TOPEKA — A new report on a health impact assessment (HIA) by the Kansas Health Institute highlights the potential positive and negative health effects of developing a casino in southeast Kansas. While previous discussions about casino development have been limited to potential economic benefit and pathological gambling, the HIA sought to bring additional health effects to the table.
The HIA uncovered potential health benefits — such as increased quality of life and life expectancy associated with new jobs— and health risks — including chronic fatigue and injury associated with pathological gambling — that were not part of previous discussions about gaming. These benefits and risks are outlined in the report, Potential Health Effects of Casino Development in Southeast Kansas.
KHI and its research partner, the University of Kansas School of Medicine–Wichita, conducted the HIA to inform members of the Kansas Legislature as they considered proposals to reduce the development fee for a casino in the Southeast Kansas Gaming Zone, a state-designated area that comprises Cherokee and Crawford counties. During the first part of the 2012 legislative session, three casino-related bills received a hearing with a Senate committee, but no action was taken on these bills and they died in the committee. At the beginning of the veto session, these three bills were repackaged into a Senate bill that also did not advance.
By providing evidence-based information to policymakers, HIAs aim to maximize the health benefits of a project while minimizing potential risks to community health. Because so many things can affect health, HIAs often bring issues that otherwise might not have been discussed to the attention of policymakers.
"Health impact assessment is a natural extension of our work in Health in All Policies,” said Robert F. St. Peter, M.D., CEO and president of KHI. “Our first HIA intended to inform the discussion of potential casino development in southeast Kansas. In many cases, issues like this may seem not to have direct connections to health, making them a good fit for health impact assessment. We hope that the HIA findings will be a valuable resource for policymakers and will stimulate discussions of the many issues that affect the health of Kansans.”
The HIA results suggest that even after accounting for effects from existing casinos in the region, residents of Cherokee and Crawford counties likely would experience some added positive and negative impacts from a new casino. The potential positive health effects relate to creation of jobs, particularly for the leisure and hospitality industry. However, the project also identified several potential negative health consequences, which will mostly result from increased access to a casino. Specifically, the region could experience increases in pathological gambling. Adverse health consequences of pathological gambling include nicotine dependence, substance use, depression and insomnia. Pathological gambling also has been associated with higher rates of child abuse and neglect, domestic violence, unsafe sex and divorce.
Concerns about the economy and health are not new for southeast Kansas residents. More than 27 percent of Cherokee and Crawford County children live in poverty, compared to 18 percent of all Kansas children. The region’s teen birth rate is higher than the state’s. And the percentages of Crawford and Cherokee County residents who are overweight and inactive are both significantly higher than the state averages. As the 2012 County Health Rankings show, Crawford and Cherokee counties lag behind many other Kansas counties. The result is that many residents are sicker during their lifetimes and die younger than their counterparts in other parts of the state.
To maximize the economic and health benefits offered by a new southeast Kansas casino, the HIA included several recommendations. Among them are suggestions to:
- Train primary care physicians to screen for problem gambling behaviors at medical homes.
- Eliminate smoking within and around casino buildings.
- Strengthen local services to treat and prevent gambling addictions and related conditions.
- Enhance traffic enforcement on well-traveled roads to patrol for drivers under the influence.
- Operate a “safe ride” program for patrons and residents.
- Use a “loss limit” strategy to prevent substantial financial losses among casino visitors.
“The health impact assessment process helped to identify some hidden connections between casino development and health, such as the potential effect of population growth on access to health care services,” said Tatiana Lin, KHI senior analyst and strategy team leader, who directed the casino HIA project. “In addition, the HIA allowed our research team to incorporate public input into findings and recommendations, making them more relevant to the local community. We hope policymakers and community members will find this Kansas-specific information useful.”
The HIA was funded by a grant from the Health Impact Project, a collaboration of the Robert Wood Johnson Foundation and The Pew Charitable Trusts. HIAs are part of a fast-growing field in the United States. In 2007, there were only 27 such studies. Today, roughly 200 HIAs have been completed or are ongoing. KHI plans to conduct additional HIA projects as part of its mission to inform policymakers by identifying, producing, analyzing and communicating information that is timely, relevant and objective. A related KHI issue brief, Health Impact Assessments Help Link Policy Decisions With Effects On Public Well-Being, provides more information about HIAs and the casino project.
KHI is an independent, nonprofit health policy and research organization based in Topeka. It was established in 1995 with a multiyear grant from the Kansas Health Foundation.
The opinions expressed in the HIA report are those of the authors and do not necessarily reflect the views of the Health Impact Project, Robert Wood Johnson Foundation or The Pew Charitable Trusts.