Friday, October 5, 2007

Casinos and Public Health

(My column from today's Saipan Tribune).

I’ve thought it rather witty that those who don’t support the casino have been calling it the “casiNO,” and I’ve been surprised that we haven’t yet seen the “caSINo” signs. I also fully expect to see that the supporters, who are touting “Economic Jackpot” will soon be putting up “CASHino” signs. What spin we see when elections near!

With the signs going up, and the ballots being prepared for the vote on the casino issue, I decided to do a little research of my own on the health effects of casinos on a community.

There is actually quite a bit of experience and hard data on the issue, particularly from Canada, where provincial governments have about ten years experience with the effects of casinos on their communities. It’s recognized that casinos (and gambling in general) bring problems. The motivating factor for communities to allow gambling is always money. No one says, “Wow, this is a socially beneficial activity, so let’s bring it into our community.” They say, “We need the money, so let’s allow gambling.” When government revenues decrease, as have ours, people start to look to gambling as a way to increase government income, and it works! To the extent that governments either tax the revenues, or are shareholders in the gambling operations (such as in state run lotteries, or government owned casinos) government revenue does increase. Gambling, can indeed be an “economic jackpot.”.

Now, in order for that to happen, the casino users, MUST lose money. It’s how the casinos make profit. In order for the gambling operation to be profitable, the gambler must lose money, and so all the games and the machines are designed to make you, collectively, lose. It’s simple math. In fact, it has been said, that lotteries and casinos and other gambling operations are a way to tax people who don’t understand math.

Communities that allow gambling almost immediately experience an increase in both the number of people in the community who gamble, and the amount of money spent on gambling. For example, in Niagara, the year before their casino opened, 11% of the population had gambled. A year later, 43% had gambled. The amount of money spent per individual on gambling increased five times during this same period. That’s great news for the casino and the government, but not good news for the people who are spending (and losing) their money.

Most people who gamble don’t develop any problems (other than losing money). However, a small, but significant segment of the population will experience adverse effects from gambling. According to a study looking at public health perspectives of gambling in Ontario, “problem gamblers” are defined as those individuals that “have a continuous or periodic loss of control over gambling, a preoccupation with gambling and with obtaining money to gamble, irrational thinking, and a continuation of these behaviors despite adverse consequences.”

How many people are affected by problem gambling, and what effect does a casino have on this number? In Niagara, the percentage of residents with gambling problems before the casino was 2.5%. After the opening of the casino, the number doubled. If we apply those numbers to the CNMI indigenous population, presuming about 20,000 indigenous residents, we would end up with about 1,000 people with gambling problems after the opening of a casino. That sounds like a big problem for a small tightly knit interrelated community.

The health and social problems of gambling have been well documented, and we have experience already with this problem here in the CNMI. describes the health effects of gambling as follows:

Problem gambling, while providing additional revenues, also results in significant costs to the individual, his or her family, and society as a whole. Uncontrolled spending, the resulting debts and the strategies used to gain more money to gamble has a significant impact on many determinants of health and can cause marital conflict, child neglect, poor work performance, multiple addictions, stress-related physical ailments, crime and even suicide. Children of pathological gamblers are two times more likely to attempt suicide, have lower grades than their peers and have higher rates of substance abuse.

The cost of problem and pathological gambling does not only affect individuals and their families. Society also bears the brunt of gambling, with the overall cost to taxpayers estimated at $56,000 for each problem gambler, including cost of treatment, health-related costs, absenteeism at work and time spent in courts.

Problem gamblers are more likely than the general population to be involved in other forms of addictive behavior such as alcohol or drug abuse. Stress-related ailments such as ulcers, colitis, high blood pressure, heart disease, migraines and skin problems are also much more common among problem gamblers. Even more serious is the rate of attempted suicide, which is higher among pathological gamblers than among all other addictive behaviors. A Québec study of college students found that 26.8% of pathological gamblers had attempted suicide compared to 7.2% of college students with no gambling problem.

Crime is also an issue between problem and pathological gamblers and becomes a viable option to support gambling habits when all other resources are exhausted. "Studies show that two out of three pathological gamblers commit crimes to pay off debt or to continue gambling. While the majority of crimes are nonviolent and involve embezzlement, cheque forgery, stealing credit cards, tax evasion, fencing stolen goods, insurance fraud, bookmaking, and/or employee theft, in some cases they involve violence and armed robbery." (National Council on Welfare, 1996, p.28)

So, there is no question that casinos bring increased revenue to their shareholders and to the government. There is also no question that casinos bring social and health problems into their communities. There is no need denying the financial benefits, nor the problems. Where you stand on the casino issue depends on how you weigh the benefits against the problems. Either way, there are trade-offs. You give something and you get something. Either you give up the money, and maintain social and mental health; or you give up social and mental health and get money. That’s a definite. It’s been studied and shown in communities that have the experience with casinos. Casinos bring more money. And they bring more problems. No matter how you vote, you will be giving something up. Just have your eyes open to this fact.

As for me, I see enough social ills and health problems on a daily basis in our community. I don’t want to see any more. If we follow the pattern of other communities that bring in casinos (and there is no reason to think we won’t), within a year of casinos we will have twice the number of people suffering from problem gambling and the economic and mental devastation it brings to their families. From my perspective, the money just isn’t worth it.


Saipan Writer said...

This is so well-written and clear. I love it. It also strikes a thoughtful balance on the issues we're facing.

While casinos in general have generated funds for the Indian tribes, governments or private commercial enterprises running them, I think that the Saipan Casino Act is being touted as providing a huge cure-all "public" benefit, when in fact most of the money that goes toward the public coffers will be eaten up by the costs of regulatory administration and only offset the fair value of the rented public land.

The revenues from the BGRT would be the public money available and that could be a nice little bit of revenue, but that's all what we're looking at to benefit our government budget. The real cash benefits (the 94-95% of gross revenues) will go to the private casino owners and operators.

I've been doing research, too, on casinos in other areas. One of the bits of information that I found that I hadn't expected is the increase in bankruptcies in casino towns. The study I read compared 8 different casino locations over a period of years, and found that in 7 of them, the rise in bankruptcies was significant, and the rise worsened the longer the casinos operated.

Another bit I found that totally surprised me was the repeated finding in several places that casinos are "contained" and that the increased traffic to them does not spill over into the community as an increase in spending there. In fact, casinos usually hurt local businesses--any increased tourist traffic spends at the casinos and not at the local businesses. And the residents spend more at the casinos and less at the local businesses.

The usual refrain is --if not casinos, then what? I think there is not one answer to that question. I don't think there is a magic bullet, as much as we would all like some miracle solution to our present economic woes.

We do need to do something. I just wish we'd stop spinning our wheels on casinos and start building on the stable foundation of hard work, natural resources, and inspiration.

Thanks for the thoughtful insights and opinion. It is important to keep things in persepctive (in case we have to live with casinos after the election).

Bruce A. Bateman said...

Perhaps the reason the money is not worth it for you, David is that your business is not economy driven and you personally have plenty of it. Like Jane who gets her money from taxpayers back in the states, you derive yours from a strictly needs based physical necessity process. Neither requires a vibrant economy. If someone is broke, or can't pay their taxes or can't buy enough food, they will still seek medical attention when it is needed.

I would pose the point that if you really cared for the population and specifically the indigent, you would want to see the economy blossom and thus see their quality of life improve.

You can afford to stay here. Those on the bottom rungs are getting to the point where they cannot.

I can understand the "so what, more for me" philosophy...but it does not sound like you.

Marianas Eye said...


Your comments, which are respectfully stated, nevertheless fall into the category of "ad hominem" arguments. I take no offense to them, but it's a point worth noting. I'll address them anyway.

In terms of my personal business, eye care is one of the first things people give up when the dollars get tight. Sure, people come in for the injuries and emergencies, and in those situations, as an economy worsens, they often cannot afford to pay for the emergency care because they have no money or they dropped their insurance to save on the premiums. Other than the emergencies, eye care is one of those areas of health-care that people set aside due to economic reasons. We are by no means immune to the effects of a bad economy as you purport.

I'm all for a vibrant economy, and nothing in my column implies that I'm not. It's an error in logic to assume that just because I'm not for casinos, I'm not in favor of economic growth.

The ends and the means are two different things. I'm all for economic growth. I'm just not for casinos as the means (nor legalizing marijuana, or crack or prostitution not putting in a nuclear reactor for reliable power). The reasons have nothing to do with my personal economic situation. They have to do with the problems that casinos (and these other endeavors) bring. I'm sure that some people don't give a whit about the problems BECAUSE of their economic situation. Sure, those who are in a poor economic situation may be more likely to accept ANY idea that can bring them more money. The presumption is that money is all you need to be happy, so damn the social consequences of whatever idea. Ultimately, it's happiness we seek, and money is part of that picture, but not the whole picture.

My opinion is heavily influenced by the fact that I'm in very close touch with our indigent population through my work. I didn't mention it in my column, but those at highest risk for problem gambling are those with incomes under $25,000 -- that's a huge segment of our population. I know plenty of people who have blown entire paychecks on poker within an hour of getting that paycheck, and then the spouses come to my office carrying the baby, with the three other kids in tow, asking for a loan to buy groceries. This is real. I don't want to see more of it.

If it will help you consider the essence of the column, disregard the last paragraph where I talk about my personal opinion, which has nothing to do with the issues that need to be considered. I'm sharing information from other communities that have experience with casinos. It's useful information. You might still be in favor of casinos after understanding the information, but at least you go into with a conscious decision of what you're trading. Ultimately, it's a question of personal values.

It's not good idea to undermine the value of information on an "ad hominem" basis.


dane said...

This is superb analysis of the casino issue before us and is among the best articles I have ever read in our local newspaper.

My last trip to the Tinian casino was five or six years ago. I sat at the blackjack table between two NMI elected Congressmen. There play was so poor that the young dealer could barely keep a straight face. When they left the table we both cracked up.

I would value the opinion of a physician that you would intrust to open your childs eye like Dr. K, or an honors physics teacher like Jim Philips, before the opinions of politicians that would double down fives, likely with NMI funds.

As far as I am concerned, the casino case is closed.

dane said...

PS Dane is Ron Hodges in case there is any confusion about the signing.

Jeff said...

But don't we have gambling already -- everywhere? It's not like we'd be going from no gambing to gambling. Why not have gambling that the tourists might avail themselves of, and might be a tourist draw. I think the number was 25 states had casinos. If we're against gambling, just get rid of it completely, which hasn't happened, and doesn't seem likely to, but why just limit it to the dingy poker rooms the locals use or an isolated place in Tinian.

And don't glaucoma patients get relief from weed, Doc? Lots of things are bad for you, cigarettes, alcohol, twinkies. Why the jihad on marijuana goes on I don't get. Lots of fear mongering and demonization on that one. You're the medical expert, don't you think it is absurd that cigarettes are legal, but marijuana isn't?

In the words of Angelo, why do you hate freedom David?

Marianas Eye said...


Just because we already have some gambling (and its associated problems), doesn't mean we should have more. I'm for getting rid of all of it.

I do think it's absurd that cigarettes are legal. I don't think it's absurd that marijuana isn't.

A few years ago in Yap, they banned the import of SPAM. I like Yap.

Human beings do all kinds of things to hurt themselves in the name of personal freedom and the pursuit of individual rights and pleasures. But they don't just hurt themselves, they hurt the whole society. Health care spending is astronomical because people sit on their Freedom butts eating Freedom Twinkies, drinking Freedom Beer, watching Freedom TV, and smoking Freedom cigarettes. It's ludicrous for a society to not ban the harmful stuff, even though those limits may curtail the individual's pursuit of pleasure.


Daniel said...

This is a really great article. David, would you please consider submitting this to the Philadelphia Inquirer and Philadelphia's Daily News? I'd like to help you do that because we need this article in Philly.

- Daniel Hunter

Daniel said...

This is a really great article. David, would you please consider submitting this to the Philadelphia Inquirer and Philadelphia's Daily News? I'd like to help you do that because we need this article in Philly.

- Daniel Hunter

Bruce A. Bateman said...

Thanks for replying, David. I am glad you didn't take umbrage to the comment above.

Ad hominem was not the central thrust of the argument, just pointing out that your inner motivation for that belief might be different if you looked at the real results more closely.

I can appreciate that your biz too would experience some setbacks. Every case is not an eye worm needing immediate treatment. You also need to sell some frames to make the CUC payment (soon to be about 30% larger thanks to the idiots in the legislature).

Still, I think the trade off of some possible (even probable or likely) social problems for the few is more than offset by the benefits for the many.

BTW, pointing out the motivations or possible motivations of a position proponent does not 'undermine the value of information'. It merely puts it into perspective. We all have our biases. Sometimes we see them ourselves, sometimes not.

Another BTW, I vehemently disagree with your premise above that "society" should ban Twinkies, beer, TV, cigarettes or anything else that a consenting adult wants to do or consume as long as doing it does not interfere with the Freedom, yes Freedom of others. For the record, I don't like beer (but do drink one on occasion), I detest Twinkies (but think you should be allowed to imbibe one of the sickenly sweet things if you are of a mind to), I don't have a connected TV at home, and I don't smoke. Nevertheless, do I want some puerile bureaucrat calling himself the voice of 'society' curtailing my activities or those of others so he can increase his sense of power over others? No, I do not.

That power is the beginning stages of the “they came for the Bahai's” you commented so forcefully on in an earlier post. The power only differs in degree. And not that for long, once you relinquish it to them.


Double down on FIVES, Ron? That is the stuff Steve Wynn builds palaces on. Did they have a good time losing or were they sour about it?

EJ said...

My friends would like to look at your house for sale/ rent. Do you have time tomorrow?

Sean said...

Excellent post, Dave.