The global health impacts of gambling are much worse than previously thought, according to an international medical journal.
The new report by the Lancet Public Health Commission, which involved experts ranging from gambling studies, public health, global health policy, risk control and regulatory policy, called for stronger regulation.
"Our conclusion is clear: gambling poses a threat to public health, the control of which requires a substantial expansion and tightening of gambling industry regulation," the report said.
"Timely response to this growing worldwide threat necessitates concerted action at intergovernmental, national, and regional government levels."
International regulation for gambling needed, expert says
The study found consumers' net losses from commercial gambling were projected to exceed $1 trillion a year globally by 2028.
It also estimated that about 80 million adults experience a gambling disorder or problematic gambling.
"Specific groups face an elevated risk of gambling harms. These include children and young people, now routinely exposed to gambling product advertising and industry messaging and sponsorship, in ways that were unprecedented before the digital revolution," the report said.
One of the authors of the report, Monash University's Charles Livingstone, said governments needed to explore ways to regulate gambling through international agreements.
"So that there isn't any threat to governments and countries that want to prohibit or to restrict gambling from overseas illegal operators," Professor Livingstone said.
"There are international agreements around doping in sport and so on, we think it's really important that we have international agreements to protect the integrity of sport.
"And to make sure that we get proper regulation of online wagering at least a minimum international standard."
Australians spend the most on gambling per capita
Professor Livingstone said betting and electronic gaming machine use continued to grow in Australia.
Australians lose more than $25 billion annually on gambling, which represents the largest per capita losses in the world.
"There is a desire for change and to rightly treat gambling as a serious public health issue in Australia, given the extent and nature of harm," he said.
Surveys have found that about two in three Australians believe that betting advertising is too common. (Supplied: Grattan Institute)
The study has been critical of the federal government for delaying its decision on the 31 recommendations from a parliamentary committee inquiry into online gambling.
Some of those recommendations included banning all advertising for online gambling and establishing a national regulator for online gambling.
"The only reason for the delay appears to be that government is concerned about the revenues for TV broadcasters and sports," Professor Livingstone said.
"That's not the problem. The problem is that gambling advertising causes real harm. People get hooked on it."
Professor Livingstone said the inquiry, which tabled its report two years ago, conducted a comprehensive review and heard from a range of groups including sporting bodies and betting companies.
"And it decided that the best thing for Australia would be to prohibit advertising on wagering. Now we don't allow other forms of gambling to advertise, with the exception of lotteries," he said.
The federal government has been approached for comment.
Responsible Wagering Australia chief executive Kai Cantwell said last month a blanket ban on advertising would not be effective.
"Banning online advertising will not stop Australian's gambling, it will simply push Australians towards illegal offshore providers, who lure customers in with large bonuses and then don't pay out winnings or provide their customers with any safer gambling tools," he said.
Responsible Wagering Australia represents Australian licensed wagering service providers, including online gambling companies.
"It will be a missed opportunity if the government fails to leverage sophisticated online platform technologies that can ensure that gambling advertisements are shown only to users who are logged in, have verified that they are over 18 years old, and have the option to opt out of receiving such ads," Mr Cantwell said.
Sally Gainsbury, director of the University of Sydney's Gambling Treatment and Research Clinic, described the delay by the government as perplexing.
She highlighted surveys that have shown almost 70 per cent of Australians believe that betting advertising is too common.
"It's understandable that there are numerous stakeholders that are pushing for their own agenda," Professor Gainsbury said.
"However, it's been very clear from the Australian community that there is a change needed and that people want to see less advertising.
"It's really important that the Commonwealth government and all the state governments … recognise the importance of serving the community interests and protecting the population, and put this above any revenue."
Do gambling bans work overseas?
There have been countries such as Belgium that have adopted a ban on advertising but Professor Livingstone described it as a "partial ban".
Sports sponsorship, gambling companies advertising on their own channel online, and business-to-business advertising were still available.
"What they're now doing is going back to the drawing board and revisiting that partial ban, because although the ban on advertising was effective, the companies immediately tried to get their way around that," he said.
"The solution to these problems is to make sure that the promotion and advertising and gambling is comprehensively prohibited, so that the gambling operators, don't find ways around it."
There have been other international examples of stricter laws on gambling advertising.
For example, Spain and Italy have bans in place.
"They're all making changes to how gambling is advertised," Professor Gainsbury said.
"It's important that Australia looks in the other direction as jurisdictions which don't have advertising restrictions, like the US and Canada, which are currently legalising sports betting.
"There's been a huge proliferation of gambling and sort of inundating the population."
But beyond gambling advertising, Professor Gainsbury said accessibility to gambling, specifically electronic gaming machines, needed to change.
"This makes it very normal to gamble, and machines can allow you to spend a very large amount of money per session," she said.
"There's no natural break in play. So the environment is set up to facilitate people to gamble very, very high amounts without any natural breaks or barriers."
To combat that, Professor Livingstone believes more jurisdictions in Australia should adopt pre-commitment schemes, which have been introduced in Victoria and Tasmania.
"What that does, is it says you've got to set a limit. You've got to stick to that limit, because it's technically impossible for you to continue after you've hit that limit," he said.
"It gives people not only the ability to enforce their best intentions, because unfortunately, when gambling, many people lose that ability.
"They get lost in the zone, as they call it, and it allows them to not only do that."