The idea of lotteries, with the state benefiting, has existed in Britain since the Middle Ages. But for 168 years Britain had been a national lottery-free zone - until the law established the National Lottery in 1994. Since then it has developed on an awesome financial scale.
According to Camelot's website the average weekly spend by players (including the Instants games) is£4.65. The company's annual report indicates that more than£5.5bn a year is gambled - a weekly£1.70 for every person in the country.
But less than one-third of this revenue goes to 'good causes'. The remuneration of the Camelot chief executive has become£636,000 - several times that of an NHS trust chief executive.
The Lottery has been criticised for encouraging gambling and unfair distribution of prize money. Even the 1998 Camelot annual review acknowledges possible adverse effects, including Lottery playing by children, encouragement of gambling through promotion of new games and loss of charity revenue.
A report on behalf of the Joseph Rowntree Foundation noted that more than half the adult population was playing the Lottery.
But poorer communities, less involved in sporting and cultural activities, appeared to be disadvantaged in the distribution of proceeds. An analysis of sports grants suggested that the most advantaged local authorities were favoured in funding allocations.
Another problem was the introduction of scratch-cards.
These are associated with compulsive gambling. Scratchcard games can be completed in seconds, there is a high frequency of wins and opportunity exists for immediate replay.
The Joseph Rowntree Foundation predicted 'a growth in the number of people addicted to gambling. . . through scratch-cards and other opportunities deregulated in the wake of the Lottery'.
Research from Westminster University indicates that higher spending on the Lottery is related to older age, poorer social functioning and being a manual worker.
This means a reduction in financial well-being in sections of the community that are already poorer and consequently at greater risk of ill-health. The researchers also noted a correlation between higher spending on the Lottery and greater alcohol and cigarette consumption.
The irony is that the Lottery, in part established because of a perceived need to support 'good causes', has become a method of redistribution of wealth from the poorer (and less healthy) sections of society, to make others wealthy.
By mid-1998, 593 new millionaires had been created by Camelot's activities.
That this economic machinery should be supported by the present government, with its stated concern for health inequalities, is perverse.
Further evidence of consequences of involvement with lotteries comes from the US. Despite the 'good fortune' experienced by lottery winners, their assessments of present, and likely future, happiness, were similar to those of a control group of non-winners, but the winners took significantly less pleasure than non-winners in everyday activities.
A 'subtle message' about the Lottery being a benign institution appears to be accepted. An example is the popularity of Lottery television shows, which are favourite viewing of 10 to 15-year-old children. The promotion of the Lottery in this way has parallels with initiation into other potentially addictive behaviours such as tobacco and nicotine consumption.
What are the implications for NHS managers? There is an obligation to set healthy living examples in relation to the Lottery, and to acknowledge the adverse social and health effects of this form of gambling. Inevitably the NHS will pick up some of the costs of these, either through treatment for addictions or exacerbation of the circumstances of illness in financially disadvantaged patients.
But health service managers can exercise their own right not to support the Lottery.
Doing the Lottery may be a strategy to escape the day-to-day grind for some people. And there will be many NHS staff who see the Lottery as a way of supporting charities.
But tax-efficient payroll schemes or deeds of covenant are more effective.
The implementation of personnel policies sympathetic to employees with gambling addictions would do much to acknowledge potential problems.
Where trusts run their own lottery, the board could be invited to consider whether supporting gambling in this way is consistent with NHS values.
The long-term future of the Lottery should be a matter of public debate. One aspect of this is whether positive effects on health and well-being outweigh the disadvantages.
There are few suggestions of the former and increasing evidence of the latter.
1 Camelot Annual Report and Accounts , 1998.
2 Fitzherbert L. Winners and Losers: the impact of the National Lottery . Joseph Rowntree Foundation, 1995.
3 Reid S, Woodford S, Roberts R, Golding J, Towell A. Healthrelated correlates of gambling on the British National Lottery. Psychology Reports 1999; 84(1):247-54.
4 Brickman P, Coates D, JanoffBulman R. Lottery winners and accident victims: is happiness relative? J of Personal and Social Psych 1978; 36(8): 917-27.
5 Griffiths M. The National Lottery and scratch cards. The Psychologist 1997; 10(1): 23-26.
Dr Donald Coid is honorary senior lecturer, department of epidemiolgy and public health, Dundee University.