It is gratifying to note that all commentators [1,2,3] responding to our paper  have agreed that adoption of up-stream, public health responses to harm from gambling are not only justified in the face of the current global expansion of gambling. They all acknowledge the need for a high level commitment to effective strategies for eliminating harm. However, the focus adopted by Ariyabudhiphongs  and Blaszczynski  on micro-remedies such as improved consumer education and staff training tends to obscure this consensus to some degree.
Certainly, there is considerable fragmentation of the general government response to gambling growth, most notably the clear conflict of interest associated with regulating gambling, ostensibly in the public interest, whilst at the same time reaping a substantial proportion of the profits. Our contention is that in Australia and New Zealand this conflict has not been well managed, to say the least. The conflicting demands between public health and revenue responsibilities have usually been resolved in favour of the latter. Lip service is a common response to calls for an effective and integrated public health approach to gambling harm . Accordingly, a call for greater collaboration between government, research, advocacy and the gambling industry is unlikely to result in productive collaborations. Rather, experience from other areas of dangerous consumption such as tobacco and alcohol suggests that the pursuit of consensus equates to the delaying of effective interventions and the continuation of profit oriented expansion.
Different situations undoubtedly require specific responses and interventions. The particular approach adopted in Britain for the liberalisation of gambling, including greater diffusion of electronic gambling machines (EGMs) across the community, will require a unique response. Such a response should account for the manner in which specific technical and systematic arrangements will reflexively configure social space and subjectivity. However, despite the specificity of technical and social circumstances, we would suggest that the principle is unaltered. The proliferation of gambling opportunities, particularly with highly tuned EGMs deployed in substantial chunks of social space, creates a situation where multiple partners have an interest in maintaining extractive rights for as long as possible. These partners are many and varied but their power and financial resources far exceed those of public health researchers and advocates. On this basis, attempts at collaboration between industry, government and public health interests are, as Adams and colleagues have argued , futile if not counter-productive. Indeed, as researchers, we are particularly alarmed by the extent to which it is now commonplace for gambling researchers to accept funding directly from industry sources. This speaks not only to the financial power of gambling industries and the tacit approval of governments but also to the widespread challenges those involved have in recognizing and responding appropriately to deep-set conflicts of interest.
The long history of tobacco control remains instructive. Global gambling liberalisation provides an opportunity for development of a comprehensive and effective response by governments, constructed using contemporary public health principles. These principles, we would contend, demand not only technical fixes (as useful and effective as these may frequently be) but effective separation of conflicting interests at every level of research, advocacy and regulation. This is the real challenge presented by the symbiotic nature of global gambling, as showcased by the Australasian experience. It demonstrates that public health advocacy, to be most effective, requires a political dimension.