How Does Opening a Casino Impact Public Health?

In the last year, Kansas lawmakers have considered legislation that would make it easier for entrepreneurs to open a casino in Crawford and Cherokee counties. The bills would reduce the privilege fee and minimum investment required to earn approval to establish a casino. For a region of the state that has struggled economically in recent years, supporters are understandably pointing to the potential for new jobs and broader economic growth.

But a group of public health advocates wants to remind lawmakers that, though their fiscal intentions might be pure, opening a casino has impacts outside of state coffers and private sector pocketbooks. The Kansas Health Institute released a health impact assessment (HIA) Wednesday outlining what a casino could mean for the area's health and how they can aim to offset any negative consequences.

It's part of the broader HIA movement, an effort to incorporate health considerations into policy decisions that might, on their face, not have much to do with health at all. The Kansas casino HIA demonstrates how versatile these new tools of public policy can be.

Its authors drew on a variety of data sources -- including the experience of nearby counties that are already home to a casino -- and interviews with stakeholders to gauge the health impacts of a casino opening in southeast Kansas. Here are some of the most striking findings:

• A new casino could create up to 350 new jobs. That could lead to greater health insurance coverage, which is demonstrated to reduce health-care costs and improve outcomes. Higher incomes are also linked to a longer life expectancy and better health metrics, such as body-mass index.
• However, there could also more adverse residual effects like workers who suffer from interrupted sleep schedules and insomnia because of the shifts required for work in the gaming business. Employees will also be exposed to secondhand smoke (estimates put the costs at $103 per year per employee), and gaming workers also smoke more than the general population (39 percent to 29 percent). They have been shown to be at a greater risk of gambling addictions, alcoholism and depression as well.
• Crime, linked to both a growth in population (estimated at 1,200 to 1,600) and increased tourism, could rise. Research is inconclusive about whether opening a casino definitively increase crime, but other Kansas counties have seen a small, but notable, uptick.
• More traffic congestion, resulting from new commuters and incoming patrons, could lead to decreased air quality, which increases risks for conditions like asthma and bronchitis.
• Gambling addiction (estimated to increase 75 percent in the surrounding area when a casino opens) has been linked to increased domestic abuse, unsafe sex and alcohol abuse. Sexually transmitted diseases and conditions associated with alcoholism could rise, as could automobile accidents linked to drunken driving.
• Increase liquor tax revenue (estimated at close to $100,000) could be directed toward various health initiatives to counter some of these potentially negative effects.

While the above findings might be sobering to those touting the casino's economic benefits, the HIA's authors also suggested policies and actions that could help to mitigate some of the negative outcomes. Using new tax revenue to invest in public health efforts is one of them. Here are a few more:

• Casinos could open workplace wellness clinics to preemptively address some of the health risks for gaming workers.
• Casino management could ban smoking in and around the establishment.
• Local health officials should monitor any changes in air quality and work with casino management to increase public transit access and improve infrastructure around the facility.
• Casinos should implement a "tracking and exclusion system" for gambling addicts. Primary-care physicians should also work with accredited organizations to familiarize themselves with gambling addiction treatment. Local health officials should also improve public programs to address addiction.

The findings will be shared with state legislators and made available with the general public to inform discussion of the bills during the next legislative sessions, according to their authors. As they wrote in the introduction, the intention of the HIA is not to persuade policymakers one way or the other, but to simply bring health into a conversation that has focused almost entirely on the economy.

The full HIA is below.