People Make Glasgow as the city motto has it. Yet it is useful to think of any city not as one people but many peoples in many different communities. Indeed, you could say of any city that it is many cities.

In Glasgow it is impossible not to see by just walking around the citizens of the many cities sharing the same geographical space. There are for instance clear examples of inequality. You can stroll from a district characterised by poverty and disadvantage to a leafy suburb of relative privilege a few miles away. And perhaps you won’t be surprised to find far more bookmakers in one district than the other.

So when we talk about gambling harms in Glasgow we need to remember that these are not distributed evenly. Their nature and prevalence will vary not only in relation to disadvantage and poverty. They will also be experienced differently by different population sectors such as refugees, by religion, by gender, by mental health, by ethnic background.

One implication is that in taking a ‘whole-city’ approach to reducing gambling harms, we have to focus clearly on the many different and varied communities and citizens in Glasgow.

It is also important to recognise that our lives are influenced and shaped by factors beyond the city boundaries. Whether you’re in Glasgow or Miami, you’ll probably have a potential casino in your pocket. Gambling is a global industry.

Gambling harms represent a serious public health issue. In this, they fit with many other issues that negatively affect citizen wellbeing.

You could replace ‘gambling harms’ with one of many topics. The diagram above shows some of the main factors involved, not all of them.

Commercial determinants include marketing and promotion, and product design. Often, these exploit basic human vulnerabilities.

Social and cultural determinants include pervasive norms and values in society. Gambling was once seen as a somewhat shameful activity to be hidden away. These days it is far more out in the open and more widely accepted as a legitimate leisure activity. While some religious traditions still prohibit gambling, many that once did so have turned their focus to reducing harms. Not only the National Lottery promotes gambling as a way of raising funds for good causes, so now do many charities.

Peer behaviour – what your classmates or neighbours are doing – is a strong influence on an individual’s lived experience of what is acceptable and what is worth pursuing.

Inequality and disadvantage are fundamental aspects of social determinants. They are very strongly implicated in educational achievement, life expectancy and years of good health, income, involvement with the criminal justice system, determinants of lifestyle. Inequality is the topic of greatest concern to social reformers of all stripes over the past 200 years.

Online/digital harms represent an area of growing concern (as witnessed in the debated White Paper on online harms). Here, as in all the items in the diagram, there are connections with other areas. For instance, one aspect of inequality is poor digital literacy and exclusion from digital access. The digital environment generally has seen enormous and ever-accelerating impacts on society and how we live our lives: gambling is one case among very many.

Individual biological and psychological factors can sometimes be forgotten. We are all who we are because of our genetic inheritance and life experience (nature and nurture). We know, for instance, that trauma is a key predictor of ill-being and strongly correlated with addiction. Many other life experiences also contribute to risks of addiction and other mental health disorders. Some mental health disorder themselves carry higher risks of encountering gambling harms. This area of individual life is the concern of sociology, psychology, medicine and other disciplines. It too is related to the other topics in the diagram.

Research, Education and Treatment (RET) and Prevention around gambling harms or any other issue relating to ill-being are complex areas. With reference to gambling harms, attention is drawn by many to a need for withdrawal from industry funding applied to any of the four subjects. Many advocates for reform say that there is insufficient emphasis on industry practices (commercial determinants) in preventing harms arising. Treatment in Scotland for those suffering gambling harms is in the hands of charities as is much education, charities largely funded by industry voluntary contributions. As with all the topics in the diagram, each one here could be endlessly discussed, debated, fought over. It’s complex.

Regulation, Local & National Policies and Strategies. Scotland does not have devolved powers, for instance to introduce laws prohibiting gambling companies’ sponsorship of sports. We await the long-delayed new White Paper from Westminster towards a new Gambling Act (which one of the recent prime ministers was in favour of scrapping). Campaigns for reform hope it will contain prohibition of sports-related marketing by gambling companies, curtailment of television advertising, a compulsory levy on industry profits which will be ring fenced for independent RET, and the introduction of affordability checks for all gambling customers.

The Scottish government has shown interest in addressing gambling harms but this is in development. Glasgow has adopted a whole-city approach with a multi-agency partnership including city council, public health, third sector, lived experience voices and others, and strategies towards initiating on-the-ground implementations aiming to mitigate gambling harms. As the notes above may suggest, this is a complex process of development.

In Glasgow there has been in recent years vibrant activity among some third sector organisations engaged with the subject of gambling harms. Some of these organisations are partnered with statutory agents in the whole-city approach, and all are partnered with each other.

For our own small-scale work and this project, one practical direction emerges from the above. Since there is a shared general framework of factors between the topic of gambling harms and other public health issues, it is useful to consider positioning gambling harms as an example of, for instance inequality or online harms, rather than as a single issue item (though the latter may occur alongside). So, for instance, in aiming to reach community sectors,  rather than promoting an event advertised as about gambling harms, we could – possibly with partners and co-production – design such events as ‘protecting our communities from online harms’ with gambling issues being an item or an example.

To end with a reminder. Having raised small-scale community focus in the last paragraph, it may be salutary to repeat that we are all subject to corporate, economic, technological and other influences from the global realms.