In 2021, the Canadian Senate approved Bill C-218, the Safe and Regulated Sports Betting Act, an amendment to the Criminal Code, which gives provinces and territories discretion to conduct and manage single-event sports betting in their jurisdictions. In response, most provinces and territories began offering in-person singleevent sports betting through Crown lottery corporations. Nine provinces also began offering online single-event sports betting through Crown corporations, and Ontario opened its online market to privately owned gambling companies such as Bet365 and DraftKings to offer sports betting and other forms of online gambling. The legalization of single-event sports betting and the opening of the Ontario online market resulted in a sudden increase in opportunities to legally gamble. As of December 2023, 49 different gambling companies were operating 72 different gambling websites in Ontario alone. Since these policy changes, Canadians across all provinces and territories have also witnessed an appreciable rise in gambling advertising. This increase has been most noticeable through the promotion of sports betting during breaks in live sports broadcasts, including during the broadcast itself.

The impact of these significant changes in gambling policy on the health of Canadians is largely unknown as there is no national or provincial/territorial monitoring and surveillance of gambling-related harm. The last national, publicly available, assessment of gambling participation and harm was in 2018. Results from this survey indicated that between 2002 and 2018, rates of gambling and problem gambling in Canada were declining. The increase in opportunities to legally gamble and the increase in gambling advertising in Canada is cause for concern because of the following considerations:

1. Early evidence suggests the changes have resulted in increased gambling participation, which has been associated with increased gambling-related harms among the general population and among youth, young adults and other vulnerable populations.
2. The type of gambling being made available and promoted (single-event sports betting and live or “in-play” betting) is associated with greater risk of harm.
3. The volume of gambling advertisements repeatedly pairing sports with betting and featuring celebrity endorsements “normalizes” gambling, leading people to think of betting as an integral part of sports and by extension a healthy, “normal” behaviour. This normalization is especially a concern for youth and young adults who are at greater risk of harm.
4. The increase in opportunities to legally gamble and the increase in gambling advertising occur at a time when many Canadians are more vulnerable to problematic gambling and gambling-related harms because of the lingering health impacts of COVID-19 and a rise in the cost of living.

In response to these concerns, this report recommends a national independent organization, such as the Canadian Centre on Substance Use and Addiction, convene stakeholders to develop a pan-Canadian strategy to address gambling-related harm. Federal, provincial and territorial Crown corporations and regulators, public health practitioners, researchers, people affected by gambling harms and other concerned individuals should be consulted to develop a national strategy to guide regulatory, health promotion, prevention, treatment, research and enforcement efforts to respond to the expected increase in gamblingrelated harms. This strategy must address: 

• The need for national standards governing the promotion and availability of gambling;
• Problematic conflicts of interest among gambling stakeholders;
• Inadequate funding for gambling harm prevention and reduction initiatives and research across jurisdictions; 
• social and economic costs of gambling; and
• The need to increase awareness of gambling-related harms among health and social service professionals and the public.

National gambling strategies have been developed in other countries (Government of the United Kingdom, Gambling Commission, 2019) and Canadian strategies have been developed for addictive products such as alcohol (National Alcohol Strategy Working Group, 2007), tobacco (Government of Canada, 2023) and opioids (National Advisory Council on Prescription Drug Misuse, 2013). This report describes the policy changes that led to the increase in gambling availability and advertising, analyses why the increase in legal opportunities to gamble and the increase in gambling advertising in Canada is cause for concern and argues for the need for a national strategy.