2027 Budget, gambling addiction and smoking fund the health service – and goodbye to prevention

A paradox that highlights the schizophrenia of the system: looking at the balances of the 2027 budget, summarised in the Dossier on the Budget Bill (A.C. 3174), produced by the Senate Budget Service, the State Budget Service and thethe Observatory on Public Finance and Budgetary Policies – which sets out the effects on the balances and the statement of resources and expenditure – a full 2.4 billion in funding over the 2027–2029 three-year period comes from ‘gaming and tobacco products’. In particular, this is due to the increase in the single tax rates on gaming machines (Article 23; approximately 1.2 billion) and the extensions to gaming licences (Articles 26 and 28). To put it another way – pushing the paradox a little further – over a third of the funding for the health service, which totals around 7.3 billion – with all due respect to the regions and doctors ready to take to the streets on 5 December – will come precisely from some of the most well-established factors of addiction, as well as from direct and indirect risk factors (smoking) for at least 17 types of cancer.

The ‘gambling-promoting’ state, which is increasing its revenue from gambling (legal, mind you) and tobacco addiction in order to stretch a budget that is even tighter this year, in short, contradicts the proclaimed and sacrosanct protection of prevention policies that Health Minister Schillaci identifies as the primary strategy on which to focus for the health and wellbeing of Italians today and, above all, tomorrow. But the figures do not add up, and whilst healthcare – even if a long way from the 18 billion over three years requested by the regional presidents – is among the “largest negative balances (net effects of major interventions corresponding to a worsening of the deficit)”, following the provisions relating to families and workers (Chapter I of Title II), with a net expansionary impact of approximately 11.5 billion over the three-year period, and following the measures relating to energy and infrastructure contained in Chapter I of Title VI (approximately 11.4 billion), in some way, the health measures dealt with in Title V also had to be covered.

This is confirmed by the Black Book on Gambling, as reported by the Radiocor news agency as recently as mid-October: problem gambling costs society over 2.2 billion a year, including lost work, court costs and prison expenses, treatment costs and the impact on families. Therefore, continued investment by the state seems a short-sighted measure, because around one in five euros of tax revenue from gambling is recouped in the form of social costs. And in Italia, according to the CNR, there are around 800,000 people aged between 18 and 84 with a moderate to severe gambling profile, plus 200,000 students aged between 15 and 19. According to calculations by GiocoResponsabile.info, each of them costs around 2,780 euros, of which 1,500 euros is attributable to lost work and reduced productivity, and 800 euros to the courts and prisons. In contrast, the cost per gambler per year for ad hoc healthcare services is 10 euros.

Prevention, along with another major issue – namely, lack of self-sufficiency – has been sidelined. This runs counter to the provisions of the previous Budget Act, which had allocated 500 million a year, and despite the institutions’ proclamations. Quite the contrary. On smoking and gambling (not to mention alcohol), as mentioned, the government is stepping up the pressure. Yet the figures are alarming, particularly amongst adolescents, who should be receiving clear educational messages: just consider that in Italia, among 14- to 17-year-olds, as many as 37 per cent smoke more or less regularly. Of these, 22 per cent use heated tobacco products and 30 per cent use e-cigarettes.

Clinicians and civil society, however, take the opposite view, backed by scientific evidence: the Italian Association of Medical Oncology (Aiom) has just presented, ahead of the national congress in Rome, a ‘Manifesto for the Protection of Non-Smokers’ Rights’, together with the AIRC Foundation for Cancer Research ETS, the Umberto Veronesi Foundation ETS and the Aiom Foundation. The proposal to Parliament and the Government is to extend and standardise the bans currently in place for traditional cigarettes to all devices that generate inhalable emissions (such as e-cigarettes, with or without nicotine, and heated tobacco products) in enclosed spaces open to the public or for communal use. The key points: a total ban on indoor smoking and on all forms of advertising, seen as two urgent measures to protect non-smokers and, more generally, the younger generations from the dangers of cigarettes and all smoking products. The Manifesto will now be sent to the Senate Health Committee with a view to securing its approval as soon as possible.