A multilevel and multistakeholder approach to gambling prevention and control: Lombardy experience

Abstract Gambling is a complex phenomenon with significant impacts on public health, well-being, economy, and safety. The growing availability of onsite and online gambling represents a major risk factor for the population. In Italy, the total amount of money spent on gambling reached 150 billion euros in 2023 (+10,3% compared to 2022). Lombardy Region (LR) has developed an integrated intervention model based on One Health and Health in All Policies strategies, aiming to promote a systemic respons. LR has adopted an operational program (DGR80/2023, formerly DGR585/2016) for gambling prevention and control. The program provides for environmental prevention actions and support for health and social policies, promotion of health literacy in the population, strengthening preventive interventions and enhancing opportunities for early diagnosis, treatment and rehabilitation. This approach actively involves healthcare professionals, local authorities, communities, schools, workplaces, nonprofit entities, law enforcement and local networks. The LR model has led to stronger networks, greater integration between health and social sectors, increased preventive actions in school, work and community settings as well as improved opportunities for early diagnosis and care. Stable intersectoral partnerships have been established, with all stakeholders actively involved in design and implementation. The definition of shared indicators facilitated the development of a monitoring system focused on continuous improvement and dissemination of best practices. Lombardy experience demonstrates that an integrated approach, based on multi-level governance and the active participation of different stakeholders, enables the development of effective and sustainable responses to complex and multifactorial issues such as gambling. The systematic integration between health, social, educational, and security policies represents an opportunity that can be reproduced in other regional and national contexts. Key messages • The LR model demonstrates the effectiveness of an integrated approach to prevent gambling. • Multi-level and multi-stakeholder governance is a key element for policy innovation and sustainability.