Special Report: Casino

McMaster Department of Psychiatry Warns Council about Casino Public Health Impacts

A letter by the McMaster Department of Psychiatry warns about the potential for negative health impacts from a new downtown casino.

By RTH Staff
Published February 06, 2013

this article has been updated

The chair of the Department of Psychiatry and Behavioural Neurosciences at the DeGroote School of Medicine, McMaster University has sent Hamilton City Council a letter to "express our concern at the possibility that a casino could be built in Hamilton's downtown core."

The letter, which is dated February 6, 2013, warns that the evidence indicates a new downtown casino would "likely result in an increase in the prevalence of problem gambling" with negative impacts that include "depression, anxiety, and suicide, as well as crime, dysfunctional relationships, and bankruptcy."

The letter concludes that Council must weigh the potential economic benefits against the potential for "an impact on the health and wellbeing of our community for years to come."

Following is the full text of the letter.

February 6th. 2013

To Mayor Bratina and members of Hamilton City Council:

On behalf of McMaster University's Department of Psychiatry and Behavioural Neurosciences, I am writing to express our concern at the possibility that a casino could be built in Hamilton's downtown core. This concern is based upon the experience of many other communities who found that the opening of a casino led to an increase in the number of people with a gambling problem (currently estimated to be 15,000 in Hamilton), which in turn led to mental health problems, family breakdown and financial hardship for many of these individuals.

A comprehensive review of the current evidence by the Centre for Addictions and Mental Health in Toronto identified the harmful effects on individuals who are vulnerable to a gambling problem included depression, anxiety, and suicide, as well as crime, dysfunctional relationships, and bankruptcy. They added that "increased availability or accessibility of gambling ... will likely result in an increase in the prevalence of problem gambling."

This is borne out by studies in other communities that show that easier access to gambling facilities increases the number of people presenting for treatment of a gambling problem, with people who are recovering from previous problems with gambling being especially vulnerable. Indeed, one US Study found that the likelihood of being a problem gambler doubles for someone living within 16 miles of a casino, while the experience in Halifax, Detroit and St. Louis has been that rather than stimulating new development, the presence of a casino leads to decay in adjacent neighbourhoods.

In both Toronto and Hamilton, Public Health Departments have expressed concern that the increased availability or accessibility of gambling will likely result in an increase in the numbers of problem gamblers. Moreover, in a recent report to the Hamilton Board of Health, Dr. Elizabeth Richardson, our Medical Officer of Health, opined that "the construction of a casino would be detrimental to the well-being of our community and particularly to people with low incomes and those who are prone to addiction."

Although there may be some economic benefits deriving from a new casino, there is clear and consistent evidence from other communities that highlight the potential damage the arrival of a casino can cause to individuals, families and communities. It is for this reason that almost every mental health, addictions and healthcare organization in Hamilton has expressed its concerns about, or opposition to the establishment of a casino in downtown Hamilton. We would therefore urge you to consider this evidence very carefully before making your decision, as the decision you make will have an impact on the health and wellbeing of our community for years to come.

Nick Kates MBBS FRCPC MCFP (hon)
Acting Chair, Department of Psychiatry and Behavioural Neurosciences
Michael G. DeGroote School of Medicine
McMaster University

Update: The title and description for this article erroneously stated that the letter was from the McMaster School of Medicine. In fact it is from the Department of Psychiatry. RTH regrets the error.


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By Today (anonymous) | Posted February 06, 2013 at 14:12:59

If gambling is that bad, then I suggest the Government of Canada abolish it, like they have smoking. Oh wait, it's still fine to smoke, sorry about that, forgot. The point is if health is such a huge issue in such matters, then it should matter one would think.

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By -Hammer- (registered) | Posted February 06, 2013 at 19:05:15 in reply to Comment 85921

No, it's fine to keep it, just keep it away from economically vulnerable people, by locating it somewhere else, like in a fairly well off suburb near horse farms...like Flamborough where one already exists.

That or put it in a tourist heavy area, like, Niagara Falls or Toronto or...not Hamilton.

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By Conrad66 (registered) | Posted February 06, 2013 at 14:21:32 in reply to Comment 85921

Your soo wright on

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By Tomorrow (anonymous) | Posted February 06, 2013 at 14:33:42 in reply to Comment 85923

On what? I read the GP three times and have no idea what Today is trying to say.

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By Today (anonymous) | Posted February 06, 2013 at 15:45:57

All I'm trying to convey is that gambling and casinos are perfectly legal as proposed here. While health is important and many people wish that casinos, tobacco and other things shouldn't exist, they have every right to exist and therefore, it seems to me, health isn't the overriding factor here. The government says no problem, do it. Health arguments are good reads nevertheless but unfortunately they don't carry much weight, so it seems on things and activities that can be apparently very bad for our health. Liquor as well.

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By Sticky Eyes (anonymous) | Posted February 06, 2013 at 17:16:33

Add to this the OLG's modernized vision for lottery sales. Apparently 1/5 of Ontarian adults buy a lottery ticket at least once a week, but the OLG would like to make it more mainstream.

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By Sticky Eyes (anonymous) | Posted February 06, 2013 at 19:53:47 in reply to Comment 85928

Player Participation and Customer Segmentation

OLG conducts regular tracking of customer behaviour through surveys. Customers are segmented into the following categories:

• “core” players who play any lottery at least once a week;
• “regular” players who play any lottery at least once over a 2 month period; and
• “infrequent” players who have played any lottery in the past year but not in the past 2 months.

Retailers in Ontario are paid a 5% commission on Lottery Revenue from terminal-based products and 8% on Lottery Revenue from Instant Products, plus a redemption commission of 2% and 3% on terminal-based and Instant Products, respectively. OLG also pays a bonus commission to retailers who sell major or secondary winning tickets which generally ranges from $100 to $1,500. Relative to other jurisdictions, OLG’s retail network density of one terminal for every 1,337 Ontarians presents an opportunity to optimize the number of retail points of sale for lottery products.

The number of adult regular players in Ontario has remained about the same over the past ten years. However, over the same time period, the adult population in Ontario has increased by 11%.

On average, regular players tend to be 35-54 years old, with men and women playing equally, and with higher rates of employment and slightly higher household income than non-players.

Opportunity exists to attract a greater number of new Ontarians to lottery play through more innovative products and more convenient ways and places for customers to purchase these products. In particular, OLG believes that:

• infrequent players represent significant opportunity for responsible growth;
• Lottery Revenue from core 18-44 year old players is significantly under-developed (38% of Lottery Revenue versus 47% of adult population);
• Lottery Revenue among core female players is also under-developed (42% versus 51% of the population); and
• Lottery Revenue is under-developed in urban areas, including metropolitan areas like
Toronto and Ottawa.

Lottery Opportunity Highlights

OLG is looking to enter into a Lottery Services Integrator Agreement with a Service Provider to efficiently operate and grow the lottery business in Ontario for a period of 10 years, plus possible extensions. The Service Provider will be responsible for day-to-day operations, process and cost optimization, developing products and marketing plans and recommending strategies to maximize the growth and success of the lottery business. The Service Provider will receive a combination of a fixed payment and a percentage of the Net Win above an annual threshold as compensation. This compensation is intended to provide a reasonable financial return to the Service Provider. The fixed payment will be approximately $100 million (to be finalized as part of the RFP Process) and is intended to compensate the Service Provider for the cost of operating the lottery business in its current state. Both the variable percentage of Net Win and the Net Win threshold will be bid by the Prequalified Respondents as part of the RFP Process. The compensation structure is intended to provide the Service Provider with an opportunity to capture a share of the additional revenue it succeeds in driving. This model will allow the Service Provider to be fairly compensated for the role it is playing in driving growth in the
lottery business. OLG believes that this opportunity is particularly attractive to potential private sector service providers for a number of reasons which have been summarized below.

1. Large and successful lottery business with opportunity to increase sales per capita

OLG Lottery Revenue of $3.2 billion in Fiscal 2012 represents a $611 million increase or a 4% CAGR over the past five years. Lottery Revenue and Lottery NPP are strong and stable, as the business has historically seen consistent growth and stability despite turbulence in the external economic environment. OLG operates the largest lottery business in Canada and is the 8th largest by Lottery Revenue among all North American jurisdictions. The lottery business in Ontario exceeds its share of national game Lottery Revenue (42%) versus its population size (38%) but is ranked second in Lottery Revenue per capita in Canada (US$244 versus Atlantic Canada at US$264). Compared to North American lotteries, OLG is 10th in Lottery Revenue per capita and 13th internationally, which indicates an opportunity for continued growth.

2. Engaged core player base with strong support for lotteries in the Province and
potential to increase frequency of play

Two million adults in Ontario play lottery games weekly. Lotteries have strong acceptance in Ontario with over 85% of adults supporting the existence of lotteries in the Province. While the Ontario adult population has grown by 11% over the past 10 years, the number of Ontarians playing lottery games on a regular basis has remained static. Over the long term, with healthy population and economic growth expected to continue in Ontario, an opportunity exists to develop more regular and core players among the 3 million adult Ontarians who currently only play lotteries infrequently.

3. Significant growth opportunities

OLG has identified several growth opportunities to attract new and infrequent players, increase Lottery Revenue per capita, and Lottery NPP. These initiatives include expansion into new channels such as digital (internet and mobile), optimizing the convenience of how lottery products are sold in under-developed channels, such as multi lane, increasing the retail points of sale, and continued product innovation. Capitalizing on these opportunities will require investing in technology, creating flexible open systems to improve back end efficiency and unlocking new opportunities in the way lottery products are sold. The Service Provider will likely be able to expand on the following initiatives/opportunities:

Digital Channels: In 2013, OLG will be launching its internet gaming (iGaming) site where the National Lotto and Spiel (add-on) games will be sold digitally for the first time. The Service Provider will have the option of leveraging the OLG iGaming site and/or introducing its own internet and mobile sites or software.

Multi-lane Channels: Around 90% of adult Ontarians shop monthly at grocery and drug stores yet only 9% and 7%, respectively, of OLG Lottery Revenue is generated through these channels. An opportunity exists to develop new ways to leverage technology and software solutions to change the way lottery products are sold and redeemed in these channels to capitalize on the impulse nature of lottery purchases by offering in-lane sales.

Product Innovation: As new channels and technologies emerge, opportunities are created to meet customer needs for a more entertaining and engaging lottery playing experience with products designed to meet different customer needs.

Optimizing the Retail Base: An opportunity exists to increase the number of retailers to capture unmet demand in the Province given the ratio of population to retailers as compared to other jurisdictions. A recent expansion of 350 terminals has resulted in incremental Lottery Revenue with minimal cannibalization of surrounding retailers.


Nations Fresh will already be on the OLG's radar.

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By me,me and me (anonymous) | Posted February 06, 2013 at 18:22:50

You can buy lottery tickets at the Univercity and the Medical Center;)

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By John Neary (registered) | Posted February 06, 2013 at 21:26:39 in reply to Comment 85930

The Department of Psychiatry has absolutely no control over what is sold in the gift shops, etc. in the University and the hospitals. Moreover, the social impacts of lottery tickets are not comparable to those of casinos.

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By Woody10 (registered) | Posted February 07, 2013 at 00:09:14 in reply to Comment 85936

You're right but, I have seen people at grocery stores buy every scratch ticket on that slideout tray and 649 and lotto max tickets as well. Just making a statement, not agreeing or disagreeing.

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By Joanna (anonymous) | Posted February 06, 2013 at 21:53:12

Thank you for this clear and concise letter to Council.
I appreciate your publicly sharing your position for all of us in this format.
Let's hope they all are able to read this.

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By Today (anonymous) | Posted February 06, 2013 at 22:58:50

I also commend the letter writer albeit it will not have any effect on whether a casino arises in this city or not.

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By RenaissanceWatcher (registered) | Posted February 06, 2013 at 23:58:24

Thank you for your informative letter to Hamilton city council, Dr. Kates. One hopes that council gives it the attention that it deserves. However, it is difficult to be hopeful given the scant attention the Hamilton Board of Health has paid to the public health dimension of casino issue to date.

On December 3, 2012, a report titled "Health and Social Impacts of Gambling" by Dr. Elizabeth Richardson, Medical Officer of Health for the City of Hamilton, was received by the Hamilton Board of Health and referred to the Gaming Facility Proposal Subcommittee without discussing the report or adopting any of its recommendations.

Here is the link to Dr. Richardson's report: http://www.hamilton.ca/NR/rdonlyres/319C...

And here is the link to the Minutes of the Hamilton Board of Health meeting on December 3, 2012: http://www.hamilton.ca/NR/rdonlyres/319C...

On February 4, 2013, the Hamilton Board of Health approved the Minutes of their December 3, 2012 meeting with no discussion or amendments: http://hamilton.siretechnologies.com/sir...

The Hamilton Board of Health has a mandate "To consider and recommend to Council on policy matters and emerging issues on Public Health". http://hamilton.siretechnologies.com/sir...

It is unconscionable that the Hamilton Board of Health has not even discussed Dr. Richardson's report or adopted any of the recommendations made in the report at this late date. Their next meeting is on March 18, 2013. It is therefore possible that Hamilton city council will make one of the most important local public health decisions of this century (i.e. whether to permit a downtown casino) by the March 1, 2013 deadline with no direct input from its own Board of Health. That would be more than unconscionable. That would be illegal.

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By DanJelly (registered) | Posted February 07, 2013 at 00:29:56

If all forms of gambling were equal then we wouldn't even be talking about putting in a casino. The fact that there's such a big push from some to have one at all tells me that it has the ability to generate significantly more revenue for its owners than lottery sales would. It doesn't make sense to treat them the same.

Slot machines are really what's at the heart of the current discussion. All forms of gambling can be addictive, but only slot machines allow you to sit there by yourself and gamble away a fortune in a relatively short amount of time without so much as a single word to another person during the process. They are literally engineered to exploit the human brain through false rewards, losses disguised as wins, etc. Lottery tickets are much more limited in their ability to fuel addictions. The mere fact that you have to ask another human being to purchase a lotto ticket can make a difference as it creates an opportunity to second-guess yourself before asking the cashier for ticket after ticket (yes, it still happens, but far less often).

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By me, me and me! (anonymous) | Posted February 07, 2013 at 03:31:43

Don't fool yourself, clinical study or not there are many people addicted to buying lottery tickets. For the University to write this letter shows me how hypocritical McMaster is. Councilor Mchattie should be ashamed for pulling these hypocrites into the formula...shame!
The false statements and excuses on this issue is not helping the cause.

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By John Neary (registered) | Posted February 07, 2013 at 11:28:31 in reply to Comment 85947

It's not the University. It's the Department of Psychiatry, which does not speak for the university as a whole.

If the university had issued a statement opposing gambling in any form, then it would indeed be mildly hypocritical. But the statement was from one department, not the entire university, and it does not oppose gambling in general, but rather the expansion of one specific type of gambling in one specific venue.

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By ORiTvOnline (registered) - website | Posted February 07, 2013 at 10:00:25

FYI I sent this to PJ asking what he thinks about HR asked Delaware Bankruptcy Court Chapter 7, foreclosure sale of the HR hotel-casino in Las Vegas, Lenders file foreclosure notice against HR Hotel, HR & the Westin Casuarina foreclosure proceedings were initiated, The HR Casino, as big a brand, couldn’t ward off recession woes. Toronto HR? After facing a bleak outlook which included foreclosure & bankruptcy. What do you think about that PJ?

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By Truss (anonymous) | Posted February 07, 2013 at 11:41:26 in reply to Comment 85957

Apologies for the uncouth imagery. I had difficulty unpacking your message because of its punctuation but also because its reference points were anchored outside of the thread.

To digress again from the mental health thrust of the above letter/entry, I would not get too hung up on the particulars of the Mercantis' proposal. The past week's theatre, whatever you thought of its merits, had little to nothing to do with the RFPQ.

I have found it useful to re-read the nuts and bolts of the OLG's bid process and reflect on the powerful legal privilege enjoyed by the Province, which has allowed it to do as it wishes for as long as anyone can remember. In doing so, I have begun to appreciate that the will of locals, pro or con, may ultimately have little impact upon the outcome of this "modernization" process, whether the facility is sited at Brock and 5 or Bay and King.

Anyway, thank you for sharing the letter, Ryan.

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By Truss (anonymous) | Posted February 07, 2013 at 10:45:43 in reply to Comment 85957

No offense, but the dysenteric abundance of commas makes that read like Nigerian spam.

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By what are we talking about? (anonymous) | Posted February 07, 2013 at 17:12:31 in reply to Comment 85958

The language did make me laugh though! btw are you a recently returning rich and powerful canadian (and british lord) who spent the last 4 years on forced vacation in florida?

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By RenaissanceWatcher (registered) | Posted February 08, 2013 at 07:51:49

A letter to the editor by Dr. Kates titled "We must think of the damage a casino can do" was published in today's Hamilton Spectator: http://www.thespec.com/opinion/letters/a...

His opinion is largely shared by representatives of St. Joseph's Hospital, St. Joseph's Healthcare, Hamilton Health Sciences, the Hamilton Academy of Medicine, the Hamilton Family Health Team, and the Hamilton Community Foundation, all of whom have sent letters to the City of Hamilton that are now attached as Appendix "F" in Dr. Richardson's supplementary report to be presented the Hamilton General Issues Committee on February 14, 2013: http://www.hamilton.ca/NR/rdonlyres/249C...

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By RenaissanceWatcher (registered) | Posted February 11, 2013 at 21:46:58

An article titled "Toronto Board of Health opposes new casino" by Sunny Dhillon was posted on the Globe and Mail website this evening: http://www.theglobeandmail.com/news/toro...

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