The district of Fairfield is a unique western suburb of Sydney, Australia. It is by far the most multicultural city in the state of North South Wales, with almost 60 percent of residents born overseas. It is also the most disadvantaged area in Sydney, according to the Fairfield City council; the average Fairfield family earns 30 percent less that the national average. The region’s poverty is exacerbated by an entrenched problem that affects the entire country—problem gambling.
This summer, a team of global field course students, led by Assistant Professor of Practice Sarah Moreland-Russell, worked with local partners to find a solution rooted in evidence and implemented using an equity lens.
Moreland and a group of three MSW and eight MPH students completed a rapid health impact assessment (HIA) over the course of two weeks on a hypothetical proposal to remove all electronic gambling machines (EGMs) in Fairfield. In partnership with southwest Sydney’s Center for Health Equity Training Research and Evaluation (CHETRE), the Brown School students followed a rigorous process for the assessment that involved literature reviews, community health profiles, data collection through community interviews, and observation of how EGMs are integrated into the Fairfield community.
“I had never completed an HIA related to this type of policy proposal – so this was an amazing learning experience for me and for the students,” said Moreland-Russell. “This trip and collaboration with researchers in Australia allowed us to learn how to apply this important policy tool (HIA) to a broader social issue and link it to mental and physical health as well as the health of the community.”
Problem gambling is defined as gambling that adversely affects players and their families financially, physically, or mentally. These effects can be debilitating, and range from tachycardia to suicidal ideation for those affected. Nationally, approximately 2.5 percent of Australians are moderate to severe problem gamblers.
The team found that there are 24.6 EGMs per 1000 people in Fairfield, compared to 15.8 nationally; Fairfield residents are estimated to lose $1.3 million per day to gambling.
These issues have spurred advocates to consider removing EGMs in Fairfield over a five-year period. However, the HIA revealed possible unintended side effects and challenges to the success of this proposal. Some local community service providers fear that eliminating the gambling machines could lead to isolation for populations who use gambling venues as community gathering hubs, or that gambling might simply move underground. Others point to a historical lack of trust in government services as a barrier in convincing people to utilize state-sponsored gambling interventions. Communities that have come to rely on the revenue generated by EGMs may be reluctant to support removal efforts.
The students presented the completed HIA to local health district stakeholders, with recommendations to gather additional data to make a stronger case for EGM removal. The project illustrated how complicated – and rewarding – implementing new health policies can be outside the classroom. “This course […] showed how important policy is and how much it affects people’s everyday lives,” said Christina Craig, MSW ’18.
“When we presented our final report, there was palpable excitement in the air about having a strategy to move forward,” added Christina Moore, MPH ’18.
The group also suggested amending the current proposal to implement a phased removal of the machines. A comprehensive policy that includes enhanced, culturally appropriate social services for problem gamblers was recommended as well. The results of this HIA will be used to make a case for policy in the upcoming March 2019 election, and Moreland-Russell and her students will publish a paper on the project.