gender

the percentage of Māori, Pacific and Asian practitioners who are working in mainstream organisations6

the range of languages spoken by the problem gambling workforce

the percentage of the workforce that speaks te reo Māori

the percentage of the problem gambling workforce who identify as recovering gamblers or who have used problem gambling intervention services in the past

Six-yearly



Identify competencies for staff working within services designed to prevent and minimise gambling harm

Identify and implement career pathways and tertiary training opportunities for staff working within services designed to prevent and minimise gambling harm

5 All analysis should include a breakdown by service type – Māori, Pacific, Asian and general. 6 Low Māori participation in the mainstream workforce is commonly seen as a consequence of few

Māori practitioners. However, critiques of mainstream mental health services argue that it is in fact due to a lack of appeal of mainstream working environments and organisational cultures for Māori practitioners. If mainstream organisations are culturally safe and responsive they will have more culturally diverse service usage and a more diverse workforce.

Identify Māori, Pacific and Asian specific competencies for staff working within Māori, Pacific or Asian dedicated services designed to prevent and minimise gambling harm

Objective 6: People have the life skills and the resilience to make healthy choices that prevent and minimise gambling harm

The Ministry recognises that for the majority of the population gambling is a recreational activity that is enjoyed safely and in moderation. However, there remains a significant minority who struggle with gambling. For some indigenous and ethnic groups gambling is not something they have been exposed to before, while youth, migrants, the elderly and others may be vulnerable to the attraction of gambling for a variety of reasons. The Ministry will continue to focus public health programmes and resources aimed at reaching vulnerable groups in the population. These will focus on the development of life skills and information on responsible gambling activity and the functioning and mechanics of the various forms of gambling in New Zealand. Objective 6: People have the life skills and the resilience to make healthy choices that prevent and minimise gambling harm


Analysis of the prevalence of protective and resiliency factors demonstrated in the New Zealand Health Survey for different population groups

Six-yearly

Analysis of community involvement in the Ministry-funded Behaviour Change Survey Six-yearly

Review and summary of the range of public health initiatives reported to the Ministry by public health providers that are community action-based and have community policy implementation

Annually

Analysis of Ministry service-user data for referral from and referral to life skills and resiliency programmes

Annually



Identify protective and resiliency factors for problem gambling

Support the development of an evidence base and programme logic for initiatives that build protective factors, life skills and resilience for people who gamble

Increase community participation in the development of culturally and linguistically relevant campaigns and/or communications that provide information to people on the health and social risks of gambling

Increase community exposure to culturally relevant social marketing campaigns and/or communications

Identify mechanisms and systems to support people who are seeking to independently moderate or manage their gambling behaviour (or the behaviour of their family/whānau) in some way

Provide effective support to people who are seeking to independently moderate or manage their gambling behaviour (or the behaviour of their family/whānau) in some way



Objective 6: People have the life skills and the resilience to make healthy choices that prevent and minimise gambling harm

Increase the links between problem gambling services and broader mental health promotion life skills and resiliency programmes

Support the development and resourcing of community-based life skills and resiliency programmes that support people to make healthy choices that prevent and minimise gambling harm

Objective 6: People have the life skills and the resilience to make healthy choices that prevent and minimise gambling harm (continued)



Increase the links between problem gambling services and other agencies to improve client access to a wide range of support services

Support the implementation of processes and systems to improve the way problem gambling services and other social and health services work together to support problem gamblers (and their family/whānau) in a cohesive way

Establish effective communication and referral processes to ensure that other services that offer support to people experiencing harm from gambling address the needs of a referred client (and their family/whānau)

Objective 7: Gambling environments are designed to prevent and minimise gambling harm

Both international and New Zealand research shows that certain types of gambling activity are more closely linked with problem gambling behaviour than others. The Ministry will continue to advocate for technological and/or environmental changes where there is evidence that these will have a positive effect on gambling behaviour. Gambling environments and the host responsibilities expected of venues will be an ongoing focus of the Ministry’s work during this strategy. Healthy venues and responsible stewardship of venue licences granted by The Department of Internal Affairs are key tools in ensuring gambling is undertaken as a healthy, responsible and enjoyable activity. Venues, by their very nature, provide one of the best environments in which to observe, identify and intervene in gambling behaviour that is problematic or displaying signs of being out of control. Although there is a strong expectation that operators will effectively monitor and address gambling in their venues, the Ministry recognises that signs of problem gambling behaviour are not always obvious. As a key area of focus, the Ministry is committed to working with industry where appropriate in order to make best use of the early detection potential that venues offer. The Ministry is also committed to assisting with the identification of those venues where host responsibility is not meeting the expected commitment.

Objective 7: Gambling environments are designed to prevent and minimise gambling harm


A summary of progress made by the joint Ministry of Health and Department of Internal Affairs relationships with the gambling industry

Annually

Analysis of a periodic stakeholder satisfaction survey of the joint Ministry of Health and Department of Internal Affairs relationships with the gambling industry

Six-yearly

Analysis of industry data on training and programmes that assist gambling providers to be responsible hosts (ie, host responsibility programmes)

Annually

Analysis of Department of Internal Affairs data on gambling venue compliance (and breaches) of relevant legislative requirements

Annually

Analysis of client data for referrals from gambling venues Annually

Review of the effectiveness of industry mechanisms for identifying problem gamblers and gamblers at risk of problem gambling

Annually

Review of the number of venues, or societies, that have policies specific to key risk groups and behaviours (ie, table games for Asian gamblers, self exclusion for non-English-speaking gamblers)

Six-yearly



Continue to build strong relationships between the Ministry of Health, The Department of Internal Affairs and the gambling industry

Develop and refine guidelines for gambling operators and venues on policies that actively and effectively prevent and minimise gambling harm

Develop and refine guidelines for gambling operators and venues on how to implement host responsibility programmes in a range of gambling environments (including gambling venues and telephone and online environments)

Support the development of public monitoring of host responsibility programmes in all gambling venues and gambling environments (including telephone and online environments)

Increase the participation and involvement of Māori, Pacific and Asian providers in The Department of Internal Affairs monitoring and surveillance processes

Support links between host responsibility programmes and problem gambling intervention services to prevent or minimise the harm from problem gambling

Support the development of systems and processes to collect data on regular gamblers by the gambling industry, and support the identification of gamblers at risk of becoming problem gamblers

Develop protocols and systems to make data collected by the gambling industry on regular gamblers and gamblers at risk of becoming problem gamblers available to research groups and other stakeholders



Objective 8: Problem gambling services7 effectively raise awareness about the range of harms from gambling that affect individuals, families/whānau and communities for people who are directly and indirectly affected

Surveys show that while there is a reasonable knowledge of problem gambling services among the general public, with around 60 percent of people surveyed able to name a service provider, this awareness could be further improved. An improved awareness of problem gambling services will remove a key barrier to seeking help. Ministry-funded services are expected to build relationships with relevant organisations in their area that may deal with at-risk or vulnerable populations. Through these inter-agency relationships, the Ministry will share information and increase the overall awareness of the harms associated with problem gambling, possible signs of problem gambling behaviour and other relevant information. Families and whānau are often the worst affected by someone’s problem gambling, and helping families to recognise the problem, address the issues and seek help if necessary is a significant step to reducing harm for the wider family/whānau and the affected individual. This awareness raising will be supported through the Ministry’s media campaign, which also supports help-seeking behaviour. Objective 8: Problem gambling services effectively raise awareness about the range of harms from gambling that affect individuals, families/whānau and communities for people who are directly and indirectly affected


Analysis of client data for referrals from health sector and community services Annually

Analysis of New Zealand Health Survey and problem gambling service presentation data for trends in presentation and a reduction in barriers to presentation

Six-yearly

Analysis of Ministry-funded social marketing impact data Six-yearly

Analysis of the periodic service-user satisfaction survey and barriers to service usage survey

Six-yearly

Assessment of the percentage of social marketing activities delivered specifically to at-risk groups

Annually



Develop tools and protocols to support the primary health care sector and other community services to include screening, brief assessment and brief and early intervention as part of general health screening and day-to-day delivery, where appropriate

7 The reference to problem gambling services for this objective includes health services that treat

problem gamblers, and it excludes all primary health care services.


Objective 8: Problem gambling services effectively raise awareness about the range of harms from gambling that affect individuals, families/whānau and communities for people who are directly and indirectly affected

Develop guidelines and training to support problem gambling services to be aware of how their activities contribute to problem gambling outcomes

Increase the evidence base for interventions that address the range of harms from gambling that affect individuals, families and communities

Develop systems and processes that increase problem gamblers’ and their family/whānau’s access to problem gambling services

Refine and deliver social marketing programmes that promote and increase awareness of the range of harms from gambling to people both directly and indirectly affected by problem gambling

Objective 9: Accessible, responsive and effective interventions are developed and maintained

A key part of fulfilling the Ministry’s obligations under the Act is the provision of high-quality, effective and accessible problem gambling services. Those employed by these services should be appropriately qualified, services should be culturally relevant to the communities they serve, and all areas with gambling opportunities should have access to intervention services. It is not financially viable to furnish every geographical area with face-to-face services, despite the widespread availability of gambling opportunities, both physical venues and telephone- and web-based, throughout New Zealand. However, the Ministry will continue to fund a toll-free helpline service offering referrals to face-to-face services where available/appropriate and intervention services for those without access to face-to-face services or who prefer a helpline service. The Ministry is committed to investigating the devolution of services to DHBs during the first half of this strategy period. DHBs fund alcohol and other drug (AOD) services, and there is the potential not only for efficiencies through aligning problem gambling and mental health and AOD services but also for improved access to services and outcomes for those presenting with coexisting mental health, alcohol or other drug issues. Objective 9: Accessible, responsive and effective interventions are developed and maintained


Analysis of periodic clinical audits of intervention services Six-yearly

Analysis of periodic cultural audits for intervention and public health services Six-yearly

Analysis of client data for trends in comprehensive assessment and identification of multiple needs

Annually

Analysis of independent moderation service data (resource demand, etc) against New Zealand Health Survey prevalence data

Six-yearly

Analysis of client data for trends in culturally specific presentations compared to New Zealand Health Survey prevalence data

Annually

Analysis of periodic service user satisfaction and barriers to service usage survey specific to dedicated services

Six-yearly

Analysis of the diversity of client characteristics (ethnicity, age, and gender) presenting to different service types (general, dedicated Māori, Pacific or Asian services)

Annually



Develop criteria and evidence for client-centred culturally responsive secondary and tertiary prevention services that meet the needs of individual clients and their family/whānau

Develop processes and evidence to ensure problem gamblers and their family/whānau have access to a range of client-centred culturally responsive secondary and tertiary prevention services

Identify and validate best-practice models for intervention services, including the identification and validation of a comprehensive assessment to be used by treatment services for problem gamblers with high and complex needs

Develop guidelines and training to support intervention providers to use a standardised gambling screen, brief interventions and assessments (designed for different stages in the continuum of care) to identify problem gamblers, or people at risk of becoming problem gamblers

Develop audit criteria and standards to assess intervention service compliance with Ministry contract requirements

Identify and develop processes, resources and systems to support and manage all people who are looking to independently moderate their behaviour

Objective 10: A programme of research and evaluation establishes an evidence base, which underpins all problem gambling activities

A research strategy has been developed to run parallel to this strategic plan. Covering the same six-year period, it addresses both short-term and long-term priorities, including longitudinal studies. The research strategy addresses the requirement of the Act for ‘independent scientific research’. The Ministry has recognised that there are efficiencies to be gained from collaborating with Australian researchers, and this has been factored into the strategy for the first time. The Ministry will continue to collect comprehensive data from problem gambling service providers, with the expectation that the collection and maintenance of this information will move within the Ministry once an appropriate database is established.


Objective 10: A programme of research and evaluation establishes an evidence base, which underpins all problem gambling activities


Analysis of a periodic stakeholder satisfaction survey of the Ministry’s management of the problem gambling research programme

Six-yearly

Summary of progress made in managing processes to provide agreed outcome and monitoring data

Annually

Summary of research infrastructure project delivery (scholarship and provider/research-initiated projects) for Māori, Pacific and Asian capacity to participate in research

Annually

Summary of research programme delivery Annually

Review of the number of research reports finalised within Ministry of Health timeframes Annually

The number of research projects completed that successfully involve all target groups, based on cultural identity (Pākehā, Māori, Pacific, Asian) age and gender

Six-yearly

Analysis of the diversity of applications and successful awards for Ministry of Health-funded gambling scholarships

Annually



Identify and develop effective ways to ensure that research funded by the Ministry contributes to strategic outcomes

Establish monitoring processes to ensure that research funded by the Ministry contributes directly to the outcomes and objectives of the Ministry’s Strategic Outcomes Framework

Establish reporting systems to ensure that population surveys on gambling prevalence, participation, attitudes and behaviours, and co-morbidities are available to inform the problem gambling sector

Identify and agree on appropriate outcome measurement tools for evaluating initiatives to prevent and minimise gambling harm

Establish reporting systems to promote evaluation findings on the effectiveness of initiatives to prevent and minimise gambling harm

References

Abbott M, Volberg R. 1991. Gambling and Problem Gambling in New Zealand, Wellington: Department of Internal Affairs.

Abbott MW, Volberg RA. 2000. Taking the Pulse on Gambling and Problem Gambling in New Zealand: A Report on Phase One of the 1999 National Prevalence Study, Wellington: Department of Internal Affairs.

Amey B. 2001. People’s Participation in and Attitudes to Gaming, 1985–2000: Final results of the 2000 survey. Wellington: Department of Internal Affairs.

Casswell et al. 2008. Assessment of the Social Impacts of Gambling in New Zealand. Auckland: SHORE Whariki, Massey University.

Christoffel P. 1992. People’s Participation in and Attitudes Towards Gambling. Wellington: Department of Internal Affairs.


Department of Internal Affairs. 2008a. People’s Participation in, and Attitudes to, Gambling, 1985–2005: Final results of the 2005 survey. Wellington: Department of Internal Affairs.

Department of Internal Affairs. 2008b. The Department’s Strategic Approach to Gambling. URL: http://www.dia.govt.nz/diawebsite.nsf/Files/StrategicApproachToGambling_Dec08/$file/ StrategicApproachToGambling_Dec08.pdf. Accessed 9 March 2009.

Health Sponsorship Council and National Research Bureau. 2007. 2006/07 Gaming and Betting Activities Survey: New Zealanders’ knowledge, view and experiences of gambling and gambling-related harm. Auckland: Health Sponsorship Council.

Korn DA, Shaffer HJ. 1999. Gambling and the Health of the Public: Adopting a public health perspective. Journal of Gambling Studies 15: 4.

Ministry of Health. 2005. Preventing and Minimising Gambling Harm: Strategic Plan 2004–2010. Wellington: Ministry of Health.

Ministry of Health. 2007. Te Uru Kahikatea: The Public Health Workforce Development Plan 2007–2016. Wellington: Ministry of Health.

Ministry of Health. 2008. A Portrait of Health. Key Results of the 2006/07 New Zealand Health Survey. Wellington: Ministry of Health.

Ministry of Health. Preventing and Minimising Gambling Harm: Three-year Service Plan 2010–2013. Wellington: Ministry of Health, in press.

Reid K, Searle W. 1996. People’s Participation in and Attitudes Towards Gambling: Final results of the 1995 survey. Wellington: Department of Internal Affairs.

Wither A. 1987. Taking a Gamble: A survey of public attitudes towards gambling in New Zealand. Wellington: Department of Internal Affairs.



Thr

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Three-year service plan 2010–2013

1 Introduction

1.1 Background

The Gambling Act 2003 (the Act) charges the Ministry of Health, as the department responsible for developing and implementing an integrated problem gambling strategy to prevent and minimise gambling harm. The Act states that the strategy must include:



independent scientific research associated with gambling, including (for example) longitudinal research on the social and economic impacts of gambling, particularly the impacts of gambling on different cultural groups

evaluation. Gambling harm is defined in the Act as follows. ‘Harm’:

(a) means harm or distress of any kind arising from, or caused or exacerbated by, a person’s gambling; and

(b) includes personal, social, or economic harm suffered –

(i) by the person; or

(ii) by the person’s spouse, civil union partner, de facto partner, family, whānau, or wider community; or

(iii) in the workplace; or

(iv) by society at large. The Ministry appropriates funding for problem gambling services and activities through Vote Health. The Crown then recovers the cost of this appropriation through a levy on gambling operators, referred to as the ‘problem gambling levy’.

1.2 The integrated strategy

The Ministry’s draft integrated problem gambling strategy for consultation comprises:

a six-year strategic plan 2010–2016

a needs assessment

a proposed levy calculation

a three-year service plan 2010–2013. This document is the Ministry’s three-year service plan for 2010–2013 and outlines the Ministry’s forecast budget and intentions for this period.


1.3 Funding principles

Underpinning the Ministry’s integrated strategy are a number of key principles that have guided the planning and funding processes for problem gambling primary prevention (public health) and secondary and tertiary prevention services. These principles are to:

maintain a comprehensive range of public health services based on the Ottawa Charter and New Zealand models of health (such as Te Pae Mahutonga and Whare Tapa Wha)

fund services that target priority populations

strengthen communities

address health inequalities

build the knowledge base

develop the workforce

apply an intersectoral approach

ensure links between public health and intervention/addiction services.

1.4 The strategic plan

The Ministry’s draft six-year strategic plan, Preventing and Minimising Gambling Harm: Strategic Plan 2010–2016, outlines how the Ministry will address the continuum of gambling harm and identifies the following 10 objectives.

Objective 1: There is a reduction in health inequalities related to problem gambling.

Objective 2: People participate in decision-making about local activities that prevent and minimise gambling harm in their communities.

Objective 3: Healthy policy at the national, regional and local level prevents and minimises gambling harm.

Objective 4: Government, the gambling industry, communities, families/whānau and individuals understand and acknowledge the range of harms from gambling that affect individuals, families/whānau and communities.

Objective 5: A skilled workforce is developed to deliver effective services to prevent and minimise gambling harm.

Objective 6: People have the life skills and the resilience to make healthy choices that prevent and minimise gambling harm.

Objective 7: Gambling environments are designed to prevent and minimise gambling harm.

Objective 8: Problem gambling services8 effectively raise awareness about the range of harms from gambling that affect individuals, families/whānau and communities for people who are directly and indirectly affected.


Objective 9: Accessible, responsive and effective interventions are developed and maintained.

Objective 10: A programme of research and evaluation establishes an evidence base, which underpins all problem gambling activities.

This service plan outlines the services required to advance these 10 objectives over the 2010–2013 levy period.

1.5 The needs assessment

The Ministry’s problem gambling needs assessment was developed in 2009 to inform strategic and service planning for the 2010–2013 period. The Ministry contracted an external consultancy to undertake research for the 2009 needs assessment, and the resulting report, Informing the 2009 Problem Gambling Needs Assessment: Report for the Ministry of Health, is available on the Ministry’s website.9 The 2009 needs assessment, a summary of the report the Ministry received, is included in the Ministry’s draft problem gambling consultation document. Key findings of the problem gambling section of the 2006/07 New Zealand Health Survey are also included in the needs assessment. The full publication, A Focus on Problem Gambling: Results of the 2006/07 New Zealand Health Survey, is available on the Ministry’s website. The needs assessment indicates that problem gambling intervention services meet current demand and provide good geographical coverage across New Zealand. There was evidence that some smaller populations are without services, primarily where it is not cost-effective to site face-to-face services, but overall there were few populated areas lacking access to face-to-face services. An increased role for the Helpline means that all areas have a problem gambling service available regardless of the ability to access face-to-face services. The gambling/problem gambling geographical analysis confirmed the findings of previous needs assessments showing that people living in more deprived areas are at greater risk of developing problems with gambling. This research also showed that gambling opportunities are concentrated in high deprivation areas, which also have high Māori and Pacific populations. Responding to these findings, modelling of public health service demand showed several gaps in service coverage and capacity. The Ministry has moved to address these gaps through an increase in public health funding for the 2010–2013 service period.

1.6 The research agenda

To inform its research programme for the 2010–2013 period, the Ministry reviewed its research agenda for the 2010–2016 period. This research agenda was based on a range of sources, including:

9 http://www.moh.govt.nz/problemgambling


the priorities and rationale from the 2004–2010 problem gambling strategy

the findings of previously commissioned research

the 2009 problem gambling needs assessment

the International Think Tank on Gambling Research, Policy and Practice

the Ministry’s gambling research reference group feedback

feedback from the joint Ministry of Health/Department of Internal Affairs Stakeholder Reference Group on Preventing and Minimising Gambling Harm

a process of alignment with Gambling Research Australia projects, recently completed, underway or scheduled over the 2010–2013 period.

The research agenda outlines the full range of questions identified, the rationale for each category of investigation and links between categories, national and international evidence available to inform particular categories of investigation, and questions to be addressed by projects during 2010–2013. The research agenda is available on the Ministry of Health website.10

2 2007–2010 service period

2.1 Service changes

Over the 2007–2010 service period, the Ministry has introduced a range of service changes, including:

implementation of a revised service delivery model for public health and intervention services

expansion of Helpline services to 24 hours a day and expanded intervention services

improved data collection and monitoring requirements.

Public health and intervention service model review

The service model review aligned public health and intervention service delivery. The new model ensures clear links between public health and intervention services to ensure a comprehensive range of services along the continuum of care. The implementation of a revised service delivery model saw a revision to the requirements for brief interventions, a requirement for all services to provide follow-up to clients, and the introduction of a facilitation role to provide a better integration of services with other relevant agencies on a client-by-client basis.

10 http://www.moh.govt.nz/problemgambling

As part of supporting this implementation, the Ministry undertook a significant amount of education and alignment work with service providers. Central to this was clarification of the core components of the Ministry’s model for addressing problem gambling and the development of key documents to assist providers: the Intervention Service Practice Requirement Handbook, the Data Management Manual and the Data Collection and Submission Manual. The handbook in particular sets out clear definitions for all purchase units and includes guidance on ideal patterns of care. The resulting increase in service usage in 2008 reflected the work that was being undertaken to better address the needs of those experiencing gambling harm.

Helpline services

The Ministry moved to a 24-hour Helpline service in late 2008, which also provides full intervention services, ensuring access for areas without face-to-face services and for those who prefer a telephone-based service.

Improved data collection

The revised service model also allowed for improved data collection and monitoring, allowing the Ministry to better measure workload for intervention service providers. The improved data available in 2008 allowed the Ministry to adjust the capacity purchased to meet actual clinical service demand.

2.2 Ongoing delivery

Despite the changes introduced to the sector over the 2007–2010 period, service delivery continued unabated. Key points of note are summarised below under the intervention, public health and research areas.

Intervention

The 2008 year saw a significant increase in the number of people accessing intervention services. Although the Ministry made changes at the start of 2008 to the way presentations are defined, these changes were minor, and comparing both 2007 and 2008 data, using identical definitions, a 33 percent increase from 2007 is evident. Much of this increase is attributable to the increased emphasis on brief interventions, but there was also a 12 percent increase in full interventions from 2007 to 2008.

Public health

Central to the Ministry’s national public health activity was the continuation of the Kiwi Lives awareness-raising campaign, co-ordinated by the Health Sponsorship Council (HSC). Phase 2 of the campaign addressed what people could do to address their problems at both an individual and a community level.


Service providers continued to participate in the territorial authority process for reviewing gambling venue policies, providing a community perspective to the consultation process undertaken three-yearly by territorial authorities. This process has seen a number of authorities introduce either gaming-machine caps or sinking-lid policies in their regions.

Research

The research programme has been a key focus for the Ministry over the 2007–2010 period, with a significant quantity of research undertaken, including:

completion of eight projects begun in the 2004–2007 period

commencement of seven national projects

establishment of a scholarship programme to encourage research in gambling and problem gambling

establishment of a small competitive fund to support and encourage innovation in gambling and problem gambling research

establishment of protocols for reviewing and accepting final reports and publication of the findings

the development of a monitoring programme for reporting progress against the sector’s strategic objectives

commencement of a national effectiveness trial for an internationally validated brief intervention.

3 Factors for consideration 2010–2013

Although the Ministry allowed for a ‘bedding-in’ period following the implementation of the revised service model in 2008, its ability to accurately forecast demand for services will evolve over time. The Ministry anticipates that future forecasts will continue to improve in accuracy. A number of stakeholders have raised concerns about the potential for Internet gambling to increase. However, so far Internet gambling has featured low in both participation and presentation data, although the continued rise in the popularity and coverage of poker, the Government’s move to increase Internet speed and capacity, and Internet gambling patterns from overseas jurisdictions suggest an increase in online gambling is feasible. It is worth noting here that 6.6 percent of problem gamblers cited ‘other’ as their primary problem gambling mode, a category that includes Internet gambling. The uncertainty in predicting gambling behaviours during recessionary periods complicates estimates of future gambling activity and behaviour. There are two main schools of thought here:

gambling and problem gambling increase during times of recessionary hardship

like other discretionary spending, gambling may see a reduction in participation, and problem gambling will decline correspondingly.


At the time of writing it was too early to tell what the current recession’s impact on gambling in New Zealand is likely to be over the next three years. However, forecast expenditure trends from The Department of Internal Affairs suggest that patterns will not change markedly.

4 Three-year service plan 2010–2013

This service plan is guided by the objectives outlined in the strategic plan and sets out the funding for primary (public health), secondary and tertiary prevention (intervention) services, including research, evaluation and workforce development, for the period 1 July 2010 to 30 June 2013. The service plan signals a shift to a more outcome- and results-based approach to funding problem gambling services, with a focus on achieving value for money alongside optimal service coverage. The plan takes into account information presented in the needs assessment and changes that have taken place in the gambling environment since the previous plan was developed, and will also include feedback received from the public consultation process. The emphasis on improving the delivery, performance monitoring and evidence for the four core components of the Ministry’s comprehensive approach – brief intervention, full intervention, facilitation and follow-up services – will continue. A key Ministry priority is to continue to investigate opportunities for efficiency and improved outcomes. With this aim in mind, further alignment of problem gambling services with alcohol and other drug services will occur as the Ministry undertakes assessment of the benefits of alignment with District Health Board (DHB) services during the 2010–2013 period. However, the Ministry appreciates that while aligning services with other addictions services has clear efficiencies, devolution to DHBs will be a significant change to the way services are contracted and will require careful assessment of the positive and negative impacts of such a move. As evident through a variety of sources, Māori and Pacific people continue to be over-represented in problem gambling prevalence statistics. Services tailored to these population groups will continue to be a focus in the 2010–2013 levy period. Service providers are expected to contribute to improvements in Whānau Ora and to a reduction in health inequalities, recognising the cultural values and beliefs that influence the effectiveness of services for Māori and Pacific people.

5 Funding

This section sets out the services and funding the Ministry believes are required to achieve the outcomes set out in the draft strategic plan for preventing and minimising gambling harm 2010–2016. Part of the funding requirements for each service period include a reconciliation of actual and forecast expenditure for the previous funding period. This is discussed below, followed by an overview of forecast expenditure for 2010–2013.



5.1 2007–2010 reconciliation

Table 1 shows the funding outlined in the 2007–2010 service plan. Over this period, the Ministry of Health was able to maintain adequate service delivery without spending the total amount allocated in the service plan. It is anticipated at the time of writing this document that over the 2007–2010 period the Ministry will spend 2.175 million (GST exclusive) less than the amount allocated in the service plan. In addition to this forecast underspending for the 2007–2010 period, at the completion of the previous service period (2004–2007), the Ministry reconciled a further underspending of $893,000, over and above the $1.45 million (GST exclusive) accounted for in the 2007–2010 service plan. Therefore the total underspending accounted for in this service plan is $3,068,000 (GST exclusive).

Table 1: Problem gambling services: Ministry of Health service plan 2007–2010 (GST exclusive)11

Services 2007/08 ($) 2008/09 ($) 2009/10 ($)

Public health services 5,653,000 5,810,000 6,270,000

Intervention services 9,436,000 9,709,000 9,840,000

Research contracts 2,200,000 2,200,000 1,400,000

Public health operating 475,000 489,000 504,000

Audit (public health operating) 200,000

Mental health operating 475,000 489,000 504,000

Audit (mental health operating) 200,000

Total 18,239,000 19,097,000 18,518,000

5.2 2010–2013 forecast services

Based on the needs assessment and the Ministry’s assessment of future service need and requirements, the Ministry has calculated the budget requirements for the 2010–2013 period. The forecast budgets for each of the four main service lines are outlined in Table 2.

11 This document has been prepared in accordance with the Cabinet Office guidelines on GST status as

GST exclusive and in accordance with the Public Finance Amendment Act 2004 requirement that appropriations should be exclusive of GST. However, it should be noted that the costs to industry will be inclusive of GST, so the full cost including GST is 12.5 percent higher than shown in the tables.


Table 2: Problem gambling services: Ministry of Health Spend 2010–2013 (GST exclusive)

Services 2010/11 ($) 2011/12 ($) 2012/13 ($)

Public health services 6,757,795 7,090,551 6,965,362

Intervention services 8,413,180 8,549,343 8,563,730

Research contracts 2,499,073 2,224,073 1,423,000

Ministry operating costs* 957,044 978,617 1,000,839

Total 18,627,092 18,842,584 17,952,931

* Ministry operating cost increases between years are due to the cost of consultation in the 2012 calendar year.

Each budget line is discussed in more detail in section 6.

6 Existing and new services

The Ministry has grouped its services under four main budget lines. These are:

public health services

intervention services

research contracts

Ministry operating costs.

6.1 Public health services

The public health component of the Ministry’s integrated strategy to prevent and minimise gambling harm includes the following services:

primary prevention services

public health workforce development and training

problem gambling awareness and education programme

national co-ordination12

conference support13

audit.

12 Note that while the national co-ordination and conference support services represent overall sector

capacity, the nature of the services aligns with public health principles and they have been budgeted to reflect this alignment.

Table 3: Public health expenditure on problem gambling, by service area, 2010–2013 (GST exclusive)

Service 2010/11 ($) 2011/12 ($) 2012/13 ($)

Primary prevention (public health action) 4,887,795 4,985,551 5,085,262

Workforce development 120,000 120,000 120,000

Awareness and Education Programme 1,480,000 1,480,000 1,480,000

National co-ordination services 250,000 255,000 260,100

Conference support 20,000 100,000 20,000

Audit – 150,000 –

Total 6,757,795 7,090,551 6,965,362

Note: All the service areas above include provision for dedicated Māori, Pacific and Asian services and activities.

Primary prevention services

Primary prevention services include health promotion, increasing community action, raising community awareness about gambling and problem gambling, working with territorial authorities on gambling venue policies and supporting the awareness and education programme at a local and regional level. In line with the Ministry’s strategic funding principles, the Ministry will continue to fund dedicated Māori, Pacific and Asian public health services to provide appropriate and relevant services in their respective communities.

Public health workforce development and training

As noted previously, the Ministry regards public health workforce development and training as a key activity area for the 2010–2013 plan. The development of broader public health competencies and career pathways has been an ongoing activity for the public health sector for many years. Progressing this area for the problem gambling sector is timely, with the opportunity to align with Te Uru Kahikatea: The Public Health Workforce Development Plan 2007–2016, which provides a national strategic approach to public health workforce development. Workforce development and training for public health will focus on assisting staff to implement problem gambling public health programmes that are evidenced-based, accessible, easy to understand and relevant to a particular community’s needs.

Problem gambling awareness and education programme

A key foundation of the Ministry’s population-focused public health approach is to continue building public awareness and understanding of gambling harm using national media as a crucial part of the future work programme. The concept of Kiwi Lives was developed to implement the Ministry’s Problem Gambling Awareness and Education Programme. Kiwi Lives, launched in April 2007, asks New Zealanders to think and talk about the broad impacts of problem gambling on individuals, communities and families and to understand solutions that can prevent and minimise gambling harm.


The next phase of the programme builds on stages one and two of the Kiwi Lives campaign and includes a national media component, the development of resources to support public health and intervention strategies, and a continued focus on evaluating the effectiveness of the programme. The programme is also central to developing and strengthening links between national and community-level activities, promoting and destigmatising help-seeking behaviour, and working with the industry to promote harm minimisation initiatives.

National co-ordination and conference support

The national co-ordination and conference support services provide support to both the public health and intervention service capacity overall. Because the nature of these services aligns with public health principles, these services have been budgeted in this service area to reflect this alignment.

National co-ordination

The national co-ordination service provides a central point for disseminating key messages and information across the problem gambling provider sector, ensures problem gambling providers across the range of services are kept informed of significant developments, and assists collaboration among agencies involved in preventing and minimising gambling-related harm. The service also facilitates the co-ordination of training and workforce development events for all problem gambling services. For smaller providers, it facilitates networks and collegial support through hui, fono and other national events.

Conference support

This funding represents the Ministry’s contribution to a biennial international problem gambling conference held in New Zealand and an annual contribution to a national addiction and/or public health conference relevant to problem gambling. Holding an international conference in New Zealand reflects and promotes New Zealand’s role as a world leader in minimising and preventing problem gambling harm. Such a conference enables problem gambling practitioners, researchers, industry representatives and government officials from around the world to meet and exchange ideas specific to problem gambling. Those attending will benefit from exposure to international speakers. National addiction sector or wider public health conferences enable problem gambling practitioners to meet and exchange ideas with practitioners from other related sectors, and enable a wider network for the exchange of knowledge. By contributing to and making use of existing workforce development opportunities, such as conferences, the Ministry is encouraging greater addictions sector alignment. This is cost-effective and extends the skills of both alcohol and other drug and problem gambling practitioners, which will allow for greater service flexibility, particularly in smaller towns or more remote areas. The funding for national and international conference support is broken down as follows:


Table 4: Conference budget (GST exclusive)

Conference 2010/11 20011/12 2012/13

National addictions sector and/or public health conference support

$20,000 $20,000 $20,000

International problem gambling conference support – $80,000 –

Audit

The Ministry undertakes a routine three-yearly audit of problem gambling services. The audits focus on governance and financial management, data management and service quality and delivery.

6.2 Intervention services (secondary and tertiary prevention)

The Ministry’s approach to preventing and minimising gambling harm at a secondary and tertiary prevention level includes the following services:

the Helpline and web-based services

psychosocial interventions and support

the problem gambling information system

workforce development and training

audit.

Table 5: Intervention services expenditure on problem gambling, by service area, 2010–2013 (GST exclusive)

Services 2010/11 ($) 2011/12 ($) 2012/13 ($)

Helpline services 1,500,000 1,530,000 1,560,600

Psychosocial interventions and support 6,558,180 6,689,343 6,823,130

Problem gambling information system 175,000 – –

Workforce development 180,000 180,000 180,000

Audit – 150,000 –

Total 8,413,180 8,549,343 8,563,730

Note: All the services listed above include provision for dedicated Māori, Pacific and Asian services.

Helpline and web-based services

Helpline services provide a first point of contact for people experiencing gambling-related harm, either directly or as a result of a family/whānau member’s or significant other’s gambling. A 24-hour Helpline service represents a frontline first contact point for people in crisis as a result of their own or someone else’s gambling. The Helpline service also represents a public contact point for national campaigns and for general enquiries by media and interested parties.


Helpline services encompass a number of aspects of the Ministry’s service delivery model nationally, including:

provision of direct information

access by phone or other telecommunication/electronic means to intervention services for people unable to access face-to-face services

referral to other problem gambling service providers

web-based information on self-help, peer-to-peer support options and assessment guides.

The service includes dedicated Māori and Pacific and Asian phonelines, and access points for other population groups, such as youth, who present with significant need.

Psychosocial Interventions and support

Problem gambling psychosocial intervention and support services include a range of interventions delivered to individuals or groups in a variety of settings. The Ministry remains committed to improving access to services for all people adversely affected by gambling. The Ministry recognises that identifying people experiencing harm from gambling before they reach crisis is crucial to minimising the impact gambling may have on individuals and families and may lessen their need for more intensive interventions. Specialist services include assessment, a range of interventions (including brief and psychosocial, active case management, referrals and facilitation to allied health and social services) and follow-up. Family and whānau members affected by someone else’s gambling can access the same range of services as are available to those experiencing gambling harm due to their own gambling. All services are expected to be culturally safe and culturally competent. Dedicated Māori, Pacific and Asian problem gambling services will continue to be provided to ensure appropriate access and services for these population groups.

Problem gambling information system

During the 2007–2010 service plan, the Ministry commenced a data improvement programme to improve the accuracy and timeliness of the monitoring data collected from problem gambling intervention service providers, both for the purposes of contract management and for calculating the problem gambling levy. The changes made in this period resolved many of the data issues the Ministry had noted during the 2004–2007 period and has provided a good platform from which to implement ongoing improvements. In 2009 the Ministry will commence a project to further improve the client information collection (CLIC) database and transfer the operation to the Ministry for ongoing management. The project will continue into 2010/11, with the outcome being a simpler version of CLIC available to providers to support data entry workflow and electronic collection of data from provider branches. This will reduce the time and skills required to enter data and will also reduce data entry errors.


Simplifying the national CLIC database collation and management functions will enable the data collation and operational management of the national CLIC database to be performed by the Ministry. Once the transition is complete, ongoing data management costs will be incurred through the Ministry’s operational expenditure.

Intervention workforce development and training

Training and development of the problem gambling workforce will continue to be important service components to support psychosocial intervention services. A key focus for intervention workforce development over the 2010–2013 service period will be to better align the problem gambling intervention workforce with other addiction services. There is a body of research to show that alcohol and other drug problems are often an issue for those experiencing harm from gambling. A review of addiction sector competencies was initiated in 2008 to support the alignment of problem gambling workforce development with the wider addictions sector. The review explores the development of integrated base addiction treatment competencies to improve support for the addiction treatment workforce to have the essential knowledge, skills and attitudes required to deliver effective co-existing treatment services. The outcomes of the review will be implemented over the term of this service plan.

Audit

The Ministry undertakes a routine three-yearly audit of problem gambling services. The audits focus on governance and financial management, data management and service quality and delivery.

6.3 Research and evaluation

The Ministry will continue to undertake independent research in accordance with the Act, which states:

‘An integrated problem gambling strategy must include independent scientific research associated with gambling, including (for example) longitudinal research on the social and economic impacts of gambling, particularly the impacts of different cultural groups; and evaluation.’

It is important to note the clear intent of the Act to support a research agenda that is broader than specific health interests. The Ministry has considered the information needs of The Department of Internal Affairs and the wider gambling and problem gambling sector interests in developing its research agenda. The specific priorities identified by the Ministry for the 2010–2013 period are:

refining the routine collection of gambling participation and problem gambling prevalence data in the New Zealand Health Survey

enhancing the sector’s knowledge of the impact of gambling for Māori, Pacific and Asian populations


supporting the collection and analysis of longitudinal data to inform understanding of risk and resiliency factors relating to the incidence of problem gambling

aligning projects with research occurring in Australia and other international jurisdictions, where appropriate

continuing to develop the evidence informing intervention services

developing and trialling the implementation of protocols for the collection of gambling and problem gambling data in all relevant government agencies, such as the Department of Corrections, and the ministries of Justice, Housing and Social Development

supporting ongoing quality improvement in public health and intervention service delivery

continuing to support and build problem gambling research capacity in New Zealand

collecting and analysing data to inform the Ministry’s outcome and reporting programme for the gambling sector.


Table 6: Research budget totals

Service area 2010/11 ($) 2011/12 ($) 2012/13 ($) Project total ($)

2007–2010 completion 339,073 99,073 – 438,146

2010–2013 project 1,480,000 1,350,000 1,043,000 3,873,000

Outcome reporting 500,000 450,000 300,000 1,250,000

Service evaluation 180,000 325,000 80,000 585,000

Research budget total 2,499,073 2,224,073 1,423,000 6,146,146

7 Ministry of Health operating costs

Ministry operating costs (departmental expenditure) include the contract management role, ongoing policy and service development work, management of the research, monitoring and evaluation programme, and management of the CLIC database within the Ministry.

Table 7: Budget (GST exclusive)

Services 2010/11 ($) 2011/12 ($) 2012/13 ($)

Operating costs 957,044 978,617 1,000,839

Total 957,044 978,617 1,000,839



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Problem Gambling Needs Assessment

Background

The Ministry of Health is required under the Gambling Act 2003 (the Act) to undertake and consult on a problem gambling needs assessment. In previous levy periods, preparation of the needs assessment has been prepared in-house by the Ministry, but in 2008 the Ministry chose to contract out the gathering and analysis of the relevant information. This included a literature review, updating the Ministry’s problem gambling geography, a review of Ministry-contracted research and an analysis of prevalence and presentation data and findings from the first stages of the Ministry’s evaluation of problem gambling services. The result, Informing the 2009 Problem Gambling Needs Assessment: Report for the Ministry of Health, has been the key document informing the 2009 problem gambling needs assessment. It is available on the Ministry’s website, in the problem gambling section. Additional information has also been incorporated where it has become available after the report was finalised. Key findings from the problem gambling section of the 2006/07 New Zealand Health Survey are included as part of this needs assessment. The full publication, A Focus on Problem Gambling: Results of the 2006/07 New Zealand Health Survey is available on the Ministry of Health’s website. The New Zealand Health Survey is a significant piece of Ministry of Health research, surveying some 12,500 people across New Zealand, with increased sampling of Māori, Pacific and Asian peoples to ensure sufficient sample sizes for these groups. It is recommended that this needs assessment document be read in conjunction with Informing the 2009 Problem Gambling Needs Assessment: Report for the Ministry of Health and A Focus on Problem Gambling: Results of the 2006/07 New Zealand Health Survey. Both are large documents and for this reason have not been published with the Ministry’s problem gambling consultation documents.

Summary of service demand, 2007 and 2008 calendar years

Demand for services in 2007 and 2008 differed markedly, with demand fluctuating for both Helpline and intervention services. The 2008 calendar year was notable for the sizeable increase in client numbers. Although much of this increase is attributable to an increased emphasis on brief interventions by service providers, there was also a 12 percent rise in full interventions from 2007 to 2008. Other relevant data is listed below.

2007

A total of 5168 clients received face-to-face problem gambling intervention services in 2007, 3930 of whom are classed as total full clients (ie, excluding brief and early intervention clients). This represents a slight increase from total full clients presenting to face-to-face intervention services in 2006 (3895).

Problem gambling service-user statistics showed a 9.8 percent increase in new clients from 2006 to 2007 for the Gambling Helpline, although visits to the website decreased by 35 percent in the same period.

Non-casino gaming machines (NCGMs) continued to be the primary mode of problem gambling cited by new clients (75.6 percent of new Helpline clients and 66.8 percent of new face-to-face intervention clients).

2008

Although the Ministry made changes at the start of 2008 to the way presentations are defined, these changes were minor, and when comparing 2007 and 2008 data using identical definitions a 33 percent increase in 2008 to 7388 clients is evident, with a 12 percent increase in full interventions.

Gambling Helpline data for 2008 showed a 25 percent decrease in both new and repeat clients – from 8303 in 2007 to 6290 callers. Visitors to the Gambling Helpline website (www.gamblingproblem.co.nz) increased from 67,891 in 2007 to 70,827 in 2008.

NCGMs continue to be the primary problem gambling mode represented in presentation data. Around 80 percent of gambler callers to the gambling Helpline and 64 percent of clients presenting to face-to-face services cited NCGMs as the primary gambling mode in 2008.

Current intervention service provision is meeting demand for services. This is a key priority for the Ministry’s funding of problem gambling services.

Problem gambling and demographic factors

Ethnicity

The ethnic breakdown of clients to both intervention and helpline services reflects the disproportionate impact of problem gambling on Māori and Pacific populations and continues the trends noted in previous needs assessments. Both Māori and Pacific peoples are disproportionately over-represented in presentation data for intervention services, with Māori significantly over-represented at 44 percent of intervention service clients and 38 percent of Helpline gambler callers. Pacific people are over-represented to a lesser degree, at 8 percent of intervention service clients and 10 percent of Helpline gambler callers. (Māori comprise 14 percent of the population and Pacific peoples 6.6 percent, according to the 2006 census.) Although the disproportionate level of presentations for Māori is of concern in as much as it indicates a continued strongly disproportionate negative effect of gambling, the high level of service use by Māori is encouraging from a service uptake perspective. Presentation rates for Asian peoples remain comparatively low but warrant further attention to ensure the population subgroups within this category are being reached by public health activities.


http://www.gamblingproblem.co.nz/

Geography

The gambling/problem gambling geographical analysis confirmed findings of previous needs assessments, showing people living in more deprived areas are at greater risk of developing problems with gambling. Fifty-six percent of all NCGM expenditure occurred in census area units with a deprivation decile rating of 8 or above, and Māori and Pacific peoples are over-represented in these deciles, suggesting they are more likely to be affected. Although there were fewer NCGMs overall (19,856, a decrease of 9 percent from 2005), they continue to be concentrated in more deprived areas. Like NCGM venues, New Zealand Racing Board and New Zealand Lotteries Commission outlets were also concentrated in high deprivation areas.

Summary: profile of people experiencing gambling problems

People aged 35–44 years had a high prevalence of problem gambling (1.2 percent).

Māori and Pacific adults were approximately four times more likely to be problem gamblers compared to the total population, after adjusting for age.

The prevalence of problem gambling was higher for adults living in neighbourhoods of high deprivation than for adults living in neighbourhoods of low deprivation, after adjusting for age.

Socio-demographic factors that were found in regression analysis to be significantly associated with problem gambling included:

– being aged 35–44 years

– identifying as being of Māori or Pacific ethnicity

– having fewer educational qualifications

– living in areas of higher neighbourhood deprivation.

Problem gambling and health

Problem gambling is associated with higher levels of smoking, depression, hazardous alcohol consumption and poorer self-rated health. Of note is the high level of health or allied health service usage by those with gambling problems. On the face of it, these high rates of usage, particularly of general practitioners, present an opportunity for better screening and earlier intervention for those in need and is an area warranting further investigation. Following is a brief overview of the relationship between problem gambling and health from the 2006/07 New Zealand Health Survey.

Compared to people with no gambling problems, and after accounting for possible confounding factors, problem gamblers had:

– 3.73 times the odds of being a current smoker

– 5.20 times the odds of having a hazardous drinking behaviour.


Problem and moderate-risk gamblers were more likely to have a high or very high risk of an anxiety or depressive disorder compared to people with no gambling problems.

Problem gamblers were more likely to have worse self-rated health compared to people with no gambling problems.

Nine in ten (91.6 percent) problem gamblers had visited a general practitioner in the last 12 months, compared to eight in ten people with no gambling problems (81.2 percent).

One in six problem gamblers (17.0 percent) had visited a psychologist, counsellor or social worker in the past 12 months, compared to 3.4 percent of people with no gambling problems.

Gambling and problem gambling in New Zealand

Changes in the gambling environment

There have been some significant developments during the 2007–2010 service period, with new technologies, the introduction of an electronic monitoring system (EMS) for NCGMs, an online avenue for lottery sales, and a significant decrease in the number of NCGMs being key features of the changed landscape. So far Internet gambling has featured low in both participation and presentation data. However, the continued rise in the popularity and coverage of poker, the Government’s move to increase Internet speed and capacity, and Internet gambling patterns from overseas jurisdictions suggest that an increase in online gambling is plausible. It is worth noting that 6.6 percent of problem gambling intervention service clients in 2008 cited ‘other’ as their primary problem gambling mode, a category that includes Internet gambling. Further investigation into what comprises gambling modes recorded as ‘other’ is warranted.

Prevalence in the past 12 months

Information about the prevalence of problem gambling was gathered as part of the New Zealand Health Survey 2006/07, which found that 1 in 58 adults (1.7 percent) were experiencing either problem (0.4 percent) or moderate-risk (1.3 percent) gambling. For those who had gambled in the past 12 months, the prevalence was 0.6 percent (15 years and over) with an additional 2 percent of adults identified as moderate-risk gamblers. This represents 1 in 40 past-year gamblers who were either problem or moderate risk gamblers in New Zealand. This is in contrast with the 2006/07 Gaming and Betting Activities Survey, which found that 9 percent of adults had gambled to a harmful level during the last 12 months. However, some caution should be used when comparing the two surveys because different measures of gambling harm were used. The 2006/07 New Zealand Health Survey also found the following for gambling behaviour in the preceding 12-month period.



Two in every three adults (65.3 percent) had gambled in the last 12 months.

The gambling activities most widely participated in by adults during the previous 12 months were:

– Lotto (55.2 percent)

– Instant Kiwi (26.5 percent)

– NCGMs (10.2 percent)

– track betting (8.7 percent)

– casino gaming machines (7.7 percent).

Among people aged 15–17 years, one in four (25.3 percent) had gambled in the last 12 months and one in six (17.5 percent) had played Instant Kiwi or other scratch tickets in the last 12 months, despite it being illegal for people younger than 18 years to purchase Instant Kiwi in New Zealand.

From 2002/03 to 2006/07 there was a decrease in overall past-year gambling participation, and a decrease in past-year participation in the following activities: Lotto, Instant Kiwi, NCGMs, track betting and Keno (not in a casino). There was an increase in past-year sports betting.

People experiencing harm from gambling

The 2006/07 New Zealand Health Survey found the following for harmful gambling experiences.

Overall, 2.8 percent of people aged 15 years and over had experienced problems in the last 12 months due to someone’s13 gambling, representing about 87,000 adults.

A large proportion of adults who had experienced problems due to someone’s gambling in the last 12 months reported that the problems were due to gaming machines – either NCGMs (53.0 percent) or casino gaming machines (33.0 percent).

Of those people who had experienced problems in the last 12 months due to someone’s gambling, approximately 20 percent had not gambled in the last 12 months, 55 percent were recreational gamblers with no reported gambling problems, and 25 percent were either low-risk, moderate-risk or problem gamblers.

There was a higher prevalence of experiencing problems due to someone’s gambling among Māori adults, Pacific adults and people living in neighbourhoods of high deprivation.

Gambling expenditure

Total gambling expenditure by players (player losses) on the four main types of recorded gambling activity (racing, New Zealand Lotteries Commission, NCGMs and casinos) increased every year between 1984 and 2005, before dropping slightly in 2005/06 to $1.977 billion. Increases were again seen in 2006/07 and in 2007/08, when gambling expenditure increased by 0.71 percent from $2.020 billion to $2.034 billion (which represents a 2.8 percent rise between 2005/06 and 2007/08).

13 ‘Someone’ can include oneself, if one is a gambler.


Table 8 shows gambling expenditure statistics for 2006–2008 in actual dollars (non-inflation adjusted) for the four main types of recorded gambling activity. It shows that expenditure is highest for NCGMs, followed by casinos, then lottery products and racing.

Table 8: Gambling expenditure, 2006–2008

Gambling venue 2006 $ m

2007 $ m

2008 $ m

Gaming machines (outside casinos) 906 950 938

Casinos 493 469 477

NZ Lotteries Commission 321 331 346

Racing 258 269 273

Total 1977 2020 2034

Source: Gambling Expenditure Statistics, The Department of Internal Affairs (2009).

Conclusions

A range of information sources and research indicates that problem gambling continues to be a social and health issue in New Zealand, with an estimated 87,000 adults experiencing problems due to someone’s gambling in the last 12 months. Although these numbers are relatively small compared to the estimated number of adults with hazardous drinking behaviour (551,300) or who are current smokers (619,900),14 there is still a burden of gambling-related harm in New Zealand communities. Service coverage currently addresses both geographic and 24-hour/seven day availability, either through face-to-face or telephone coverage. Key ongoing issues include:

the disproportionate levels of harm experienced by Māori and Pacific people

the effects of higher levels of exposure to gambling products – and how to mitigate them – for people living in more deprived areas

high rates of co-morbidities among problem gamblers, and correspondingly high usage of health and allied health services, and the opportunities these present

an anticipated increase in Internet-based gambling and associated problems – further investigation into Internet gambling activity in New Zealand may help prevent or promptly address any emerging issues as this mode evolves

14 Ministry of Health. 2008a. A Portrait of Health: Key Results of the 2006/07 New Zealand Health

Survey. Wellington: New Zealand.

high rates of youth involvement in gambling on New Zealand Lotteries Commission Instant Kiwi-type products, highlighted in the 2006/07 New Zealand Health Survey – this may warrant further investigation, including issues relating to access and the ongoing impact of exposure to this type of gambling

the uncertainty around patterns of gambling behaviours during recessionary periods, which complicates estimating future gambling activity and behaviour.



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Problem Gambling Levy Calculations

Background

Problem gambling services are funded and co-ordinated by the Ministry of Health. The problem gambling levy is collected on the profits of the gambling industry (player expenditure) and reimburses the Crown for the costs of delivering problem gambling services, ensuring they are fiscally neutral to the Crown. The problem gambling levy is set under the Gambling Act 2003. The purpose of the levy is ‘to recover the cost of developing, managing, and delivering the integrated problem gambling strategy’ (section 319[2]). The problem gambling levy is collected on the profits of New Zealand’s four main gambling sectors:

non-casino gaming machine (NCGM) operators

casinos

the New Zealand Racing Board

the New Zealand Lotteries Commission. The formula used for calculating the levy rate for each sector is specified in the Gambling Act 2003 (section 320). The levy is calculated using rates of player expenditure (losses) on each gambling sector and rates of client presentations to problem gambling services attributable to each gambling sector. The levy rates are set every three years. The next period is from 1 July 2010 to 30 June 2013.

Process for calculating the levy

The process for calculating the levy is contained in the Gambling Act 2003 (the Act). As part of this process, the Ministry of Health has undertaken a needs assessment, outlined the funding required to implement the first three years of the six-year Preventing and Minimising Gambling Harm Strategic Plan 2010–16 (the strategic plan) and proposed the problem gambling levy calculation. The Ministry is now consulting on the draft strategic plan for 2010–2016, the needs assessment, the draft service plan for 2010–2013, and this proposed levy calculation. Following consultation, the Ministry will submit proposals to the Ministers of Health and Internal Affairs, and to the Gambling Commission. The Gambling Commission will then undertake its own consultation and make recommendations to the Ministers of Health and Internal Affairs. Cabinet will make the final decision on the funding appropriated to the Ministry of Health and will recommend to the Governor-General the levy amount and the rates it considers appropriate.

Levy formula and definitions

The formula for calculating the levy provides a mechanism for allocating among gambling operators, and collecting from them, the approximate cost of developing,

managing and delivering the services required to implement the first three years of the strategic plan. The Act specifies that the Ministry ‘must take into account the latest, most reliable, and most appropriate sources of information’ to use in the formula for calculating the levy. The levy formula figures used below are 1 April 2008 to 31 March 2009 figures. However, to ensure compliance with the Act, these figures should be considered indicative only, as they will be updated following the consultation process to include more recent data.

Expenditure

Player expenditure in the casino, the New Zealand Racing Board and the New Zealand Lotteries Commission gambling sectors has been supplied by Inland Revenue and is subject to tax confidentiality. Public figures on levels of gambling expenditure are available on The Department of Internal Affairs’ website.

Presentations (people seeking problem gambling assistance)

Figures on problem gambling presentations were generated by the Ministry of Health from data collected by problem gambling intervention service providers. Presentation figures relate to all clients who received a full facilitation or follow-up problem gambling intervention session during 1 April 2008 to 31 March 2009. Brief interventions have not been included as presentations due to the nature of the contact with the client and because the current problem gambling harm screens used in brief interventions were only introduced in July 2008.

Forecast expenditure

The current climate of economic uncertainty has made forecasting expenditure levels for four years into the future difficult. It remains to be seen what effect the economic downturn will have on New Zealand and whether gambling will contract or people will turn to gambling, or at least some forms of gambling, as a perceived way out of difficulty. In projecting player expenditure in each part of the gambling sector, the following matters have been taken into account.

Non-casino gaming machines

Spending in this sector dropped from $950 million in 2007 to $938 million in 2008. More recent electronic monitoring system data suggests this drop is continuing. The number of gaming machines is also continuing to decline. There were 20,182 NCGMs in December 2007 and 19,739 in March 2009. The introduction of player information displays (PIDs) on all gaming machines from 1 July 2009 may lead to a further decline in machine numbers, particularly in small clubs, and may also have an impact on spending on NCGMs. In addition, territorial authority venue policies in major centres do not seem conducive to growth, although there is no direct relationship between gaming machine numbers and expenditure. The Ministry of Health, in consultation with The Department of Internal Affairs and Inland Revenue, has considered a proposal to split the non-casino gaming machine


sector into two separate gambling sectors, gaming machines in pubs and gaming machines in clubs, for the purpose of calculating and collecting the 2010–2013 problem gambling levy. This issue was raised by the Gambling Commission New Zealand in its 2006 report to Ministers on the 2007–2010 problem gambling levy. However, there are significant difficulties with implementing the proposal, including increased fiscal and administration costs for the Government, and therefore it is not a viable option for the immediate future.

Casinos

Casino spending increased from $469 million in 2007 to $477 million in 2008, but may have been limited by the refurbishment of SKYCITY Auckland’s gaming floor. There are indications of growth in casino gaming machine expenditure following the recent popularity of table games, which was fuelled partly by the worldwide popularity of poker. Overseas, information has suggested that the resilience casinos have shown in the past to economic conditions may be at an end. However, this information is derived from destination casinos, which constitute a small percentage of the casino sector in New Zealand. Modest growth can be expected during the period of the proposed levy.

New Zealand Racing Board

Historically, gambling on New Zealand Racing Board products has shown annual growth of about 2.5 percent. While there are indications that the current economic conditions are having a negative impact on betting expenditure, it is not expected that there will be a substantial change to the amount that people gamble at the TAB.

New Zealand Lotteries Commission

Spending on New Zealand Lotteries Commission products has shown considerable volatility and appears to be most influenced by the number of large jackpots in any given period. While the number of large jackpots is determined by chance, the introduction of Big Wednesday and changes to Powerball have increased the likelihood of large jackpots. However, overseas experience suggests that lottery markets mature and that more modest growth can be expected for the period of the proposed levy.

Weightings

For the 2007/08–2009/10 levy period, a weighting of 10 percent on expenditure and 90 percent on presentations has been applied to determine the relative shares for each gambling sector. For the 2010/11–2012/13 levy period the Ministry of Health proposes a weighting of 30 percent on expenditure and 70 percent on presentations. The Ministry considers the levy rates should continue to apply a heavier weighting to presentations over expenditure because presentations are a reasonable indicator of the proportion of responsibility each gambling sector should carry for the individual harm of problem gambling occurring in New Zealand.


Evidence for this can be found by comparing the similar distribution of gambling harm shown through the presentation figures with other national studies and surveys, such as the 2006/07 New Zealand Health Survey, the 2006/07 Gaming and Betting Activities Survey, and the Assessment of the Social and Economic Impacts of Gambling in New Zealand. A presentation represents an individual who has been harmed, by either their own or someone else’s gambling, and has sought help at a problem gambling service. This harm is directly attributable to a gambling sector through the recording of the primary gambling modes cited by clients. The Ministry recognises, however, that intervention service presentations only represent part of the picture. Gambling expenditure also needs to be considered. The Ministry believes that gamblers’ expenditure in each gambling sector also represents the degree of responsibility of the respective industry for the broader harm likely to be occurring in communities. The Ministry has proposed an increased weighting on expenditure to 30 percent, from the 10 percent weighting in 2006/07–2009/10 levy period, for the following reasons.

Presentations do not encompass all the harms that can result from gambling

The Gambling Act’s definition of gambling harm is very broad. It recognises that harm occurs on an individual, family and societal level and that the range of possible harms arising from gambling is a complex aggregate of issues. These issues can include:

diversion of funding from high deprivation communities

the effects of criminal and anti-social behaviour

direct and indirect impacts on family, whānau, employers and other associates of gamblers

direct financial, legal, health and/or social consequences for individuals who gamble, ranging from poor mental and/or physical health to social isolation and suicide.

Presentations only represent a small subset of gambling harm, as they are a measure of the demand on problem gambling intervention services from each sector of the gambling industry, and tend to represent the more severe end of the problem gambling spectrum (research has found that help-seeking for a gambling problem is primarily associated with a crisis event). Analysis of the gap between the estimated problem gambling prevalence in New Zealand and problem gambling intervention client data indicates that only a small proportion of problem gamblers seek formal help for their gambling problems.

It better reflects the fact that the funding is not only for problem gambling treatment services but for a broader public health approach for which all gambling sectors should be responsible

The Act requires that the integrated problem gambling strategy focus on public health and include measures to promote public health and prevent and minimise the harm from problem gambling. The Ministry, therefore, funds public health services – including



public awareness media campaigns – to raise awareness of problem gambling, promote safe gambling practices, and encourage early help-seeking behaviour. The integrated problem gambling strategy must also include a programme of independent scientific research associated with gambling. All gambling sectors bear some responsibility for funding this research. Overall, the Ministry of Health considers a weighting of 30 percent on expenditure and 70 percent on presentations to be an appropriate balance for the 2010/11–2012/13 levy period. Other options are 10:90 or 20:80 expenditure:presentation weightings. The higher the weighting placed on presentations, the higher the amount of levy that must be paid by the gambling sectors recording the highest numbers of problem gambling service clients citing their products as a primary problem gambling mode. The higher the weighting placed on expenditure, the higher the amount of levy that must be paid by the gambling sectors that players spend the most money on. The Ministry is presenting information here on the 10:90, 20:80 and 30:70 weighting options and is seeking feedback through this consultation process on which option is preferred and why.

Levy calculations15

The tables that follow set out the Ministry of Health’s proposed costs for delivering the first three years of the strategic plan, and allocate those costs to each gambling sector, weighted as outlined in the three options above. The formula for calculating the levy rate is:

Levy rate = ((A x W1) + (B x W2)) x C D where:

A = estimated current expenditure in a sector, divided by the total estimated current player expenditure in all sectors subject to the levy

B = the number of customer presentations to problem gambling services that can be attributed to gambling in a sector, divided by the total number of customer presentations to problem gambling services in which a sector that is subject to the levy can be identified

C = the funding requirement for the period for which the levy is payable, taking into account any under-recovery or over-recovery in the previous levy period

D = forecast player expenditure in a sector for the period during which the levy is payable.

W1 and W2 are weights, the sum of which is 1.

15 Inland Revenue will provide information to The Department of Internal Affairs and Ministry of Health

relating to the gaming duty paid by gaming operators. The Tax Administration Act 1994 requires both agencies to maintain the secrecy of the information received.

Please note that there is currently a Gambling Amendment Bill (No. 2) before Parliament. While this Bill proposes a change to the levy formula, the public consultation is proceeding on the basis of the formula as it currently exists in the statute.

Over-strike and under-recovery in the previous levy period

In calculating the amount of C (the funding requirement for the period for which the levy is payable) in the levy formula, the Gambling Act (section 320) provides that any under-recovery or over-recovery of levy in the previous period (2007–2010) must be taken into account. Because the 2007–2010 levy period has not yet finished, a forecast of the levy collection is required. The Department of Internal Affairs has forecast an under-recovery of $1,792,456 (GST exclusive) for the 2007–2010 period. This figure must be added to the funding requirement for the 2010–2013 levy period (see Table 11 below). There are a number of reasons for the under-recovery:

forecast expenditure levels for casinos and non casino gaming machines were not achieved

there was a better than expected performance by the New Zealand Lotteries Commission due to the introduction of new products

changes to the definition of player expenditure for Racing resulted in an increase in the amount that the levy is paid on.

In calculating the amount of C in the levy formula, it is also necessary to take into account the Ministry of Health’s forecast spending towards implementing the integrated problem gambling strategy in the 2007–2010 levy period. The Ministry has forecast an under-spend of $2,175,000 (GST exclusive) for the 2007–2010 period. This figure must be subtracted from the funding requirement for the 2010–2013 levy period (see Table 11 below). It is also necessary to account for any actual levy collection and Ministry spending for the 2004–2007 levy period, over or below what was forecast when the 2007–2010 levy was calculated. In the 2004–2007 levy period, an additional $347,060 (GST exclusive) levy funding was collected from what was forecast, and the Ministry of Health spent $893,000 (GST exclusive) less than was forecast. The additional levy collect and under-spend are added to give a total $1,240,060 (GST exclusive) over-strike in the 2007–2010 period, which is subtracted from the funding requirement for the 2010–2013 levy period (see Table 11 below).

Table 9: Sector share of presentations, April 2008–March 2009


Casinos New Zealand Racing Board

NZ Lotteries Commission

Sector share 0.71 0.19 0.07 0.03


Table 10: Forecast expenditure by sector (GST inclusive)

Forecast expenditure




2010/2011 ($M) 882.2673 465.4774 280.8198 381.5496

2011/2012 ($M) 881.0750 474.7870 287.8403 389.1806

2012/2013 ($M) 879.8950 484.2827 295.0363 393.0724

Table 11: Problem gambling funding requirement (taking into account forecast under-recovery, under-spend, and over-strike in the 2007–2010 levy period)

Problem gambling funding requirement $ (GST exclusive)

2010/11 $18,627,092

2011/12 $18,842,584

2012/13 $17,952,931

Subtotal $55,422,607

Plus forecast under-recovery from 2007–2010 levy period $1,792,456

Less forecast Ministry of Health under-spend from 2007–2010 levy period ($2,175,000)

Less over-strike due to additional under-spend from forecast ($893,000), and additional levy collect from forecast ($347,060), for the 2004–2007 levy period

($1,240,060)

Total funding requirement for 2010–2013 $53,800,003

Table 12: Proposed problem gambling levy rates for gambling sectors – 10/90 weighting

Collection period starts 1 July 2010 All GST exclusive

Non-casino gaming

machines



Sector levy rates (%) 1.38 0.72 0.50 0.23

Expected levy ($ million) 36.4767 10.2567 4.3185 2.6767



Non-casino gaming

machines







Non-casino gaming

machines






Discussion of Regulatory Impact Analysis Elements

What is problem gambling?

While most people do not experience problems resulting from their gambling, it can cause harm for some people. Section 4 of the Gambling Act 2003 (the Act) defines gambling-related harm. In this context, harm: (a) means harm or distress of any kind arising from, or caused or exacerbated by, a

person’s gambling; and (b) includes personal, social, or economic harm suffered –

(i) by the person; or (ii) by the person’s spouse, civil union partner, de facto partner, family, whanau,

or wider community; or (iii) in the workplace; or (iv) by society at large.

What are the impacts of problem gambling?

The impacts of problem gambling can be very broad, ranging from relatively mild to very severe. A 2001 report, What Do We Know about Gambling and Problem Gambling In New Zealand (http://www.dia.govt.nz/Pubforms.nsf/URL/Report7.pdf/$file/Report7.pdf), notes that:

‘gambling problems exist on a continuum. A significant minority of people experience one or a few problems that are often transient, a smaller number experience more serious problems that vary in duration, and a smaller number still have very serious problems that are often chronic or chronically relapsing. For people at the severe end of the continuum, the consequences of their problems are devastating for themselves and often for others in their lives. They not infrequently lead to serious psychological disturbance, relationship breakups, financial ruin, criminal offending, imprisonment and suicide.’ (Abbott 2001)

What is the prevalence of problem gambling?

New Zealand research suggests that, at any given time, between 0.3 percent and 1.8 percent of adults living in the community in New Zealand are likely to score as ‘problem gamblers’ on standard questionnaires. This conclusion is largely derived from three large surveys, using different questionnaires, over a period of eight years (Abbott and Volberg 2000; Ministry of Health 2006, 2008a). The most recent of these surveys, the 2006/07 New Zealand Health Survey (http://www.moh.govt.nz/moh.nsf/indexmh/portrait-of-health), returned the lowest estimate (0.4 percent of the total adult population, which equates to about 13,000 people), but this may be because of the questionnaire used rather than because the prevalence of problem gambling has declined.


http://www.dia.govt.nz/Pubforms.nsf/URL/Report7.pdf/$file/Report7.pdf

http://www.moh.govt.nz/moh.nsf/indexmh/portrait-of-health

Who else is affected by problem gambling?

There are also a number of people who are at risk of becoming problem gamblers. The 2006/07 New Zealand Health Survey indicated that approximately 1.3 percent of the total adult population, or 43,000 people, are at moderate risk of their gambling becoming a problem, and 3.5 percent, or 115,000 people, are at low risk of their gambling becoming a problem. In addition to the estimated numbers of problem gamblers in New Zealand, there are also a significant number of people who are harmed by someone else’s gambling. A recent New Zealand study, Problem Gambling: Barriers to help seeking behaviours (http://www.moh.govt.nz/moh.nsf/indexmh/problemgambling-research-implementation0407-barriers), which also reviewed a range of research, concluded that ‘each problem gambler is likely to directly affect at least five other people ... These estimates are thought to be conservative’ (Bellringer et al 2008b). New Zealand’s 2006/07 Gaming and Betting Activities Survey (http://www.ourproblem.org.nz/content/research-and-information-students) noted that around 16 percent of adults reported someone in their wider family household going without something they needed or bills being unpaid because someone spent too much money on gambling. The 2006/07 New Zealand Health Survey (http://www.moh.govt.nz/moh.nsf/indexmh/portrait-of-health) estimated that 2.8 percent of adults (around 87,000 adults) had experienced problems due to someone’s gambling in the year before the survey.

What are the economic costs and benefits of gambling?

Quantifying the costs and benefits of gambling is extraordinarily difficult. Analyses of gambling’s economic benefits often do not factor in its social costs and the displacement of other retail activities. Analysing the costs of gambling is also problematic. Some costs would persist in any realistic alternative regime; it is difficult to separate social and personal costs; it is extremely difficult to put a dollar figure on some impacts (emotional distress, for example); and gambling may confer net national benefits while imposing very significant and disproportionate costs on some section of the community.

What are the wider affects of problem gambling on society?

Research has found a number of factors that are associated with problem gambling, including socioeconomic deprivation, low income, ethnicity, co-morbidities and crime. It is important to note, however, that the factors found to be associated with problem gambling are not necessarily causally linked with problem gambling.

Deprivation

People living in high-deprivation neighbourhoods are more exposed to gaming machines and TABs and are more likely than people living in other neighbourhoods to be problem gamblers and to suffer gambling-related harm. This is indicated by the following research findings.


http://www.moh.govt.nz/moh.nsf/indexmh/problemgambling-research-implementation0407-barriers

http://www.moh.govt.nz/moh.nsf/indexmh/problemgambling-research-implementation0407-barriers

http://www.ourproblem.org.nz/content/research-and-information-students


The 2006/07 New Zealand Health Survey (http://www.moh.govt.nz/moh.nsf/indexmh/portrait-of-health) found that the prevalence of problem gambling increased as neighbourhood deprivation increased, from zero prevalence in neighbourhoods of low deprivation to 1.2 percent of people living in neighbourhoods of high deprivation.

The 2002/03 New Zealand Health Survey (http://www.moh.govt.nz/moh.nsf/49ba80c00757b8804c256673001d47d0/3d15e13bfe803073cc256eeb0073cfe6) found that problem gambling rates were higher in the 20 percent of most deprived areas compared with the 20 percent of least deprived areas.

The data from the 2002/03 New Zealand Health Survey was used to complete further analysis, Raising the Odds? Gambling behaviour and neighbourhood access to gambling venues in New Zealand (http://www.moh.govt.nz/moh.nsf/indexmh/raising-the-odds?Open) established that people who lived in neighbourhoods closer to gambling venues were more likely than people who lived in neighbourhoods furthest from gambling venues to be problem gamblers who had gambled at a gambling venue in the previous year (Ministry of Health 2008b).

Recent research has found that Class 4 gaming machines and TABs are far more likely to be found in more deprived areas than in less deprived areas (Ministry of Health 2006a).

The 2006/07 Gaming and Betting Activities Survey (http://www.ourproblem.org.nz/content/research-and-information-students) found that people in deprived areas were more likely to report harm in the wider family or household than people in less deprived areas.

Low income

The 1999 New Zealand National Prevalence Survey (http://www.dia.govt.nz/diawebsite.nsf/wpg_URL/Resource-material-Our-Research-and-Reports-New-Zealand-Gaming-Survey?OpenDocument#two) found that low-income groups spent proportionately more of their household incomes on gambling and that gambling harm disproportionately affected low-income New Zealanders (Abbott and Volberg 2000).

Ethnicity

Māori and Pacific peoples are more likely than other groups to be problem gamblers, and are more likely to suffer gambling-related harm. This is indicated by the following research findings. The 1999 New Zealand National Prevalence Survey

(http://www.dia.govt.nz/diawebsite.nsf/wpg_URL/Resource-material-Our-Research-and-Reports-New-Zealand-Gaming-Survey?OpenDocument#two) estimated that while Māori and Pacific peoples formed less than 20 percent of the general population, they made up 44 percent of problem gamblers. It also estimated that Māori were 4.5 times more likely than the general population to be problem gamblers and Pacific people 6.2 times more likely.

The 2006/07 New Zealand Health Survey (http://www.moh.govt.nz/moh.nsf/indexmh/portrait-of-health) estimated that Māori



http://www.moh.govt.nz/moh.nsf/49ba80c00757b8804c256673001d47d0/3d15e13bfe803073cc256eeb0073cfe6

http://www.moh.govt.nz/moh.nsf/49ba80c00757b8804c256673001d47d0/3d15e13bfe803073cc256eeb0073cfe6

http://www.moh.govt.nz/moh.nsf/indexmh/raising-the-odds?Open

http://www.moh.govt.nz/moh.nsf/indexmh/raising-the-odds?Open


http://www.dia.govt.nz/diawebsite.nsf/wpg_URL/Resource-material-Our-Research-and-Reports-New-Zealand-Gaming-Survey?OpenDocument#two





and Pacific adults were 3.5 times more likely than adults in the total population to be problem gamblers. The survey also estimated that 7.0 percent of Māori and 7.6 percent of Pacific people experienced problems in the previous year due to someone’s gambling, compared with 2.1 percent of Europeans/Others.

The 2006/07 Gaming and Betting Activities Survey (http://www.ourproblem.org.nz/content/research-and-information-students) found that Māori and Pacific people were more likely to report problematic gambling behaviour and were more likely to report harm in the wider family or household than European/Other people. In particular, 38 percent of Māori and 28 percent of Pacific people reported someone in their wider family household going without something they needed, or bills being unpaid, because someone spent too much money on gambling, compared with 13 percent of the Asian group and 12 percent of European/Other people.

Class 4 gaming machines pose particular risks for Māori and Pacific people, especially women. This is indicated by the following research findings. The 2005 Participation and Attitudes Survey

(http://www.dia.govt.nz/diawebsite.nsf/wpg_URL/Resource-material-Our-Research-and-Reports-Participation-in-Gambling?OpenDocument) indicated that Māori played Class 4 gaming machines more often than other ethnic groups, had longer sessions, spent more and were more likely to believe (probably mistakenly) that they had won or broken even overall. These are all risk factors for problem gambling. In addition, men reported playing Class 4 gaming machines more often, but women played for longer, spent more and were more likely to believe they had won or broken even overall.

The 2006/07 Gaming and Betting Activities Survey (http://www.ourproblem.org.nz/content/research-and-information-students) found that women were more likely than men to play Class 4 gaming machines regularly and Māori and Pacific people were more likely than Asian people and European/Other people to play regularly.

The 2007 Problem Gambling Service-User Statistics (http://www.moh.govt.nz/moh.nsf/indexmh/problem-gambling-intervention-2007) found that 78.7 percent of new female clients of the face-to-face intervention services received help for problems associated with Class 4 gaming machines compared with 57.7 percent of new male clients. Furthermore, although Māori women make up only a small percentage of the female population, there were almost as many Māori women clients as New Zealand European/Pākehā women citing problems with casino and Class 4 gaming machines.

Co-morbidities

Problem gamblers have disproportionate rates of psychiatric disorders, smoking addictions and alcohol and drug addictions. This is indicated by the following research findings. A Review of Research on Aspects of Problem Gambling

(http://www.rigt.org.uk/documents/a_review_of_research_on_aspects_of_problem_ gambling_auckland_report_2004.pdf) completed by the Auckland University of



http://www.dia.govt.nz/diawebsite.nsf/wpg_URL/Resource-material-Our-Research-and-Reports-Participation-in-Gambling?OpenDocument

http://www.dia.govt.nz/diawebsite.nsf/wpg_URL/Resource-material-Our-Research-and-Reports-Participation-in-Gambling?OpenDocument


http://www.moh.govt.nz/moh.nsf/indexmh/problem-gambling-intervention-2007

http://www.rigt.org.uk/documents/a_review_of_research_on_aspects_of_problem_

Technology, found that ‘some mental disorders are highly comorbid with pathological gambling. There is a large body of research, including methodologically sound general population studies, indicating particularly high comorbility with alcohol and other substance abuse disorders’.

The Queensland Household Gambling Survey 2006–07 (http://www.olgr.qld.gov.au/resources/responsibleGamblingDocuments/queensland HouseholdGamblingSurvey0607.pdf) found that nearly half of low, moderate and problem gamblers had reported gambling under the influence of alcohol or illegal drugs in the past 12 months; that two-thirds of problem gamblers were smokers and that problem gamblers had high rates of personal mental health issues.

The authors acknowledge, however, that ‘it is not apparent whether associated psychological states or comorbid disorders precede, develop in conjunction with, or occur subsequent to the development of problem gambling’ (Abbott et al 2004).

Crime

A recent study, Problem Gambling: Formative investigation of the links between gambling (including problem gambling) and crime in New Zealand, (http://www.moh.govt.nz/moh.nsf/indexmh/problemgambling-research-implementation0407-crime) found that ‘gamblers and significant others believe that a relationship exists between gambling and crime’, and that ‘there is substantial unreported crime, a large proportion of which is likely to be related to gambling and that there are a large range of crimes committed in relation to gambling (particularly continuous forms of gambling), and not just financial crimes’ (Bellringer et al 2008a).

How does the Gambling Act 2003 address problem gambling?

The Gambling Act 2003 (the Act) provides that the Government may allocate responsibility for an integrated problem gambling strategy to a department, which need not be the department responsible for the Act. The Ministry was allocated responsibility for the funding and co-ordination of problem gambling services. The Act requires the development of an integrated problem gambling strategy focussed on public health (prevention), which must include:


services to treat and assist problem gamblers and their families and whānau independent scientific research associated with gambling evaluation.

The cost of developing, managing and implementing the integrated problem gambling strategy is funded by an appropriation to the Ministry of Health. The problem gambling levy is collected on the profits (player expenditure) of the gambling industry and reimburses the Crown for the appropriation, ensuring that these costs are fiscally neutral to the Crown. The Act makes explicit:


http://www.olgr.qld.gov.au/resources/responsibleGamblingDocuments/queensland%20HouseholdGamblingSurvey0607.pdf

http://www.olgr.qld.gov.au/resources/responsibleGamblingDocuments/queensland%20HouseholdGamblingSurvey0607.pdf

http://www.moh.govt.nz/moh.nsf/indexmh/problemgambling-research-implementation0407-crime

http://www.moh.govt.nz/moh.nsf/indexmh/problemgambling-research-implementation0407-crime

the process for developing an integrated problem gambling strategy, including the

requirement for a needs assessment to be undertaken and funding requirements for a three-year period

the Ministry’s consultation obligations on the integrated problem gambling strategy. The Act outlines what is to be consulted on and which groups are to be consulted with.

Is the problem gambling levy necessary?

The period of the current problem gambling levy, under the Gambling (Problem Gambling Levy) Regulations 2007, is from 1 July 2007 to 30 June 2010 (both dates inclusive). If a problem gambling levy was not struck for the 1 July 2010 to 30 June 2013 period, the Ministry of Health – as the department responsible for developing, managing and implementing an integrated problem gambling strategy focused on public health – would require additional funding to Vote: Health to meet its obligations under the Act.

How many businesses are affected by the problem gambling levy?

The problem gambling levy is collected on the profits of New Zealand’s four main gambling sectors:

non-casino gaming machine operators

casinos

the New Zealand Racing Board

the New Zealand Lotteries Commission. There are six casinos in New Zealand, which are all subject to the levy. Non-casino gaming machine operators are also subject to the levy. There are just under 400 non-casino gaming machine societies, of which close to 350 are clubs. Non-casino gaming machine gambling is gambling from which the net proceeds (profits) are applied to, or distributed to, authorised purposes: in general terms, this means the profits are distributed back to the community.

What is the best mix of services to minimise and prevent the harm from gambling?

Components of a comprehensive public health programme comprise supply side interventions (regulatory measures), demand reduction interventions (public health services and activities) and problem limitation interventions (interventions for individuals affected by gambling harm). These interventions are networked across national, regional and local levels. The programmes seek to reach people at all levels: geographic, cultural and demographic. A comprehensive programme needs to incorporate all these elements if it is to be successful and cost efficient. A collaborative approach with the gambling industry has been adopted with some aspects of the public health approach (such as host responsibility and educational materials).


The Ministry has grouped its services under four main budget lines. These are: public health services intervention services research contracts Ministry operating costs. A detailed description of each of these services is provided in the Service Plan (page 21 of the consultation document). The rationale for each of these services is provided below.

Public health services

The service plan for 2010–2013 proposes an increase in funding for public health services. This proposed increase is based on a model used by the Ministry to estimate the ideal problem gambling public health service FTE numbers and geographical coverage. The model uses a range of relevant data variables (such as gambling opportunities and the demographic composition of a region) and calculates both the total sum FTE and the ideal spread and mix of the FTE at a regional level. Based on the model, and taking into account the Government’s call for restraint and prudence within the state sector, the Ministry proposes that public health FTE increase from 46.5 FTE in 2009/10 to 52 FTE in 2010/11. For each additional public health FTE purchased, the Ministry expects the following outputs (as identified in the service specifications): Undertake work with eight medium-sized organisations (or four large organisations)

per annum to increase adoption of organisational policies that support the reduction of gambling related harm for employees and an organisation’s client groups (ie, employee assistance policies, organisational positions on accepting gambling funding, relationships with gambling venues, permitting gambling promotions in internal/external media)

Undertake work with eight medium-sized organisations per annum (or four large organisations) and establish and provide co-ordination and leadership to one harm-minimisation network that meets at least four times a year to ensure that gambling environments are safe and provide effective and appropriate harm-minimisation activities

Deliver four medium-sized mental health promotion projects per annum (or two large projects) to ensure that communities have access to services that provide strong protective factors and build community, family and individual resiliency

Deliver eight medium-sized public health awareness and education projects per annum (or four large projects) to improve community awareness and understanding of the range of harms that can arise from gambling

Undertake work with eight medium-sized organisations per annum (or four large organisations) so that relevant organisations, groups and sectors are made aware of the potential harms that can arise from gambling and actively screen and refer individuals to appropriate gambling intervention services.

The increase in public health FTE is expected to result in a number of measurable benefits for preventing and minimising problem gambling, including:


Lowering problem gambling prevalence by working with communities to:

raise awareness of the potential harms that can arise from gambling increase individual and family resilience to problem gambling ensure that environments that provide gambling opportunities actively

minimise harm and support individuals to make healthy choices Reaching more individuals earlier in their problem gambling experience before a

crisis situation develops, therefore reducing the costs of longer-term, more intensive interventions.

Enabling a greater emphasis on effective screening environments to provide greater awareness and client referral from social service agencies to problem gambling treatment services

Improving the response to indigenous and ethnic groups’ needs.

How does the Ministry know that public health services are effective?

The Ministry has developed an outcomes framework, which identifies key objectives, and the actions required to achieve them. The framework outlines short-, medium- and long-term goals and includes indicators to demonstrate the efficacy of services, including public health activities. The outcomes framework is available on the Ministry’s website.

Intervention services

In late 2007, the Ministry reviewed existing services and relevant emerging evidence in relation to effective client-based treatment interventions. As a result of the revision, a clear service delivery model was identified. This was then used to scope the service funding and contracts for the provision of psychosocial interventions and support services. The model included an ideal pattern of care from which a formula to calculate FTE workload was developed. It should be noted treatment interventions for gambling addictions are not an exact science and that evidence in regard to best practice is still emerging worldwide. The future services will be informed by the results of current and future research and evaluation projects. In early 2009, a detailed review of service utilisation was undertaken at a provider level. This review took place following the first year of service delivery under the new service specifications. The review resulted in a number of provider contracts receiving positive endorsement as client session numbers were being achieved or exceeded in relation to their contracts for service delivery. However, a number of provider contracts were subject to proposed reductions, due to low service utilisation during the 2008 calendar year. In addition, two provider contracts were signalled for exit. The net effect was a reduction from a total psychosocial intervention and support services capacity of 81 FTE nationwide to 70.11 FTE. The Ministry has further reviewed service utilization and current capacity and considers that 67 FTE provides adequate capacity to address forecast service demand in the 2010-2013 service period.


In addition to face-to-face intervention services, the Ministry also funds helpline and information services. These services provide first contact and support via a 24-hour 0800 number for those experiencing gambling harm. More recently the Ministry expanded helpline services to provide full interventions as a ’safety net‘ for clients who for valid reasons were unable to attend a face-to-face gambling intervention service provider or made a conscious choice to stay with the Helpline service. The provision of support and intervention services via telephone and or another electronic medium is a cost-efficient method of ensuring coverage in more remote geographical areas while also meeting the Ministry’s requirements for maintaining access to services.

How does the Ministry know that intervention services are effective?

Assessment and reassessment data collected from face-to-face clients who were reassessed in 2007 showed the following key findings: Problem gambling screen (SOGS-3M) scores reduced substantially for 48.3 percent

of reassessed clients but fell to a lesser extent for a further 34.5 percent. 85.2 percent of clients reported they had lost less money in the four weeks prior to

reassessment than in the four weeks prior to initial assessment, and 63.8 percent reported losing 80–100% less.

At first assessment just 27.1 percent of clients reported being in control or mostly in control of their gambling. At reassessment this figure had increased to 77.4 percent.

Comparing progress measures in the 2002–2007 period, significant differences were found in favour of those who completed treatment over those who had not completed treatment.

The Ministry contracted an evaluation of problem gambling intervention services in 2008. Ninety-five percent of the client survey respondents reported that their gambling treatment service had helped them with their gambling issues. The evaluation report is available on the Ministry’s website.

Research contracts

To inform its research programme for the 2010–2013 period, the Ministry reviewed its research agenda for the 2010–2016 period. This research agenda was based on a range of sources, including: the priorities and rationale from the 2004–2010 Problem Gambling Strategy the findings of previously commissioned research the 2009 problem gambling needs assessment the International Think Tank on Gambling Research, Policy and Practice the Ministry’s gambling research reference group feedback feedback from the joint Ministry of Health/Department of Internal Affairs Stakeholder

Reference Group on Preventing and Minimising Gambling Harm a process of alignment with Gambling Research Australia projects, recently

completed, underway or scheduled over the 2010–2013 period.


The research agenda outlines the full range of questions identified, the rationale for each category of investigation and links between categories, national and international evidence available to inform particular categories of investigation, and questions to be addressed by projects during 2010–2013. The research agenda is available on the Ministry of Health website (http://www.moh.govt.nz). The Ministry proposes an overall increase in the research contracts budget line for the 2010–2013 period, compared with the 2007–2010 period. This increase is the result of a continuation of funding for projects commenced and budgeted for in the 2007–2010 period, the introduction of new funding for the Ministry’s six-year and annual outcome monitoring and reporting processes, and the inclusion and alignment of research projects previously reported under other budget lines. Although there is an overall increase in the research contracts budget line, funding for new individual research contracts has been reduced by $1.9m in the 2010–2013 service period compared with the 2007–2010 service period, in line with the Government's requirement for prudence and restraint in state-sector spending.

Ministry’s operating costs

The service plan also includes departmental expenditure funding for Ministry operational requirements for the management of the funding and co-ordination of problem gambling services. This includes the contract management role, ongoing policy and service development work and the management and analysis of service utilisation data for the monitoring of services. Departmental expenditure has reduced slightly from the 2007–2010 funding period.

References

Abbott M. 2001. What Do We Know About Gambling and Problem Gambling In New Zealand: Report Number Seven of the New Zealand Gaming Survey. Wellington: Department of Internal Affairs. Abbott M, Volberg R. 2000. Taking the Pulse on Gambling and Problem Gambling in New Zealand: Phase one of the 1999 National Prevalence Survey: Report number three of the New Zealand Gaming Survey. Wellington: Department of Internal Affairs. Abbott M, Volberg R, Bellringer M, et al. 2004. A Review of Aspects of Problem Gambling. Auckland: Gambling Research Centre, Auckland University of Technology. Bellringer M, Abbott M, Coombes R, et al. 2008a. Problem Gambling: Formative investigation of the links between gambling (including problem gambling) and crime in New Zealand. Auckland: Gambling Research Centre, Auckland University of Technology. Bellringer M, Pulford J, Abbott M, et al. 2008b. Problem Gambling: Barriers to help seeking behaviours. Auckland: Gambling Research Centre, Auckland University of Technology.


Health Sponsorship Council. 2007. 2006/07 Gaming and Betting Activities Survey: New Zealanders’ knowledge, views and experience of gambling and gambling-related harm. Auckland: Health Sponsorship Council. Ministry of Health. 2006. Problem Gambling in New Zealand: Analysis of the 2002/03 New Zealand Health Survey. Wellington: Ministry of Health. Ministry of Health. 2008a. A Portrait of Health: Key results of the 2006/07 New Zealand Health Survey. Wellington: Ministry of Health.

Ministry of Health. 2008b. Raising the Odds? Gambling behaviour and neighbourhood access to gambling venues in New Zealand. Wellington: Ministry of Health.


Submissions: Preventing and Minimising Gambling Harm 2010–2016: Consultation Document

Submissions close on Friday 21 August 2009 at 5 pm. Please note: any submissions received after this time will not be included in the analysis of submissions. Please detach and return. Please include the following detachable pages with your written submission or email your response to [email protected]. You do not have to answer all the questions or provide personal information if you do not want to.

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Nathan Clark Preventing and Minimising Gambling Harm Submissions Ministry of Health PO Box 5013 WELLINGTON Email: [email protected]



All submissions will be acknowledged by the Ministry of Health, and a summary of submissions will be sent to all those who request a copy. The summary will include the names of all those who made a submission, unless individuals request their name not be published. A copy of all submissions received will be forwarded to the Gambling Commission New Zealand to assist their independent consultation process. Do you wish to receive a copy of the summary of submissions?

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